Lung cancer non small cell: about, risks, symptoms, diagnosis, stages, treatments

Zellos Lambros
Last updated: Fri, 12/08/2017 - 23:34

M.D, M.P.H Thoracic Surgeon, Instructor in Surgery Harvard Medical School

General information about non small cell lung cancer

The lungs are a pair of cone-shaped organ located in the chest. During breathing lungs bring oxygen to the body and release carbon dioxide. Each lung is divided into sections called lobes. The left lung has two lobes. The right lung is slightly larger and has three lobes. The main airway is called trachea and branches to two airways called bronchi one to the right lung and one to the left. The bronchi are sometimes also involved in lung cancer. Small air sacs called alveoli make up the inside of the lungs. A thin membrane called the pleural covering the outside of each lung and lines the inside wall of the thoracic cavity. This creates a sac called the pleural cavity. The pleural cavity normally contains a small amount of fluid that helps the lungs move smoothly in the chest when breathing. Lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.


There are two main types of lung cancer:
• non-small cell lung cancer and
• small cell lung cancer.
This summary provides information about non-small cell lung cancer.

There are several types of non-small cell lung cancer. Any type of non-small cell lung cancer has different kinds of cancer cells.

Risk factors:
• Smoking cigarettes or cigars, now or in the past.
• Exposure to passive smoking.
• Exposure to radiation to the chest.
• Exposure to asbestos, radon, chromium, arsenic, soot, or tar.
• Air pollution.

Smoking cigarettes or cigars is the most common cause of lung cancer. The more years a person smokes, the greater the risk. If a person has stopped smoking, cancer risk declines as the years pass, but never zero. When smoking is combined with other risk factors, the risk of lung cancer is increased.
 

Symptoms:
Sometimes, lung cancer causes no symptoms and is found during a routine chest radiograph. The symptoms may be caused by lung cancer or other conditions. The opinion of a physician should be consulted if any of the following problems occur:
• A cough that persists.
• Trouble breathing.
• Discomfort.
• Wheezing.
• Strips of blood in the sputum.
• Hoarseness.
• Loss of appetite.
• Unexplained weight loss.
• Fatigue.

Tests and procedures to detect, diagnose, and stage

The appropriateness of each test depends on the clinical scenario and the physical condition of the patient.

History and Physical examination.

Chest radiograph.

Computed tomography (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body taken from different angles. The images made by a computer linked to an X-ray device, a dye may be injected into a vein or swallowed to help the organs or tissues show more clearly. This is also called computed tomography, computerized tomography, or CT scan.

PET scan (positron emission tomography scan): A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is used in the body. Malignant tumor cells appear brighter in the picture because they are more active and take up more glucose than normal cells.

Sputum Cytology: A procedure in which a pathologist examines a sample of sputum under a microscope to check for cancer cells.

Lung biopsy with fine-needle: The removal of part of a lump, suspicious tissue, or fluid in the lungs using a thin needle. This process is also called needle biopsy with ultrasound, CT scan or other imaging procedure used to detect the abnormal tissue or fluid in the lung. A small incision can be made in the skin where the biopsy needle inserted into the abnormal tissue or fluid. A sample is removed with a needle and sent to the laboratory. A pathologist examines the sample under a microscope for cancer cells. A chest radiograph done after the procedure to make sure that there is no leakage of air from the lungs.

Bronchoscopy: a review process within the trachea and large airways of the lung abnormalities. The bronchoscope (a thin, lighted tube) is inserted through the nose or mouth to the trachea and lungs. Tissue samples can be taken for biopsy.

Mediastinoscopy: A surgical procedure for biopsy. A small incision is made above or next to the breastbone and an endoscope (a thin, lighted tube) is inserted into the chest. Tissue samples and lymph nodes can be taken for biopsy.

Bone scan: A procedure for detection of bone metastases. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

Treatment Options by Stage and method


There are several types of treatment for patients with non-small cell lung cancer.
Some treatments are standard (the currently used treatment), and some tested in clinical trials.
The appropriateness of each treatment depends on the stage of cancer and the physical condition of the patient.
• One, that any combination of the following treatments may be indicated.

Surgery

• Wedge resection: Surgical removal of tumor and a small amount of normal tissue around it.

• Segmental resection: resection of an entire section with the corresponding bronchus.

•Lobectomy: Surgical removal of the entire lobe.

• Pneumonectomyi: Surgical removal of the entire lung.

• Sleeve resection: Surgical removal of part of the loop with or without lobectomy.

The indications and selection of appropriate surgical procedure depends on the type, stage of cancer treatment and physical condition of the patient.

Radiotherapy
Radiotherapy is a cancer treatment that uses high energy X-rays or other radiation to kill cancer cells or stop expansion. There are two types of radiotherapy. External radiation therapy uses a machine outside the body to send radiation to cancer. Internal radiation therapy uses a radioactive substance in needles, seeds, wires, or catheters placed directly into or near the cancer.

The indications and the way we give the radiation therapy depends on the type, stage of cancer treatment and physical condition of the patient.

Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or by injection into a vein or muscle, enters the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ or body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

The terms and administration of chemotherapy depend on the type, stage of cancer treatment and physical condition of the patient.

Laser Treatment
Laser treatment is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Photodynamic therapy (PDT)
Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until exposed to light is injected into a vein. The drug is most concentrated in cancer cells than in normal cells. The Fiberoptic tubes are then used to deliver laser light to the cancer cells, where the drug is activated and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is mainly used for endobronchial tumors.

Treatment Options by Stage

Stage 0 (carcinoma in situ)
Treatment of stage 0 may include the following:
• Surgery (wedge , segmental  resection).
• Photodynamic therapy using an endoscope.

Stage I non-small cell lung cancer
Treatment of stage I can include the following:
• Surgery (wedge , segmental  resection, lobectomy).
• External Radiotherapy (for patients unable to undergo surgery or choose not to undergo surgery).
• Surgery followed by chemotherapy.

Stage II non-small cell lung cancer
Treatment of stage II can include the following:
• Surgery (wedge , segmental  resection, lobectomy, pneumonectomy).
• External Radiotherapy (for patients unable to undergo surgery or choose not to undergo surgery).
• Surgery followed by chemotherapy with or without other treatments.

Stage IIIA non-small cell lung cancer
Treatment of stage IIIA may include the following:
• Surgery with or without radiotherapy or chemotherapy.
• External radiation therapy alone.
• Chemotherapy combined with external beam radiotherapy.
• Chemotherapy combined with external beam radiotherapy followed by surgery.
• Only chemotherapy.
• A clinical trial of new combinations of treatments.

IIIB non-small cell lung cancer

Treatment of stage IIIB may include the following:
• External radiation therapy alone.
• Chemotherapy combined with external beam radiotherapy.
• Chemotherapy combined with external beam radiotherapy followed by surgery.
• Only chemotherapy.
• A clinical trial of new combinations of treatments.

Stage IV non-small cell lung cancer
Treatment of stage II can include the following:
• Watchful waiting.
• External Radiotherapy as palliative therapy to relieve pain and other symptoms and improve quality of life.
• Chemotherapy.
• Laser therapy and / or internal radiation therapy.
• A clinical trial of chemotherapy or biological therapy.

Relapse of non-small cell lung cancer
The cancer may recur in the brain, lungs or other parts of the body.

Treatment of relapse may include the following:
• External Radiotherapy or palliative therapy to relieve pain and other symptoms and improve quality of life.
• Only chemotherapy.
• Surgery (for some patients who have a very small amount of cancer that has spread to the brain).
• Laser therapy or internal radiation therapy.
• Radiosurgery (for certain patients who can not have standard surgery).

 

 

 

 

 

 

Info:

Lambros Zellos

MD MPH American Board of Thoracic Surgery Certified

American Board of Thoracic Surgery Certified
 

Dr.  Lambros Zellos  (lzellos@post.harvard.edu)   is a highly qualified thoracic surgeon and researcher with experience in studying mesothelioma, the cancer that affects the pleura and other membranes within the body's cavities.

He was trained at Harvard, and practiced thoracic surgery for a number of years at the Brigham & Women’s Hospital (the busiest thoracic surgery division of the Harvard Medical School with over 2800 thoracic procedures annually) at the rank of Instructor in Surgery.
 
Dr Zellos performed lung and esophageal resection, as well as lung transplants. He was named one of Boston’s 2007 top thoracic surgeons as voted by his peers. He treats thoracic malignant and benign disease, and specializes in the use of minimally invasive techniques that avoid painful rib spreading, also known as VATS (video-assisted thoracoscopic surgery).