Non-small cell lung cancer (NSCLC) is the most common type of lung cancer , making up about 80 to 85 percent of all cases.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bbc9f5e1-c757-4958-a5cf-6ec09dd61812 It’s referred to as metastatic NSCLC when it has spread from the lungs to other parts of the body. There are several subtypes of NSCLC, depending on which type of cell the cancer originated in. But they’re usually grouped together, because the treatment approach and prognosis are often similar. These subtypes include adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Once NSCLC has metastasized, it is no longer considered curable, but there are treatments available to provide comfort and slow the cancer’s progression.
Recognizing the Symptoms of Metastatic NSCLC Symptoms Many cases of NSCLC are not discovered until the cancer is in an advanced stage, often because people either don’t experience symptoms, or attribute their symptoms to another condition, such as an infection. Most NSCLC is diagnosed when a tumor grows and begins to make breathing more difficult or causes problems in parts of the body near the lungs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cfaacea9-0eb8-414a-8c2f-23a88fd85047 Symptoms of NSCLC include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629257cc80d-6ebf-4075-b635-4f50224b2b91 A cough that does not go away Chest pain that gets worse with deep breathing or laughing Coughing up blood Weight loss, loss of appetite, shortness of breath , and fatigue Because these symptoms often mirror those of other conditions, NSCLC diagnosis may be delayed. This makes screening vital, particularly for those at high risk, because the cancer can quickly spread, or metastasize, to other organs.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290fb09654-1647-4ab9-87b9-f2ba4d7522c8 As with many other cancers, the danger increases when NSCLC spreads. Tumor cells can break away in the lungs and travel through the bloodstream to other parts of the body. Metastatic NSCLC cells are most likely to spread to lymph nodes in the middle of the chest, liver, adrenal glands, bones, and possibly brain, says David Graham, MD , a hematologist and medical oncologist at Atrium Health Levine Cancer Institute in Charlotte, North Carolina. Symptoms of metastatic NSCLC depend on where in the body the cancer has spread:e60dc2a1-f33c-4a05-9b50-8e3e8e597629d3666c7b-eb90-4990-b61a-6d2d5c8aa06d Bones: Bone pain in the back or hips Brain: Headaches, weakness, numbness of an arm or leg, dizziness, seizures Liver: Yellowing of the skin and eyes Skin or lymph nodes: Lumps or swelling near the surface of the skin Adrenal glands: Often no symptoms, but possible dizziness, weakness, or fatigue
How Metastatic NSCLC Is Diagnosed Diagnosis A number of tests are used to diagnose NSCLC, see if it has spread, and look for signs that the cancer might be recurring after treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0db180c-3ada-42f6-8fd3-95aa50ac8726 Your doctor will likely start with a chest X-ray . If there are any suspicious masses, they may follow up with a CT (computerized tomography) scan , MRI (magnetic resonance imaging) , or PET (positron emission tomography) scan , which can help your doctor tell if the cancer has spread to the bones, brain, liver, other organs, or spinal cord. Once a doctor determines there is reason to suspect lung cancer, the actual diagnosis is made by conducting a biopsy (a procedure in which cells, tissue, or fluids are removed to be examined in a lab). Sample cells can be collected by a syringe needle, surgery, or fluid removal from the area around the lungs. Your doctors may also use mucus samples to conduct tests. Interventional radiology (IR) guided biopsy is where a radiologist uses imaging techniques, such as CT, to help guide the needle through the skin to the area of concern. A secondary needle passes through the first needle and takes the biopsy samples.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a2836574-c8a4-4a42-9649-6f159e74cb6b Additional procedures to diagnose NSCLC include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629033f327b-9a3d-4bd5-88e2-0e1d564652d7 Bronchoscopy A lighted flexible or rigid tube with a camera is inserted through the nose or mouth to help doctors see inside the airways and collect samples for testing. Mediastinoscopy An endoscope (a thin tube with a light and camera) is inserted through a small surgical opening in the chest to look behind the breastbone (the sternum) and take tissue samples from the lymph nodes along the windpipe and major bronchial tube areas. Mediastinotomy When lymph nodes can’t be reached using mediastinoscopy, a surgeon may use this, which is the same procedure but with a slightly larger incision between the ribs, next to the breastbone. Thoracoscopy A thin, flexible tube with a camera and light, called a thorascope, is inserted through an incision near the lower end of the shoulder blade, between the ribs, to allow doctors to examine that area. NSCLC is categorized in four stages:e60dc2a1-f33c-4a05-9b50-8e3e8e597629df2953bf-1135-426c-ae8d-4b65b298fdaf Stage 1 It is nonmetastatic and only affects the lungs. Stage 2 The cancer has spread to nearby lymph nodes in the lung. Stage 3 It has spread to the lymph nodes in the center of the chest, the mediastinum, or is a very large tumor. Stage 4 Cancer has spread to other organs.
Treatment Options for Metastatic NSCLC Treatment Current treatments don’t cure metastatic NSCLC for most people. But they can ease your symptoms and help you live longer and feel better, according to Taofeek Owonikoko, MD , a thoracic medical oncologist and executive director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center in Baltimore. Treatment options depend on many factors, including where the cancer has spread and the characteristics of the cancer. “We want to find the specific alterations in the cancer cell,” says Dr. Owonikoko. “If there are mutations, the particular treatment would be dictated by that.” Targeted Therapy Doctors commonly order biomarker testing (also called molecular or genomic testing), which looks for changes in the tumor’s DNA. Biomarker testing can be done on tissue samples, blood, or other bodily fluids, such as urine or sputum (known as a liquid biopsy ). This can help doctors plan personalized treatment based on genetic mutations and your likely response to immunotherapy. The test looks for DNA from dead tumor cells present in the bloodstream to determine whether the cancer cells have mutations in specific genes (including EGFR, ALK, ROS1, RET, and BRAF).e60dc2a1-f33c-4a05-9b50-8e3e8e597629d1e07201-b29a-45ac-9175-8f8ebc5ee6fa “We have targeted therapies that will take advantage of changes associated with those genetic markers,” says Dr. Graham. “They offer a treatment opportunity we wouldn’t have otherwise.” Each of those genes is associated with a pathway in the cells that spurs cancer growth. Targeted therapies can home in on certain gene mutations with drugs to block the pathways and slow the growth and spread of cancer cells. Such treatments are known as targeted therapies because they are directed at specific types of cancer cells and cause less damage to healthy cells. Immunotherapy Your tumor may also be tested for a protein called PD-L1. High levels indicate that the cancer may respond better to immunotherapy drugs, one of the most important advances in the treatment of metastatic NSCLC (and other cancers) and now a standard treatment for most patients with advanced lung cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629289d618b-9159-42c0-8859-aaffab0c143c Cancer cells have devised all kinds of clever biological tricks to hide from the body’s immune system, which would otherwise attack them. Immunotherapy — using drugs called checkpoint inhibitors — makes the cancer cells visible to the immune system, which is then mobilized. Treatment of lung cancer, as well as cancer that’s spread to the bones , brain, liver, or elsewhere, might require conventional cancer treatments , such as radiation therapy or chemotherapy. In some cases, surgery may be done to remove tumors that have spread to the brain .
Prevention of Metastatic NSCLC Prevention Early detection is key for preventing NSCLC from metastasizing. Avoid smoking (or exposure to secondhand smoke), which is the most common cause of lung cancer, but also be aware of exposure to chemicals in the workplace or at home.e60dc2a1-f33c-4a05-9b50-8e3e8e59762979ad8204-81cb-4aa7-b9e6-2e44234cc13e Using personal protective equipment can help minimize this risk. Having been exposed to radiation near the lungs (such as for prior cancer treatment) also increases your risk.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a53386b1-ad1e-4214-bdc9-31411b4a339b If you have a family history of lung cancer, your doctor may choose to monitor your lung health more closely, and possibly recommend genetic testing.
The Outlook for Metastatic NSCLC Outlook How long you’ll live — and what kind of life you’ll have — are related to the particular mutations present in your tumor cells, which treatments are available, and how well you respond to those treatments. Treatment of metastatic NSCLC has improved dramatically in the past decade or so, says Graham. Just a decade or two ago, “The chances of living two years with metastatic NSCLC were pretty small,” he says. Thanks to advancements in treatment, the outlook is “definitely a lot better than it was,” Graham says. Because of advancements in treatment, survival rates for people with metastatic NSCLC are improving. If you respond to treatment, you could live four or five years, says Owonikoko. “Overall, the prognosis has improved,” he says, “but it’s still not where we want it to be.” The five-year survival rate is 9 percent, although this can vary, and these statistics don’t predict how long you’ll live. If the cancer has only spread to the lymph nodes or nearby tissues (regional NSCLC), the five-year survival rate is 37 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e597629635bb1a9-8634-41cf-82a0-826dea473958 Clinical trials are constantly being conducted to find ways to improve treatments and quality of life for people with metastatic NSCLC. Ask your doctor whether you may be a candidate for such a trial, which you can find at www.clinicaltrials.gov .
Research and Statistics: Who Has Metastatic NSCLC? Research and Statistics The most common risk factor for NSCLC is smoking, but nonsmokers can still develop NSCLC, too.e60dc2a1-f33c-4a05-9b50-8e3e8e59762934aefa18-af05-482c-8a86-fcd707a19e89 Men are more likely than women to develop lung cancer, and Black men are 12 percent more likely to develop lung cancer than white men.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293f003766-a879-4a18-89e0-5fad46432288 One older study found that approximately 47 percent of NSCLC diagnoses occur after metastasis, although they note that previous research found these statistics to be slightly lower (30 to 40 percent). No newer research is available.e60dc2a1-f33c-4a05-9b50-8e3e8e597629896c5c69-6928-4d67-a623-6fb3a8370245
Support for People With Metastatic NSCLC Support LUNGevity LUNGevity is a nonprofit that has information both for patients and their caregivers or partners, ranging from cancer screenings and cancer care to survivor resources. They also provide a lung cancer hotline, as well as a mentorship program that pairs cancer patients with mentors who had similar experiences. American Lung Association The American Lung Association has a variety of mental health support groups and resources, as well as a free HelpLine to chat with healthcare professionals. They also offer a variety of educational resources about lung cancer. CancerCare CancerCare provides support groups, specialized programs, information, financial assistance, education, and counseling to people affected by cancer. American Cancer Society The American Cancer Society provides information, programs, resources, and assistance in finding additional free or low-cost programs to cancer patients.
The Takeaway NSCLC is often diagnosed after it has spread, as it often mimics the symptoms of other health conditions, or you may have no symptoms at all. Although metastatic NSCLC is unlikely to be cured, there are treatment options that can improve your quality of life, and possibly slow the spread of cancer. Targeted therapies and immunotherapies are commonly used to treat metastatic NSCLC, in addition to more conventional cancer treatments. Early detection is key to preventing the spread of cancer.
Resources We Trust Mayo Clinic: Clinical TrialsLUNGevity: Transforming Lung CancerAmerican Lung Association: Lung CancerCleveland Clinic: Non-Small Cell Lung CancerNational Cancer Institute: Metastatic Cancer: When Cancer Spreads
Additional reporting by Colleen de Bellefonds .
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Metastatic Non-Small Cell Lung Cancer: Symptoms, Diagnosis, Treatment, and Prevention
