Non small cell lung cancers are broadly divided by their main cell type into squamous cell, adenocarcinoma and large cell. If detected early they can initially be managed with local treatments such as surgery and/or radiotherapy.
Incidence
There are approximately 9180 cases of lung cancer diagnosed in Australia each year, 9% of all cancers and 19% of cancer deaths). Non small cell lung cancer represents approximately 80% of lung cancers.
Screening
No screening test is routinely used.
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 and lethary
- loss of appetite
Diagnostic options include a biopsy of the cancer during a bronchoscopy (a tube inserted into the airways) or examining the sputum for cancer cells.
Staging
Staging is based on the TNM (Tumour, Nodes, Metastases) 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. In early stage disease where a decision to operate depends on the evaluation of the mediastinal lymph nodes, a mediatinoscopy where they are directly visualised is performed. If PET is unavailable a bone scan is done.
Causes
Cigarette smoking is the major cause. Occupational exposures, such as asbestos, radon, hydrocarbons and metals (eg. chromium, nickel), are also associated with lung cancer.
Prevention
Quitting smoking is a major preventative measure.
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
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.
For further information, please contact The Cancer Council Helpline on 13 11 20 (cost of a local call within Australia).