Lung cancer
What is this ?
Lung cancer, or bronchial cancer, affects more than 50,000 patients each year in France (52,777 new cases in 2023 according to data from INCa).
This cancer occurs as a result of the transformation of a normal cell into a cancerous cell in the lungs. It is the third most common cancer in women, with 19,339 new cases (after breast cancer and colorectal cancer), and the second most common in men, with 33,438 new cases (after prostate cancer).
Since 2010, the number of cases has been very slightly decreasing among men (-0.5% per year), but increasing significantly among women (+4.3% per year on average)
It is the leading cause of cancer death in France.
It is considered the second leading cause of cancer death in women behind breast cancer. It is the leading cause of cancer death in men. The median age at diagnosis of lung cancer in men is 68 years and 66 years in women.
Learn more about lung cancerTypes of lung cancers:
Two types of bronchial cancers exist and are different both in appearance and management:
- Non-small cell lung cancer (NSCLC). It accounts for 85% of all lung cancers. In this category, the 3 most common subtypes are:
• Adenocarcinoma
• Squamous cell carcinoma
• Large cell carcinoma
- Small cell lung cancer (SCLC). It affects 15% to 20% of patients with lung cancer.
Interview with Professor Fabrice Barlesi
Learn more about screening of lung cancerCauses and risk factors
The risk factors for lung cancer are multiple and varied.
The primary risk factor is tobacco, which is considered the leading factor involved in the development of lung cancer and is responsible for 8 out of 10 lung cancers.
Environmental or occupational factors have an impact on the development of bronchial cancers. These include asbestos, exhaust gases, hydrocarbons, etc.
There is no hereditary transmission risk for lung cancer.
Tobacco and Cancer
Tobacco is responsible for 75,000 deaths, including 45,000 due to cancer, each year in France.
It is thus the most significant avoidable risk factor for cancer: it is estimated that, without tobacco, nearly one-third of cancer deaths could be avoided.
Tobacco causes 1 in 5 cancers, responsible for lung, bladder, colon, liver, pancreas, cervix, kidney, mouth cancers, etc.
Learn more about the causes and risk factors of lung cancerSymptoms
The most common symptoms of lung cancer combine both respiratory issues and an unexplained decline in the patient’s overall condition:
- Persistent cough
- Shortness of breath
- Hoarseness or voice changes
- Unusual and persistent fatigue
- Presence of blood in sputum
- Loss of appetite
- Fever
- Unexplained weight loss
- Respiratory infections
- Significant, unexplained acute or chronic pain
Diagnosis
Different tests can diagnose lung cancer. The characteristics of the cancer help doctors decide which tests to perform: its histological type (the type of cells involved) and its stage (extent of spread).
To obtain a comprehensive diagnosis and understand all the characteristics of the cancer, the medical team will conduct various tests:
- Imaging for staging : this includes a chest X-ray, a CT scan of the chest, a CT scan or MRI of the brain, and a PET scan.
- Histological diagnosis : After a biopsy, the pathologist will analyze the tissues to determine the type and histological subtype of the cancer and identify any biological markers that may indicate prognosis and treatment response (such as PDL1). This biopsy may be performed via bronchoscopy, CT-guided needle biopsy, or surgical techniques.
- Molecular analysis : To search for potential mutations in the DNA of cancer cells that could guide treatment.
Treatments
Tobacco is responsible for 8 out of 10 lung cancers. The first part of the treatment will be to stop smoking completely.
Next, the oncologist will choose treatments based on several criteria:
- The type of cancer: Non-Small Cell Lung Cancer (NSCLC) or Small Cell Lung Cancer (SCLC)
- The stage of the disease: Stage I, Stage II, Stage III, Stage IV
- Whether the patient is operable or not
- Whether the tumor is resectable (i.e., can be removed through surgery) or not
- Specific molecular alterations: ALK, EGFR, ROS1
- The patient's overall health and other medical conditions
Treatment strategies for non-small cell lung cancers may include surgery, chemotherapy, radiation therapy, targeted molecular therapy (in the case of specific molecular alterations), and immunotherapy.
For small cell lung cancer, given its high tendency for dissemination, surgery is rarely performed. Treatment choices also consider whether the tumor can be irradiated and include chemotherapy, radiation therapy, and immunotherapy.
Learn more about lung cancer treatmentsWhat makes the difference
1 - Rapid management
Lung cancer can progress rapidly. Therefore, it is recommended not to wait more than 6 weeks between the first consultation and the start of treatment.
2 - Wide range of available treatments
Significant progress has been made in recent years, and there are now many treatments available.
These treatments include local treatments (surgery, radiotherapy, radiofrequency, cryotherapy), as well as drug treatments (chemotherapy, immunotherapy, targeted therapies, some of which are taken orally).
Finally, physicians combine treatments in different ways depending on the type, stage, and location of cancer.
3 - Individualization of therapeutic strategy to the exact subtype of lung cancer
Especially for metastatic cancers, the therapeutic strategy is tailored to the exact subtype of cancer.
This subtype is determined on biopsy by histological examination . Molecular biology is also performed to study the DNA of cancer cells to establish their exact identity.
Thus, if a mutation is found on the DNA, the best treatment will be oral targeted therapy. If the PD-L1 protein is present on a majority of cancer cells, the best treatment will be immunotherapy alone . If PD-L1 protein is rare, the best treatment will be a combination of chemotherapy and immunotherapy .
The patient's overall health and nutritional status, as well as other health issues, individualize the treatment.
This is called " Ã la carte " treatment, which allows the patient to be offered the best treatment for their disease and for them.
4 - Early supportive care
It has been shown that in metastatic stages (stage IV), early implementation of supportive care has been shown to improve both the quality of life and life expectancy. Supportive care involves tailored treatment of the patient's symptoms.
This also entails comprehensive patient care, which may include psychological and social support if needed. Patients may encounter a specialized team for this supportive care.
There is still much progress to be made, especially in terms of management strategies. These advancements can occur in both early and advanced stages. Hence, physicians should prioritize inclusion in clinical trials.
Radiotherapy is a cancer treatment that utilizes the properties of ionizing radiation against tumor cells. These radiations induce damage to the DNA.
While the rays cannot completely spare healthy cells, these cells have the ability to repair their DNA afterward, unlike tumor cells, which are more vulnerable. The effect of radiotherapy is localized (only where the rays are directed), similar to surgery, and can be synergistic with other treatments, particularly chemotherapy.
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Article updated on Sep 27, 2024
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