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Your Genes And Non-Small-Cell Lung Cancer
Most non-small-cell lungcancer is caused by smoking, but your genes may also help determine your chances of getting the disease. Lung cancer is when cell growth in the lungs becomes abnormal and cancer cells are created. A gene mutation, or change, can make this happen.
Cells normally divide, grow, and may die, at set times. But a gene that changes in a certain way can trigger cells to continue to divide and grow, even when they shouldn't. This out-of-control cell growth can lead to cancer.
Sometimes, a mutated gene that should make sure cells divide slowly or stop won't, or it won't make sure that cells die when it's time. All this can also lead to cancer.
Some people have genes that mutate during their lifetimes for different reasons, and those changes can raise their chances of lung cancer. Other people inherit changed genes from their parents. Still others have cells that change for no apparent reason.
There are a few different ways that genes -- tiny pieces of your DNA -- can mutate and lead to non-small-cell lung cancer.
Gene Changes Caused by LifestyleMost gene mutations that lead to lung cancer happen because of things you've been exposed to. Tobacco is the most common cause of genetic changes to lung cells, but it isn't the only one.
Your genes could change if you come into contact with asbestos or radon on a regular basis. It can also happen if you deal regularly with air pollution, or if you spend a lot of time around certain metals or chemicals, like diesel exhaust.
Secondhand smoke can also cause the genes in your lungs to mutate. You don't need to smoke to raise your odds of lung cancer, if you spend long periods of time in enclosed spaces with people who do.
Gene Changes That You InheritIt's possible to have a genetic mutation passed down to you that can make you more likely to get lung cancer. But it's less common than gene changes caused by other things. (Lung cancer does run in some families, but that doesn't happen very often.)
Some people who have an inherited gene mutation in one of their chromosomes may have more of a chance for the disease, even if they don't smoke. Other people are less likely to be able to clear certain cancer-causing chemicals from tobacco out of their systems. Still others may get a mutation that breaks the system that repairs their DNA. This may lead to more mutations and cancer.
If You Have Lung CancerKnowing what genetic mutations you have may be helpful if you've been diagnosed with non-small-cell lung cancer. Some treatments target some genetic changes and are more likely to be effective tools to fight the disease.
Other treatments are less effective against some genetic mutations, so your doctor might not try that treatment if you have a certain mutation. For these reasons, your doctor may test your genes to see if they should prescribe or avoid certain drugs.
Genetic tests for non-small-cell lung cancer may not be offered by every doctor or hospital, but you may want to ask for a tumor marker test if you've been diagnosed.
Lung Cancer Researcher Diagnosed With Stage 4 Disease Despite Never Smoking: 'I Never Thought I Would Have This'
Stanford University School of Medicine clinical professor and researcher Dr. Bryant Lin has been diagnosed with stage 4 lung cancer despite never smoking in his life.
The oncologist, per the Stanford Medicine blog Scope, was diagnosed with non-small cell cancer — also known as never-smoker lung cancer — in early May, around a month before his 50th birthday.
Lin, who is the co-founder of Stanford's Center for Asian Health Research and Education (CARE), has dedicated a lot of his career to researching lung cancer specifically among Asian American non-smokers, The Stanford Daily reported.
"I never would've thought that I would have this cancer, or become the poster child for my center working on this cancer," Lin told Yahoo! Life.
Bryant Lin.Stanford University
Speaking with the outlet, Lin detailed his road to diagnosis. He first experienced lingering cough and a tight throat for around five or six weeks over spring.
Asking for advice from an ear, nose and throat (ENT) physician colleague, Lin was encouraged to have a chest X-ray. The X-ray "showed opacity in the lungs, indicating infection or cancer," according to Yahoo! Life. Lin then had a CT scan and a bronchoscopy to examine his lung tissue.
Less than two weeks later, Lin received a diagnosis and began treatment.
"Getting a cancer diagnosis is horrible. I went through the stages of grief several times when I was diagnosed. However, I'm grateful that 99.99 percent of my life has been positive," the professor told PEOPLE.
"This 0.01 percent of my life sucks but I consider myself, in the words of [Lou] Gehrig, the Luckiest Man on the Face of the Earth," he added while referencing the baseball player's famous 1939 New York Yankees farewell speech.
Dr. Heather Wakelee, Stanford's chief of oncology — who studies lung cancer in people who have never smoked — has been among those treating Lin. "I can just call people up and say, 'Let's get this done,' " he told Yahoo! Life.
According to Scope, 15 to 20 percent of people diagnosed with lung cancer are non-smokers. The diagnosis "is the result of a gene mutation that disproportionately affects those of Asian descent, particularly women."
"About 50% of nonsmoker Asians [with lung cancer] have this mutation, and less than 20% of non-Hispanic whites have it," Lin told Yahoo! Life. "We don't really know why Asians get this mutation more than other groups."
A stock photo of a doctor inspecting an X-ray image.Getty
According to the American Cancer Society, "Lung cancers in people who don't smoke are often different from those that occur in people who do. They tend to develop in younger people and often have certain gene changes that are different from those in tumors found in people who smoke. In some cases, these gene changes can be used to guide treatment."
Lin told Yahoo! Life he's taking "a relatively new daily pill, called Osimertinib, which attacks the mutated cancer cells," and targets the cancer with fewer side effects because it's so "precise."
"I feel great, and I'm lucky that I'm doing so well clinically and in terms of quality of life," he said to the outlet.
The researches still has to undergo more chemotherapy every few weeks. "The downside is that eventually, the cancer can develop resistance to this targeted treatment," Lin added to the publication.
He went on to say that he's been given advice from a former colleague also diagnosed with cancer, "He said, 'You just have to live long enough for the next treatment to work,' " Lin recalled to Yahoo! Life.
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Lin has been teaching a class named "MED 275: From Diagnosis to Dialogue: A Doctor's Real-Time Battle with Cancer."
In the class, he told students about a letter he'd received from an elderly patient with chronic kidney disease, in which the patient thanked Lin for "taking such good care" of him. "That letter arrived two weeks after the man's death ... Which means that he spent time in his final hours writing a letter for me," Lin said, per Scope.
"I'm not sure how long I have. One year? Two years? Five years?" the professor told students. "In a way, this class is part of my letter — what I'm doing to give back to my community as I go through this."
Lin added to PEOPLE of how well-received his class has been, "I've been overwhelmed by the response from the students, colleagues and community. It's been rewarding to see how impactful the class has been. I've taught many classes and have never seen students so engaged and supportive."
Non-Small-Cell Lung Cancer Treatment By Stage
After your lung cancer is diagnosed, the doctor will run tests to find out the size of the tumor and whether the cancer has spread to other parts of the body. This process is called staging. Knowing the stage of your disease is crucial because it will help you and your doctor choose the best course of treatment.
Here's a look at the options for each stage. Keep in mind that no one can say for sure how your cancer will respond. Every person is different, and so is every cancer. Your doctor will make changes along the way to find what works best.
STAGE 0How It's Defined
The cancer is only in the lining of your airways.
Treatments
Surgery: If your health is good overall, surgery is probably all you need. Depending on where the tumor is, your surgeon will suggest one of these procedures:
Photodynamic therapy (PDT): This process uses a drug called a photosensitizer and a certain type of light to create a form of oxygen that kills nearby cells. It can help shrink tumors without the side effects of other drugs.
Brachytherapy: This is a form of internal radiation where radioactive material is put into a tumor or into an airway next to a tumor.
STAGE IHow It's Defined
In stage IA, the tumor is no larger than 3 centimeters (about 1 1/4 inches) across and hasn't spread to any other tissues or lymph nodes. In stage IB, it's no more than 4 centimeters and has spread to the main bronchus of the lung's lining, or both.
Treatments
Surgery: If you're in good health, surgery may be all you need. Based on the tumor's size and placement and how well your lungs work, your surgeon may suggest one of these procedures.
Chemotherapy: With any of these surgeries, nearby lymph nodes are also removed to see if the cancer has spread. If your medical team feels your cancer could come back, they'll probably suggest you get chemo after surgery to destroy any leftover cancer cells. You might hear this called adjuvant chemotherapy. You could take a chemo drug by mouth or get it in a vein.
Radiation: If you're not healthy enough for surgery, your doctor may go with this therapy. It uses powerful X-rays to kill cancer cells. You may hear the doctor call it external radiation.
Radiofrequency ablation (RFA): This is a procedure where heat produced by radio waves kills cancer cells.
STAGE IIHow It's Defined
The tumor is between 3 and 7 centimeters across, or it has spread to your lymph nodes, or both.
Treatments
Chemotherapy: Your doctor may want to do chemo (sometimes paired with radiation) before surgery to shrink the tumor. They might call this neoadjuvant chemotherapy. Even if your doctor doesn't find cancer cells during surgery, they might suggest chemo afterward just in case cancer cells were left behind.
Immunotherapy: An immunotherapeutic drug has now been approved by the FDA to treat some types of stage II NSCLC.
Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment. They were typically used in NSCLC that had spread, but now there's one targeted therapy that's for use in earlier-stage NSCLC that has certain traits.
Surgery: If you're healthy enough, the doctor will likely recommend one of the following:
After surgery, your doctor will check the tissue they removed to see if cancer cells are at the edges. If so, you may need another operation to remove more cancer cells.
Radiation: If you're not healthy enough for surgery, you may get radiation instead.
STAGE IIIHow It's Defined
Cancer is found in the lung and in the lymph nodes in the middle of the chest. Stage III has three subtypes:
STAGE IIIAHow It's Defined
If the cancer has spread only to lymph nodes on the same side of the chest where it began, it's called stage IIIA.
Treatments
Chemotherapy and radiation: If you can stand the side effects, treatment usually starts with chemo. It might be combined with radiation.
Surgery: If you're healthy enough and your doctor thinks there's a good chance they can remove any cancer that remains, they may suggest surgery. In some cases, it may be his first choice of treatment. It's often followed by chemotherapy and sometimes radiation. The type of surgery depends on the size and location of the tumor, how far the cancer has spread into the lymph nodes, and whether you've had surgery before.
Immunotherapy:There are many immunotherapeutic drug options, depending on the type of lung cancer you have, any mutations or biomarkers that may be present, treatments you've already had, and your overall health. Your doctor can guide you through these choices.
Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment. They were typically used in NSCLC that had spread, but now there's one targeted therapy that's for use in earlier-stage NSCLC that has certain traits.
STAGES IIIB and IIICHow It's Defined
The cancer has spread to lymph nodes near the opposite lung or in your neck. These cancers can't be completely removed by surgery.
Treatments
Chemotherapy with radiation: Again, treatment depends on your overall health and how you can handle the treatments. If you're in fairly good health, chemo and radiation might improve your condition.
Radiation or chemotherapy: If you can't handle the combo treatment, you'll probably get radiation therapy alone. Chemo by itself is less common.
Clinical trials: These cancers can be difficult to treat, so you may want to think about taking part in a clinical trial of newer treatments.
Immunotherapy: There are many immunotherapeutic drug options, depending on the type of lung cancer you have, any mutations or biomarkers that may be present, treatments you've already had, and your overall health. Your doctor can guide you through these choices.
Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment. They were typically used in NSCLC that had spread, but now there's one targeted therapy that's for use in earlier-stage NSCLC that has certain traits.
STAGE IVHow It's Defined
The cancer has spread to both lungs, to fluid in the area surrounding the lungs, or to other organs.
Treatments:
Chemotherapy and radiation: A cancer that's spread to distant sites in your body can be hard to cure. As long as you're in fairly good health and can handle the side effects, treatments like chemotherapy and radiation can ease your symptoms and help you live longer.
Immunotherapy: This involves drugs that help your body's own immune system find and destroy cancer cells.
Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment.
Photodynamic therapy: Doctors use light to kill cancer cells and shrink tumors.
Stent: Lung tumors that have grown into an airway can cause trouble breathing or other problems. Your doctor puts a hard silicone or metal tube called a stent into the airway to hold it open.
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