What Is Lung Cancer?

Lung cancer begins in normal lung cells that have been altered in such a way that they no longer behave like a normal cell. These abnormal cells grow in an uncontrolled fashion, causing harm or invading normal tissue,   may even spread to other parts of the body. Once thought to be a single disease, research has shown that lung cancer is actually a group of diseases characterized by 1) what type of lung tissue the abnormal cells originated in (the “histology”) and 2)what type of changes or mutations have taken place in the altered cell ie: presence of molecular proteins (“markers”). Knowing the specific type of lung cancer is critical to guiding treatment decisions and personalizing a patient’s management, and ultimately improving quality of life and optimizing chances for survival.


Lungs imageYOU OR A LOVED ONE IS DIAGNOSED WITH LUNG CANCER

The good news is that our understanding of this disease has changed dramatically in recent years. Thanks to researchers, new and highly personalized treatment options are now available, improving dramatically the overall survival and quality of life for lung cancer patients.


FOR MANY PATIENTS, KNOWLEDGE AND UNDERSTANDING CAN BE EMPOWERING!

QUESTIONS TO DISCUSS WITH YOUR DOCTOR:

WHAT TYPE OF LUNG CANCER DO I HAVE?

Lung cancer is not a single disease, but a group of diseases. Treatment decisions are based upon your doctor’s detailed understanding of many aspects of your tumor-

  • What part of my lung did the cancer originate in?
  • What kinds of cells is it made up of?
  • What stage is it? Has it spread to other parts of my body?
  • What are the molecular changes in the cancer cells that are driving its growth?

Knowing what type of lung cancer you have is important for treatment. The first classification of the cancer is based on histology – or the tissue in the lung in which the cancer begins in. It is broadly classified as follows:

Non-small cell lung cancer – the most common type of lung cancer affecting more than 8 out of every 10 cases of the disease. Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are all subtypes of non-small cell lung cancer.

Small cell lung cancer – a less common form of lung cancer that affects about 1 out of every 10 people diagnosed.

Other– examples include rarer forms such as endocrine tumors ie: lung carcinoid.

Lung Cancer diagram

WHAT STAGE IS MY LUNG CANCER?

Stage refers to the growth of the cancer and how far it has spread, and will help determine treatment. How the cancer is staged depends on the type of lung cancer.

Non-small cell lung cancerStage is commonly referred to as I-IV (one through four) but may also be referred to as TNM (tumor, node and metastasis).

  • Stage I – the tumor is small and localized to a small area in one lung. Tumors are usually removed by surgery and doctors may recommend additional treatment
  • Stage II – the tumor is slightly bigger and may have spread to certain structures in the chest, including structures called lymph nodes. The cancer has not spread to other parts of the body, including the other lung.
  • Stage III – the tumor has spread to the center of the chest or to lymph nodes on the opposite side of the chest, but has not spread to other parts of the body.
  • Stage IV– the cancer cells can be found in other parts of the chest along with buildup of fluid or the tumor has spread to other parts of the body, such as bone or liver.

Small cell lung cancer– Staging from small cell lung cancer is divided into two.

  • Limited-stage cancer refers to cancer present in only one lung, which may have spread to surrounding lymph
  • Extensive-stage cancer refers to cancer that has spread to both lungs, lymph nodes far from the original cancer, or other parts of the body.

HAVE MY CANCER CELLS BEEN TESTED FOR MOLECULAR MARKERS?

Over the last decade, lung cancer cells have been shown to express certain molecular markers that can help guide and personalize treatment decisions. This is especially important for people with advanced stage (Stage IV) non-small cell lung cancer. To determine the best possible treatment for the individual’s cancer, it is essential that the tumor tissue biopsy or blood be tested to determine if the tumor expresses any of these markers. For treatment decisions, the markers that are most often evaluated are EGFR, ALK, PD-L1, KRAS, MET and ROS1.

IS MY TREATMENT PLAN PERSONALIZED FOR MY SPECIFIC CANCER? DOES IT TAKE INTO ACCOUNT ALL OF THE LATEST ADANCES IN LUNG CANCER TREATMENT?

Research has shown that lung cancer is a group of several different diseases that require different treatment approaches. Stage of the disease, tissue type and the presence or absence of molecular markers are important pieces of information, as are other factors such as the patient’s age, overall health and any other medical conditions they might have.

Your doctor and team of healthcare professionals will work with you to recommend the best treatment plan for your disease. However, new treatment options are becoming available or being evaluated in clinical trials on a regular basis – and it is important that all potential options are considered.

Talk to with your doctor so both of you feel confident that your treatment plan is the best option for you.

SHOULD I BE PARTICIPATING IN A CLINICAL TRIAL?

Clinical trials are a form of research that evaluates patients receiving new promising treatments prior to official approval by the FDA. .Such trials are constantly evaluating the best ways to treat people with various forms of lung cancer. The treatments that are currently available had to first be evaluated in clinical trials in order to be approved by the FDA

Your doctor can help you decide if participating in a clinical trial is the best option for your cancer.

Clinical trials have their own benefits and risks. In many cases, but not all, current treatments available are the best option to begin with. Knowing that clinical trials are available to you is important, especially in the event that current treatments prove ineffective for your disease.

SHOULD I BE SEEKING A “SECOND OPINION?”

An opinion from another lung cancer expert, ie: a thoracic oncologist, in addition to your oncologist’s recommendation can be extremely valuable – not only for diagnosis but for helping with treatment decisions. Most cancer specialists welcome their patients seeking second opinions. Your doctor wants to make sure you receive the best care available and that you are comfortable with the decision.

Be sure to bring to your visit as much information as possible about your diagnosis – biopsy results, the type and stage of the cancer, as well as markers evaluated. Even if your diagnosis does not change with a second opinion, a second opinion on treatment can help you feel confident that you are receiving the best care tailored to your specific cancer.

HOW OR WHY DID I GET LUNG CANCER? I FEEL UNCOMFORTABLE TELLING PEOPLE ABOUT MY DIAGNOSIS!

It is important to remember that around the world lung cancer is one of the most common cancers diagnosed, and can affect anyone. It is diagnosed in people young or old, of every race and every socioeconomic group, in non-smokers as well as smokers.

Unfortunately, historically there are many misconceptions that some people have about lung cancer. This unfortunate stigma may prevent a patient or their loved ones from openly talking about their cancer and seeking treatment. Just know that are not alone. Research through The Lung Cancer Project is attempting to draw awareness to, and to change, this stigma.

Today people are living longer and enjoying a better quality of life with lung cancer –

even a cure is possible in the earliest stages.

So please, talk about your doctor, learn more about your cancer, and receive the best treatment available to you!

“It is important for patients to realize that they do have a variety of options that depend on this kind of genetic analysis of their tumor and make sure their oncologist is aware of this and make sure their tumor is appropriately analyzed.” -David Carbone, M.D., Ph.D. Ohio State Comprehensive Cancer Center