An Overview of Non-Small Cell Lung Cancer

Non-small cell lung cancer is the most common type of lung cancer and is the most common form in women, young adults, and people who haven't smoked. Symptoms may include a persistent cough, shortness of breath, coughing up blood, and more.

While smoking is an important cause of lung cancer, other factors such as radon exposure, exposure to chemicals and other substances, and genetics are important as well. The diagnosis may be suspected on a chest X-ray, but chest X-rays can miss the disease. Tests such as a chest CT or bronchoscopy may be done, followed by a lung biopsy.

Treatment options have expanded greatly in recent years, and include surgery, targeted therapies, immunotherapy, chemotherapy, and radiation. Everyone who has been diagnosed with non-small cell lung cancer should have molecular profiling done to see if their tumor carries genetic changes that can be treated.

Let's look at all of these areas in greater depth, as well as how you can best cope if you've been diagnosed. Since lung cancer affects not just individuals, but families, we will also look at what you may wish to know if your loved one has non-small cell lung cancer.

Types of Non-Small Cell Lung Cancer
Verywell / Emily Roberts

Overview

Non-small cell lung cancer is the most common form of lung cancer, and the type of lung cancer most commonly found in women, non-smokers, and young adults. It does not spread as rapidly as small cell lung cancer but is still often diagnosed when it is at an advanced stage. It's important to note that even though an advanced non-small cell lung cancer is inoperable, it is still treatable. There have been many recent advances in the treatment of lung cancer, and survival rates are improving for all stages of the disease.

It comes as a surprise to many people that never-smokers can and do develop lung cancer. In fact, the majority of people who develop non-small cell lung cancer today are non-smokers—they are either former smokers or never smokers. One in five women who develop lung cancer has never smoked. And while lung cancer is decreasing in older people and in men, it is increasing in young adults, especially young, never-smoking women.

Types

There are three primary types of non-small cell lung cancer. These include:

Adenocarcinoma

Adenocarcinoma is the most common form of non-small cell lung cancer accounting for approximately 40 percent of cases in the United States. It occurs mainly in current or former smokers, but it is also found in young adults, women, and people who have never smoked. Lung adenocarcinoma usually begins in the outer regions of the lungs and can grow quite large before it is detected. Since these tumors are usually located away from the airways, commonly recognized symptoms such as coughing are less common. Early symptoms are often subtle, with shortness of breath with activity, and a general sense of ill health.

Squamous Cell Carcinoma of the Lungs

Squamous cell carcinoma accounts for roughly 25 percent to 30 percent of non-small cell lung cancers in the United States. It usually starts in the bronchial tubes, centrally in the lungs, and is commonly found after people develop a persistent cough, coughs up blood, or develop recurrent respiratory infections (due to obstruction of the airways). It has been speculated that filtered cigarettes have caused the decline in squamous cell lung cancer and that adenocarcinoma is more common now since toxins are inhaled deeper into the lungs.

Large Cell Carcinoma of the Lungs

Large cell lung cancers are less common, accounting for approximately 10 percent to 15 percent of non-small cell lung cancers in the United States. They occur in the outer edges of the lungs and tend to grow rapidly.

Symptoms

It's very important to be aware of the symptoms of non-small cell lung cancer. Lung cancer CT screening is available for some people who have smoked, but the majority of people need to rely on an awareness of symptoms to find the disease in the earliest stages possible.

Symptoms of non-small cell lung cancer may include:

  • A persistent cough
  • Coughing up blood
  • Shortness of breath, especially with activity
  • Wheezing
  • Hoarseness
  • Recurrent respiratory infections such as pneumonia or bronchitis
  • Unintended weight loss

Causes

Smoking is certainly one of the major causes of non-small cell lung cancer. Secondhand smoke is also a risk factor, but there are other important causes as well. Exposure to radon in our homes is the second leading cause of lung cancer and the number one cause in people who have never smoked. If you have never tested your home for radon, do so as soon as possible. Some people may also have a genetic predisposition to lung cancer, and it's notable that if someone has a primary relative with lung cancer—a mother, father, sibling, or child—their risk of lung cancer doubles.

Diagnosis and the Diagnostic Tests

The diagnosis of non-small cell lung cancer can be challenging, and it's not uncommon for people to at first be misdiagnosed with something else, such as asthma. The diagnosis may be suspected on a chest X-ray, but chest X-rays can miss the disease. Tests such as a chest CT or bronchoscopy may be done, followed by a lung biopsy.

Staging

Non-small cell lung cancer is broken down into four stages, depending on the size of the tumor and how far it has spread. You can learn more about the stages of non-small cell lung cancer and the TNM system of staging lung cancer, or learn more about specific stages in these articles:

Treatments

The treatments for lung cancer are broken down by the stage. Treatments overall can be broken down into two types. Local treatments treat cancer where it originates and include surgery and radiation therapy. Systemic treatments are broader treatments which address cancer wherever it happens to be in the body and include chemotherapy, targeted therapies, and immunotherapy. Many people with lung cancer receive treatments with both of these forms of therapy. Possible treatments may include:

  • Surgery: Surgery for lung cancer can sometimes offer the chance for a cure in the early stages of the disease. In addition, some tumors that are initially too extensive for surgery may decrease after chemotherapy or radiation therapy to a point at which surgery is possible. Thankfully, treatments are improving even for those with inoperable lung cancer.
  • Chemotherapy: Chemotherapy may be done for lung cancer which has spread, or as "adjunctive" treatment for people who have surgery.
  • Radiation Therapy: Radiation therapy may be done along with chemotherapy, and may be done before or after lung cancer surgery. One type of radiation therapy called stereotactic body radiation therapy (SBRT) may be used in an attempt to cure lung cancer in patients who are unable to have surgery for a potentially curative cancer.
  • Targeted Therapies: Targeted therapies are drugs which address specific genetic changes in cancer cells which drive the growth of tumors. This area of treatment is rapidly expanding, with approved treatments being used for those with EGFR mutations, ALK rearrangements, ROS1 rearrangements, as well as other mutations via clinical trials.
  • Immunotherapy: Immunotherapy is an exciting new approach to lung cancer, with the first drug in this category having been approved in 2015. These treatments work by helping our own immune systems recognize and attack cancer cells.
  • Clinical Trials: According to the National Cancer Institute, it's a good idea to talk to your doctor to see if you should participate in a clinical trial for non-small cell lung cancer. Learn more about finding clinical trials for lung cancer.

Prognosis

While the five-year survival rate for non-small cell lung cancer is 23 percent, (compared to 6 percent for small cell lung cancer), it's important to realize that these are numbers, not people. Everyone is different and responds differently to a treatment. In addition, these numbers are probably not a good predictor of how someone will do anyway. Statistics are a measure of how someone did in the past with treatments that were available at that time. Of note is that there were more new treatments approved for lung cancer in the time period from 2011 to 2015 than during the 40 year period preceding 2011. In other words, numbers discussing how someone survived with lung cancer in 2010 probably say little about how someone will do today.

Support and Coping

If you are newly diagnosed with lung cancer, you are probably feeling frightened and overwhelmed. Check out these tips on the first steps to take after a lung cancer diagnosis. 

Research suggests that learning as much as you can about your cancer may help you better follow treatment plans, and may even help with outcomes. Take a moment to learn about how to find good cancer information online. Becoming connected with the community also has many benefits, as you can connect with others facing a similar situation, and also see what they have learned along the way.

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Article Sources

  1. American Cancer Society. Non-Small Cell Lung Cancer Survival Rates


  2. American Cancer Society. What Is Non-Small Cell Lung Cancer?


  3. American Cancer Society. Non-Small Cell Lung Cancer Signs and Symptoms


  4. American Cancer Society. Non-Small Cell Lung Cancer Risk Factors


  5. American Cancer Society. Tests for Non-Small Cell Lung Cancer


  6. American Cancer Society. Non-Small Cell Lung Cancer Stages


  7. American Cancer Society. Treating Non-Small Cell Lung Cancer


  8. National Cancer Institute. Treatment Clinical Trials for Non-Small Cell Lung Cancer


  9. Dana-Farber Cancer Institute. Your Emotions after Treatment


Additional Reading

  • College of American Pathologists. Lung Cancer. Lung Adenocarcinoma. http://www.cap.org/apps/docs/reference/myBiopsy/lung_adenocarcinoma.html

  • Lung Cancer. Medline Plus. https://medlineplus.gov/lungcancer.html. Updated March 19, 2019.

  • Lung Cancer - Non-Small Cell: Statistics. Cancer.Net. https://www.cancer.net/cancer-types/lung-cancer-non-small-cell/statistics. Published January 2019.

  • Non-Small Cell Lung Cancer Survival Rates. American Cancer Society. https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/survival-rates.html. Updated February 4, 2019.