NSCLC-non-small cell lung cancer is the most prevalent type of lung cancer. Other kinds of lung cancer include small-cell lung cancer (SCLC), and carcinoid tumors.
Early symptoms of lung cancer resemble those of the common cold. They may include a tenacious cough, shortness of breath, or chest pain that worsens while breathing deeply, laughing, or coughing. Other signs may include: coughing up mucus or blood, hoarseness, and sometimes also repeated respiratory infections such as bronchitis or pneumonia.
To diagnose lung cancer, patients usually undergo a series of tests and procedures:
- Imaging tests- an X-ray of the lungs may show an irregular nodule or mass. Other scans, such as CT and PET, can provide a more detailed picture and detect smaller lesions.
- Sputum cytology- when a cough produces a discharge, a microscopic exam of the phlegm might reveal the presence of cancer cells.
- A biopsy- the surgeon performs a biopsy, and the pathologist checks the tissue sample for cancerous cells. The pathologist generates a report detailing the type of cells in the tumor and the cancer aggressiveness. Special lab tests might also specify whether the tumor cells have specific mutations. This information assists the medical team to plan the appropriate treatment.
There are different types of biopsies: a surgical biopsy or a percutaneous biopsy. Some surgical biopsies for lung cancer include those done by a:
- Bronchoscopy- a specialist inserts a slim device with a light and a camera (bronchoscope) into the mouth or nose. It goes down the throat into the airways in the central part of the chest, allowing the surgeon to visualize the area and take a sample tissue.
- Endobronchial Ultrasound Scan (EBUS)- this procedure combines bronchoscopy with an ultrasound scan. There is an ultrasound probe at the end of the camera. It allows the specialist to take a biopsy from the lymph nodes in the center of the chest as well.
- Mediastinoscopy- this procedure allows the surgeon to take a biopsy of the lymph nodes from the mediastinum (the center of the chest).
Lung cancer can spread locally within the lungs and into the chest wall. It can spread regionally to nearby lymph nodes, the nerve close to the lungs (phrenic nerve), or the pericardium (the outer layer of the heart), and systemically to other organs. Common systemic spreading might occur to the contralateral lung, adrenal gland, bones, brain, and liver. To learn whether cancer has spread, the doctor might recommend imaging tests. They may include CT, MRI, PET, and bone scans.
Treatment options for lung cancer include radiation therapy, chemotherapy, and surgery. The medical team might also recommend combinations of treatments, for example, chemotherapy or radiotherapy after surgery. Another example includes a combination of chemo with radiation. For some patients with advanced or metastatic lung cancer, and with specific cancer mutations, there is also the option of targeted therapy or immunotherapy, alone or in combination with chemotherapy. Some patients have the option of clinical trials with new medications and combination treatments.
Lung Cancer Mutation
Lung cancer treatments might be mutant-dependent. Of all the existing cancers, lung cancer is now the leader in the number of genetic mutations that allow personalized cancer treatment according to the genetic profile, both through drugs proven to be effective for certain mutations and by novel drugs whose effectiveness is still being
. under clinical investigation. The above is particularly evident in those patients with non-small cell lung cancer.
Below there are some of the most common mutations associated with lung cancer that allows personalized treatments with the use of targeted therapies for those specific mutations.
EGFR mutations are found on approximately 20% of patients with non-small cell lung cancer and the rate is even higher in those of Asian origin. Mutations are identified mainly in women who have never smoked cigarettes before, but are also diagnosed in current or former cigarette smokers.
ALK mutation: About 5% of people with non-small cell lung cancer have a mutation in the ALK gene, especially those who did not smoke cigarettes in the past or were defined as mild smokers and those diagnosed with adenocarcinoma.
Mutated forms of the ALK gene have been found in other types of cancer, including neuroblastoma, and anaplastic large cell lymphoma.
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ROS1: This mutation is present in about 2% of people with non-small lung cancers, most of them among light smokers or non-smokers and young people diagnosed with an adenocarcinoma.
MET: This is one of the mutant groups studied in advanced stages. Changes that have been linked in recent years to kidney cancer are also diagnosed in people with lung cancer of various types (including those with small cell lung cancer). It appears to be present in 2% and 4% of patients.
BRAF: This mutation has been associated with melanoma in recent years, and recently also in 1-4% of patients with lung cancer. It is noticeable among current or former cigarette smokers.
HER2: These mutations: have been identified mainly in patients with breast cancer and recently linked with lung cancer, in 2% to 4% of patients with non-small cell lung cancer. Studies currently underway suggest therapeutic benefit to mutation carriers treated with HER2 inhibitors, including a biological drug designed for breast cancer.
K-RAS: This is a mutation closely associated with colorectal cancer and recently been found in lung cancer. Occurs in approximately 30% of patients with the disease.
Knowing whether a patient’s tumor has a wild-type or a mutated KRAS gene may help planning their cancer treatment. (Cancer.gov).
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PD-L1 In recent years there has been increasing awareness of this protein. that helps keep immune cells from attacking nonharmful cells in the body. PDL1 expression in the tumor cell is used to select non-small cell lung cancer patients that might benefit from immunotherapy.
If you have one of the mutations mentioned above and you are interested to find out if there is a clinical trial that could be relevant to you, post your comment below and we will do our best to assist.
Some Of The Medications For Treating Lung Cancer:
Nivolumab (trade name: Opdivo)
Pembrolizumab (trade name: Keytruda)
Durvalumab (trade name Imfinzi)
Paclitaxel (trade name Taxol)
Osimertinib (trade name Tagrisso)
Pemetrexed (trade name Alimta)
Erlotinib trade name Tarceva)
Gefitinib (trade name Iressa)
Crizotinib (trade name Xalkori)
Cis/Carboplatin ( different trade names)
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