Lung cancer – non small cell

Symptoms and diagnosis

Patients may present with specific symptoms related to the lung including:
  • shortness of breath and wheezing
  • chest pain
  • cough which can produce blood stained sputum.

or general symptoms which may include:

  • weight loss
  • lethargy
  • loss of appetite.

Diagnostic options include a biopsy of the mass during a bronchoscopy (a tube inserted into the airways) or examining the sputum for cancer cells.


Staging

Staging is based on the TNM system and classified by the size of the primary tumour, or whether it has spread to the draining lymph nodes or more widely, particularly to the liver, bones, adrenal glands and brain. The staging scans are essentially a CT scan of lungs and centre of the chest (mediastinum), liver and adrenals. A PET scan can add additional information about distant spread including to bones. If PET is not available a bone scan is done.

In early stage disease, a mediastinoscopy may be performed to see the mediastinal lymph nodes, in order to work out whether surgery is possible.


Causes

Cigarette smoking is the major cause, although some people diagnosed with lung cancer have never smoked. Occupational exposures to asbestos, radon, hydrocarbons and metals (e.g. chromium, nickel) are also associated with lung cancer.


Prevention

The major way to prevent lung cancer is by not smoking or quitting smoking.


Treatment

For small tumours surgery alone can be curative. For operable tumours with spread to the lymph nodes, chemotherapy in addition to surgery can improve the outcome. In cancer confined to the chest, but thought to be inoperable, chemotherapy combined with radiotherapy can be used. For widespread disease, chemotherapy doublets such as cisplatin with vinorelbine, or gemcitabine or paclitaxel with carboplatin, can be used.

Second line chemotherapy with docetaxel or pemetrexed can induce a further response after relapse in patients who maintain a good performance level. With some lung cancers (particularly in non-smoking women, and more commonly in people of Asian extraction), agents targeted at the Epidermal Growth Factor Receptor can be beneficial.


Prognosis

An individual’s prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis. For small operable cancers, up to 80% patients can be alive at five years. This drops to a 25-30% five year survival rate for tumours with spread to the lymph nodes, but still treatable by surgery. For patients with spread to other parts of the body who are fit enough to receive chemotherapy, 15-35% will be alive at five years.


Lung cancer – small cell

Symptoms and diagnosis

Patients may present with specific symptoms related to the lung including:

  • shortness of breath
  • wheezing
  • chest pain
  • cough which can produce blood stained sputum.

or general symptoms which may include:

  • weight loss
  • lethargy
  • loss of appetite.

Diagnostic options include a biopsy of the cancer during a bronchoscopy (a tube inserted into the airways) or examination of the sputum for cancer cells.


Staging

Lung cancer is defined as either limited disease (about 30% of cases), where disease is confined to one side of the chest and is small enough to be included in a tolerable radiation field, or extensive disease, which has spread to both sides of the chest or to organs beyond, usually liver, bones, adrenal glands or the brain. Scans of these organs are taken to determine the stage.


Causes

Cigarette smoking is the major cause, although some people diagnosed with lung cancer have never smoked.


Prevention

The major way to prevent lung cancer is not smoking or quitting smoking.


Treatment

Limited disease is treated with combination chemotherapy (commonly cisplatin and etoposide). Radiotherapy to the chest is given with the early doses of chemotherapy.

Response rates (shrinkage by at least a half) are seen in up to 90% of patients and complete response rates (no visible tumour left) in up to 75% of patients are achieved. Patients who have a complete response can be treated with radiotherapy to the brain to prevent relapse in the brain.

Extensive disease is treated with chemotherapy.