Concomitant preoperative airflow obstruction confers worse prognosis after trans-thoracic surgery for esophageal cancer
Stage 4 Lung Cancer
Lung cancer is a type of cancer that grows in your lung tissue. Stages of cancer span from 0-4, with stage 4 being the most advanced stage of lung cancer. Lung cancer is often diagnosed in the later stages because symptoms may be difficult to detect before stage 3 or 4. There are two main types of lung cancer—small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).
Small cell lung cancer (SCLC) makes up about 10-15% of all lung cancer cases, and non-small cell lung cancer (NSCLC) makes up about 80-85% of lung cancer cases. SCLC tends to spread more rapidly beyond the lungs to other parts of the body.
Lung cancer is the leading cause of cancer-related death in the United States. However, more research is being done every day to advance treatment and detect lung cancer sooner. Your healthcare team will create a treatment plan based on how advanced your cancer is. Treatment options for stage 4 lung cancer include chemotherapy, radiation therapy, and immunotherapy.
An oncologist (a doctor who specializes in the diagnosis and treatment of cancer) will perform several tests to determine what stage, or how advanced, your cancer is. Knowing the stage of cancer helps them develop an effective treatment plan. The American Joint Committee on Cancer (AJCC) developed the TNM staging system to determine how advanced cancer is. The system is broken down into three factors: T for tumor: Measures the size and location of a cancerous tumor N for nodes: Determines if cancer cells have spread to the lymph nodes (a group of glands part of the immune system) M for metastasis: Assesses if cancer cells have spread (metastasized) beyond the lungs to other areas of the body The less advanced stages of lung cancer are stages 0-3. Stage 4 lung cancer means the cancer has spread to other parts of the body. There are two types of stage 4 lung cancer: stage 4A and stage 4B. Stage 4A usually means the cancer has spread to the chest, both lungs, the lining around your lungs (pleura), and the lining around your heart (pericardium). Stage 4B means the cancer has spread to one or more tumors outside of your chest or to other lymph nodes and organs. Both non-small cell lung cancer and small-cell lung cancer use the same staging system, though the system is generally not as important in SCLC. Instead, the cancer might be considered to be in a limited stage (cancer is only on one side of your chest) or an extensive stage (cancer has spread to other parts of your body). Stage 4 lung cancer develops when cancer cells from the lung spread to other parts of the body. The cancer cells can move in several ways, including growing into nearby tissue and passing through lymph node or blood vessel walls. Lung cancer is most commonly caused by smoking tobacco. Smoking is linked to 80% of lung cancer deaths in the U.S. Smoking cigars or menthol cigarettes and using chewing tobacco can also cause lung cancer. It is rare to be diagnosed with lung cancer if you have never smoked, but it's possible. Exposure to secondhand smoke, air pollution, and diesel exhaust can also cause lung cancer. Risk Factors There are several environmental and lifestyle risk factors for lung cancer. Depending on the environment you live or work in, you may be able to alter some of the following risk factors: Secondhand smoke: Being physically close to someone who is smoking increases your risk of lung cancer over time. Radon exposure: Radon is a radioactive gas found in soil and rocks. Consider conducting a radon test in your home to check for exposure. Asbestos exposure: People who work in mines, textile plants, and shipyards are at increased risk for asbestos exposure. Asbestos is a chemical commonly used to create commercial and industrial products. Exposure to chemicals: Inhaling chemicals such as arsenic, beryllium, or diesel exhaust in work environments increases your risk of lung cancer. Beta-carotene supplements: People with a history of heavy smoking may have an increased risk of lung cancer if they take beta-carotene (a compound that gives plants their color) supplements. Radiation therapy: If you have received radiation therapy for another type of cancer, it may raise your risk of lung cancer. Air pollution: People who live in cities with more air pollution with more exposure to things like diesel exhaust from cars are more likely to develop lung cancer. Family history: If one of your family members has been diagnosed with lung cancer, your risk is higher. With stage 4 lung cancer, you can experience the symptoms of lung cancer that people with less advanced stages might experience, as well as symptoms in other parts of your body based on where the cancer has spread. Common symptoms of lung cancer include: A bad cough Hoarse voice Chest pain The presence of blood when you cough Loss of appetite Unintended weight loss Shortness of breath Wheezing Tiredness or weakness Chronic (long-term or repeated) respiratory infections like bronchitis and pneumonia Because stage 4 lung cancer affects other parts of the body, you may also experience: Bone pain, such as in your back or hips Yellowing of the skin and eyes (jaundice), if the cancer has spread to the liver Swollen lymph nodes in the neck or above the collarbone Headache, weakness or numbness in your arm or leg, dizziness, balance issues, seizures, and other nervous system changes if the cancer has spread to the brain Lung cancer can also cause syndromes as it spreads. For instance, cancer that spreads to nerves in the face can lead to Horner syndrome, which causes eyelid drooping. Other conditions that may occur include superior vena cava syndrome (cancerous tumors that grow in the upper right lung) and paraneoplastic syndrome (a group of syndromes that can affect organs that lung cancer cells have not yet spread to). Several tests help diagnose stage 4 lung cancer. When you develop symptoms of lung cancer, your healthcare provider will likely start by performing a physical exam and asking about your medical history. They will ask questions about the symptoms you are experiencing and any risk factors, such as smoking history. Diagnostic tests for lung cancer include: Blood tests: A complete blood count (CBC) can measure blood cells and tumor markers. Sputum markers: A test of saliva and phlegm can detect tumor markers. Lung biopsy: A small sample of lung tissue is taken and sent to a lab to be tested for cancer cells. Bronchoscopy: A healthcare provider inserts a tubed camera into the lungs to look for signs of cancer. Chest X-ray: Images of the lungs and chest cavity can identify abnormalities like tumors. Magnetic resonance imaging (MRI) scan: This test uses strong magnets to take X-ray pictures of the lungs at several angles. Computed tomography (CT) scan: This radiation test can locate the lung tumor and determine its size. People with a history of heavy smoking may benefit from regular lung cancer screenings with a low-dose CT scan. Positron emission tomography (PET) scan: This nuclear scan locates cancer cells throughout your body and determines how far lung cancer has spread. Several treatment options are available, but stage 4 lung cancer can be hard to cure. Your healthcare provider will discuss the ultimate goal of treatment, which may be to help prolong your life or to let you live more comfortably in the time you have left. The treatment plan will depend on how much your cancer has spread and which areas of the body are affected. Stage 4 NSCLC: Treatment may include a combination of surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, photodynamic therapy, and laser therapy. Stage 4A: If the cancer has spread to just one other location, you might have surgery and radiation on the secondary location before treating the cancer in the lung. Stage 4B: If the cancer is more widespread, your treatment may begin with genetic testing. Tumors that test positive for certain gene mutations may have to receive targeted therapy (treatment that uses drugs to target specific molecules). Stage 4B NSCLC: If you have high levels of the PD-L1 protein, your healthcare provider may recommend immunotherapy. Immunotherapy drugs boost the immune response to cancer cells, which can attack the PD-L1 protein in cancerous tumors. Targeted therapy and immunotherapy may be given with chemotherapy (cancer cell-killing drugs are injected into your vein). Treatment for stage 4 SCLC typically does not include surgery or radiation, as they are usually ineffective. Chemotherapy and immunotherapy may improve your symptoms and prolong your life. If your symptoms are breathing-related, radiation may help improve your symptoms. Palliative Care With stage 4 lung cancer, it is not uncommon for the cancer to return even after a period of remission (symptoms of your cancer go away). Palliative care is a type of treatment that focuses on extending and improving your quality of life. The goal of palliative care is not to cure cancer but to ease the burden of symptoms from treatment. Palliative care is different from hospice or end-of-life care. This is supportive care that aims to improve symptoms and reduce pain or discomfort. Palliative care varies from person to person, depending on the toll the cancer takes on your body. Your healthcare provider may prescribe pain medications and anti-nausea medications to reduce symptoms related to the cancer and cancer treatments. If one of your symptoms is difficulty breathing, you may be given airway support and oxygen to open your airways and improve breathing. Experiencing cancer often affects your mental health. A solid support system is important throughout the treatment process. For this reason, your healthcare team may add emotional support and counseling to your palliative care. Most cases of stage 4 lung cancer are not curable. Your prognosis (how the cancer will behave in your body over time) depends on several factors: The type of lung cancer you are living with How the cancer is spreading Your age Your overall health before being diagnosed How your body responds to treatment When predicting outcomes, your healthcare team will consider the five-year survival rate. This estimates the percentage of people who will survive five years after diagnosis. The five-year survival rate is 9% for NSCLC and 3% for SCLC. Preventing all lung cancer cases may not be possible, but you can take steps to lower your risk. Although it can be challenging, quitting smoking can reduce your chances of developing lung cancer later in life. The risk of lung cancer can decrease 30-60% after 10 years of quitting smoking. For long-term smokers, it is also important to not take beta-carotene supplements. Check with your healthcare provider right away if you are experiencing common symptoms of lung cancer. Being diagnosed with stage 4 lung cancer can be a scary experience. A big part of living with stage 4 lung cancer is the palliative care you receive as you go through the treatment process. This can vary depending on multiple factors, including the type of lung cancer you are living with, your age, and how your cancer is progressing. Treatment for stage 4 lung cancer can be mentally taxing. Reach out to your healthcare provider or a loved one for emotional and mental health support if it is not already a part of your treatment plan. Although not many people with stage 4 lung cancer live for long, there are treatments available to extend your life.Thanks for your feedback!
New Predictors Of Metastasis In Patients With Early-stage Pancreatic Cancer
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Image illustrating four prognostic scenarios that may be found in liver biopsies when pancreatic cancer is diagnosed before metastasis. (Left to right) Orange: neutrophil extracellular traps (NETs), suggesting liver metastasis in less than 6 months. Red: NETs and T cells, suggesting liver metastasis in greater than 6 months. Green: T cells and fatty liver suggesting metastasis to a different organ. Blue: Normal liver with fatty liver suggesting no-evidence of future metastasis.
view moreCredit: Vanessa Dudley
Researchers at Weill Cornell Medicine with an international team have used liver biopsies to identify cellular and molecular markers that can potentially be used to predict whether and when pancreatic cancer will spread to an individual's liver or elsewhere, such as the lung.
The study, published on June 28 in Nature Medicine, proposes that information from a liver biopsy—a small tissue sample collected for lab analysis—when pancreatic cancer is diagnosed may help guide doctors in personalizing treatment, such as liver-directed immunotherapies, before cancer cells have the chance to metastasize.
Only 10 percent of people with pancreatic cancer will survive more than two years after initial diagnosis. "If we can predict the timing and location of metastases, that could be a real game changer in treating pancreatic cancer, particularly patients at high metastatic risk," said study co-senior author Dr. David Lyden, the Stavros S. Niarchos Professor in Pediatric Cardiology and professor of pediatrics and of cell and developmental biology at Weill Cornell Medicine.
In 2015, Dr. Lyden and his colleagues discovered that pancreatic cancer cells secrete factors that reach distant organs, most often the liver, to establish a pre-metastatic niche for new tumors to form.
To find out how these alterations prime their new location for cancerous colonization, Dr. Lyden collaborated with lead author Dr. Linda Bojmar, an adjunct assistant professor of molecular biology research in pediatrics at Weill Cornell Medicine and assistant professor of clinical and experimental medicine at Linköping University in Sweden.
Together with researchers at Memorial Sloan Kettering Cancer Center, including co-senior author Dr. William Jarnagin, co-first authors Drs. Constantinos Zambirinis and Jonathan Hernandez, and the hepatopancreatobiliary team, they obtained liver biopsies from 49 individuals who underwent surgical treatment for early-stage pancreatic cancer. They also collected liver biopsies from 19 people who underwent a similar operation for conditions unrelated to cancer, for example, removal of benign pancreatic cysts.
Liver Biopsies Reveal Early Signs of Rapid Metastasis
The researchers then conducted a battery of molecular, cellular and metabolic analyses on these samples to determine whether they could identify hallmarks that preceded—or potentially prevented—subsequent metastases in the patients. They found that the livers of recurrence-free survivors, who showed no signs of cancer spread after a follow-up period of at least three years, looked much like the livers of people who never had cancer.
At the other end of the spectrum were those who developed liver metastases within six months of diagnosis—a patient group that has poor prognosis with limited therapeutic options. Their livers were riddled with so-called neutrophil extracellular traps (NETs), dense tangles of DNA and enzymes released by dying neutrophils, immune cells that are a first line of defense against infection. Because these NETs are strongly associated with future metastases and develop so early in the course of disease, radiological imaging in the near future may be able to detect them and identify patients in danger of this aggressive spread.
"These individuals could then receive a full course of chemotherapy or, if the metastases are detected when only a few appear, perhaps the secondary tumors could be surgically removed," said Dr. Lyden, who is also a member of the Sandra and Edward Meyer Cancer Center and the Gale and Ira Drukier Insitute for Children's Health at Weill Cornell Medicine. In addition, he and his colleagues are investigating whether drugs that digest the DNA which forms the NETs could prevent liver metastases.
Immune Responses in Later Metastases
The researchers identified two other categories of patients in the study: those who would go on to develop later metastases to the liver and those who would have the cancer spread to other sites, such as the lung. Patients whose cancers spread to organs other than the liver, showed a strong immune response fighting the cancer—protective T cells and natural killer cells had infiltrated their livers, and many immune-regulatory genes were activated. These individuals who are prone to developing metastases outside the liver may benefit from immunotherapy to boost their ongoing anti-tumor immune response.
On the flip side, those whose livers succumbed to later metastases also accumulated immune cells—but the cells showed signs of metabolic exhaustion. "It's as if the liver was trying to protect itself, but lost the battle in the end," said Dr. Bojmar.
The researchers plan to validate their findings in a larger cohort of patients with pancreatic cancer and examine if this approach could be useful with other newly diagnosed cancers. "We hope to develop a tool for predicting which patients with colorectal cancer will go on to develop liver metastases based on the cellular, molecular and metabolic profiles of their liver biopsies," said co-senior author Dr. Robert Schwartz, associate professor of medicine at Weill Cornell Medicine.
Authors from multiple institutes throughout the United States and in Sweden and Israel contributed to this study.
Many Weill Cornell Medicine physicians and scientists maintain relationships and collaborate with external organizations to foster scientific innovation and provide expert guidance. The institution makes these disclosures public to ensure transparency. For this information, please see profile for Dr. David Lyden.
This work was supported in part by: National Cancer Institute grants CA224175, CA210240, CA232093, CA163117, CA207983, CA163120, CA169416, CA169538, CA218513 and the National Institute of Allergy & Infectious Diseases grant AI144301; the United States Department of Defense grants W81XWH-13-1-0425, W81XWH-13-1-0427, W81XWH-13-1-0249, W81XWH-14-1-0199 and W81XWH-21-1-0978; the National Institutes of Health/National Center for Advancing Translational Sciences grant UL1TR002384; and the National Institutes of Health grants R01CA234614 and R01DK121072.
Disclaimer: AAAS and EurekAlert! Are not responsible for the accuracy of news releases posted to EurekAlert! By contributing institutions or for the use of any information through the EurekAlert system.
You Ask, We Answer: How Quickly Does Lung Cancer Spread?
Lung cancer is one of the most common types of cancer. A person's outlook with lung cancer depends on the type of disease they have, the stage at diagnosis, and their overall health.
Lung cancer is localized when it has not spread beyond the lungs.
However, over time, it may spread, or metastasize, to other parts of the body. The outlook for localized lung cancer is better than it is for metastasized lung cancer.
Receiving a diagnosis of lung cancer can be challenging and may leave someone with many questions. This article will take a look at how quickly lung cancer can spread and how that affects a person's outlook with the condition.
Healthcare professionals broadly classify lung cancer as one of two types: small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC).
Different types of lung cancer grow at different rates.
NSCLC accounts for about 80% to 85% of lung cancer cases. SCLC is less common than NSCLC at about about 10% to 15%, but it tends to spread faster. On average, doctors also tend to diagnose SCLC at a later stage.
Lung cancer is more treatable in the early stages, but early detection is relatively uncommon. Approximately 53% of all lung cancers have metastasized by the time a doctor diagnoses the condition.
That number goes up in the case of SCLC. The American Cancer Society (ACS) report that two out of three cases of SCLC have already spread beyond the lungs by the time of diagnosis.
The American Lung Association (ALA) estimates that providing screening for people at high risk of lung cancer could reduce the lung cancer mortality rate by around 20%.
Risk factors for lung cancer include being a current or past smoker and being between 50 and 80 years of age.
To learn whether or not lung cancer has spread, a healthcare professional may order tests such as:
These tests will help them determine whether the cancer is localized to the lungs and chest or has spread to other areas of the body.
In the early stages, lung cancer may spread to nearby lymph nodes but remain within the chest cavity.
However, over time, lung cancer may spread to more distant parts of the body through the process of metastasis. The most common sites in the body for lung cancer metastases to appear are:
Lung cancer cells can spread into nearby tissue in the chest or spread throughout the body through blood vessels or the lymphatic system.
A person's outlook depends on the specific type of lung cancer they have, the stage at diagnosis, and their overall health.
Between 2014 and 2020, the overall 5-year survival rate for lung cancer in the United States was 26.7%, according to the National Cancer Institute (NCI).
This means that about 1 out of 4 people with lung cancer will live for 5 years or longer after diagnosis.
The outlook improves when a doctor diagnoses and treats lung cancer early. The NCI adds that 63.7% of people who receive a diagnosis of localized lung cancer will live for 5 years or longer following diagnosis.
As diagnosis and treatment strategies improve, more people with the condition survive for a decade or longer with the condition.
The survival rates for NSCLC are higher than they are for SCLC.
NSCLCThe ACS reports that among people who received a diagnosis of NSCLC from 2012 to 2018, the 5-year survival rate was:
The overall 5-year survival rate for people with NSCLC was 28%.
SCLCThe ACS report that among people who received a diagnosis of SCLC from 2012 to 2018, the 5-year survival rate was:
The overall 5-year survival rate for people with SCLC was 7%.
Early diagnosis and treatment for lung cancer improve survival rates. Without treatment, the outlook for lung cancer is negative.
However, research into the specific statistics for this issue is lacking. Two older reviews examined the mortality rates in people with lung cancer who did not receive treatment.
A 2013 review of studies found that the average survival time for people with NSCLC who do not receive treatment is just over 7 months. A 2012 review found that the survival time for untreated SCLC is in the range of 2 to 4 months.
A person's cancer care team can help them weigh the potential benefits and risks of getting treatment. They may consider the following factors:
Treatment may improve survival but can cause side effects that lower quality of life.
Lung cancer is an aggressive form of cancer that spreads rapidly. Survival rates are improving but remain low, particularly for small cell lung cancer (SCLC).
Early diagnosis and treatment improve a person's likelihood of living for 5 years or longer with lung cancer.
People who smoke or used to smoke need to consult a doctor about whether or not lung cancer screening is right for them.
Receiving a lung cancer diagnosis can be scary, but support is available. A person can connect with their healthcare team to learn more about strategies to slow the spread of lung cancer and improve their outlook.
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