Take a deep breath in, and a deep breath out. Most people don’t spend a whole lot of time thinking about their lungs, but as a part of our respiratory system they provide a vital service to our body. They allow us to breathe. Lung cancer includes several types of cancer that start in the lungs. That is, when the cells that make up the lungs no longer grow or function as they are meant to. In this page we will discuss lung cancer and its management.
Anatomy
In order to better understand lung cancer, it is helpful to have an idea of how healthy lungs look and function. Your lungs are a pair of organs that are located in your chest on either side of your heart. Each lung is made up of smaller sections called lobes. Your right lung has three lobes, and your left lung has two.
Air reaches the lobes of your lungs each time you breathe in. In order to get there, the air travels through your nose or your mouth, to your trachea. Some people call the trachea their windpipe. From the trachea, the air must then move through smaller tubes called bronchi, which fork like the branches of a tree into smaller bronchioles. At the very end of the bronchioles are tiny sacs called alveoli, which to me resemble grapes on a vine. The alveoli are where all the action occurs: here, your body can absorb oxygen into its bloodstream, and get rid of waste such as carbon dioxide. This process occurs each time you breathe in and out, and it happens without you having to think about it at all.
In general, there are two main classes of cancer that start in the lungs, which are based on the type of cell that is involved. These categories are small cell lung cancer, and non-small cell lung cancer. We will discuss these further below.
Non-Small Cell Lung Cancer (NSCLC)
The vast majority of lung cancers are categorized as non-small cell lung cancer, with around 80% of lung cancers included here. Within this larger category, there are several more specific diagnoses. These include:
- Adenocarcinoma: this is a form of lung cancer that starts in the epithelial cells that line the lungs.
- Squamous cell carcinoma
- Large cell carcinoma
- Large cell neuroendocrine carcinoma
There are others as well, but they are far less common than those listed above. NSCLCs are all grouped together because, for the most part, treatment is similar. On the other hand, it differs from how Small Cell Lung Cancer is tackled.
Small Cell Lung Cancer
Small Cell Lung Cancer makes up a small percentage of lung cancers, approximately 10-15%. As this type of cancer tends to grow and spread more quickly than other lung cancers, it is often considered more aggressive. It is treated differently than NSCLC, and tends to respond well to both chemotherapy and radiotherapy.
Treatment
The treatment for lung cancers depend on the specific diagnosis, and can be multifactorial. Often, treatment will include one or more of: surgery, radiation, and chemotherapy. Immunotherapy, which harnesses the body’s immune system to combat cancer, is also becoming a mainstay treatment for certain types of lung cancer. Treatment plans will depend on where the cancer is, how much cancer is present, and whether or not it has spread to other locations. Surgical, radiation, and medical oncologists often work together to come up with a plan that is individualized to the patient and their disease.
In the case of NSCLC, surgery is often one of the major components of treatment. In some cases, chemotherapy is also delivered before, after, or both before and after surgery. This can be combined with immunotherapy for certain cancers, as well. Metastatic NSCLC can also be managed with chemoimmunotherapy, and the specific choice of medication is determined based on the cancer's specific characteristics.
SCLC is usually managed with a combination of chemotherapy and radiation, rather than surgery. These patients are often closely monitored for spread of the disease to other areas, including the brain. Treatment is generally catered depending on the cancer's initial response, and how long it takes to recur after treatment.
References:
1. https://www.cancer.org/cancer/types/lung-cancer/about.html
2. https://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-lu-nsclc-summary.pdf
3. Minna, J. D., Roth, J. A., & Gazdar, A. F. (2002). Focus on lung cancer. Cancer cell, 1(1), 49-52.
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