NSCLC: non-small cell lung cancer
and Martina Feichter, medical editor and biologist Updated onMarian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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The term "non-small cell lung carcinoma" (NSCLC) encompasses several forms of lung cancer. They are all treated similarly and have a comparable prognosis at the same stage. Find out everything you need to know about non-small cell lung cancer here!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. C34
NSCLC: description
Doctors know several types of lung cancer (medical bronchial carcinoma). First of all, they distinguish between two large groups: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In small cell lung cancer, there are many small, densely packed cells under the microscope. In contrast, the cells in NSCLC are larger.
Small cell and non-small cell lung cancer differ in their course and treatment. Most lung cancer patients have a non-small cell tumor. It can be further subdivided.
What types of NSCLC are there?
Non-small cell lung cancer can arise from different cell types. Accordingly, a distinction is made between the following sub-forms:
- Adenocarcinomas
- Squamous cell carcinoma
- large cell carcinomas
- other non-small cell lung cancer
Adenocarcinomas and squamous cell carcinomas are the most common forms of NSCLC and lung cancer in general. Large cell carcinomas are less common. This applies even more to other small-cell lung carcinomas - these include variants that only occur very rarely.
How do the different types of NSCLC arise?
Adenocarcinomas typically tend to grow at the edge of the lungs (peripheral). They arise from mucus-producing gland cells in the lungs. Adenocarcinomas tend to develop in scar tissue that can be left behind after contracting tuberculosis, for example. They affect the surrounding lymph nodes and other organs or tissues at a relatively early stage.
Squamous cell carcinomas usually consist of solid associations of degenerate cells that do not form mucus. They usually grow in the center of the lungs, preferably at the branches of smaller airways (bronchi). Squamous cell carcinoma of the lungs usually develops as a result of chronic irritation of the mucous membranes, for example from tobacco smoke.
Doctors usually speak of large cell carcinoma when they cannot identify a non-small cell lung carcinoma under the microscope as either adenocarcinoma or squamous cell carcinoma. It is therefore a diagnosis of exclusion. As the name suggests, the cells of this cancer variant are strikingly large.
Special case of Pancoast tumor
A special form of NSCLC is the Pancoast tumor, named after its discoverer. This rapidly growing bronchial carcinoma arises at the tip of the lung. It can spread very quickly to surrounding structures such as the ribs, soft tissues of the neck or the nerve plexus of an arm. Pancoast tumors are in most cases adenocarcinomas.
NSCLC: causes and risk factors
The main trigger for non-small cell lung cancer (and other forms of lung cancer) is smoking: the longer someone smokes and the more cigarettes a day, the higher their risk of developing a malignant tumor in the lungs.
But not only smokers themselves are at risk: people who smoke passively - that is, inhale the tobacco oil of people who smoke - also have an increased risk of lung cancer.
Other factors that promote the development of a malignant lung tumor are, for example, air pollutants, asbestos and arsenic.
Read more about the development of lung cancer and important risk factors under Lung Cancer: Causes and Risk Factors.
NSCLC: symptoms
Lung cancer (such as non-small cell lung cancer) usually causes hardly any symptoms in its early stages. Most patients report only unspecific symptoms such as fatigue, cough, and chest pain. The further the tumor spreads, however, the more and more severe signs there are. This can be, for example, bloody sputum, shortness of breath and a slight fever.
If a non-small cell lung carcinoma has formed daughter tumors (metastases) in other parts of the body, corresponding symptoms can also be added. For example, brain metastases can cause headaches, impaired vision and balance, confusion and / or paralysis.
You can read more about the general symptoms of lung cancer and the specific symptoms of Pancoast tumor in the text Lung Cancer: Symptoms.
NSCLC: examinations and diagnosis
If lung cancer (such as non-small cell lung cancer) is suspected, patients should see their family doctor first. If necessary, he will refer you to a specialist, for example to a pulmonologist (pulmonologist) or a cancer specialist (oncologist).
First of all, the doctor will ask the patient about the exact symptoms and possible previous or concomitant illnesses. He also asks if the patient smokes or comes into contact with hazardous substances such as asbestos while working.
This is followed by careful physical and various apparatus examinations. This includes, for example, an X-ray examination of the chest (chest X-ray). The doctor will also take tissue samples from suspicious areas in the lungs and have them analyzed in the laboratory.
Read more about the necessary examinations for all types of lung cancer under Lung Cancer: Examinations and Diagnosis.
NSCLC: treatment
The different NSCLC types are treated similarly in the respective tumor stages. It is therefore less important for the treatment whether it is adeno- or squamous cell carcinoma. Much more important is how far a non-small cell lung cancer has already spread in the body.
The three most important therapeutic approaches are:
- Surgery to surgically remove the tumor
- Radiation therapy to kill the cancer cells
- Chemotherapy with drugs that inhibit cell division
The different approaches can be combined with one another in different ways - especially adapted to the stage of the disease and the general condition of the patient. Each patient receives an individual therapy plan.
The exact therapeutic procedures for NSCLC are very complicated. Therefore, only a simplified overview can be given here.
Treatment in the early and middle stages
If a non-small cell lung cancer is still relatively small, one tries to cut it out as completely as possible. For this, the tumor should have no or only a few lymph nodes and, above all, no metastases.
In the very early stages, surgery alone is often enough to completely remove the cancerous tissue. Sometimes the affected lung area is also irradiated. Any remaining cancer cells are killed in this way.
If a non-small-cell lung cancer has spread further and has affected several lymph nodes, the patients also receive chemotherapy (adjuvant chemotherapy) after the operation. For larger tumors, chemotherapy is sometimes started before the operation (neoadjuvant chemotherapy): It is supposed to shrink the cancerous tumor. Then the surgeon has to cut out less tissue afterwards.
Treatment in advanced stages
If a non-small cell lung cancer has already spread strongly in the body and has metastasized, there is little chance of a cure. Then the patient is treated palliatively. So you try to alleviate your symptoms and extend your survival time. In many cases, such therapy then consists of chemotherapy and / or radiation therapy.
Modern therapies for selected patients
In certain cases of non-small cell lung cancer, other therapeutic options can also be considered.These include, on the one hand, targeted therapies (with antibodies or tyrosine kinase inhibitors) and, on the other hand, immunotherapies:
Targeted therapies target specific characteristics or properties of cancer cells. In the case of non-small cell lung cancer, such targeted therapy with antibodies or tyrosine kinase inhibitors can be carried out:
- Antibody therapy involves administering artificially produced antibodies that target certain properties of non-small cell lung cancer. For example, some of these antibodies can destroy certain features on the surface of a cancer cell or the entire cancer cell.
- The artificially produced tyrosine kinase inhibitors (tyrosine kinase inhibitors) are absorbed in the body by the cancer cells or the cells of the blood vessel walls: Inside the cancer cells, they block signaling pathways that are important for tumor growth. They also block certain signaling pathways inside the vascular cells. The result is that the vessels can no longer grow or even perish. This affects the blood supply to the tumor - its growth is slowed down.
Another modern therapy option for NSCLC is immunotherapy with immune checkpoint inhibitors: Every body has special immune control points ("immune checkpoints"). They ensure that the immune system only acts against sick, but not against healthy body cells.
However, some cancer tumors cause these checkpoints to cause the immune cells to ignore the cancer cells and not attack them. Affected patients can benefit from checkpoint inhibitors. These immunotherapeutic drugs ensure that the immune checkpoints continue to function properly and that the cancer cells attack more intensely.
Both targeted therapies and immunotherapy can only be used in patients in whom the tumor meets certain requirements (e.g. has a certain gene mutation or has certain docking points on the surface). So they are only suitable for selected patients.
NSCLC: course and prognosis
Non-small cell lung cancer grows more slowly than small cell lung cancer. Therefore, in principle, he has the better prognosis. The chances of recovery and life expectancy depend in each individual case on how early the tumor is discovered and treated.
Other factors that have an influence on how well a non-small cell lung cancer can be treated are the general health of the patient and possible concomitant diseases such as high blood pressure or heart disease.
You can read more about the chances of recovery and life expectancy of bronchial carcinoma in the text Lung Cancer: Life Expectancy.
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