Lung Cancer in Men

Lung cancer is different in men but there is reason for hope

Man talking with his doctor about lung cancer in men

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Lung cancer in men differs from lung cancer in women in a number of ways. The most common types of lung cancer differ, as do the treatments that may be most effective. While the prognosis of lung cancer in men has historically been poorer than that of women, there is hope for men in the age of new treatments. A higher mutation burden in tumors, often considered a prognostic sign, may also predict a better response to immunotherapy drugs.

Statistics

Lung cancer is the leading cause of cancer deaths in men, both in the United States and worldwide. Though historically, men were more likely to develop the disease than women, the number of men and women diagnosed yearly is very close. On a positive note, the incidence of lung cancer in men appears to be decreasing at the current time.

The average age at which lung cancer is diagnosed in men is somewhat older than that of women at age 71. The lifetime risk of a man developing lung cancer (smokers and non-smokers combined) is 1 in 13.

Symptoms and Signs

Just as men tend to have more “typical” symptoms of a heart attack, they are also more likely to have symptoms and signs typically associated with lung cancer. The types of lung cancer that are more common in men often grow near the central airways of the lungs. Because of this a persistent cough, coughing up blood, wheezing, and repeated infections due to airway obstruction (such as pneumonia) may be more common.

A unique set of symptoms called paraneoplastic syndrome is also more common in the types of lung cancer found in men. These symptoms may include weakness in the upper limbs, muscle cramps, and loss of coordination among others.

Causes

Occupational exposures account for a significant percentage of lung cancers in men, and in some studies is considered to be responsible for 13 to 29% of cases. Common occupations linked with an increased risk of developing lung cancer include metal workers, painters, cleaners, bakers, plumbers and pipe fitters, welders, freight handlers, and construction workers.

While smoking is considered the cause of roughly 80% of lung cancers in women, close to 90% of lung cancers in men are related to smoking. It is important to note that many men that develop lung cancer do not currently smoke. In fact, roughly half of the men currently living with lung cancer were former smokers at the time of their diagnosis.

Common Types

There are two primary types of lung cancer, non-small cell lung cancers and small cell lung cancers.

Non-small cell lung cancers are in turn broken down into three types that account for about 80% of lung cancers. Of these, squamous cell lung cancers and large cell lung cancers, cancers that grow near the central airways in the lung, are more common in men. In contrast, lung adenocarcinomas, cancers that grow near the outer regions of the lung, are more commonly found in women.

Small cell lung cancers are more commonly found in men. These cancers also tend to grow in the central areas of the lung and spread early on, often to the brain.

Treatment

There are now several different types of treatment available for lung cancer.

Surgery

For early stage tumors, lung cancer surgery is the treatment of choice and offers the chance of a cure. For those who are unable to tolerate surgery or would like a different option, stereotactic body radiotherapy can sometimes provide results similar to surgery.

Radiation

Radiation may either be given to reduce symptoms (as a palliative treatment) or with a curative intent (SBRT).

Chemotherapy

Chemotherapy may be used with early stage cancers either before or after surgery, or with advanced stage disease. It may also be combined with immunotherapy drugs.

Targeted Therapies

There are now a number of targeted therapies available that target specific mutations or other alterations in lung cancer cells. While women are more likely to have "targetable mutations," its important that every man who has non-small cell lung cancer be tested. While these drugs do not "cure" cancer, they can sometimes control the disease for a significant period of time.

Immunotherapy

While men traditionally do not respond to treatment for lung cancer as well, this may be changing. Unlike targeted therapies that control the growth of a tumor but do not cure the disease, there is some thought that immunotherapy drugs may result in long term control of lung cancer, at least in a minority of cases.

A 2016 study demonstrated an average higher tumor mutation burden in lung tumors in men compared with women, even when controlled for smoking, age, and other factors.

In turn, a higher mutation burden appears to predict (at least some of the time) a better response to the immunotherapy drugs known as checkpoint inhibitors. 2019 study.

Prognosis

The survival rate for lung cancer in men is lower than that for women at all stages of the disease. Sadly, the overall 5-year survival rate is only around 16 percent. Yet, it's important to realize that survival rates are statistics that tell us how someone did with lung cancer treatment in the past. Many new treatments for lung cancer have been approved in just the last few years, and statistics do not take into account these newer treatments. For example, a 2018 noted that the median survival rate for people with ALK positive stage 4 lung cancer who were treated with appropriate therapy was 6.8 years.

Coping and Support

While support communities traditionally have greater numbers of women (both because women tend to seek out support and the survival rate is higher), there are many men who are very active in the lung cancer community; men who will welcome the opportunity to lend an ear, help you research your disease, and much more.

Due to the stigma of lung cancer, both men and women have often felt less compassion than do people with other forms of cancer. Many excellent lung cancer support groups and online support communities are available to help men connect and support each other in their journey's with lung cancer. It's also not at all uncommon to learn of people who were given no hope, but learned of lifesaving treatments via social media and the lung cancer community

Prevention

Quitting smoking is by far the most important thing anyone can do to lower their risk of developing lung cancer. That said, since the majority of people who develop lung cancer do not smoke⁠—they are either former smokers or never smoked⁠—it is important to look at other ways risk can be lowered as well.

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  1. Xiao D, Pan H, Li F, Wu K, Zhang X, He J. Analysis of ultra-deep targeted sequencing reveals mutation burden is associated with gender and clinical outcome in lung adenocarcinoma. Oncotarget. 2016. 7(16):22857-22864. doi:10.18632/oncotarget.8213


  2. Cao D, xu H, Xu X, Guo T, Ge W. High tumor mutation burden predicts better efficacy of immunotherapy: a pooled analysis of 103078 cancer patients. Oncoimmunology. 2019. 8(9):e1629258. doi:10.1080/2162402X.2019.1629258


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