Treatments Options for Non-Small Cell Lung Cancer

According to information released by the Centers for Disease Control and Prevention (CDC), lung cancer is the leading cause of death in the country and the second most diagnosed cancer. The death rate exceeds that of colon, breast, and pancreatic cancers put together. More than half the people diagnosed die within one year of diagnosis.

Cancer cells are classified according to the type of cell and how these cells appear under a microscope. There are two main subtypes of lung cancer:

  • Small cell carcinoma: accounts for 15% of cases
  • Non-Small cell carcinoma: accounts for 85% of cases and is further subdivided into the squamous cell, adenocarcinoma, and large cell carcinomas.

In rare cases, some cancers contain elements of both types. The diagnosis may contain a noting NOS (not otherwise specified).

1. What is non-small cell lung cancer (NSCLC)?
Cancer cells form in the tissues of the lung, causing non-small cell carcinoma of different types.

  • Squamous cell NSCLC, also known as epidermoid cancer is a malignancy of the thin, flat cells that occur in the inner lining of the lungs.
  • Adenocarcinoma NSCLC is the most common variety and occurs in the cells that line the alveoli that generate mucus and other substances.
  • Large cell NSCLC occurs in several types of large cells.

Risk factors include smoking, radon exposure, family history, exposure to toxic environments containing asbestos, arsenic, chromium, beryllium, nickel, soot, tar, and vehicular pollution. Second-hand smoke, atomic bomb radiation and other types of radiation, excessive beta carotene supplements and being an HIV-patient increase the risks of developing NSCLC.

Symptoms may overlap with other illnesses or may be absent. Persistent cough, chest-pain/discomfort, hoarseness, appetite/weight loss, fatigue, swallowing difficulties, wheezing, swelling in the face or veins in the neck are typical symptoms.

Tests and diagnosis include physical exam and history, lab tests, chest X-ray, CT scan, sputum cytology, thoracentesis. Further tests to confirm the diagnosis include fine-needle aspiration biopsy, bronchoscopy, thoracoscopy, anterior mediastinoscopy/mediastinotomy, lymph node biopsy, molecular tests, immunohistochemistry.

Once the diagnosis has been confirmed and the staging of cancer according to stages from Stage 0 (occult) to Stage 4 has been completed, the oncologist can also confirm whether the cancer has spread to other parts of the body.

2. Treatment options for non-small cell lung cancer
Based on the stage of cancer diagnosed, the patient’s health status, age, possible side-effects and projected response to treatment, non-small cell lung cancer treatment options may follow standard procedures or participation in clinical trials.

Standard non-small cell lung cancer treatments include:

  • Watchful waiting and monitoring
  • Surgery
  • Chemotherapy
  • Radiation
  • Immunotherapy
  • Laser-based therapy
  • Cryosurgery
  • Photodynamic therapy
  • Electrocautery

Clinical trials and new therapies can be started before, during and after standard treatments for non-small cell lung cancer have begun. They include:

  • Chemoprevention
  • Radiosensitization
  • New frontiers in targeted drug combinations
  • Targeted monoclonal antibody medication
  • Tyrosine kinase inhibitors

In general, a multidisciplinary approach to non-small lung cancer treatments is adopted. Constant monitoring to check for recurrence is part of the regimen. The team consists of treating physicians, surgeons, oncologists, radiologists, pharmacologists, nurses, psychological counselors, among others who provide information as well as treatment to patients.