22 research highlights from the past year
Treat Brain Tumors From Non-Small-Cell Lung Cancer
If your non-small-cell lung cancer (NSCLC) has spread to the brain, your doctor has to take extra care to get your treatment just right. Your brain controls everything you do, from snapping your fingers to remembering your name.
So the key is to relieve the symptoms of your brain tumors without causing any harm. For years, that has meant surgery, radiation, or both. But recently, people with brain tumors from non-small-cell lung cancer have another option: targeted therapy.
How Will I Know Which Treatment Is Right?You and your doctor will talk it through. You'll consider:
And one other thing comes into play: your genes. This is a big one. Doctors have figured out some of the changes in genes that can cause NSCLC. If you have one of them, there's a good chance you'll start with targeted therapy. If not, surgery and radiation are the main choices.
Targeted TherapyDrugs used in targeted therapy attack specific changes in how cancer cells work. So they tend to leave healthy cells alone, which can mean fewer side effects.
If you have one of the known NSCLC gene changes, you'll likely start with targeted drugs no matter where the cancer has spread. And since some of these drugs help with brain tumors, you might avoid surgery and radiation, or at least put them off.
But treating the brain with drugs comes with an extra challenge. You have a blood-brain barrier that keeps harmful stuff in your blood from getting to your brain. For a drug to work, it has to make it through that barrier.
Doctors are still working out which drugs are best at this. Some of the older targeted ones, like crizotinib (Xalkori), can't get through that barrier. But some newer ones can, like alectinib (Alecensa), which is used when you have the ALK gene change. And the results have been promising.
No matter which drug you start with, you'll get regular MRIs to check how it's working.
Continued SurgeryYour skull is hard and your brain is soft. So as these tumors grow, there's only one place to go: They press on your brain. Doctors call this the mass effect.
For a tumor that's causing a lot of pressure, surgery may be the first choice. Even removing just part of it can relieve your symptoms within hours.
In general, surgery makes the most sense when:
Doctors can do the surgery in different ways. Some may use smaller tools guided by cameras. Others may do a more traditional open surgery.
Radiation TherapyRadiation uses high-energy beams to kill cancer cells. There are two main types for attacking brain tumors:
Stereotactic radiosurgery. Also called the gamma knife, doctors sometimes use it when they can't safely remove a tumor with surgery. And it's more common when you have just a few tumors.
You get a high dose of radiation in a specific part of the brain. This keeps your healthy brain cells safe. How many doses you need depends on the size, location, and number of tumors.
Whole-brain radiation therapy (WBRT). This is the standard treatment when you have several tumors that are more spread out. As the name suggests, you get radiation on the entire brain.
You usually need it once a day for 5-10 days, depending on things like how bad your symptoms are and what other treatments you decide on.
Doctors sometimes use WBRT after surgery or the gamma knife to help keep tumors from coming back.
Medicines That Might Ease SymptomsYour doctor might also suggest a few drugs, which play more of a supporting role:
Steroids. They're a likely first step in treating brain tumors in the short term. They lower swelling and pressure, which can help relieve headaches and other symptoms.
Side effects from steroids often get worse the longer you're on them and the higher the dose. Some common problems include trouble sleeping, being hungry a lot, and mood swings.
Anti-seizure drugs. They're important if your brain tumors cause seizures. These drugs can help keep them at bay.
Side effects depend on which drug you take. They may include an upset stomach and throwing up, feeling sleepy, dizziness, and memory problems.
WebMD Medical Reference
SourcesSOURCES:
UpToDate: "Brain Metastases in Non-Small Cell Lung Cancer," "Overview of the Treatment of Brain Metastases," "Patient education: Non-small cell lung cancer treatment; stage IV cancer (Beyond the Basics)."
Canadian Cancer Society: "Brain Metastases."
Johns Hopkins Medicine: "Metastatic Brain Tumors."
Journal of Thoracic Disease: "Alectinib for the management of ALK-positive non-small cell lung cancer brain metastases."
Texas Oncology: "Stage IV Non-Small Cell Lung Cancer."
American Cancer Society: "Treatment Choices for Non-Small Cell Lung Cancer, by Stage."
© 2021 WebMD, LLC. All rights reserved.Metastatic Lung Cancer
When cancer has started to spread from its original location, it is called metastatic cancer. Metastatic lung cancer denotes a lung cancer that has begun to spread. Metastasis is the process by which cancer cells detach themselves and travel through the body via the bloodstream or lymph system.
Image Credit: Yok_onepiece/Shutterstock.Com
Types of metastatic lung cancerMetastasis does not usually occur early on, with most metastatic lung cancers being stage 3 or 4. The spread of cancerous cells to other areas of the body typically starts with the invasion of nearby areas, such as from one part of the lung to the other. When this occurs, it is referred to as local metastasis.
In more extreme cases, cancer cells can travel through the lymph nodes to other parts of the body. This can lead to the formation of secondary tumors in other organs. When this occurs, it is known as distant metastasis. Spread via the lymph system typically takes longer than spread via the bloodstream.
The most common places a lung cancer would metastasize to are the brain, bones, and adrenal glands. On the other hand, the most common types of cancer tumors that metastasize to the lungs are breast, colon, prostate, and bladder cancer, neuroblastoma, sarcoma, and Wilm's tumor. While these are the most common ones, almost any cancer is capable of spreading to the lungs.
Steps of cancer metastasisThere are four general steps to metastatic lung cancer: tumor establishment, vascular invasion, extravasation, and creation of the distant metastatic focus. The first of these, tumor establishment, focus on the growth of the tumor, including organizing vascular supply, escaping the immune system, and movement. Once established, the cells of the primary tumor can adopt a different morphology to facilitate movement to new metastatic centers.
Vascular invasion can be both lymphatic and hematologic. Invasion into lymph nodes is easier to do than into blood vessels. This is related to the thinner thickness of the walls of the lymph vessels. However, when in the lymph system, cancer cells are faced with the immune system, which they can avoid in the blood vessels. The type of vascular invasion can also dictate where the metastasis will set – along with the lymph nodes or along the blood vessels.
After having entered the lymph or blood system, the cancer cells need to escape circulation and establish themselves. However, the process by which this is done is not well understood. It is believed that blood flow must be reduced to allow the tumor cells to express adhesion molecules, which then find their specific receptors. The cells then poke holes between endothelia to facilitate migration out of the lumen of the vessel.
Not many tumor cells survive the process of moving in the circulatory system, and even fewer successfully establish metastatic nodules. There are many outstanding questions about when metastasis occurs, if the cells move randomly or how the homing mechanisms work. The establishment of the distant metastatic focus differs depending on the location of the new site, and there is therefore no general mechanism in metastatic lung cancers.
Treatment and prognosisMetastatic lung cancer can be difficult to treat since it is a sign that cancer has spread. Removal of visible tumors does not usually improve the treatment outcome. Instead, chemotherapy is the most common treatment used.
If the metastatic lung cancer is local, surgery can be an option and can lead to full recovery and cure, but this is rare otherwise. Other treatment options include radiation therapy, placing stents in the airways, and laser therapy.
Unfortunately, the prognosis for most forms of metastatic lung cancer is not good. Survival for more than 5 years is rare with metastatic lung cancer. The median survival after diagnosis of metastatic lung cancer is only 5 months, with other studies putting the survival time at around 3 to 12 months. If the original form of the cancer was lymphoma or testicular cancer, there is improved prognosis when using chemotherapy.
Studies looking at patterns in metastatic lung cancer find that the metastatic sites and chances of survival are dependent on sex, the type of original cancer, and the age at which the patient is diagnosed. The study found that the survival of metastasis in the nervous system was better than that of liver metastases from metastatic lung cancer. The most common type of lung cancer that gave rise to metastatic lung cancer was adenocarcinoma of the squamous cell type.
SourcesWhat Is Secondary Lung Cancer?
Secondary lung cancer is when a cancer that started somewhere else in the body has spread to the lung.
Where a cancer starts is called the primary cancer. If some cancer cells break away from the primary cancer they can move through the bloodstream or lymphatic system
to another part of the body, where they can form a new tumour. This is called a secondary cancer. Secondary cancers are also called metastases (pronounced met-ass-ta-sees).
The secondary cancer is made of the same type of cells as the primary cancer.
If the cancer started in your bowel and has spread to your lung, the areas of cancer in the lung are made up of bowel cancer cells.
This is different from having a cancer that first started in the lung (a primary lung cancer). In that case, the cancer is made up of lung cells that have become cancerous. This is important because the primary cancer tells your doctor which type of treatment you need.
This video is about secondary cancer, it lasts for 2 minutes and 42 seconds.
A secondary cancer is a cancer that has spread from where it first started to another part of the body. You might hear people call it a metastasis, metastases or advanced cancer.
Where a cancer starts is sometimes called the primary cancer. A secondary cancer is made up of the same type of cells as the primary cancer. SO, for example a cancer that starts in the bowel may spread to the liver. The cancer cells in the liver are the same type of cells that started in the bowel.
Secondary cancers happen when cancer cells break off the primary cancer and move through the body. This can happen by cancer cells passing through the blood or the lymphatic system.
The lymphatic system is a network of tubes and glands that filters body fluid and fights infection.
The cancer cells can travel through the blood and lymphatic systems to other parts of the body. Most cancer cells die when they are moving through but some don't and can pass through the blood and lymphatics into another part of the body. They can then grow and develop into another cancer in that part of the body.
Cancer can spread to anywhere in the body but there are places that it is more likely to spread to depending on where your cancer started. So for example bowel cancers are most likely to spread to the liver and lungs and cancers that start in the lungs is more likely to spread to the brain and bones.
Treatment will depend on where your cancer started. This is because the primary and secondary cancer cells are the same and will respond to the same types of treatment. Treatment might include one or more types. You should talk to your doctor to find out how the treatment will work. Once a cancer has spread it can be more difficult to cure.
The aim of treatment may be to control the growth of the cancer and any symptoms you have for as long as possible or sometimes the aim might be to get rid of the cancer completely.
For more information about secondary cancer go to cruk.Org/secondary-cancer. For more information about your cancer type go to cruk.Org/cancer-type
Which cancers spread to the lungsAny cancer can spread to the lung. The most common cancers to do so are:
Symptoms of secondary lung cancer might include:
A build up of fluid between the lung and chest wall (pleural effusion) stops the lungs from expanding fully. When you breathe in it can cause shortness of breath, achy chest, discomfort and heaviness.
Remember, these symptoms can also be due to other more common conditions. If you have any of them tell your doctor so that they can check them out.
Tests for secondary lung cancerThere are different tests you might have to diagnose secondary lung cancer. You may have one or more of the following:
Secondary cancer can't usually be cured. But treatment can control it for some time and help prevent problems developing. Some people may not be able to have treatment for their cancer because they are too unwell.
SurvivalMost people worry about their outlook (prognosis) when they have a secondary cancer. Your individual outlook depends on many factors including whether the cancer has spread to more than one part of your body, how quickly it is growing and how it responds to treatment.
It is usually difficult to predict and this uncertainty can be hard to deal with. Speak to your doctor who can give you more information about your outlook.
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