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Non-Small Cell Lung Cancer Symptoms

Non-small cell lung cancer (NSCLC) is a type of cancer that begins in the tissues of the lungs, the two spongy organs in your chest that help your body absorb oxygen. Lung cancer is the third most common cancer affecting adults in the United States and the leading cause of cancer death. 

There are several types of non-small cell lung cancer including squamous cell carcinoma, large cell carcinoma, and adenocarcinoma. NSCLC makes up about 80-85% of all lung cancer diagnoses in the United States. It is estimated that smoking causes up to 90% of cases of lung cancer.

The common symptoms of non-small cell lung cancer are shortness of breath and a persistent cough. Fortunately, there are several treatment options available for NSCLC.

There are many different types of lung cancer, and each one affects different types of cells and spreads in different ways. The main types of non-small cell lung cancer include:  Squamous cell carcinoma: This type forms in the thin, flat squamous cells in the lungs, which line the inside of the airways. It is also possible for it to develop in the skin. Large cell carcinoma: This begins in different types of large cells in the lungs. Adenocarcinoma: This starts in the cells that line the alveoli (small air sacs in the lungs).  When NSCLC develops in the lungs, it affects your ability to breathe. Common symptoms may include:  Persistent cough Shortness of breath (dyspnea) Chest pain Wheezing Coughing up blood (hemoptysis) Hoarse voice Trouble swallowing (dysphagia) No appetite  Unintended weight loss Fatigue  As NSCLC grows and spreads, it can start to affect other organs and areas of the body. Later symptoms may include: Bone pain Joint pain  Muscle weakness Eyelid drooping (ptosis)  Swelling in the face and neck Non-small cell lung cancer occurs when certain cells in the lungs become damaged and begin to grow and multiply at an out-of-control rate. The most common cause of cell damage in the lungs is smoking. Researchers believe that up to 90% of all lung cancer cases are caused by smoking tobacco. Risk Factors The main risk factor for NSCLC is smoking. The earlier a person starts smoking and the more often they smoke, the higher their risk for lung cancer.  Other risk factors include: Second-hand smoke exposure  Workplace exposures to chemicals including asbestos, radon, chromium, beryllium, nickel, soot, or tar History of radiation therapy to the breast or chest History of frequent imaging tests Exposure to atomic bomb radiation  Exposure to air pollution Family history of lung cancer Human immunodeficiency virus (HIV) Beta carotene supplements (for heavy smokers only) Older age Gene mutations such as the KRAS-G12C mutation, which is found in 13% of people with NSCLC Non-small cell lung cancer is usually diagnosed by an oncologist, a medical doctor who specializes in the diagnosis and treatment of cancer. If your healthcare provider is concerned that you have symptoms of lung cancer, you will likely be referred to an oncologist who specializes in lung cancer.  Medical tests used to diagnose NSCLC include: Physical exam: The oncologist will perform a thorough physical exam to look for signs of cancer.  Health history: Your oncologist will ask questions about your health history and risk factors to understand your cancer risk.  Lab tests: Your oncologist may order lab tests of tissues, blood, and urine to look for signs of cancer or infection.  Chest X-ray: You may need a chest X-ray to rule out other causes of lung cancer symptoms such as pneumonia or another infection.  Sputum cytology: A pathologist examines a sample of your sputum (mucus) under a microscope.  Thoracentesis: A healthcare provider removes fluid from the space between the lungs and chest wall, and then examines it under a microscope.  Endoscopic ultrasound: A healthcare provider inserts a scope down the throat to produce pictures of the lungs.  Bronchoscopy: The oncologist may use a bronchoscopy to look inside the trachea (windpipe) and the large airways.  Mediastinoscopy: A surgeon makes an incision in the breastbone and guides a scope into the chest to examine the lungs and take a biopsy if needed.  Lymph node biopsy: If your oncologist is concerned that cancer has spread to the lymph nodes, they may remove all or part of a lymph node to test it for cancer cells.  Once you have been diagnosed with non-small cell lung cancer, your oncologist may order additional tests to determine how advanced the cancer is. These tests can include: Magnetic resonance imaging (MRI): An MRI uses magnets and radio waves to produce detailed pictures of the lungs and surrounding tissues.  Computed tomography (CT) scan: A CT scan provides detailed pictures by taking several X-rays from different angles. Positron emission tomography (PET) scan: A PET scan finds fast-growing cells in the body to tell how far cancer has spread. Bone scan: Your oncologist may recommend a bone scan to determine if cancerous cells have spread to the bone. Pulmonary function test (PFT): PFTs can be used to tell how well the lungs are working.  Stages of Non-Small Cell Lung Cancer Treatment for non-small cell lung cancer depends on the stage. Cancer staging is used to determine how far cancer has spread throughout the body.  The stages of NSCLC include: Occult (hidden) stage: Cancer cells cannot be detected with imaging or bronchoscopy but can be found in the sputum. Stage 0: Cancer cells are present in the lining of the airways but have not spread beyond the lungs. Stage IA: The cancerous tumor is no larger than 3 centimeters (cm) and has not spread to the lymph nodes.  Stage IB: The tumor is between 3 and 4 cm and has not spread to the lymph nodes. Stage IIA: The tumor is between 4 to 5 cm and has not spread to the lymph nodes.  Stage IIB: The tumor is not larger than 5 cm but has spread to the lymph nodes. Stage III: Cancer cells have spread to areas on the same side of the chest as the primary tumor.  Stage IV: Cancer cells have spread to distant areas of the body, such as the liver or the brain.   The treatment for non-small cell lung cancer depends on the cancer stage, symptoms, and your overall health. There are several possible treatment options, and your oncologist will recommend a plan based on your individual health.  The goal of treatment for people with stage I or stage II NSCLC is to cure cancer. The goal of treatment for those with stage III or stage IV is usually to extend life and improve quality of life.  If the tumor can be removed, surgery is usually the first treatment option. Surgical options include: Wedge resection: Remove the tumor and the surrounding normal tissue Lobectomy: Remove the entire lobe of the lung Pneumonectomy: Remove the whole lung Sleeve resection: Remove part of the bronchus  If cancer cells have spread beyond the lungs, you may require additional treatments, including: Radiation therapy: Radiation therapy uses high-energy rays or particles to destroy cancer cells. It may be useful after surgery to kill any remaining cancer cells. Chemotherapy: Chemotherapy includes drugs used to destroy cancer cells.  Immunotherapy: Immunotherapy supports the body's immune system so it can better fight cancer.   Laser therapy: Laser therapy uses a laser beam to destroy cancer cells. Photodynamic therapy (PDT): PDT combines light energy with drugs that help destroy cancer cells when activated by light. Cryosurgery: Cryosurgery freezes and destroys abnormal tissue to stop cancer from spreading.   Electrocautery: Electrocautery uses a heated needle or probe to destroy cancerous tissue. Another treatment option for non-small cell carcinoma is targeted therapy. Targeted therapy uses drugs to help the body identify specific cancer cells. Targeted therapy options include: Monoclonal antibodies: Monoclonal antibodies are able to attach to specific targets on cancer cells. Tyrosine kinase inhibitors: These drugs enter the cell membrane and tell cancer cells to stop growing and dividing.  Mammalian target of rapamycin (mTOR) inhibitors: These drugs block the mTOR proteins (which coordinate cell growth) to keep cancer cells from growing and dividing.  KRAS G12C inhibitors: These inhibitors block the KRAS-G12C mutation to keep them from growing more cancer cells.  Not all cases of non-small cell lung cancer can be prevented. However, it is possible to significantly lower your risk. Because smoking causes a majority of lung cancer cases, avoiding tobacco is the best way to prevent lung cancer.  If you currently smoke, talk with your healthcare provider about resources to help you quit. There are prescription medications and support groups that may help.  People with NSCLC are at an increased risk of developing other types of cancer in the future. If you have a history of cancer, talk with your healthcare provider about regular cancer screenings.  People with NSCLC are at an increased risk of certain complications, including:  Pneumonia: Infection and inflammation in the lungs  Thrombosis: Blood clot, which can start in or travel to the lungs (pulmonary embolism)  Paraneoplastic syndrome: A group of symptoms that occur when the immune system reacts to cancer Many people with non-small cell lung cancer can be cured with successful treatment. However, some people may live with this type of cancer without a cure. Lung cancer is the leading cause of cancer death in the United States.  Fortunately, there are several treatment options and resources available as you navigate living with NSCLC. People with this type of lung cancer can expect to regularly meet with their healthcare team for follow-up exams, imaging tests, and screenings. If you or a loved one with NSCLC smokes cigarettes or uses other tobacco products, joining a smoking cessation program can help with quitting. You may also find further resources and support by joining a lung cancer support group and/or seeing a therapist.

Dolph Lundgren Shares Cancer Treatment Updates: 'I'm Living A Normal Life'

Two years after being told he had terminal cancer, Dolph Lundgren is feeling good — and looking forward to the future.

"I'm living a normal life. I'm still taking oral medication, but it doesn't really affect me," Lundgren, 65, told Entertainment Tonight. "I mean, there's no side effects. Every day to me is a blessing, and I really enjoy it, and I feel really good about that." 

The actor was originally diagnosed with kidney cancer in 2015, and promptly underwent treatment while continuing to work on films like Aquaman and Creed 2. 

But after a tumor was found in his liver in 2021, Lundgren said his doctor "started saying things like, 'You should probably take a break and spend more time with your family and so forth.'"

"So I kind of asked him, 'How long do you think I got left?' I think he said two or three years, but I could tell in his voice that he probably thought it was less," the action star revealed.

Dolph Lundgren as Ivan Drago in Rocky IV. MGM/Courtesy Everett Collection

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Admitting that he was feeling "depressed," he sought a second opinion. His physician was able to treat his kidney cancer by targeting a mutation he had that is common in lung cancer, according to Dr. Alexandra Drakaki, Lundgren's oncologist.

"If I'd gone on the other treatment, I had about three or four months left," Lundgren told the outlet. "I couldn't believe that that it would be that radical of a difference that within three months, things were shrinking by 20, 30%."

From there, "2022 was basically watching these medications do their thing," Lundgren said.

And now, the Swedish actor — who married fiancée Emma Krokdal, 27, in Mykonos on July 13 — is looking forward, with a new film about his life slated to debut next year.

"I have a documentary they've been shooting about my life for two years," he told ET. "They've been filming it, and we're in there editing right now. I'm going to see it in a few weeks and I think that it will come out next year, so that's pretty exciting."

Lung Cancer Outcomes Significantly Improved With Immunotherapy-based Treatment Given Before And After Surgery

image: 

John Heymach M.D., Ph.D.

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Credit: The University of MD Anderson Cancer Center

HOUSTON ― A regimen of pre-surgical immunotherapy and chemotherapy followed by post-surgical immunotherapy significantly improved event-free survival (EFS) and pathologic complete response (pCR) rates compared to chemotherapy alone for patients with operable non-small cell lung cancer (NSCLC), according to results of a Phase III trial reported by researchers at The University of Texas MD Anderson Cancer Center. 

The findings, published today in the New England Journal of Medicine, were first presented at the American Association for Cancer Research (AACR) Annual Meeting 2023.  

The AEGEAN trial evaluated durvalumab given perioperatively, meaning therapy is given both before and after surgery. Participants on the trial received either pre-surgical (neoadjuvant) durvalumab and platinum-based chemotherapy followed by post-surgical (adjuvant) durvalumab or neoadjuvant placebo and chemotherapy followed by adjuvant placebo.  

AEGEAN was the first Phase III trial investigating perioperative immunotherapy in patients with resectable NSCLC to report positive outcomes, and these data add to the growing evidence supporting the benefits of both neoadjuvant and adjuvant immunotherapy for these patients  

"Our goal is to increase cures for lung cancer. Throughout decades of research with adjuvant and neoadjuvant chemotherapy, we only succeeded in increasing cures by around 5%,"  

said principal investigator John Heymach, M.D., Ph.D., chair of Thoracic/Head & Neck Medical Oncology at MD Anderson. "This one study alone has the potential to increase that percentage significantly, and we look forward to many more improvements going forward." 

Of the patients receiving perioperative durvalumab, 17.2% had a pCR compared to just 4.3% of those receiving chemotherapy alone. At the first interim analysis of EFS, with a median follow-up of 11.7 months, the median EFS was 25.9 months in the placebo arm, but it had not yet been reached in the durvalumab arm. 

These data correspond to a 32% lower chance of patients experiencing disease recurrence, progression events or death with the immunotherapy-based treatment when compared to chemotherapy alone. Approximately four times as many patients treated with perioperative durvalumab plus chemotherapy achieved a pCR when compared to those treated with chemotherapy alone. 

Durvalumab, an immune checkpoint inhibitor targeting PD-L1, has previously been approved for treating specific patients with biliary tract cancer, liver cancer, small cell lung cancer and NSCLC. Currently, durvalumab is used for treating patients with locally advanced, unresectable NSCLC following definitive chemoradiotherapy and for patients with metastatic NSCLC in combination with tremelimumab and platinum-based chemotherapy. 

For resectable NSCLC, previous studies have shown some benefit from using adjuvant or neoadjuvant immunotherapy, but Heymach explained the benefits have been modest so far. MD Anderson is engaged in longstanding multidisciplinary efforts to use neoadjuvant treatments to improve outcomes for patients. Numerous clinical studies, such as the NEOSTAR and NeoCOAST trials, are evaluating neoadjuvant immunotherapy and novel combinations to eliminate viable tumors before surgery and to reduce recurrence rates. 

The Phase III AEGEAN trial is a randomized, double-blind, placebo-controlled study to evaluate the benefits of perioperative durvalumab added to platinum-based chemotherapy in adults with untreated stage IIA-IIIB NSCLC. A total of 802 patients were randomized 1:1 into each arm. The study's primary endpoints are pCR, assessed by a central lab, and EFS using a blinded independent central review. 

Patients with EGFR/ALK mutations were excluded from the modified intent-to-treat population. A total of 740 patients were included in the efficacy analysis, including 366 on the durvalumab arm and 374 on the placebo arm. The median age of participants in each arm was 65 and 71.6% were male. Patients were 53.6% white, 41.5% Asian and 4.9% other. 

Overall, the treatments were well tolerated, and side effects were consistent with previous studies. The researchers observed maximum grade 3-4 any cause adverse events in 42.4% and 43.2% of patients on the durvalumab and placebo arms, respectively. 

The benefits in both pCR and EFS largely were consistent across predefined patient subgroups, and the trial continues assessment for long-term EFS as well as disease-free survival and overall survival outcomes. 

"This study shows that a combination of neoadjuvant and adjuvant durvalumab offers benefit for patients and may have the potential to change standard-of-care for patients with resectable non-small cell lung cancer," Heymach said. "Going forward, we face a series of questions about how to build more effective regimens without giving more treatment than is necessary." 

Heymach explained that future studies must determine which patients receive the most benefit from neoadjuvant therapy and may be able to avoid further treatment as well as those who remain at high risk of recurrence and may require more intensive adjuvant regimens. 

The study was conducted by AstraZeneca. Heymach serves on advisory committees for Genentech, Mirati Therapeutics, Eli Lilly & Co, Janssen Pharmaceuticals, Boehringer Ingelheim, Regeneron, Takeda, BerGenBio, Jazz Pharmaceuticals, Curio Science, Novartis, AstraZeneca, BioAtla, Sanofi, Spectrum Pharmaceuticals, GSK, EMD Serono, Blueprint Medicines and Chugai Pharmaceutical. He receives research support from AstraZeneca, Boehringer Ingelheim, Spectrum, Mirati Therapeutics, Bristol Myers Squibb and Takeda, as well as royalties and licensing fees from Spectrum. A full list of collaborating authors and their disclosures can be found here. 

Read this press release on the MD Anderson Newsroom. 

Journal

New England Journal of Medicine

Subject of Research

People

Article Publication Date

23-Oct-2023

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