Lung Cancer: Symptoms of Non-Small Cell Lung Cancer & Treatment by Stage

What is non-small cell lung cancer?

Lung cancer is one of the leading causes of cancer-related deaths in the U.S. and worldwide. In 2012, lung cancer was diagnosed in 1.8 million people and caused approximately 1.6 million deaths. When someone is diagnosed with lung cancer, one of the first steps is to stage the disease in order to determine both treatment and prognosis. Ninety-five percent of all lung cancers can be categorized as “small cell” or “non-small cell.” About 10 to 15 percent of lung cancers are considered small cell lung cancers while 80 to 85 percent are non-small cell lung cancers. Cancer, in general, is a condition characterized by overgrowth of a certain cell type. Our bodies naturally have a variety of cell types to serve different functions. The distinction between small cell and non-small cell lung cancer can be determined by looking at a small sample of the lung tissue where the cancer is growing and determining what cell type is overgrowing. Based on the stage of the lung cancer, surgical resection may offer the best outcomes. There are a number of symptoms associated with lung cancer that will be discussed in this article, the most common of which being cough.

What are the types of lung cancer?

There are two main types of lung cancer: non-small cell lung cancer and small cell lung cancer, and two rarer forms of lung cancer: carcinoid tumors and lung sarcomas.

• Non-small Cell Lung Cancer: Non-small cell lung cancer is the most common type of lung cancer, accounting for about 85% of all cases. It usually grows and spreads slower than small-cell lung cancer. The three main types of non-small cell lung cancer are:
  • Adenocarcinoma: This type of lung cancer arises from the cells that line the airways and is the most common type of lung cancer in men.
  • Squamous cell carcinoma: This type of lung cancer arises from the cells that line the airways and is the most common type of lung cancer in women.
  • Large cell carcinoma: This type of lung cancer is a relatively uncommon but aggressive subtype that tends to occur in smokers.
• Small Cell Lung Cancer: Small cell lung cancer is a less common but more aggressive type of lung cancer with lower survival rates. It grows and spreads faster than non-small cell lung cancer and tends to arise from the cells lining the airways and blood vessels in the lung.

Squamous cell lung cancer is a distinct subtype of non-small cell lung cancer, accounting for about 30% of all lung cancer cases. This type of cancer typically develops in the central part of the lung or in the main airway, such as the left or right bronchus. Squamous cell lung cancer is strongly associated with a history of smoking, with approximately 80% of cases in men and 90% in women linked to tobacco use. Unlike adenocarcinoma, which can occur in both smokers and non-smokers, squamous cell carcinoma is less common in individuals who have never smoked.

The risk factors for squamous cell lung cancer are similar to those of other types of lung cancer, but with a stronger connection to smoking. Additional risk factors include exposure to secondhand smoke, occupational exposure to certain minerals and metal particles, and a family history of lung cancer. Squamous cell carcinoma often presents with symptoms such as persistent cough, coughing up blood (hemoptysis), and recurrent respiratory infections due to its central location in the lungs.

In terms of treatment, squamous cell lung cancer may respond differently to certain therapies compared to other non-small cell lung cancers. For instance, it tends to be less responsive to some targeted therapies that are effective against adenocarcinomas with specific genetic mutations. However, recent advancements in immunotherapy have shown promising results for patients with squamous cell lung cancer, offering new treatment options for this subtype.

Additionally, there are other types of lung cancers, such as carcinoid tumors and lung sarcomas, but these are much less common.

• Carcinoid Tumors: Carcinoid tumors are a type of neuroendocrine tumor that arises from the cells that produce hormones in the lung. These tumors can be benign or malignant and tend to grow slowly. They can cause symptoms such as coughing, wheezing, and shortness of breath. The treatment options for carcinoid tumors include surgery, chemotherapy, and/or radiation therapy.
• Lung Sarcomas: Lung sarcomas are a type of cancer that arises from the connective tissue or supportive cells in the lung. These tumors are relatively uncommon and can be either malignant or benign. They can cause symptoms such as coughing, chest pain, and difficulty breathing. The treatment options for lung sarcomas may include surgery, radiation therapy, and/or chemotherapy, depending on the type and stage of the tumor.

Lung cancer symptoms

Main symptoms

While lung cancer can present with a wide array of symptoms, the most common clinical manifestations of the condition are as follows:

• Cough: It is estimated that cough is present in 50 to 75 percent of lung cancer patients. If a current or former smoker presents with a new cough, they should undergo an evaluation for lung cancer.
• Hemoptysis: This is the term used to describe the process of coughing up blood. This can range from scant amounts of blood to much larger quantities.
• Chest pain: Chest pain is present in 20 to 50 percent of people with lung cancer. The pain is usually on the same side as the tumor.
• Shortness of breath: This symptom occurs in about 70 percent of people with lung cancer. This shortness of breath is usually caused by airway obstruction by the tumor. Less commonly, this shortness of breath can be due to compromise of the phrenic nerve, the nerve that governs the movement of the diaphragm.
• Hoarseness: The nerve that controls the vocal cord is called the recurrent laryngeal nerve. This nerve courses under the aorta in the chest where it can be compromised by the mass effect of lung cancer. A tumor pressing on this nerve can thereby cause hoarseness.

What causes lung cancer?

Smoking is responsible for 90 percent of all lung cancers. Non-small cell lung cancer includes the subtypes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These subtypes are determined by which cell type is over-proliferating. Smoking is the leading cause of cancer in all of these subtypes. As is the case with most cancers, carcinogens like smoking inflict damage on the normal cells. These damaged cells then need to be cleared from the body and regenerated. Iterations of regeneration create an opportunity for cell mutations that lead to uncontrolled growth and subsequently produce cancer. A number of carcinogens in addition to smoking have been tied to lung cancer and will be described below in “Prevention.”

Diagnosis of Lung Cancer

Treatment options and prevention

If you are found to have lung cancer, a procedure is usually done to take a sample of lung tissue suspected to be cancerous. This tissue is examined under the microscope to determine if it falls under the category of small cell or non-small cell. The tissue sample is also used to perform genetic testing to determine a possible specific mutation that led to the development of the cancer. Once your cancer is staged, this staging is used to determine your treatment course.

Treatment for early-stage cancer

Early stage cancers (stages I and II) are then evaluated by a thoracic surgeon to determine if surgical removal is possible. If so, you will undergo the procedure and then either follow-up with regular surveillance or chemotherapy and/or radiation. If you have an early stage cancer but are not a surgical candidate, you will likely undergo definitive radiation therapy.

Treatment for late-stage cancer

The treatment of late-stage cancers (stage III+) is decided on a case-by-case basis based on the evaluations of a thoracic surgeon, medical oncologist, and radiation oncologist. Traditionally, people with metastatic non-small cell lung cancer undergo systemic chemotherapy. This chemotherapy can be incredibly taxing on the rest of the body while in the process of destroying the tumor. Genetic testing is performed on these tumors because a newer treatment option for metastatic cancer is immunotherapy. In this course of treatment, the specific mutation causing the cancer is identified and immunotherapy drugs directed specifically at that mutation are given. These can be highly effective therapies and lead to far fewer side effects given that they are not attacking normal cells like chemotherapy.

Prevention

Prevention of lung cancer is aimed at the avoidance of risk factors. Risk factors include the following:

• Smoking
• Radiation therapy: People with other cancers in the past and receive radiation are at increased risk of developing a second cancer, like lung cancer.
• Inhaling asbestos
• Inhaling radon
• Inhaling metals: arsenic, chromium, and nickel
• HIV
• Alcohol

The US Preventive Task Force recommends screening for lung cancer in high-risk patients. Medicare covers the cost of CT scanning in people 55 to 77 years old who have at least a 30-pack-per-year smoking history who have quit within the last 15 years.

Questions your doctor may ask to diagnose lung cancer

• Have you lost your appetite recently?
• Any fever today or during the last week?
• Are you sick enough to consider going to the emergency room right now?
• Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
• Are you experiencing a headache?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.” to end of doctor questions section