Non-Small Cell Cancer

What is non-small cell lung cancer?

Lung cancer is the development of abnormal cells in the lung and associated tissues. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, making up about 80 to 85 percent of all lung cancers.

What are the different types of non-small cell lung cancer?

There are a number of subtypes of non-small cell lung cancer. Some of the more common types include:

Squamous Cell Carcinoma

This subtype, which accounts for about 25 percent of lung cancers, starts in squamous cells. Squamous cells are flat cells that line the inside of the airways of the lungs. Generally linked to a history of smoking, the cancerous cells tend to be found in the middle of the lungs.

Adenocarcinoma

The most common form of lung cancer—accounting for about 40 percent of lung cancers—found in non-smokers, the cancer starts in cells that secrete mucus. It is also common in former smokers. Patients with this diagnosis tend to have a better prognosis, as the cancer grows more slowly than other versions. It is more common in women than men, usually found in outer parts of the lung and is the most likely form to be found before it spreads to other parts of the body. However, this varies from patient to patient.

Large Cell Carcinoma

This subtype can appear in any part of the lung, but grows and spreads quickly. This can make early diagnosis and treatment difficult. It functions similarly to small cell lung cancer.

What are the symptoms of non-small cell lung cancer?

Symptoms may vary depending on the type and location of the cancer, but some symptoms to look out for can include:

• A persistent cough that gets worse over time
• Coughing up blood or sputum (phlegm or spit) that is rusty in color
• Feeling chronically fatigued
• Frequently reoccurring respiratory infections, such as pneumonia or bronchitis
• Hoarseness or sudden onset of wheezing
• Shortness of breath
• Unexplained weight loss and/or appetite

If the lung cancer has spread (metastatic lung cancer) to other parts of the body, symptoms can include:

• Bone pain, such as in the hips or back
• Conditions of the nervous system—such as headaches, seizures, weakness or numbness in an arm—due to the cancer spreading to the spinal cord or brain
• Jaundice (eye and skin yellowing) if the cancer spreads to the liver
• Visible lumps under the skin—such as the collar bone or neck area—if it spreads to the lymph nodes

Syndromes

With some lung cancers, syndromes can appear. Syndromes are a series of very precise symptoms. For example, Horner syndrome can occur when the cancer forms on the top section of the lungs (also known as Pancoast tumors) and impact certain eye and facial nerves. This can result in:

• Weakness or drooping in one eyelid
• Absent or reduced sweating on the same side of the face
• A smaller pupil in the same eye

Another example is paraneoplastic syndromes. When these appear, it’s because certain lung cancers produce substances that mimic hormones and release them into the bloodstream. These substances can cause problems in other parts of the body even if the cancer hasn’t spread there, and are often the first indication that lung cancer is present. Common ones that develop include:

• Blood clot formations
• Gynecomastia, a development of breast tissue in males
• Hypercalcemia (high calcium levels in blood), which can cause symptoms like recurrent urination, nausea/vomiting, constipation and dizziness
• Overgrowth or thickening of certain bones, typically in the fingers

How is non-small cell lung cancer diagnosed?

In some cases, lung cancer is detected by getting a screening, but the majority are found because of something else going on in the body that’s caused by the cancer (e.g., syndromes). After an extensive medical history is taken and certain diagnostic tests are run depending on the symptoms—such as a chest X-ray, computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan—there are a couple of different tests to look at the cells to confirm a lung cancer diagnosis. These include:

• Bronchoscopy, which uses a lighted tube to enter the windpipe and bronchi (major air passageways to the lungs) that allows instruments to pass into the body to obtain a tissue sample for testing
• Needle biopsy, where a hollow needle is inserted into a suspected mass to remove cells and tissue for testing
• Sputum cytology, which analyzes sputum to find cancer cells
• Thoracentesis, a procedure that removes a buildup of fluid around the lungs (the fluid is tested for cancer cells)

How is it treated?

Treatment will be dependent on a number of factors including the overall health of the patient, the severity of the disease, the location of the cancer and if it has metastasized to other parts of the body. Treatment options can include:

• Chemotherapy, which is often used before surgery, after surgery or in combination with another procedure (e.g., radiation therapy)
• Radiation therapy, which uses high-energy rays (e.g., X-rays) or particles to eliminate cancer cells
• Radiofrequency ablation (RFA), an outpatient procedure that uses high-energy radio waves to heat and destroy the tumor
• Targeted drug therapies that hone in on the changes that occur within non-small cell lung cancer to disrupt growth
• Immunotherapy, which stimulates the patient’s immune system and helps it recognize and destroy the cancer cells

Surgery

Surgery is often an option when the cancer is found in an early stage. If it can be done, it is the best chance for curing non-small cell lung cancer. Procedures to remove the cancer include:

• Lobectomy—often the favored type of surgery—where one (or more) of the five lung lobes containing the cancer is removed
• Pneumonectomy, where an entire lung is removed
• Segmentectomy, also known as a wedge resection, where only a part of a lobe is removed
• Sleeve resection, where a section of a large airway containing the tumor is removed and then the airway attached back together

With any of these procedures, any nearby lymph nodes are also removed to see if the cancer had spread.

Video-Assisted Thoracic Surgery

Video-assisted thoracic surgery (VATS) is a technique that is increasing being used in place of a traditional thoracotomy (an incision made between the ribs on the side of the body). VATS is a minimally invasive alternative to a traditional thoracotomy, which means there are fewer complications, less blood loss and a faster recovery time following the procedure.

At Thoracic Group, our surgeons are pioneers of this innovative techniques. Together, they have helped thousands of patients over the years with a number of conditions using VATS, including non-small cell lung cancer.

For more information or to schedule a consultation with one of our specialists, contact us today.