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This article will review the symptoms, causes, treatment, and prevention of non-small cell lung cancer. The primary symptoms of this condition include cough, coughing up blood, chest pain, shortness of breath, and hoarseness. A history of smoking is the predominant cause.
What is non-small cell lung cancer
Lung cancer is one of the leading causes of cancer-related deaths in the U.S. and worldwide. In 2012, lung cancer was diagnosed in 1.8 million people and caused approximately 1.6 million deaths. When someone is diagnosed with lung cancer, one of the first steps is to stage the disease in order to determine both treatment and prognosis. Ninety-five percent of all lung cancers can be categorized as “small cell” or “non-small cell.” About 10 to 15 percent of lung cancers are considered small cell lung cancers while 80 to 85 percent are non-small cell lung cancers. Cancer, in general, is a condition characterized by overgrowth of a certain cell type. Our bodies naturally have a variety of cell types to serve different functions. The distinction between small cell and non-small cell lung cancer can be determined by looking at a small sample of the lung tissue where the cancer is growing and determining what cell type is overgrowing. Based on the stage of the lung cancer, surgical resection may offer the best outcomes. There are a number of symptoms associated with lung cancer that will be discussed in this article, the most common of which being cough.
Lung cancer symptoms
While lung cancer can present with a wide array of symptoms, the most common clinical manifestations of the condition are as follows:
- Cough: It is estimated that cough is present in 50 to 75 percent of lung cancer patients. If a current or former smoker presents with a new cough, they should undergo an evaluation for lung cancer.
- Hemoptysis: This is the term used to describe the process of coughing up blood. This can range from scant amounts of blood to much larger quantities.
- Chest pain: Chest pain is present in 20 to 50 percent of people with lung cancer. The pain is usually on the same side as the tumor.
- Shortness of breath: This symptom occurs in about 70 percent of people with lung cancer. This shortness of breath is usually caused by airway obstruction by the tumor. Less commonly, this shortness of breath can be due to compromise of the phrenic nerve, the nerve that governs the movement of the diaphragm.
- Hoarseness: The nerve that controls the vocal cord is called the recurrent laryngeal nerve. This nerve courses under the aorta in the chest where it can be compromised by the mass effect of lung cancer. A tumor pressing on this nerve can thereby cause hoarseness.
When to See a Doctor
If you have a new onset cough, are experiencing shortness of breath or blood in your cough, you should seek from your healthcare provider. Consulting a physician is particularly important if you are a smoker and begin experiencing the symptoms listed above.
The symptoms listed above are the most common and the ones caused directly by the lung cancer. Having a malignancy in general or metastases from lung cancer can produce the following symptoms:
- Fatigue: The body is constantly producing red blood cells and certain vitamins and molecules are necessary to produce this new supply of blood cells. However, the uncontrolled of cancer growth uses this same supply of vitamins and other molecules, resulting in a reduced supply for blood cell production. As a result, patients with cancer can get anemia and feel tired.
- Bone pain: If a lung cancer metastasizes to bone or the tumor produces a substance called parathyroid hormone-related protein (PTH-rP), patients may begin experiencing bone pain. This is the result of direct bone breakdown in the case of metastases or hormone-mediated breakdown from PTH-rP.
- Kidney stones: Metastases and PTH-rP both lead to bone breakdown and increase circulating levels of calcium in the blood . This calcium can precipitate into stones and get lodged in the ureters, which usually causes immense pain.
- Stomach pain: This may also be caused by the production of parathyroid hormone-related protein (PTH-rP).
- Eyelid drooping: The medical term for this is “ptosis.” This is one of the features of a larger condition that can be seen in lung cancer patients called Horner’s Syndrome . If the tumor of non-small cell lung cancer is at the top of the lung, it can compress nerves that run through the chest and cause drooping of the eyelid.
- Pupil constriction: The medical term for this is “miosis.” This is one of the features of a larger condition that can be seen in lung cancer patients called Horner’s Syndrome. If the tumor of non-small cell lung cancer is at the top of the lung, it can compress nerves that run through the chest and cause a constricted pupil in one eye while the other eye is more dilated.
- Decreased sweating: The medical term for this is “anhydrosis.” This is one of the features of a larger condition that can be seen in lung cancer patients called Horner’s Syndrome. If the tumor of non-small cell lung cancer is at the top of the lung, it can compress nerves that run through the chest and cause an inability or reduced amount of sweating on one side of the face.
What causes lung cancer?
Smoking is responsible for 90 percent of all lung cancers. Non-small cell lung cancer includes the subtypes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These subtypes are determined by which cell type is over-proliferating. Smoking is the leading cause of cancer in all of these subtypes. As is the case with most cancers, carcinogens like smoking inflict damage on the normal cells. These damaged cells then need to be cleared from the body and regenerated. Iterations of regeneration create an opportunity for cell mutations that lead to uncontrolled growth and subsequently produce cancer. A number of carcinogens in addition to smoking have been tied to lung cancer and will be described below in “Prevention.”
Treatment options and prevention
If you are found to have lung cancer, a procedure is usually done to take a sample of lung tissue suspected to be cancerous. This tissue is examined under the microscope to determine if it falls under the category of small cell or non-small cell. The tissue sample is also used to perform genetic testing to determine a possible specific mutation that led to the development of the cancer. Once your cancer is staged, this staging is used to determine your treatment course.
Treatment for early-stage cancer
Early stage cancers (stages I and II) are then evaluated by a thoracic surgeon to determine if surgical removal is possible. If so, you will undergo the procedure and then either follow-up with regular surveillance or chemotherapy and/or radiation. If you have an early stage cancer but are not a surgical candidate, you will likely undergo definitive radiation therapy.
Treatment for late-stage cancer
The treatment of late-stage cancers (stage III+) is decided on a case-by-case basis based on the evaluations of a thoracic surgeon, medical oncologist, and radiation oncologist. Traditionally, people with metastatic non-small cell lung cancer undergo systemic chemotherapy. This chemotherapy can be incredibly taxing on the rest of the body while in the process of destroying the tumor. Genetic testing is performed on these tumors because a newer treatment option for metastatic cancer is immunotherapy. In this course of treatment, the specific mutation causing the cancer is identified and immunotherapy drugs directed specifically at that mutation are given. These can be highly effective therapies and lead to far fewer side effects given that they are not attacking normal cells like chemotherapy.
Prevention of lung cancer is aimed at the avoidance of risk factors. Risk factors include the following:
- Radiation therapy: People with other cancers in the past and receive radiation are at increased risk of developing a second cancer, like lung cancer.
- Inhaling asbestos
- Inhaling radon
- Inhaling metals: arsenic, chromium, and nickel
The US Preventive Task Force recommends screening for lung cancer in high-risk patients. Medicare covers the cost of CT scanning in people 55 to 77 years old who have at least a 30-pack-per-year smoking history who have quit within the last 15 years.
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Questions your doctor may ask to diagnose lung cancer
- Have you lost your appetite recently?
- Any fever today or during the last week?
- Are you sick enough to consider going to the emergency room right now?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Are you experiencing a headache?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.” to end of doctor questions section
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