Lung Cancer, Non-Small Cell Health Article

Diagnosis

Physical examination and diagnostic tests

The doctor will first take a detailed medical history and assess risk factors. During a complete physical examination the doctor will examine the patient's throat to rule out other possible causes of hoarseness or coughing, and will listen to the patient's breathing and chest sounds.

If the doctor has reason to suspect lung cancer, particularly if the patient has a history of heavy smoking or occupational exposure to irritating substances, a chest x ray may be ordered to see if there are any masses in the lungs. Special imaging techniques, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), may provide more precise information about the size, shape, and location of any tumors.

Sputum analysis

Sputum analysis is a noninvasive test that involves microscopic examination of cells that are coughed up from the lungs. This test can diagnose at least 30% of lung cancers, even if tumors are not visible on chest x rays. In addition, the test can detect cancer in its very early stages, before it spreads to other regions. The sputum test does not provide any information about the location of the tumor.

Lung biopsy

Lung biopsy is the most definitive diagnostic tool for cancer. It can be performed in three different ways. Bronchoscopy involves the insertion of a slender, lighted tube, called a bronchoscope, down the patient's throat and into the lungs. This test allows the doctor to see the tubes inside the lungs, and to obtain samples of lung tissue. If a needle biopsy is to be performed, the location of the tumor is first identified using a computerized tomography (CT) scan or magnetic resonance imaging (MRI). The doctor then inserts a needle through the chest wall and collects a sample of tissue from the tumor. In the third procedure, known as surgical biopsy, the chest wall is opened up and a part of the tumor, or all of it, is removed. A doctor who specializes in the study of diseased tissue (a pathologist) examines the tumor to identify the cancer's type and stage.

Treatment team

The treatment team for patients with non-small cell lung cancer will depend on which treatment strategy is followed. For patients that are treated surgically, a thoracic surgeon will perform the procedure. These surgeons specialize in operating inside the chest cavity. Patients who require radiation therapy will be seen by a radiation oncologist. Patients who need chemotherapy will see a hematologist or oncologist. Both are doctors who specialize in cancer treatment. Chemotherapy is usually administered by oncology nurses that specialize in caring for cancer patients.

Clinical staging, treatments, and prognosis

Staging

Treatment for non-small cell lung cancer depends primarily on the stage of the cancer. Staging is a process that tells the doctor if the cancer has spread and the extent of its spread. The most commonly used treatments are surgery, radiation therapy, and chemotherapy.

Non-small cell lung cancer has six stages:

• Occult carcinoma. Cancer cells have been found in the sputum, but no tumor has yet been found.
• Stage 0. A small group of cancerous cells have been found in one location.
• Stage I. The cancer is only in the lung and has not spread anywhere else.
• Stage II. The cancer has spread to nearby lymph nodes.
• Stage III. The cancer has spread to more distant lymph nodes, and/or other parts of the chest like the diaphragm.
• Stage IV. The cancer has spread to other parts of the body.

Surgery

Surgery is the standard treatment for the earlier stages of non-small cell lung cancer. The surgeon will decide on the type of surgery, depending on how much of the lung is affected. There are three different types of surgical procedures:

• Wedge resection is the removal of a small part of the lung.
• Lobectomy is the removal of one lobe of the lung. (The right lung has three lobes and the left lung has two lobes.)
• Pneumonectomy is the removal of an entire lung.

Lung surgery is a major procedure and patients can expect to experience pain, weakness in the chest, and shortness of breath. Air and fluid collect in the chest after surgery. As a result, patients will need help to turn over, cough, and breathe deeply. Patients should be encouraged to perform these activities because they help get rid of the air and fluid and speed up recovery. It can take patients several months before they regain their energy and strength.

Radiotherapy

Patients whose cancer has progressed too far for surgery (Stages III and IV) may receive radiotherapy. Radiotherapy involves the use of high-energy rays to kill cancer cells. It is used either by itself or in combination with surgery or chemotherapy. The amount of radiation used depends on the size and the location of the tumor.

Radiation therapy may produce such side effects as fatigue, skin rashes, upset stomach, and diarrhea. Dry or sore throats, difficulty in swallowing, and loss of hair (alopecia) in the treated area are all minor side effects of radiation. These may disappear either during the course of the treatment or after the treatment is over.

Chemotherapy

Chemotherapy is also given to patients whose cancer has progressed too far for surgery. Chemotherapy is medication that is usually given intravenously to kill cancer cells. These drugs enter the bloodstream and travel to all parts of the body, killing cancer cells that have spread to different organs. Chemotherapy is used as the primary treatment for cancers that have spread beyond the lung and cannot be removed by surgery. It can also be used in addition to surgery or radiation therapy.

Chemotherapy is tailored to each patient's needs. Most patients are given a combination of several different drugs. Because these drugs also harm normal cells, doses are carefully adjusted. Chemotherapy often has severe side effects, including nausea and vomiting, hair loss, anemia, weakening of the immune system, and sometimes infertility. Most of these side effects end when the treatment is over. Other medications can be given to lessen the unpleasant side effects of chemotherapy.

Prognosis

The prognosis for non-small cell lung cancer is better if the disease is found early, and removed surgically. For patients whose disease is caught in Stage I, the survival rate five years after surgery ranges from 60% to 80%. Up to 55% of Stage II patients are alive after five years, but only about 30% of Stage III patients survive five years. Unfortunately, 85% of patients already have at least Stage III cancer by the time they are diagnosed. Many of these patients have disease that is too advanced for surgery. Despite treatment with radiotherapy and chemotherapy, the five-year survival for patients with inoperable disease is extremely low.

Alternative and complementary therapies

Because non-small cell lung cancer has a poor prognosis with conventional medical treatment, many patients are willing to try complementary and alternative therapies.

These therapies are used to try to reduce stress, ease side effects and symptoms, or control disease. Two treatments sometimes used are shark cartilage and mistletoe. Although shark cartilage is thought to interfere with the tumor's blood supply, clinical trials have so far been inconclusive. Mistletoe is a poisonous plant that has been shown to kill cancer cells in the laboratory. Again, however, clinical trials with cancer patients have been inconclusive.

Patients who decide to try complementary and alternative therapies should tell their doctor. Some of these therapies may interfere with conventional treatment.