sign in sign up
<<
Home , Lung cancer

Lung A guide for journalists on Non-Small Cell Cancer (NSCLC) and its treatment Contents Overview Section 1 Lung Cancer Section 2 Section 3 Treatment References

Contents

Contents 2 Overview 3 Section 1: Lung Cancer 4 i. Types of lung cancer 4 ii. Causes and risk factors 5 iii. Symptoms and diagnosis 6 iv. Staging 7 v. Prognosis 8 Section 2: Epidemiology 9 i. & mortality 10 Section 2: Treatment 11 i. 11 ii. Radiotherapy 11 iii. 11 iv. Biological (targeted) therapy 11 References 12

2/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

Overview

Five year survival rates for lung cancer diagnosed at an advanced stage, making Lung cancer is the leading cause of cancer death are poor when compared to other high successful treatment more difficult and globally. It kills more people than breast, colorectal and incidence . For example, the five survival outcomes poor.5 1 year survival rate for patients with breast prostate cancers combined. Each year 1.38 million cancer is up to 89%;3 for lung cancer Traditionally, treatment options have people die as a result of the disease, equating to more patients, that figure is only around 15%.4 included surgery (for patients with earlier stage disease), and than 3,000 deaths a day worldwide, or two deaths There are two main types of lung cancer; chemotherapy, alone or in combination. 1,2 non-small cell lung cancer (NSCLC) and More recently, new treatment options, every minute. small cell lung cancer (SCLC). NSCLC is including biological therapies, have become the most commonly diagnosed type of lung available and are helping to improve cancer, accounting for approximately 85% outcomes and survival for patients. of all cases.5 This guide provides an overview of lung The early of lung cancer, including its incidence, risk factors, cancer are non-specific and as a symptoms, diagnosis and treatment options. consequence the majority of cases are

3/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

Section 1 Lung cancer i. Types of lung cancer? Figure 1 Typical location of the most common types of non small cell lung cancer Lung cancer arises from the uncontrolled Squamous Cell growth (proliferation) of abnormal cells inside the lung. There are two main forms • Develops from cells that line the airways • Often found near the centre of the lung in one of the disease, non-small cell lung cancer • of the main airways (the left or right ) (NSCLC) and small cell lung cancer (SCLC). • Associated with

NSCLC is the most common form of lung LY MPH cancer, accounting for approximately NODES 85% of all cases.5 It grows and spreads • The most common type of NSCLC • Develops from a particular type of cell which more slowly than small cell lung cancer. • produces mucous (phlegm), which lines the airways. Early stage disease is associated with few BRONCHI • Often found in the periphery (outer areas) of the specific symptoms; therefore approximately 70% of cases are not diagnosed until the Large Cell Carcinoma disease is at an advanced stage when the • Cells appear large and round when viewed under a . chances for cure or significant patient LUNG LOBE • Grows quickly and can develop in any part of the lung benefit are limited.6

NSCLC comprises a number of different SCLC is highly aggressive and is types of lung cancer, which are grouped predominantly caused by smoking. It as ‘squamous’ or ‘non-squamous’. Non- metastasises (spreads around the body) squamous NSCLC includes further sub- early in the disease process and accounts types such as adenocarcinoma and large for approximately 15% of all lung cancers.5 cell carcinoma.7

4/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

ii. Causes and risk factors Ionising radiation Exposure to ionising Environment Extensive evidence suggests Diseases as risk factors for lung cancer radiation increases the risk of lung cancer.10 that lung cancer rates are higher in cities Patients with pulmonary are at Smoking The most common cause of than in rural settings. This is likely to be increased risk of lung cancer, as are those lung cancer is smoking which Atomic bomb survivors and patients treated caused by urban , although with chronic bronchitis and emphysema.11 is associated with at least 80% of all with radiotherapy for some rheumatic diagnoses.8 The risk of lung cancer diseases or Hodgkin’s are at it may also involve other factors, such amongst smokers is at least ten times moderately increased risk of developing as smoking and occupational 8 higher than that of non-smokers. This lung cancer.8 exposures. risk is reduced among ex-smokers, but Occupational risks There is an increased Indoor air pollution Indoor air pollution a small excess risk may remain for ex- risk of lung cancer amongst workers may be responsible for the increased risk smokers throughout their lives.8 There is employed in certain industries and of lung cancer that exists for non-smoking also a causal link between lung cancer and occupations which involve high-risk agents. women in certain regions of China and use of , tobacco pipes, water pipes The most significant of these are other Asian countries. This risk is highest and smoking of other tobacco products.9 and fumes. In industrialised for women living in poorly ventilated Evidence also exists of a link between lung countries, occupational risks account for homes where , wood or other solid cancer risk and (estimated 9 fuels are regularly burnt. Fumes from 9 approximately 5-10% of lung cancers. to be 20%). high-temperature cooking using unrefined Underground miners exposed to radioactive vegetable oils such as rapeseed oil have and its decay products have also Whilst smoking is the single biggest cause also been associated with an increased risk been found to be at an increased risk of of lung cancer, people who have never of developing lung cancer.8 There is also a developing lung cancer.12 smoked also develop the disease. Risk link between high concentrations of radon factors include: gas decay particles and lung cancer in some countries.8 This gas is emitted from natural sources and can accumulate in buildings, especially in confined areas such as attics and basements.10

5/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

iii. Symptoms and diagnosis Persistent Diagnosis allows confirmation of the Cytology: A sample of is taken disease. Analysis of cancerous cell Common symptoms of NSCLC are A change in a persistent cough to confirm the diagnosis and type of (histology) is particularly important in mostly non-specific and may initially lung cancer. obtaining an accurate diagnosis. There are be disregarded by the patient. As a Coughing up phlegm (sputum) with : A visual examination a variety of tests available to diagnose lung consequence many patients go to their signs of blood of the trachea and internal parts of cancer.5 doctor when the disease is at an advanced Aches or pains when breathing or the lungs. Specimens of tissue may be stage when symptoms become more coughing taken from inside the lungs to gather troublesome and persist. Symptoms to Loss of appetite cells for analysis. watch out for include: Fatigue Needle : Alongside a CT scan Loss of weight this procedure is used to obtain cells for analysis.

6/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

Magnetic resonance imaging (MRI) iv. Staging Table 1 Staging of NSCLC scan: uses a magnetic field to create Staging reflects how advanced the cancer an image of the chest to determine the Stage Classification is and whether it has spread to other parts location and extent of cancer spread. of the body. It helps to identify the most Early stage Stage I The cancer is present only in one part of the lung. scan: allows detection of spread to disease appropriate treatment options for the Stage II Cancer has spread to the nearby lymph nodes or nearby the bone. patient. tissues, such as the chest wall. Other tests Later stage Stage III The cancer has spread more extensively within the chest Staging determines how extensive Abnormal blood chemistry tests: may and, generally to the major lymph nodes. 8 (advanced) the cancer is. There are a suggest the presence of metastases in Stage IV Cancer has spread to other parts of the body, such as the variety of tests available to stage lung bone or the . liver or . cancer.5 With early stage disease there is the chance Radiological/nuclear medicine of a cure if the tumour can be successfully X-rays: detect a localised mass in the lungs surgically removed. Late stage disease has a or enlarged lymph nodes in the chest. worse prognosis than earlier stage disease.

Computed tomography (CT) scan: a computer assisted technique which produces cross-sectional images of the body to confirm the size and location of a mass as well as possible spread to other organs.

7/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

Prognosis Figure 2 Lung cancer average 5 year survival rates depending on stage at diagnosis Cancer statistics often use an ‘overall 5-year survival rate’ to give a better idea of the longer term outlook for people with a particular cancer. Five year survival rates for lung cancer are poor when compared to other high incidence cancers. For example, the five year survival rate for patients with is up to 89%.3 For lung cancer patients that figure is only around 15%.4

Average 5 year survival rates at Stage I NSCLC: 58% Average 5 year survival rates at Stage IV NSCLC: 7.5%

Cancer Research UK: http://www.cancerhelp.org.uk/type/lung-cancer/treatment/statistics-and-outlook-for-lung-cancer#nonsmall

8/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

Section 2 Epidemiology

2000 where it accounts for an average of i. Incidence & mortality Figure 3 Lung cancer incidence by region 20.3% of all cancer deaths.8 Lung cancer is the most common type of North America Central & South America Europe Asia Africa Australia & New Zealand cancer worldwide (accounting for 16.5% The average estimated age-standardised of all cancers), and is responsible for million deaths million new of cases are from lung cancer cases of lung non-small cell incidence per 100,000 population was 71.8 the greatest number of cancer deaths 1.38 every year 1.6 cancer every year 85% lung cancer for men and 21.7 for women, across the worldwide. Accounts for 28.4% of all cancer deaths in North America European Union (25-member states), in Accounts for an average of 20.3% of all cancer deaths in Europe 2006.8 Worldwide •  1.6 million new cases of lung cancer are 28.4% 20.3% North America and Canada Lung cancer diagnosed every year.1 Accounts for an average is the most common cause of cancer death •  It is the most common cancer in men, of 16.3% of all cancer 16.3% deaths in Eastern, South in North America, accounting for 28.4% and the third most common cancer Eastern, South Central and Western Asia of all cancer deaths, and is the third most in women in both developed and 8 common type of new cancer cases (14.5%) developing countries. Accounts for an 9% average of 9% in this region. North America has one of 11.6% of cancer deaths •  Lung cancer is the leading cause of Accounts for an average of in Southern and 11.6% of all cancer deaths Northern Africa the highest lung cancer incidence rates for cancer mortality and is responsible for in South and Central America 1 22.4% men and women with approximately 1.75 1.38 million deaths each year. Accounts for an average of 22.4% of all cancer deaths in Australia, million new cancer cases and deaths in •  Each day, more than 3,000 people die New Zealand and Micronesia 8 MD et al. Global Cancer Statistics, 2002. CA Cancer J Clin 2005; 55:74-108 2007. from lung cancer worldwide, equal to two Allen J et al. Neoadjuvant Chemotherapy in Stage III NSCLC J Natl Compr Canc Netw. 2008 6 (3):285-93 Garcia M, et al. Global Cancer Facts & Figures 2007. Atlanta, GA: American Cancer Society, 2007 deaths every minute.2 South and Central America Lung cancer •  Almost half of the diagnosed cases *Developed countries defined as Europe, Japan, Europe Lung cancer is the leading cause of is the most common cause of cancer death of lung cancer occur in developing Australia, New Zealand and North America. cancer related death in Europe, accounting in South and Central America (accounting countries (49.9%), with the incidence Developing countries defined as Africa, Latin for 18.9% of all cancer deaths in Western for 12% and 11.6% of all cancer deaths, generally being lower in women (globally, America and the Caribbean, Asia, Micronesia, Europe and 21.1% of all cancer deaths in respectively).8 12.1 per 100,000 women compared to Polynesia and Melanesia Northern Europe.8 Approximately 375,000 35.5 per 100,000 in men). cases were attributed to lung cancer in

9/ 11 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

Asia Lung cancer is the most common Figure 4 Incidence and mortality of some of the most common cancers worldwide cancer diagnosed in South Eastern Asia

(accounting for 13.3% of all cancer deaths) 1,092 515 Lung and the second most common cancer 948 427 diagnosed in Eastern and Western Asia 1,384 Breast (diagnosed in 17.1% and 12.8% of all 458 cancer cases, respectively).8 It is also the 663 571 leading cause of cancer death in Eastern, Colorectum 320 288 Western and South Eastern Asia accounting 640 348 for 20.9%, 18.1% and 17.8% of all cancer Stomach 463 273 deaths, respectively), and the second 523 226 most common cause of cancer death Liver among South Central Asian populations 478 217 (accounting for 8.2% of all cancer deaths).8 899 Prostate China and Japan in particular have a high 258 incidence and death rate by comparison to 1000,000 500,000 500,000 1000,000 the rest of the world. Male Female

Incidence and mortality of some of Incidence Incidence Africa Lung cancer is the third most the most common cancers worldwide Adapted from GLOBOCAN 2008 Mortality Mortality common type of cancer (6.9%), as well as the third most common cause of cancer death (at 8.5%) in Northern Africa. It is the Australia Lung cancer is the most common second most common cause of cancer cause of cancer deaths in Australia and death in Southern Africa, at 9.5%.8 New Zealand (19.6%), and in Micronesia (25.2%).8

10/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

Section 3 Treatment Treatment options vary depending on the In general the treatment options for these cases chemotherapy is often used iv. Biological (targeted) type and stage of the cancer in addition to NSCLC are: to treat patients. The most common therapy its size, position in the lung, whether it has used in NSCLC are based This is a relatively a new approach to spread to other parts of the body and the on a platinum-containing regimen in i. Surgery cancer treatment that target specific overall physical health of the patient. combination with a second therapeutic Patients with early stage, localised NSCLC biological processes often essential to agent. Patients usually receive treatment may be successfully treated using surgery. tumour growth. Biological therapy can in a number of defined “cycles” as the Up to 70% of patients survive for at least include monoclonal antibodies, vaccines incremental benefit of giving continuous five years after diagnosis if treated at this and gene therapies. As biological therapies chemotherapy does not outweigh the stage, with a proportion of these patients precisely target cancer-specific processes, cumulative toxicities experienced. being cured. they may potentially be more effective than other types of treatment (such as First-line treatment refers to the initial chemotherapy and radiotherapy) and less ii. Radiotherapy therapy a patient receives for advanced toxic to non-cancerous, healthy cells.12 For patients whose cancer cannot be disease. Several types of biological therapy exist operated on, radiotherapy may be offered Treatment until progression/ for the treatment of advanced non-small alone or in combination with chemotherapy. maintenance therapy describes treatment cell lung cancer. These are either given as In addition, radiotherapy also has a well given immediately following first-line monotherapy or in conjunction with other established role in providing control and treatment, when the tumour has not therapies at various stages of advanced relief of the symptoms of lung cancer. progressed. disease (in accordance with their approved label). Second line treatment that patients iii. Chemotherapy receive after a first-line treatment, following The majority of cases of NSCLC cases disease progression. diagnosed at an advanced stage1 when the cancer has already spread to another part of the body and can no longer be successfully removed by surgery. In

11/ 12 Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References

References

1 GLOBOCAN 2008 facts about lung cancer at http://globocan.iarc.fr/factsheet.asp. 9 IARC (2004). . In: IARC Monographs on the Evaluation of Carcinogenic Risks to Accessed 15.05.12 13. Humans, Volume 83, Tobacco smoke and involuntary smoking Lyon, France: International Agency for Research on Cancer. 51-1187 2 1.38 million deaths per year / 365 days – 3,771 deaths per day / 24 hours = 157 deaths per hour / 60 minutes = 2.61 deaths per minute 10 US Environmental Protection Agency. A Citizen’s Guide to Radon. http://www.epa.gov/radon/pdfs/ citizensguide.pdf Accessed 22.02.10 3 American Cancer Society. Breast Cancer Facts and Figures 2009-2010. Atlanta. American Cancer Society Inc. 11 Boffetta P and Trichopoulos D (2008). in cancer epidemiology. In: Adami HO, Hunter DJ, 17. Trichopoulos D, eds., Textbook of cancer epidemiology. Oxford: Oxford University Press 4 Lung cancer 5 year survival rates at http://lung-cancer.emedtv.com/lung-cancer/lung-cancer-surviv 109 – 126 al-rate-p2.html. Accessed 11.05.11 12 National Cancer Institute. Targeted cancer therapies. Last accessed April 2011 at http://www. 5 Barzi A and Pennell NA. Targeting in non-small cell lung cancer: agents in practice cancer.gov/cancertopics/factsheet/Therapy/targeted and clinical development. EJCMO (2010). 2(1):31-42

6 Schiller JH, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. NEJM (2002). 346(2):92-98

7 Cancer Research UK: About Lung Cancer at http://www.cancerhelp.org.uk/type/lung-cancer/about/. Accessed 11.05.11

8 WHO World Cancer Report 2008. Edited by Peter Boyle and Bernard Levin. Lung cancer, 12. Chapter 5.10

12/ 12