Clearing The Air: Signs, Symptoms & Treatment Options For Lung Cancer
Medically reviewed on Feb 22, 2018 by L. Anderson, PharmD.
Can You Name the Leading Cause of U.S. Cancer Deaths?
A recent survey put out by the American College of Chest Physicians asked this question above. Most participants answered breast, colon and skin cancer. But they were wrong. In fact, lung cancer is ranked as the number one contributor to cancer death in the U.S.
Did you know that lung cancer is also the most common cancer globally and is responsible for 1 in 5 cancer deaths? While rates are declining in men, they are drastically rising in women. Why don't we recognize that lung cancer is the #1 cancer killer in the U.S? Probably because we need to raise more awareness around lung cancer and the impact it has on patients.
Who's At Risk for Lung Cancer?
Obviously, the first thing that might come to your mind is smokers. And you're right. Smoking is the #1 cause of lung cancer. But you don't have to be a smoker to get lung cancer. Frankly, anyone is at risk for lung cancer. Exposure to toxins like radon, asbestos, arsenic, beryllium, and uranium have all been linked with lung cancer. A personal or family cancer history, second-hand smoke, radiation, and other diseases such as tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) are risk factors, too. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. In 2016, the NIH estimated that 224,390 new lung and bronchus cancer cases would occur, with over 150,00 deaths. This equates to over 26% of all cancer deaths.
What's the Real Risk in Non-Smokers?
British researchers looked at data from 2008-2014 and found that over a 7-year period the number of nonsmokers diagnosed with NSCLC rose from 13 to 28 percent. Studies in the U.S. confirm these findings and that nonsmokers with lung cancer were more frequently women. Lung cancer in nonsmokers seems to have a different genetic make-up from smokers. Researchers aren't sure why lung cancer diagnosis in nonsmokers is growing, or why women seem especially vulnerable.
Other risk factors besides smoking may come into play. In addition, nonsmokers lived about twice as long (51 months) as nonsmokers (25 months) after a lung cancer diagnosis.
Symptoms: How Do I Recognize Them?
As with all cancers, lung cancer is best treated early. But early lung cancer is not always linked with noticeable symptoms; often it's discovered during an x-ray or other test for respiratory infections, such as pneumonia. If you've been diagnosed with lung cancer, be sure to work with a pulmonologist, oncologist and other specialists for treatment options. A persistent cough and shortness of breath are the most noticeable symptoms. Other symptoms include:
Other Symptoms: Lung Cancer That Has Spread
When lung cancer spreads throughout the body (metastatic lung cancer) there can be additional symptoms before it's diagnosed:
- Unexplained weight loss
- Bone or joint pain
- Unexplained broken bones
- Unexpected blood clots or bleeding
- Unsteady movement
- Memory loss
- Swelling of the neck or face
Doctor's Orders: If You Smoke, Stop
Get to a doctor if you have symptoms you think need to be checked out: especially if you are a smoker. The survival rate is over 50% when detected at an early stage localized in one area of the lung. Early diagnosis and treatment with surgery or radiation can lead to a cure in many patients with lung cancer.
But you MUST stop smoking (get stop smoking help here). If you continue to smoke or restart, your chances of lung cancer returning after treatment are substantial. Plus treatment itself is hard on the lungs, so you need the best lung function possible. Ask your doctor for help to quit smoking.
The Lung Cancer Battle: A March Forward
The good news is that a new kind of therapy, "targeted" drug therapies, are now available for treatment. Not long ago, patients with advanced lung cancer had few options - surgery, radiation, hospice. The advent of lung cancer drugs (standard chemotherapy) allowed about 30% of patients to see tumor shrinkage, but survival usually did not usually surpass one year.
Today, new targeted treatments like Opdivo have been shown in clinical studies to extend lung cancer survival longer than traditional chemotherapy.
Some Are Missing Out On Treatment
Lung cancer can be of two different types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC is by far the most common, affecting up to 85 to 90 percent of lung cancer cases.
New, targeted medicines specific for certain types of tumors are helping to personalize drug treatment. Yet, too many people with lung cancer don't get treatment. In fact, of those with any type of cancer who never receive treatment, 68% have lung cancer.
Treatment Options: Non-Small Cell Lung Cancer
For treatment of NSCLC, surgery, radiation, targeted therapy and chemotherapy are options. Surgery, removing part or all of the lung, is recommended in early detected, localized tumors. Surgery may be combined with radiation treatment and/or chemotherapy in more advanced disease.
Even if the cancer has spread, drug treatment may slow the cancer growth, ease symptoms, and prolong life. Treatment is always individualized for each patient based on the cancer type, the patient's underlying health, and treatment preferences.
Targeted Drug Therapy: A Significant Advance
Not all cancer cells are the same. With special tests, genetic abnormalities (mutations) can be looked for in a tissue sample from a targeted therapy specific for that cancer type.
Targeted therapy works differently than chemotherapy. Targeted drugs kill the cancer cells with less chance of harming the healthy cells, but may be used in combination with other cancer treatments. Side effects of targeted treatment may be more tolerable. Plus, many new targeted therapies can be given as a pill instead of as an injection at the clinic every 3 weeks.
Targeted Drug Treatments
Targeted drugs are often classified by how they work or what part of a cell they target. Examples of targeted therapies for NSCLC include:
- EGFR inhibitors, such as cetuximab (Erbitux), gefitinib (Iressa), afatinib (Gilotrif), lapatinib (Tykerb), necitumumab Portrazza, osimertinib (Tagrisso), and erlotinib (Tarceva)
- Kinase inhibitors, such as crizotinib (Xalkori), alectinib (Alecensa), ceritinib (Zykadia), and brigatinib (Alunbrig)
- VEGF/VEGFR inhibitors such as bevacizumab (Avastin), the biosimilar for Avastin called Mvasi (bevacizumab-awwb), and ramucirumab (Cyramza)
- Immunotherapy drugs like pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), and durvalumab (Imfinzi)
Side Effects With Targeted Treatment
Side effects with cancer therapies can be a concern for many patients. However, targeted therapies may be better tolerated than chemotherapy, although monitoring for serious side effects will be needed. Some agents can cause serious immune-mediated reactions in many organs of the body. Skin rash, nail changes, constipation, cough, diarrhea, fatigue, muscle pain, and shortness of breath can be common side effects.
Be sure to ask your doctor about specific side effects that might occur with your medication. Often, side effects that occur with cancer treatments can be lessened by treatment with other medicines, changes in dose schedule, or with a drug change.
Treatment Options: Small Cell Lung Cancer
Small cell lung cancers (SCLC) grow aggressively and can spread to other parts of the body very fast, so treatment and cure are difficult. SCLC usually occurs in smokers, and about 90% of people who are diagnosed with SCLC are current or former smokers. NSCLC is usually found in nonsmokers.
Treatment for SCLC may include standard chemotherapy with or without radiation. Surgery is not typically used because the cancer has usually already spread to other organs by the time of diagnosis. Chemotherapy and radiation may not be curative, but they can help to relieve symptoms such as bone pain.
Standard Chemotherapy: Another Option for Lung Cancer
If specific genetic targets are not found on a lung cancer tumor, standard chemotherapy may be an option to slow or stop tumor growth, even if only temporarily. Chemotherapy is usually given in cycles, once every 21 days, with a rest period to recover from side effects. Four to six cycles is standard. Common chemotherapy drugs, often used in combination, may include:
Side Effects: Chemotherapy
Hair loss? Nausea? Side effects are one of the biggest concerns patients have with chemo treatment. These drugs may be linked with higher rates of side effects because they don't specifically target just the cancer cells; healthy cells are impacted, too. But many side effects are anticipated and can be managed with medications during chemo. For example, it is standard treatment to manage nausea with medications before chemo treatment. Hair loss, while difficult, is a temporary side effect, too. Other possible side effects include:
- Weight loss
- Neuropathy, or a numb or tingling feeling in the extremities
- Loss of appetite
- Skin rash
Join Forces: Clinical Trial Registries
If target drugs are not yet approved for your specific type of lung cancer, it may be that a clinical trial is ongoing that you could join. Understanding what a clinical trial is will help you to decide if one is right for you. Your healthcare team will also explain the specifics and help you join a trial if one is available.
Clinical trials are not the right choice for everyone; it is a personal and family decision made in conjunction with your healthcare provider. However, you can view some clinical trials for lung cancer at Clinicaltrials.gov and the National Cancer Institute. Your doctor may know of clinical trials not listed here, as well.
Group Support Can Be Meaningful
Your healthcare team should always be your top source for medical information about lung cancer treatment. However, a community forum with patients like you who are receiving the same treatments can give you an extra outlet.
Consider joining the Drugs.com Lung Cancer Support Group where you can voice concerns, ask questions, and keep up with the latest news and new drug approvals for lung cancer. Sharing your own experience may help others to cope and gain strength for the tough times, as well.
Finished: Clearing The Air: Signs, Symptoms and Treatment Options For Lung Cancer
- FDA Expands Approval of Imfinzi (durvalumab) to Reduce the Risk of Non-Small Cell Lung Cancer Progressing. February 16, 2018. Accessed February 22, 2018 at https://www.drugs.com/newdrugs/fda-expands-approval-imfinzi-durvalumab-reduce-risk-non-small-cell-lung-cancer-progressing-4700.html
- Chest. American College of Chest Physicians. Lung Cancer. Accessed March 5, 2017 at http://www.chestnet.org/Foundation/Patient-Education-Resources/Lung-Cancer/Symptoms
- Kevin MD. Blog. Why we need to pay attention to lung cancer. Accessed March 5, 2017 http://www.kevinmd.com/blog/2015/10/why-we-need-to-pay-attention-to-lung-cancer.html
- American Cancer Society. Lung Cancer (Non-Small Cell) Detailed Guide. Accessed March 5, 2017 at http://www.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf
- National Cancer Institute. SEER Stat Fact Sheets: Lung and Bronchus Cancer. Accessed March 5, 2017 at http://seer.cancer.gov/statfacts/html/lungb.html
- Tecentriq Product Labeling. Genentech Inc. South San Francisco, CA. Updated 10/2016. Accessed March 5, 2017 at https://www.gene.com/download/pdf/tecentriq_prescribing.pdf.