Non-Small Cell Lung Cancer Treatment in Delhi, India

Non-Small Cell Lung Cancer (NSCLC) is the most common type of lung cancer, accounting for a significant percentage of all lung cancer cases. It develops in the tissues of the lungs and is named "non-small cell" because the cancer cells are larger than small cell lung cancer cells when viewed under a microscope. Unlike small cell lung cancer, NSCLC tends to grow and spread more slowly.

Here's a list of the various types of non-small cell lung cancer.

• Adenocarcinoma: This is the most common subtype of NSCLC, arising from the gland cells in the outer linings of the lungs. It's more common in people who have never smoked or light smokers, and in women than men.
• Squamous cell carcinoma: This type starts in the flat cells lining the airways of the lungs. It's strongly linked to smoking and tends to occur in the central part of the lungs.
• Large cell carcinoma: This type can develop anywhere in the lung and can appear similar to other lung cancers under a microscope.
• Other less common subtypes include adenosquamous carcinoma and sarcomatoid carcinoma.

While the exact cause of NSCLC is not always clear, several risk factors are associated with its development:

• Smoking: Tobacco smoking is the leading cause of NSCLC. The risk increases with the duration and intensity of smoking.
• Secondhand smoke: Exposure to secondhand smoke, also known as passive smoking, can increase the risk of developing NSCLC.
• Environmental factors: Exposure to certain carcinogens, such as asbestos, radon, arsenic, and certain industrial chemicals, may increase the risk of NSCLC.
• Genetic factors: Some genetic mutations and inherited conditions may predispose individuals to NSCLC.
• Air pollution: Prolonged exposure to air pollution, particularly in urban areas with high levels of pollutants, may contribute to the development of NSCLC.

It's important to note that while these factors increase the risk of NSCLC, not everyone exposed to them will develop the disease. Additionally, NSCLC can occur in individuals without any known risk factors. Early detection through screening and prompt treatment can improve outcomes for individuals with NSCLC.

Non-Small Cell Lung Cancer (NSCLC) often doesn't cause symptoms in its early stages, and symptoms may not appear until the disease has progressed. However, when symptoms do manifest, they can vary depending on the size and location of the tumour, as well as whether the cancer has spread (metastasized) to other parts of the body. Common symptoms of NSCLC may include:

• Persistent cough: A cough that doesn't go away or worsens over time, especially if it produces blood (hemoptysis).
• Shortness of breath: Difficulty breathing or shortness of breath, which may worsen with physical activity.
• Chest pain: Pain in the chest, back, or shoulders that may worsen with deep breathing, coughing, or laughing.
• Wheezing: A whistling or wheezing sound when breathing, which may be due to narrowing of the airways caused by a tumour.
• Hoarseness: Changes in voice, including hoarseness or difficulty speaking, which may occur if the tumour presses on the nerves that control the vocal cords.
• Fatigue: Persistent tiredness or weakness, which may be due to the body's efforts to fight the cancer or the impact of the disease on overall health.
• Unintended weight loss: Loss of appetite and unintentional weight loss, which may occur as a result of the cancer or its treatment.
• Coughing up blood: Hemoptysis, or coughing up blood or bloody mucus, which can be a symptom of advanced NSCLC.
• Difficulty swallowing: Dysphagia, or difficulty swallowing, which may occur if the tumour presses on the oesophagus or if cancer spreads to the throat.
• Swelling of the face or neck: Enlargement of lymph nodes in the neck or above the collarbone (supraclavicular lymphadenopathy) due to cancer spread.

It's essential to remember that these symptoms can also be caused by conditions other than lung cancer. However, if anyone experiences any persistent or concerning symptoms, it's important to consult a healthcare professional for evaluation and diagnosis, especially if they are at risk for lung cancer (such as being a current or former smoker).

Diagnosis of Non-Small Cell Lung Cancer (NSCLC) typically involves several steps to confirm the presence of cancer, determine its type, stage, and extent of spread. Common diagnostic procedures and tests for NSCLC include:

Imaging tests

Imaging tests such as X-rays, CT (computed tomography) scans, PET (positron emission tomography) scans, and MRI (magnetic resonance imaging) scans can help identify suspicious areas in the lungs and evaluate the extent of the disease.

Biopsy

A biopsy is the definitive method for diagnosing lung cancer. During a biopsy, a small sample of tissue is collected from the lung tumour or a nearby lymph node and examined under a microscope by a pathologist to determine if cancer cells are present and to identify the type of lung cancer (e.g., adenocarcinoma, squamous cell carcinoma, or large cell carcinoma).

• Sputum cytology: In cases where tumours are located near the airways, a sample of sputum (mucus coughed up from the lungs) may be collected and examined for cancer cells.
• Bronchoscopy: A bronchoscopy involves using a thin, flexible tube with a camera (bronchoscope) inserted through the nose or mouth into the lungs to examine the airways and collect tissue samples for biopsy.
• Fine-needle aspiration (FNA): In this procedure, a thin needle is used to extract a small sample of tissue from a suspicious area in the lung, guided by imaging techniques such as CT or ultrasound.

Non-Small Cell Lung Cancer (NSCLC) staging is crucial for determining the extent of the cancer and guiding treatment decisions. The staging system most commonly used for NSCLC is the TNM system developed by the American Joint Committee on Cancer (AJCC). This system categorises cancer based on the size and extent of the primary tumour (T), the presence of cancer in nearby lymph nodes (N), and the presence of metastasis (M), which refers to the spread of cancer to distant organs or tissues. Here's an overview of the stages:

• Stage 0 (Carcinoma in situ): Cancer cells are found only in the top layers of cells lining the air passages, without invading deeper into the lung tissue or spreading beyond the lung.
• Stage I: Cancer is localised to the lung and has not spread to nearby lymph nodes or distant sites. It is divided into two sub-stages:
• Stage IA: The tumour is small and limited to the lung, without spread to lymph nodes.
• Stage IB: The tumour is larger than in IA but has not spread to nearby structures or lymph nodes.
• Stage II: Cancer has spread to nearby lymph nodes or structures within the lung. Stage II is also divided into two sub-stages:
• Stage IIA: Cancer has spread to nearby lymph nodes on the same side of the lung as the primary tumour.
• Stage IIB: Cancer may have spread to nearby lymph nodes and may involve nearby structures such as the chest wall, diaphragm, or membrane surrounding the heart (pleura).
• Stage III: Cancer has spread to lymph nodes in the mediastinum (the area between the lungs) or to structures in the chest beyond the lung where it originated. Stage III is further divided into:
• Stage IIIA: Cancer has spread to lymph nodes on the same side of the lung as the primary tumour.
• Stage IIIB: Cancer may have spread to lymph nodes on the opposite side of the chest or to nearby structures such as the heart, oesophagus, or major blood vessels.
• Stage IV: Cancer has metastasized to distant organs or tissues, such as the liver, bones, brain, or other parts of the body.

Once the cancer is staged, treatment decisions are based on the stage of the cancer, the overall health of the patient, and other factors such as the presence of specific genetic mutations.

Once NSCLC is diagnosed and staged, treatment options may vary depending on several factors, including the stage of the cancer, the patient's overall health, and personal preferences. Treatment for NSCLC may involve one or more of the following modalities:

Surgery

Surgery may be recommended for early-stage NSCLC to remove the tumour and surrounding tissue. Types of surgery include wedge resection, segmental resection, lobectomy (removal of a lobe of the lung), or pneumonectomy (removal of an entire lung).

Radiation therapy

Radiation therapy uses high-energy beams to target and kill cancer cells. It may be used as the primary treatment for early-stage NSCLC or in combination with surgery or chemotherapy for more advanced stages.

Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells or stop them from growing. It may be given before surgery (neoadjuvant chemotherapy) to shrink tumours, after surgery (adjuvant chemotherapy) to kill any remaining cancer cells, or as the primary treatment for advanced NSCLC.

Targeted therapy

Targeted therapy drugs are designed to specifically target cancer cells with certain genetic mutations or abnormalities. These drugs may be used alone or in combination with chemotherapy for NSCLC that has specific genetic mutations, such as EGFR mutations or ALK rearrangements.

Immunotherapy

Immunotherapy drugs work by helping the body's immune system recognize and attack cancer cells. They may be used as a first-line treatment for advanced NSCLC or in combination with chemotherapy or targeted therapy.

Treatment decisions are often made collaboratively by a multidisciplinary team of healthcare professionals, including oncologists, surgeons, radiation oncologists, and other specialists, taking into account the individual patient's circumstances and preferences. It's important for patients to discuss their treatment options, potential side effects, and goals of care with their healthcare providers to make informed decisions about their NSCLC treatment plan.

Preventing non-small cell lung cancer (NSCLC) involves minimising exposure to known risk factors and adopting healthy lifestyle habits. Here are some preventive measures:

• Avoid smoking and tobacco: Quit smoking and avoid exposure to secondhand smoke, which is a significant risk factor for NSCLC.
• Limit exposure to carcinogens: Minimise exposure to environmental carcinogens such as asbestos, radon, arsenic, and other chemicals known to increase the risk of lung cancer.
• Follow a healthy diet: Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Antioxidant-rich foods may help reduce the risk of cancer.
• Exercise regularly: Engage in regular physical activity to maintain a healthy weight and reduce the risk of cancer.
• Limit alcohol consumption: Drink alcohol in moderation, as excessive alcohol consumption is associated with an increased risk of lung cancer.
• Go for regular screening: For individuals at high risk, such as current or former smokers, consider lung cancer screening with low-dose computed tomography (LDCT) as recommended by healthcare professionals.
• Consider occupational safety: If you work in industries with potential exposure to lung carcinogens, follow occupational safety guidelines and use protective equipment to minimise risk.
• Ensure protection against radon: Test your home for radon gas and take measures to reduce exposure if levels are elevated.
• Consider genetic counselling: If you have a family history of lung cancer or other risk factors, consider genetic counselling to assess your risk and discuss preventive measures.

By adopting these preventive measures and minimising exposure to known risk factors, individuals can reduce their risk of developing non-small cell lung cancer. Regular medical check-ups and screening tests can also help detect cancer at an early stage when treatment is most effective.

Small cell vs non-small cell lung cancer: What’s the difference?

Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are two main types of lung cancer. SCLC tends to grow and spread more quickly than NSCLC, and it's often treated with chemotherapy. NSCLC, on the other hand, includes several subtypes such as adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, each with distinct characteristics and treatment approaches.

What are the potential side effects of the different treatment options for NSCLC?

Treatment options for NSCLC, including surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy, may have various side effects. Common side effects include fatigue, nausea, hair loss, changes in appetite, and increased susceptibility to infections. The severity and specific side effects vary depending on the treatment type and individual patient factors.

Can complementary or alternative therapies be used alongside conventional treatment for NSCLC?

Some complementary or alternative therapies, such as acupuncture, massage therapy, or certain dietary supplements, may be used alongside conventional treatments for NSCLC to help manage symptoms and improve overall well-being. However, it's essential to discuss these approaches with your healthcare team to ensure they are safe and compatible with your treatment plan.

What are some strategies for managing fatigue associated with NSCLC treatment?

Strategies for managing fatigue associated with NSCLC treatment include staying physically active, getting enough rest, maintaining a balanced diet, managing stress, and conserving energy by prioritising tasks and asking for help when needed. Your healthcare team can provide personalised advice and support for managing fatigue.

How can I maintain a healthy lifestyle and diet after a diagnosis of NSCLC?

Maintaining a healthy lifestyle and diet after a diagnosis of NSCLC involves eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, staying physically active, avoiding tobacco and excessive alcohol consumption, managing stress, and getting regular exercise and sleep.

Are there support groups available for people with NSCLC and their caregivers?

Yes, there are support groups available for people with NSCLC and their caregivers, both in-person and online. These support groups provide opportunities to connect with others facing similar challenges, share experiences, gain information, and receive emotional support throughout the cancer journey.

How often will I need follow-up appointments after treatment for NSCLC?

The frequency of follow-up appointments after treatment for NSCLC varies depending on individual factors such as the stage of cancer, type of treatment received, and any ongoing health concerns. Your healthcare team will recommend a follow-up schedule tailored to your specific needs, which may include regular check-ups, imaging tests, and blood tests to monitor for recurrence or complications.

What are the chances of NSCLC recurrence, and what can I do to reduce the risk?

The chances of NSCLC recurrence vary depending on factors such as the stage of cancer, type of treatment received, and individual patient characteristics. To reduce the risk of recurrence, it's essential to follow your healthcare team's recommendations for follow-up care, maintain a healthy lifestyle, avoid tobacco use, and attend regular check-ups and screenings.

How do the different subtypes of Non-Small Cell Lung Cancer (NSCLC) differ in terms of prognosis and treatment options?

NSCLC includes several subtypes, such as adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These subtypes have different characteristics, prognosis, and treatment options. Adenocarcinoma, for example, often occurs in non-smokers and may respond better to certain targeted therapies, while squamous cell carcinoma is often associated with smoking and may be treated differently.

How does the stage of NSCLC affect treatment decisions, and what are the criteria used for staging?

The stage of NSCLC plays a crucial role in determining treatment decisions. Staging involves evaluating the size and extent of the cancer, whether it has spread to nearby lymph nodes or distant organs, and helps guide treatment planning. Staging criteria include imaging tests, such as CT scans and PET scans, as well as biopsy results.

What role do genetic mutations, such as EGFR and ALK, play in NSCLC, and how do targeted therapies specifically address these mutations?

Genetic mutations, such as EGFR and ALK, are found in some NSCLC tumours and can influence treatment decisions. Targeted therapies specifically target these mutations, disrupting the cancer cells' ability to grow and survive. These treatments are often more effective and have fewer side effects compared to traditional chemotherapy for patients with these mutations.

How does smoking cessation impact the prognosis and treatment outcomes for NSCLC patients, even after diagnosis?

Smoking cessation is essential for NSCLC patients, as it can improve treatment outcomes, reduce the risk of complications, and enhance overall quality of life. Quitting smoking can also reduce the risk of developing a second primary lung cancer and improve the effectiveness of certain treatments, such as surgery and radiation therapy.

How does NSCLC affect different age groups, and are there any specific considerations or challenges for older adults diagnosed with the disease?

NSCLC can affect individuals of all ages, but older adults may face specific considerations and challenges, such as age-related health issues, comorbidities, and treatment tolerance. Healthcare providers may need to tailor treatment plans to accommodate older adults' needs and preferences, considering factors such as overall health, functional status, and goals of care.

What are the key factors that influence the prognosis of Non-Small Cell Lung Cancer (NSCLC),

The prognosis for Non-Small Cell Lung Cancer (NSCLC) depends on factors like the stage of cancer, overall health of the patient, and response to treatment. Early-stage NSCLC generally has a better prognosis compared to advanced stages. Treatment advances have improved outcomes for some patients, but individual prognosis varies. It's important for patients to discuss their specific circumstances and treatment options with their healthcare team.

Reviewed By Dr. Sajjan Rajpurohit, Senior Director, Cancer Care / Oncology on 13 June 2024.