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Everything You Need To Know About Non-Small Cell Lung Cancer (NSCLC)
Non-small cell lung cancer (NSCLC) is the most common form of lung cancer and carries a lower mortality risk than other forms. The most common risk factor for NSCLC is smoking cigarettes.
NSCLC comprises 80–85% of lung cancer diagnoses. It doesn't grow as quickly as small-cell lung cancer.
There are two main kinds of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).
There are three main kinds of NSCLCs:
In its early stages, NSCLC usually doesn't cause any symptoms. When symptoms start to develop, they can include:
If the cancer spreads to other areas of the body, it can cause additional or worsened symptoms, such as:
Sometimes there are no discernible symptoms, at least initially. An imaging test used for other purposes may reveal the diagnosis.
Speak with your doctor about any unusual symptoms so they can help guide you and, if necessary, find the right diagnosis and treatment.
Several factors can increase your risk of developing lung cancer. Smoking cigarettes or being exposed to secondhand smoke is a primary risk factor for the disease. Exposure to asbestos and certain paints or chemicals may also increase your risk.
While you may not be able to prevent NSCLC completely, there are steps you can take to reduce your risk of developing the disease. If you smoke cigarettes, you should develop a plan to quit.
Talk with your doctor about tools that can help you quit smoking and about any support groups that exist. Avoid or limit your exposure to the chemical radon, as it increases your disease risk. Have your house tested for radon and treated, if necessary.
Along with a physical exam and medical history, various tests can help your doctor diagnose lung cancer. Tests your doctor may order include:
Once the diagnosis of cancer has been confirmed, the cancer will be staged. Staging is the way doctors classify cancer according to how it spreads in the body. NSCLC has five stages, from stage 0 to stage 4, with stage 4 indicating the farthest spread.
Outlook and treatment are based on the stage. Stage 4 cancer is typically not curable, so treatment is usually aimed at relieving symptoms.
Staging of NSCLC is based on the AJCC Cancer Staging Manual and is determined by these factors:
Treatment for NSCLC can vary based on the stage of disease, your health, and other factors. Talk with your doctor about the best treatment option and possible side effects. Different modes of treatment may be combined to yield the best results.
There are five main ways to treat non-small cell lung cancer, including:
SurgerySurgery can be used in the early stages of NSCLC. Depending on the location of the cancer, one of the following procedures may be necessary:
Treatments before or after may also accompany the surgery. These could include:
Radiation therapyRadiation therapy uses high-energy rays to kill cancer cells and prevent new ones from growing. A regimen would be created consisting of several treatments over a few days to a few weeks.
Radiation wouldn't be used to treat cancer that has spread throughout the body, but it can be useful in targeting specific areas and small tumors. It may also be an option when surgery isn't.
ChemotherapyChemotherapy is a type of systemic therapy that uses anticancer drugs to kill cancer cells. For lung cancer, chemotherapy is typically administered intravenously. Like radiation, a regimen would be created with several cycles over time.
Chemotherapy drugs would be chosen based on the type of cancer and may be combined with other chemotherapy drugs. Chemotherapy can improve the outlook for all stages of lung cancer.
Targeted therapyTargeted therapies address specific proteins, genes, or the environment that enables cancer growth. They can address issues such as cells with generic mutations or stopping angiogenesis (making new blood vessels).
New targeted therapies are being developed every day and are helping people live longer and better with lung cancer. Speak with your doctor to see if any targeted therapies are right for you. They may need to do some additional testing to determine if you're a candidate.
ImmunotherapyImmunotherapy, or biologic therapy, aims to use your body's immune system to fight cancer cell growth. This type of therapy is often recommended for later-stage cancer or when other therapies aren't the preferred treatment.
Combined therapies, including immunotherapy, are often used to achieve better results.
Treatments will vary based on many factors, and your doctor will tailor your treatment specifically to you, sometimes with combined therapies. But here are some common treatment options in different stages of NSCLC:
Cancers can recur after successful treatment. Treatment options will depend on the location and severity of the recurrence. It's important to understand your diagnosis and treatment goals after a recurrence.
Your doctor may try a different treatment if the initial treatment has stopped working. Tumors can sometimes be treated with surgery, while progression to the lymph nodes may warrant chemotherapy.
In later stages, targeted therapies and immunotherapy offer an alternative for a recurrence. For cancer that recurs at a distant site from the initial diagnosis, chemotherapy, targeted therapies, and immunotherapy are likely choices for continued treatment.
In the instance of a recurrence, your doctor would develop a specific treatment plan for your needs that may include multiple treatment types.
Your outlook depends on a variety of factors. Some people who are diagnosed with NSCLC are successfully treated and go on to live normal lives. Early detection and treatment is one of the best ways to recover from NSCLC.
New treatments for lung cancer are being developed every day, and clinical trials may be an option. Speak with your doctor about your goals and potential treatments to help you live a longer, healthier life.
Lung Cancer News
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Aug. 30, 2023 — Fresh discoveries about a type of immune cells could give lung cancer patients a more accurate prognosis and better identify who will benefit from immunotherapies. Researchers found that the location ...
Aug. 14, 2023 — Patients with localized prostate cancer have a good chance of survival, but mortality rates among those with advanced, metastatic forms of the condition remain high. Until now, the precise mechanism ...
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July 12, 2023 — Cancer therapies that target specific genetic abnormalities in tumors have revolutionized treatment possibilities over the past two decades. While quality of life and survival are improved with ...
June 22, 2023 — Small-cell lung cancer is a particularly aggressive type of tumor with a consistently high mortality rate. In recent years, the research of scientists has significantly contributed to a better ...
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Mar. 13, 2023 — Scientists have discovered why breast cancer cells that have spread to the lungs may 'wake up' following years of sleep -- forming incurable secondary tumors. Their research reveals the ...
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Feb. 1, 2023 — New data from a clinical trial shows improved rates of survival and reduced risk of recurrence in patients taking osimertinib, a targeted therapy for non-small cell lung cancer ...
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Dec. 26, 2022 — Researchers report that they have developed a new experimental pipeline to combine bacterial therapy with current cancer drugs. Their study, which explores resistance to bacterial therapy at the ...
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Studies Find Nonsmoking Women Getting Lung Cancer But Going Unscreened
Over 50% of women with lung cancer are non-smokers - and that rate is only increasing.
getty"This year, nearly 250,000 Americans will be diagnosed with lung cancer," President Biden wrote to mark the beginning of National Lung Cancer Awareness Month, which takes place every November. Lung cancer is one of the most common cancers in and the leading cause of cancer death for both men and women - but the president's proclamation didn't include the fact that lung cancer is now affecting women, even non-smoking women, at a higher rate than men.
Historically, lung cancer was known as a men's disease, due to their higher occupational exposure and higher smoking rates than women's. Occupational hazards, such as exposure to asbestos, arsenic, benzene, cadmium, coal tar, disease fuel emissions, formaldehyde, and medical radiation, can all increase the risk of lung cancer. 5.3% of total cancer cases in men are linked to occupational exposure, compared to 2.3% of female cancer cases, since fields with high exposure, such as construction, freight handling, painting, pipefitting, and plumbing, are usually male dominated.
Lung cancer was known as a men's disease; occupational hazards - a common causes of lung cancer - ... [+] were and are present in professions that are male-dominated.
Eva EpkerSimilarly, men historically and currently smoke more than women. Cigarette smoking remains the most common cause of lung cancer across sexes, causing 90% of cases in men and 70-80% cases in women. As of 2021, about 13.1% of men smoke while 10.1% of women smoke.
However, over 50% of women with lung cancer worldwide are non-smokers (compared to only 15-20% of men). Non-smoking women also have a higher incidence of lung cancer (19%) than non-smoking men do (9%). And, even when adjusted for smoking status, the female sex is associated with a higher risk of lung cancer. Lung cancer diagnoses have risen 84% among women – but have dropped 36% for men – over the past 40-plus years, and women between the ages of 30 and 49 not only are being diagnosed with lung cancer (when the average age at diagnosis is about 70 years old) but also are being diagnosed at a higher rate than men of the same age.
Although smoking is the most common cause of lung cancer, the percentage of the population that ... [+] smoke or have smoked has been steadily decreasing.
Eva EpkerAnd yet there isn't any conclusive data explaining these sex-based trends. Possible and partial explanations include the makeup of cigarettes as well as women's hormones, environmental exposure (to air pollution, cooking oil fumes, secondhand smoke, wood combustion, or other carcinogens) and genetics. For genetic specifically, a protein called CYP1A1, which activates carcinogens, is overexpressed in women. Women also have more frequent p53 mutations, which are responsible for 60% of lung cancers, than men do, and have an increased gastrin-releasing peptide receptor - GRPR - that stimulates cancer cell proliferation. These genetic differences may cause women to have a higher susceptibility to carcinogens – substances that increase an individual's risk of cancer – and, subsequently, have higher rates of lung cancer than men have.
But this potentially higher susceptibility isn't reflected in the current lung cancer screening guidelines or the studies that led to the development of those guidelines. The National Lung Screening Study, which started in 2002, recruited 55,000 participants but only 39% were women. Similarly, the NELSON study, which started in 2003, had over 15,000 participants but only 16% were women. Women were, thus, underrepresented in the former and current smokers recruited for these trials – and non-smoking women weren't represented at all. As a result, lung cancer screening eligibility applies to individuals who smoke at least 20 packs a year and are at least 50 years old; there are no sex-based differences in these guidelines, despite the rising cases of lung cancer in both smoking and non-smoking women. As a 2022 review concludes, "The lack of guidelines and risk assessments for light or never smokers predisposes women with lung cancer in particular to be missed with current screening recommendations."
Lung cancer is disproportionately affecting women - but the reasons behind this sex-based ... [+] difference, including the rising rates of cancer in non-smoking women, are largely unknown
Eva EpkerIn addition to being ineligible for screening, women, both smokers and non-smokers, may not even notice that they have lung cancer until it has progressed to a late stage. Women are more likely than men to develop lung adenocarcinoma (cancer that develops in the cells that line the outside of the lungs) while men are more likely than women to develop squamous cell carcinoma (cancer that develops in the cells that line the inside of the lungs' airways). Both cancers' symptoms can include a bloody cough, a recurrent or worsening cough, difficulty breathing or swallowing, hoarseness, and swelling in the face and neck veins. However, lung adenocarcinoma can also manifest in abdominal pain, bone pain, headaches, and/or mucus secretion: symptoms that aren't necessarily specific to lung cancer and that may cause the cancer to be misdiagnosed.
In short, non-smoking women are doubly disadvantaged: they usually aren't eligible for lung cancer screenings under the current guidelines because they don't smoke, and their cancer may be missed or dismissed until a stage where it is near-fatal.
Lung cancer is the leading cause of death - and the survival rate only decreases with each ... [+] subsequent stage at diagnosis.
Eva EpkerWhen their lung cancer is correctly diagnosed and treated, however, both smoking and non-smoking women have shown to respond better to lung cancer treatments than their male peers. Women see more positive results than men across various treatment options – including EGFR inhibitors, platinum-based chemotherapies, surgery, and radiotherapy. Women with lung cancer also survive significantly longer than men, in part due to their treatment and lifestyle choices and the characteristics of their tumor.
But, much like the rising rates of lung cancer in women, the main reason behind their improved survival rates is still unknown, serving only to highlight the sparse research in sex-related differences in lung cancer. Two articles, both published in 2021 echo this fact. One states, "The double-edged sword of female sex and lung cancer necessitates that future studies aim to better understand factors (environmental, genetic, hormonal) in addition to smoking intensity and duration that may affect risk". The other argues for "targeted therapies" and "screening recommendations" that reflect the role of sex, noting that "the data regarding optimal care and outcomes is still lagging behind" for women.
These calls for sex-specific research, the rising rates of lung cancer in women, especially non-smoking women, and federal programs – including the reignited Cancer Moonshot program and recent White House Initiative on Women's Health Research – all may help catalyze change and improve the lives of both smoking and nonsmoking women. As President Biden wrote in his proclamation on National Lung Cancer Awareness Month, "During National Lung Cancer Awareness Month, the First Lady and I have one message to the Nation: There is hope."
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