Because lung cancer is associated with smoking, patients may feel that they will not receive much support or help because they may think that others will believe that their behavior has caused the disease. The truth is that most smokers do not develop lung cancer, and not all people who were diagnosed with lung cancer means that they smoke. Lung cancer is a disease that can affect anyone. In fact, most people with lung cancer nowadays have stopped smoking years ago or had never smoked.

About the lungs

When a person inhales, the lungs absorb oxygen from the air and pass oxygen to the bloodstream to supply oxygen to the rest of the body’s organs. As the body’s cells use oxygen, they release carbon dioxide. The bloodstream carries carbon dioxide back to the lungs and carbon dioxide leaves the body when a person exhales. The lungs contain many different types of cells. Most cells in the lung are epithelial cells. Epithelial cells support the airways and create mucus, which lubricates and protects the lung. The lung also contains nerve cells, hormone-producing cells, blood cells, and structural or supportive cells.

About the non-small cell lung cancer

There are two main classifications for the lung cancer: the small cell lung cancer and non-small cell lung cancer (NSCLC). These two types are treated differently.

Non-small cell lung cancer (non-small cell carcinoma-NSCLC) begins when healthy cells in the lung change and go out of control, multiply uncontrollably, forming a mass called tumor, lesion, or nodule. A tumor in the lung can start anywhere in the lung. A tumor can be cancerous or benign. Once a cancerous tumor of the lung is developed, it can release cancer cells. These cells can be transferred to the blood or the lymph that surrounds the lung tissue. The lymph flows through tubes called lymph vessels drained to collection stations called lymph nodes. Lymph nodes are tiny bean-shaped organs that help fight infections. They are found in the lungs, in the center of the chest, and elsewhere in the body. The natural flow of lymph from the lungs is towards the center of the chest, which explains why lung cancer often spreads there first (mediastinal). When a cancerous cell moves to a lymph node or to a distant part of the body through the bloodstream, this is called metastasis.

Types of Non-Small Cell Lung Cancer (NSCLC)

NSCLC starts from epithelial cells and is described based on the type of epithelial cell where the cancer starts:

The adenocarcinoma begins in cells that produce mucus.

The squamous cell carcinoma (squamous cell carcinoma) enters from the cells lining the airways.

The carcinoma of large cells starting from one of two cell types described above.

It is important for the pathologist to be able to distinguish between lung cancer that starts from squamous cells and lung cancer that starts from other cells (glandular cells). This information is used by your clinician to determine your treatment options.

The following factors may increase the risk of an individual to develop non-small cell lung carcinoma (NSCLC):

Tobacco and smoking.

Tobacco destroys the cells in the lungs, causing abnormal cell growth. The risk of smoking leading to cancer is higher for people who smoke a lot and / or for a long time. Regular exposure of a person to tobacco smoke, or cigarettes, can increase the risk of lung cancer, even if the person is not smoking. This is called environmental or “passive” smoking.

Marijuana smoking and the use of electronic cigarettes may also increase the risk of lung cancer, but the real risk is unknown.

Asbestos.

These are tricolor crystals that are found in many types of rocks and are often used as refractory insulation in buildings. When asbestos fibers are inhaled, they can irritate the lungs. Many studies show that the combination of smoking and asbestos exposure is particularly dangerous. People who work with asbestos in a job such as shipbuilding, asbestos mining, insulation or car brake repair and who smoke, have a higher risk of developing non-small cell lung cancer (NSCLC). The use of protective respiratory equipment reduces this risk.

Radon.

It is an invisible odorless gas that is naturally released from some soil and rock. Exposure to radon has been associated with an increased risk of certain forms of cancer, including lung cancer.

Other substances.

Other substances such as gases or chemicals in the workplace or in the environment can increase a person’s risk of developing lung cancer. In some parts of the world, people exposed to carbon or wood cooking flames may increase their risk of developing lung cancer. Also, fumes from diesel gas or adhesive metals could increase the risk of lung cancer. Other factors that may increase the risk of lung cancer are exposure to radiation, arsenic, nickel and chromium.

Heredity.

Some people are genetically predisposed to lung cancer. People with a parent, brother, or sister with lung cancer could have a higher risk of developing lung cancer.

People with non-small cell lung carcinoma (NSCLC) may experience the following symptoms. Sometimes people with NSCLC have none of these symptoms. Or, the cause of a symptom may be a different medical condition that is not cancer.

Fatigue

Cough

Breathing difficulty

Chest pain if a tumor spreads to the lining of the lung or other parts of the body near the lungs

Loss of appetite

Coughing phlegm or mucus

Blood coughing

Unexpected weight loss

Hoarseness

If you are concerned about any changes you are experiencing, contact your doctor. Your doctor will ask how long and how often you have experienced the symptoms, among other questions. This helps us understand the cause of the problem, called diagnosis.

For people with NSCLC who have no symptoms, the cancer may be seen on chest X-ray or computed tomography performed for another reason, such as screening for heart disease. Most people with NSCLC are diagnosed when the tumor grows, occupies space or begins to cause problems in parts of the body near the lungs. A tumor of the lung can also cause fluid to accumulate in the lung or in the space around the lung (pleural fluid) or to push air from the lungs and cause the lung to collapse.

The non- small cell lung carcinoma (NSCLC) may be spread everywhere in the body via a process called metastasis . It often spreads to lymph nodes, to other parts of the lungs, bones, brain, liver and structures near the kidneys called adrenal glands.

NSCLC metastases can cause:

More breathing difficulties

Bone pain

Abdominal or lumbar pain

Headache

Weakness

Epileptic seizures

Rarely, a lung tumor can release hormones that cause problems such as low blood sodium or high blood calcium levels.

Symptoms such as fatigue, feeling sick or loss of appetite are not necessarily caused by metastases. Cancer anywhere in the body can cause a person to feel unwell. Loss of appetite can cause weight loss and loss of muscle mass. Fatigue and weakness can further aggravate one’s ability to breathe. Loss of muscle mass also contributes to weakness and loss of mobility.

For people with NSCLC but who have no symptoms, the cancer may be seen on chest X-ray or computed tomography scan performed for another reason, such as screening for heart disease. Most people with NSCLC are diagnosed when the tumor grows, occupies space or begins to cause problems in parts of the body near the lungs. A tumor of the lung can also cause accumulation of fluid in the lung or in the space around the lung (pleural fluid) or to push air from the lungs and cause the collapse of the lung.

The non-small cell lung carcinoma (NSCLC) may be spread everywhere in the body via a process called metastasis. It often spreads to lymph nodes, to other parts of the lungs, bones, brain, liver and the structures near the kidneys called adrenal glands.

NSCLC metastases can cause:

More breathing difficulties

Bone pain

Abdominal or lumbar pain

Headache

Weakness

Epileptic seizures

Rarely, a lung tumor can release hormones that cause problems such as low blood sodium or high blood calcium levels.

Symptoms such as fatigue, feeling sick or loss of appetite are not necessarily caused by metastases. Cancer anywhere in the body can cause a person to feel unwell. Loss of appetite can cause weight loss and loss of muscle mass. Fatigue and weakness may worsen further one’s ability to breathe. Loss of muscle mass also contributes to weakness and loss of mobility.

For most types of cancer, biopsy is the only way for the doctor to know if an area of ​​the body has cancer for sure. In a biopsy, the doctor takes a small sample of tissue for histological examination in a pathological laboratory.

This list describes certain diagnostic options for this type of cancer. Not all of the tests listed below are used for each person. Your doctor will consider the following factors when choosing a diagnostic test:

The type of cancer that is suspected

Your symptoms

Your age and the general state of your health

Results of previous medical examinations

The procedures that physicians use to collect tissue (biopsy) to diagnose lung cancer and design treatment are listed below:

Biopsy.

Biopsy is the removal of a small amount of tissue for histological examination under the microscope by the pathologist. It is useful to have a larger tumor sample to determine the NSCLC subtype and perform additional molecular tests (see General & Molecular Profile). If not enough tumor is removed in order to perform all the required examinations, another biopsy may be needed. After the biopsy, the pathologist analyzes the sample. The pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs in order to diagnose diseases (histological, cytological, immunohistochemical, molecular examination).

Bronchoscopy.

At a bronchoscopy, the doctor passes a thin, flexible tube into the mouth or nose to reach the lungs. The pulmonologist is a doctor who specializes in the diagnosis and treatment of pulmonary disease. The tube allows the doctor to see through the lungs. The tiny tools in the tube can extract fluid or tissue samples which can be examined by the pathologist.

Fine needle Aspiration Biopsy (FNAB) / core needle biopsy (core biopsy).

The pulmonologist or invasive radiologist removes a sample of the lung tumor for examination. This can be done with a smaller needle or a larger needle depending on how large the sample is needed or the topography of the tumor. Often, the doctor uses a CT scan or a fluoroscope to guide the needle. Generally, the core biopsy provides a greater amount of tissue by needle aspiration. As explained above, doctors know that more tissue is needed for NSCLC for histological diagnosis and molecular testing that will come afterwards.

Chestoscopy.

Through a small cut on the chest wall, the doctor (surgeon) may insert a special tool and a small camcorder to help examine the inside of his chest. This process may be referred to as optical thoracoscopic surgery or VATS.

Mesoscopy.

The surgeon examines and takes a sample of lymph nodes in the center of the thorax below the chest making a small incision.

Thoracotomy.

The surgeon makes a chest incision, examines the lung immediately, and takes tissue samples for examination. A thoracotomy is the surgery mostly used to completely remove a lung tumor.

Your doctor may recommend performing laboratory tests on a tumor sample to identify specific genes, proteins, and other specific factors for the tumor.

There are several genes that can change (mutate), which may help cancer grow and spread. These gene mutations are found in the tumor and not in healthy cells of the body. This means that they are not inherited or transferred to your children (bodily mutations).

Mutations which are known to contribute to the development of lung cancer often occur in 1 or more genes, including EGFR, ALK, KRAS, BRAF, HER2, ROS1, RET, MET and TRK. Molecular tumor testing for some of these genes is now common to the advanced stage of NSCLC. Testing for these genes can also be done for the earlier stages of the disease.

The results of these molecular tests can help your doctor (Oncologist) determine if your treatment options include a type of treatment called targeted therapy that can target specific mutations. Mutations for which targeted therapies are available are much more likely to occur in patients with NSCLC cancer- adenocarcinoma type- and in patients who never smoke.

If you have advanced stage NSCLC, your doctor may also recommend the PD-L1 test. PD-L1 is found on the surface of cancer cells and in some cells of the body’s immune system. This protein prevents the body’s immune cells to destroy the cancer. If we know that the tumor expresses the PD-L1 marker and to what extent, it helps your doctor decide whether your treatment options include specific types of immunotherapy. These types of immunotherapy allow the immune system to target the cancer.