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In this article:
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There are different types of lung cancer. Non-small cell lung cancer (NSCLC) occurs more frequently compared to small cell lung cancer (SCLC).
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The most common cause of NSCLC is smoking, although nonsmokers can get NSCLC too. If you have a history of smoking, learn if you should be screened for lung cancer annually.
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New technology has made diagnosing and treating lung cancer easier than ever before.
What is non-small cell lung cancer?
There are different types of lung cancer. Two main types include non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC occurs when abnormal cells form in the lungs and multiply quickly.
Understanding NSCLC
“About 15% of the lung cancers diagnosed are small cell and the other 85% are non-small cell,” says Richard M. Gillespie, M.D., the medical director of the Roy and Patricia Disney Family Cancer Center at Providence. “But NSCLC isn’t just one type of cancer.”
Types of non-small cell lung cancer
The three main types of NSCLC, the most common type of lung cancer, include:
- Adenocarcinoma: The most common type of NSCLC, adenocarcinoma forms in cells on the surface of the lungs. It affects smokers and nonsmokers.
- Large cell carcinoma: Not as common, large cell carcinoma can form anywhere in the lungs and tends to spread quickly.
- Squamous cell carcinoma: More common in smokers and the second most common type of NSCLC, squamous cell carcinoma forms in cells lining the bronchi, which are tubes that help carry air to your lungs.
Other, rarer types of NSCLC include adenosquamous carcinoma and sarcomatoid carcinoma.
NSCLC causes and risk factors
“The most common cause of NSCLC is tobacco use,” Dr. Gillespie says. “Cigarette smoking is felt to be the cause of about 90% of non-small cell lung cancers. Ten percent of the patients that we take care of are non-smokers.”
Other risk factors include:
- Air pollution
- Exposure to asbestos, diesel gas, radon gas or secondhand smoke
- Family history of lung cancer
- Genetics, with young Asian women more at risk for adenocarcinoma
- Previous radiation therapy to the chest
- Respiratory conditions, including chronic obstructive pulmonary disease and pulmonary fibrosis
- Vitamin supplements, specifically beta carotene for smokers or people who have been exposed to asbestos
Some of these risk factors, such as genetics, you can’t control. Others, such as smoking, you can control. There are also some things you can do to assess your risk.
“If you have a basement, one ought to check for radon if you’re going to buy or sell a house,” Dr. Gillespie says. “And I do recommend that my nonsmoking patients with lung cancer have their homes checked for that.”
Common NSCLC symptoms
Early detection and catching lung cancer in an early stage can sometimes be difficult.
“The tough thing about lung cancer in general is that it’s not typically symptomatic until it’s pretty far along in the staging,” Dr. Gillespie says. “But when people present with symptoms, they are typically fairly subtle. Cough is probably the most common, sometimes coughing up blood, but most of the time it’s just a persistent cough that won’t go away.”
Dr. Gillespie also suggests you keep an eye on occasional, vague yet nagging chest pain that tends to happen on the side or back of the chest.
Also look for changes in your breathing patterns, such as new wheezing or, less commonly, shortness of breath. You also might notice hoarseness or a change in your voice, a loss of appetite or weight loss.
“Sometimes patients will be diagnosed with recurrent pneumonias, but it may be that there’s a little cancer blocking off an airway, which is causing an infection,” Dr. Gillespie says. “All of these things are possibilities.”
When should you worry about a cough?
Most people have experienced a nagging, annoying cough that lasts for weeks. However, some clues can indicate a need for further investigation.
“It has to be different,” Dr. Gillespie says. “Something that wasn’t there before is now there, and if it’s persistent beyond three months, it deserves an evaluation. Now, that’s not to say that we’ll find something. But you shouldn’t cough for six months and not see your doctor.”
The importance of lung cancer screening
“Lung cancer screening is well documented as very important in a community,” Dr. Gillespie says. “The first clinical trial, the National Lung Screening Trial, was published in The New England Journal in 2011. It showed that if you take a high-risk population and you screen them appropriately, you can reduce the chances of mortality by 20%. That’s a big number.”
What makes a patient at risk?
“The patients we now categorize as at risk are people who are between the ages of 50 and 80 and who are active smokers or have quit relatively recently, within 15 years,” Dr. Gillespie says. “So if you quit 20 or 30 years ago, you don’t fall into the category of someone who needs to be screened.”
If you’re a smoker, “pack years” is a helpful measurement tool doctors have developed to get a better sense of how much you’ve smoked throughout your life. To figure out your pack years, take the number of packs of cigarettes you smoke each day and multiply it by the number of years you’ve smoked.
For example, if you’ve smoked one pack of cigarettes per day for 20 years, that’s 20 pack years. If you’ve smoked half a pack of cigarettes per day for 20 years, that’s 10 pack years.
If you’re high risk, your doctor will likely recommend a low-dose CT scan once a year. A CT (computerized tomography) scan takes detailed pictures of your lungs. You lie on a table that slowly slides you through a large tube that rotates around you. A CT scan doesn’t hurt. A low-dose CT scan minimizes the amount of radiation.
“It takes about two minutes,” Dr. Gillespie says. “You get on the little CT scanner, shaped like a donut, and zip, zip, it’s done. Then we take a look at it and make sure that everything looks OK.”
How to diagnose NSCLC
A CT scan is almost always the first step in a lung cancer diagnosis. Your doctor may order a CT scan if you’re at an increased risk for lung cancer or experiencing certain symptoms. Sometimes imaging tests, such as a chest X-ray or MRI done for something else, such as back pain, might reveal a suspicious spot on the lungs. In this case, a CT scan can provide more information.
However, a CT scan can’t confirm cancer. If your doctor finds a nodule or mass on your CT scan, they will recommend a biopsy. A small tissue sample is removed during a biopsy and then sent to a lab for testing.
“I tell patients this all the time that the truth is in the microscope,” Dr. Gillespie says. “There are things other than cancer that can cause masses within the lung, so it’s important to get a biopsy.”
In the past, your doctor would perform a transthoracic biopsy, in which a needle was gently inserted into your lung while you’re awake. Medication helped numb any pain.
“Nowadays, we prefer to do biopsies endoscopically,” Dr. Gillespie says. “We use a robotic bronchoscope to put a camera into the airway. There are no incisions and no needles on the outside. We can do the biopsy from the inside.”
This type of biopsy, which has only been around for about five years, does require anesthesia. However, there are fewer complications.
“Lung collapse is the biggest complication,” Dr. Gillespie says. “Lung collapse with needle biopsies happens about 20% of the time. But if we’re doing it the reverse way, endoscopically, then the rates of lung collapse are less than 2%. We feel that’s a better deal for folks. And then we can also sample lymph nodes and other things to help with staging and get a person ready for potential treatment.”
To determine lung cancer staging, doctors will look at the size of your tumor and determine whether or not it’s spread to nearby lymph nodes or organs, bones or glands.
Treatment options
Non-small cell lung cancer treatment options depend on the type and stage of NSCLC cancer. Treatment options include:
- Chemotherapy, to attack the cancer with drugs
- Immunotherapy, to encourage your immune system to destroy the cancer
- Radiation, to kill the cancer with X-rays
- Surgery, to remove the cancer
- Targeted therapy, to attack the cancer with drugs, without harming healthy cells
“When I started in surgery 20-odd years ago, lung cancer treatment was not very modern,” Dr. Gillespie says. “It was old-fashioned chemotherapy. It was the old-fashioned radiation. It was big old surgeries done through big incisions. Nowadays, all these things have improved.”
Dr. Gillespie and his oncology team use stereotactic radiosurgery to target tumors carefully, reducing the amount of radiation cancer patients receive. New robotic surgeries now require only a small incision.
“The chemotherapy has also changed,” Dr. Gillespie says. “It’s not necessarily the old-fashioned, platinum-based chemotherapy, which is pretty toxic. Now we have immunotherapies, which can make a big difference in terms of somebody’s ability to completely clear their cancer.”
Living with NSCLC
Telling someone they have NSCLC is one of the more difficult parts of an oncologist’s job, but Dr. Gillespie says optimism can go a long way.
“And that’s well earned,” Dr. Gillespie says. “I’m not being dishonest. I’ve seen a lot of patients over the years who have beaten this and who have survived long-term and do very well.”
When Dr. Gillespie tells someone they have cancer, he knows they’re only going to remember 10% of what he says next.
“I make sure that there’s somebody else in the room with them, a family member or a friend, who can help them remember some of the things that I’m talking about,” Dr. Gillespie says. “And then I’m straightforward. I don’t try to hide the diagnosis. I tell them there are three things we’ve got to figure out: What is it? What stage is it? And what are we going to do about it? And so I give people an action plan.”
Cancer research has come a long way, and tried-and-true steps for treating NSCLC have proven to be successful, time and again, often resulting in a high quality of life.
“We’re going to take good care of you,” Dr. Gillespie says. “We’ll make sure you feel comfortable with what we’re doing. You’ll get the best treatment, everything is modern and cutting edge. We’re going to give you everything that we can to see if we can get this cancer completely eradicated.”
When to seek medical advice
If you think you might be at risk for lung cancer, contact your doctor to schedule a lung cancer screening.
“If you are a person who meets the criteria for lung cancer screening, if you’re a smoker or if you’ve quit within the past 15 years, get it done,” Dr. Gillespie says. “I beg you. Talk to your primary care doctor about it. Some people don’t know they are at risk or, if they do know, think there’s nothing they can do about it. If you’re a candidate for screening, get screened because it’s a lifesaving maneuver and so easy to do.”
Contributing caregiver
Richard M. Gillespie, M.D., is the medical director of the Roy and Patricia Disney Family Cancer Center at Providence.
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Related resources
Innovating cancer Care: A new and improved approach to lung cancer treatment
Breathe in, breathe out: Recognizing risk factors for lung cancer
Recognizing and preventing lung cancer for non-smokers
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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