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Clearing The Air: Signs, Symptoms and Treatment Options For Lung Cancer

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 8, 2022.

Can You Name the Leading Cause of U.S. Cancer Deaths?

A survey put out by the American College of Chest Physicians asked this question: "Can You Name the Leading Cause of U.S. Cancer Deaths?."

  • 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. It accounts for 24% of all cancer deaths, as noted by the CDC.
  • More people die of lung cancer annually than the sum from colon, breast, and prostate cancers deaths. However, rates of lung cancer are on the decline, dropping for men over the past few decades, but only for about the last decade in women.

The leading types of cancer overall are non-melanoma skin cancer, as well as prostate cancer (in men) and breast cancer (women). Lung cancer comes in as the second most common type of cancer. But it's the number one killer.

The American Cancer Society’s estimates for lung cancer occurrence in the U.S. for 2022 are:

  • Roughly 236,740 new cases of lung cancer (117,910 in men and 118,830 in women)
  • Close to 130,180 deaths from lung cancer (68,820 in men and 61,360 in women)
  • About 80% of lung cancers are classified non-small cell lung cancer (NSCLC) and 14% are small cell lung cancer (SCLC).

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 and is repsonsible for 80% of cases. This includes cigarettes, cigar and pipe smoking. 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 gas is the 2nd leading cause of lung cancer. Radon is released from the soil and can accumulate in indoor air.
  • Exposure to secondhand smoke.
  • Exposure to other cancer causing chemicals such as asbestos, and metals like arsenic, chromium, and cadmium 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.
  • Air pollution and diesel exhaust.
  • Abnormal gene changes that can alter lung cells and cause cancer.

Occupations at high risk for lung cancer occurrence include those in rubber manufacturing, paving, roofing, painting, and chimney sweeping.

What's the Real Risk in Non-Smokers?

Maybe you've never smoked a cigarette in your life, but are still at risk for lung cancer?

  • The simple answer is, yes. As many as 20% (20 of every 100 people) who die from lung cancer in the US every year have never smoked or used any other form of tobacco. Non-smokers are considered to be those who have smoked less than 100-lifetime cigarettes.
  • In general, the number of lung cancers overall are declining, but the rate of lung cancer in non-smokers is increasing. According to the American Cancer Society, lung cancer in people who have never smoked is one of the most fatal cancers in the United States.
  • Lung cancer in non-smokers is usually a type of cancer known as non-small cell lung cancer, with adenocarcinoma being the most common type. These types of cancers often have genetic mutations, but medicines for treatment have been developed that can target these mutations.
  • Non-smoking women are more likely to get lung cancer than non-smoking men, but once they are diagnosed with lung cancer women tend to live longer than men.

Second-hand smoke is a real risk: Each year, about 7,000 adults die of lung cancer as a result of breathing secondhand smoke, based on data from the according to the American Cancer Society. Exposure to second-hand smoke is estimated to cause 2.7% of new cases in 2022, the equivalent of about 6,400 people.

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:

  • Coughing up blood
  • Chest, shoulder, or back pain
  • Voice hoarseness
  • Recurring lung infections (such as pneumonia or bronchitis)
  • Difficulty swallowing

Other Symptoms: Lung Cancer That Has Spread

When lung cancer spreads to other areas of the body, known as metastatic lung cancer, there can be additional symptoms before it's diagnosed:

  • Unexplained weight loss
  • Weakness
  • Fatigue
  • Bone or joint pain
  • Unexplained broken bones
  • Headaches
  • 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 and 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 help to quit smoking here. Talk to your doctor or other healthcare provider about how to most effectively quit, for good.

  • If you continue to smoke or restart, your chances of lung cancer returning after treatment are substantial.
  • Plus lung cancer treatment itself is hard on the lungs, so you need the best lung function possible.
  • Ask your doctor for help to quit smoking. Combining medications with group therapy has been shown to be the most effective method.

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 such as standard chemotherapy allowed about 30% of patients to see tumor shrinkage, but survival did not usually surpass one year.

Today, new targeted treatments like Opdivo (nivolumab) 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 over 80% 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.

Learn More: Clearing The Air: Signs, Symptoms & Treatment Options For Lung Cancer

Should I Be Screened for Lung Cancer?

The US Preventive Service Task Force recommends yearly lung cancer screening with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.

  • A pack-year is a way of calculating how much a person has smoked in their lifetime. One pack-year is the equivalent of smoking an average of 20 cigarette (1 pack) per day for a year.
  • For example, if you have smoked one pack a day for the last 20 years, or two packs a day for the last 10 years, you have a 20 pack-year smoking history.

Talk to your doctor about your smoking history or other risk factors, even if you have quit, and discuss your need to be screened for 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 when localized tumors are detected early. 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 (also called mutations) can be looked for in a tissue sample. Targeted therapy for that specific cancer type can then be selected by your doctor as a treatment option.

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, although they may be still be significant, so talk to yout doctor about treatment side effects and what to expect.
  • Plus, many new targeted therapies can be given as a pill instead of as an injection at the clinic every few weeks, easing the treatment regimen considerably.

Targeted Drug Treatments

Targeted drugs are often classified by how they work or what part of a cell they target. Tumors may be tested with an FDA-approved test to determine if the treatment option is right for you. Examples of targeted therapies for non-small cell lung cancer (NSCLC) include:

EGFR inhibitors, such as:

Anaplastic lymphoma kinase (ALK) positive tumors, such as:

Targeted Drug Treatments, continued

Examples of more targeted therapies for non-small cell lung cancer (NSCLC) include:

VEGF/VEGFR inhibitors such as:

Immunotherapy drugs, examples include:

KRAS genetic mutation, which accounts for about 25% of mutations in NSCLC:

Targeted Treatments: More Options

In June 2018, Tafinlar (dabrafenib) + Mekinist (trametinib) was approved to treat patients with metastatic non-small cell lung cancer (NSCLC) whose tumors express the BRAF V600E mutation.

  • Among the 36 treatment-naïve patients receiving 150 mg of Tafinlar twice daily and 2 mg of Mekinist once daily, the overall response rate (ORR) was 61% (95% confidence interval [CI]: 44%, 77%). The most common side effects (incidence >20%) were fever, fatigue, nausea, vomiting, and diarrhea, among others.

In August 2019, the FDA approved Rozlytrek (entrectinib) from Genentech for the treatment of patients with ROS1-positive, metastatic non-small cell lung cancer (NSCLC). Rozlytrek is used with genomic testing.

  • In ROS1-positive, metastatic NSCLC studies, Rozlytrek reduced tumor size in 78% of people with a duration of response ranging from 1.8 to 36.8 months, or longer. Common side effects (≥ 20%) include: fatigue, constipation, altered taste, vomiting, edema, dizziness, and diarrhea, among others.

In Sept. 2020, the FDA approved Genentech’s Gavreto (pralsetinib). Gavreto is a RET kinase inhibitor used for the treatment of adults with metastatic rearranged during transfection (RET) fusion positive non-small cell lung cancer (NSCLC), as detected by an FDA approved test. Patients with RET gene alterations have limited treatment options. The Gavreto dose is 400 mg orally once daily on an empty stomach.

  • In the Phase I/II ARROW study, Gavreto demonstrated an overall response rate (ORR) of 57% in the group with NSCLC previously treated with platinum-based chemotherapy and 70% in a treatment-naïve group. Commonly reported side effects (≥25%) were fatigue, constipation, musculoskeletal pain and increased blood pressure (hypertension).

NSCLC with MET Exon 14 Skipping

Another genetic mutation in NSCLC is mesenchymal-epithelial transition (MET) Exon 14 Skipping. About 3% to 4% of patients with metastatic NSCLC have this mutation (4,000 to 5,000 patients each year in the U.S). Molecular testing for MET exon 14 skipping should be performed on all lung cancers.

In May 2020 the U.S. Food and Drug Administration (FDA) approved Novartis’ Tabrecta (capmatinib) for the treatment of adults with metastatic NSCLC with these specific mutations.

  • Tabrecta is classified as a kinase inhibitor that targets MET and is approved for first-line therapy. It is given as a 400 mg oral tablet twice daily with or without food.
  • Common side effects include leg swelling, nausea, fatigue, vomiting, shortness of breath and decreased appetite.

In Feb. 2021, Serono’s Tepmetko (tepotinib) was given accelerated approval to treat adults with metastatic non-small cell lung cancer (NSCLC) with MET exon 14 skipping alterations.

  • Tepmetko is given as two 225 mg tablets (450 mg) orally once daily with food until the disease worsens or there is unacceptable toxicity.
  • Common side effects include: edema (fluid build-up), fatigue, nausea, diarrhea, muscle and bone pain, and shortness of breath (dyspnea), among others.

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: 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.
  • Non-small cell lung cancer (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.

  • Atezolizumab (Tecentriq) and durvalumab (Imfinzi) target PD-L1, a protein found on some tumor and immune cells.
  • They are part of the first-line treatment for advanced SCLC, along with chemotherapy. This combination may help some people with SCLC live longer.
  • Either drug can then be continued alone as maintenance therapy.

In June 2020, the FDA approved Zepzelca (lurbinectedin) for the treatment of adults with metastatic small cell lung cancer (SCLC) with disease progression, after platinum-based chemotherapy. Zepzelca is an alkylating agent that interrupts the cell cycle causing cell death.

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 few weeks, with a rest period to recover from side effects. Four to six cycles overall 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.

Related: The Ferocity of Chemotherapy: Does The End Justify The Means?.

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 and after chemo treatment. Hair loss, while difficult, is usually a temporary side effect, too.

Other possible side effects include:

  • Weight loss
  • Neuropathy, or a numb or tingling feeling in the extremities
  • Vomiting
  • Loss of appetite
  • Skin rash

Join Forces: Clinical Trial Registries

If target drugs are not yet approved for your specific type of lung cancer, you may be able to join a clinical trial. Your healthcare team can 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

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Sources

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Further information

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