Non-Small-Cell Lung Cancer

Medically Reviewed by Dr. K on 30 March 2021

Non-Small-Cell Lung Cancer

NSCLC is the most common type of lung cancer. Despite the fact that it is a serious condition, treatment can sometimes prevent it from progressing. There are many things you can do to help you feel better.

NSCLC is more common among people who smoke or inhale a lot of smoke. Many of them are above the age of 65.

NSCLC tumours are divided into three types:

  • Adenocarcinoma: Adenocarcinoma begins in cells that produce mucus and other substances in your air sacs, mostly in the exterior sections of your lungs. It's the most prevalent form of lung cancer in smokers and nonsmokers, as well as people under the age of 45. It seems to grow more slowly than other types of lung cancer.
  • Squamous cell (epidermoid) carcinoma: Squamous cell carcinoma (epidermoid carcinoma) begins in the cells that line the lungs' inner airways. This form of lung cancer accounts for around a quarter of all lung cancers.
  • Large cell (undifferentiated) carcinoma: Large cell carcinoma (undifferentiated) grows and spreads more rapidly. This will make it more challenging to treat. It accounts for around 10% of lung cancer cases.

The treatments your doctor recommends will be determined by the extent of your lung cancer's spread.

 

Causes

The exact cause of this disease remains unclear to doctors. Many of those who develop it have smoked or been exposed to smoke. Other factors that increase the risk of lung cancer include:

  • Radon, a radioactive gas found naturally in soil and rocks
  • Asbestos
  • Mineral and metal dust
  • Air pollution
  • Radiation treatment to your chest or breast
  • HIV/AIDS

It may even run in families.

Symptoms

Early on, you may not experience any symptoms. You might even confuse them for something else, like pneumonia or a collapsed lung.
Symptoms, including those in other forms of lung cancer, may include:

  • Coughing – may be persistent or gradually worsening
  • Chest pain – may be more painful when you cough, laugh or take deep breaths
  • Hoarseness or voice changes
  • Harsh, raspy sounds when you breathe
  • Wheezing
  • Unintentional weight loss
  • Loss of appetite
  • Coughing up blood or mucus
  • Shortness of breath
  • Feeling weak or tired
  • Frequent lung infections like bronchitis or pneumonia

If there is spread to other parts of the body, you may experience:

  • Bone pains
  • Headaches
  • Dizziness
  • Balance issues
  • Numbness or weakness in an arm or leg
  • Yellow skin or eyes – known as jaundice

Getting a Diagnosis

Your doctor will first talk with you and ask you questions such as:

  • When did you first notice symptoms?
  • How is your general health?
  • Are you coughing or wheezing?
  • Does anything make your symptoms better or worse?
  • Do you, or have you ever smoked?
  • Has anyone in your family had lung cancer or any other cancers?
  • Have you been exposed to asbestos or occupational hazards?

Getting A Diagnosis

Your doctor will conduct a thorough physical examination and order special tests to further investigate your condition.

Imaging Tests

Your doctor will use imaging tests to visualise cancers in your lungs. They will even reveal whether or not the cancer has progressed.

  • X-rays: X-rays provide images of structures within the body using low levels of radiation.
  • MRI: MRI (magnetic resonance imaging) is a form of imaging that displays blood flow, organs, and internal organ structures.
  • Ultrasound: By bouncing sound waves off your internal tissues, ultrasound produces an image.
  • PET scans: PET scans use a radioactive agent or tracer that gathers in the parts of the body where the cells are the most active, indicating cancer.
  • CT scans: CT scans are high-resolution X-rays that create clear images of the lung’s tissue and blood vessels.

Sputum cytology: Sputum cytology is a lab test that looks for cancer cells in the mucus you cough up.

Fine-needle aspiration: Cells from an abnormal growth or fluid in your lungs are extracted by fine-needle aspiration biopsy.

 
Special Tests

A small, lightweight tube with a light and a tiny camera can be used by your doctor to look inside your lungs and chest. They can also take tissue samples, including lymph node samples, and search for cancer cells. They will do this in a number of ways:

Bronchoscopy: Bronchoscopy is a procedure in which a tube is placed through the lungs through your nose or mouth.

Endobronchial ultrasound: Endobronchial ultrasound examines lymph nodes and other tissues using bronchoscopy and an ultrasound inserted at the tube’s tip.

Endoscopic ultrasound: Endoscopic ultrasound is similar to endobronchial ultrasound, but the endoscope is passed into your throat and into your oesophagus.

Thoracoscopy: Thoracoscopy is a technique that includes making a few minor incisions to your side to inspect the outside of your lung and the tissue around it.

Mediastinoscopy: A tiny incision is made in the gap between your lungs right above your breastbone for mediastinoscopy.

Your doctor will assign a stage of your cancer depending on what they discover. This will help the medical team in determining the right course of action for you. You’ll need to consider what each stage entails:

  • Occult stage: “Occult" means “hidden." Cancer cells are found in lung fluid or sputum, but the doctor is unable to locate the cancer in the lungs.
  • Stage 0: Cancer cells are found in the lining of your airways.
  • Stage I: Only one lung has a small tumour. Lymph nodes have not been affected by the cancer.
  • Stage II: One lung has a larger tumour, or disease has spread to nearby lymph nodes.
  • Stage III: Cancer has spread from one lung to surrounding lymph nodes or structures.
  • Stage IV: Cancer has spread to both lungs, the fluid surrounding the lungs, or other organs such as the brain and liver.

 

Questions for Your Doctor

It’s difficult to accept the news that you have cancer. You may want to begin by asking your doctor the following questions:

  • What is the severity of my lung cancer?
  • Has it spread, and if so, where has it gone, and what does this mean?
  • What are my choices for cancer treatment? How well can they work properly?
  • What are the negative effects?
  • What other treatments would I need in order to feel better?
  • Will I have to take time off work whilst undergoing treatment?
  • What occurs if the cancer spreads further?
  • Have you ever worked with someone who had this sort of lung cancer?
  • Is it possible for me to participate in clinical trials? I’m not sure how I’m going to find out about it.
  • Is there a medical centre where I might go and get routine treatment for my kind of cancer?

Request that a friend or family member accompany you at your appointments to provide emotional support and to support you with understanding what the doctor advises.

You might feel more at ease having a second opinion before making a treatment decision.

Treatment

This form of lung cancer is treated in two ways: the cancer is targeted, and doctors aim to help you feel comfortable. Their goal is to stay ahead of the symptoms and provide you with the most comfort possible.

Depending on the type of cancer you have and where it is located, your doctor may recommend a variety of treatments.

Surgery. If the cancer is already in the early stages, your doctor would most likely recommend surgery to remove it. A portion or more of your lung can be removed. Other forms of surgery include freezing cancer cells or using a hot probe or needle to destroy them.

Radiation. It has the ability to destroy cancer cells that have survived treatment. It may also be used to treat tumours that are resistant to surgery. A high-energy beam directed at the cancer from outside the body via a special machine, or a radioactive agent placed within the body in or around the cancer, are also sources of radiation.

Chemotherapy. Chemotherapy medications circulate around the body to destroy the disease, whether you take them as tablets or get a needle inserted into a vein or muscle. To target cancer cells in that region, your doctor can inject it into your spinal fluid, a particular organ, or a space within your body. Chemo could be provided before, during, or after surgery to shrink a tumour, or even if you don't have surgery.

Targeted therapy. These medications and antibodies act in very precise ways to keep cancer cells from growing and spreading. Because of the way they work, they typically do less damage to normal cells than radiation and chemotherapy.

Laser and photodynamic therapy (PDT). This technique uses special laser light to “switch on" medications that have been absorbed by cancer cells. This destroys them while still protecting healthy tissue.

Clinical trials. Modern cancer treatments are being researched by scientists. Ask your doctor if a clinical study will be a good idea for you, what you can consider, and how to sign up on the National Cancer Institute's website.

If you experience some pain or shortness of breath, inform the doctor. There are medications available to help you feel better.

 

Taking Care of Yourself

Pay attention to the changes you notice when you follow the treatment plan. Inform the doctor about your physical and mental well-being.

Your appetite can be low on some days. However, in order to maintain your strength and energy, you'll need to eat well. Instead of a few big meals, choose to consume several small meals throughout the day.

If you're having difficulty breathing, a tank of oxygen could help. Relaxation methods such as yoga, listening to music, or meditation can all benefit. Complementary therapies such as gentle massage and aromatherapy can help you relax. Consult the doctor on what to do if you're exhausted, in pain, or out of oxygen.

It's difficult to live with the news that you have cancer. You may be scared, upset, or depressed. It's natural to experience strong emotions. A cancer support network or a counsellor who deals with cancer victims will be willing to assist you with working through your emotions. Look for advice online or in the community, or speak with your doctor about any people that may assist you, such as counsellors, therapists, spiritual leaders, or other doctors.

 

What to Expect

Your cancer may be curable if caught early enough. And if it isn't, the treatment should improve the quality of life and help you live longer. You have the capacity to make choices on what is right for you in your treatment.

Sources

Referenced on 30.3.2021

  1. College of American Pathologists: “Lung Cancer: Lung Adenocarcinoma."
  2. National Cancer Institute: “General Information About Non-Small Cell Lung Cancer," “Eating Problems and Ways To Manage Them," “Your Feelings: Learning You Have Cancer."
  3. Medscape: “Non-Small Cell Lung Cancer Treatment & Management."
  4. University of Southern California: “A Patient's Guide to Lung Surgery."
  5. Johns Hopkins Medicine Health Library: “Mediastinoscopy."
  6. LungCancer.org: “Types and Staging of Lung Cancer."
  7. Medline Plus: “Radiation Therapy."
  8. American Cancer Society: “Photodynamic Therapy," “Managing symptoms of advanced cancer, by location," “Lung Cancer (Non-Small Cell)," “Caring for the Patient With Cancer at Home."
  9. UpToDate: “Patient information: Non-small cell lung cancer treatment; stage I to III cancer (Beyond the Basics)."
  10. https://www.webmd.com/lung-cancer/non-small-cell-lung-cancer

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