Your cancer

Living with the disease

Lung cancers

What is it ?

Lung cancer or bronchial cancer affects more than 220,000 people in the United States each year (according to Cancer Statistics, 2020).

This cancer appears following the transformation of a normal cell into a cancerous cell in the bronchi. Lung cancer occurs when a normal cell in the bronchial tubes turns into a cancerous cell. It is the 2nd most common cancer in women with 112,520 new cases (after breast cancer) and the 2nd most common in men with 116,300 new cases (after prostate cancer). It is considered the 1st cause of death by cancer in women and men.

Types of cancer

Two types of lung cancers exist and are different in their appearance
and their management :

Non-small cell lung cancer (NSCLC)

accounts for 85% of all lung cancers. Within this category, the 3 most common subtypes are :
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma

Small cell lung cancer (SCLC)

affects 15% to 20% of lung cancer patients.

Rapid management

Lung cancer can progress rapidly. It is therefore recommended that you wait no more than 6 weeks between your first visit and the start of treatment.

A wide range of treatments available

Many advances have been made in recent years and there are now many treatments available, including local treatments (surgery, radiotherapy, radiofrequency, cryotherapy) and drug treatments (chemotherapy, immunotherapy, targeted therapies, some of which are taken as tablets). These treatments are combined in different ways depending on the type, stage and location of the cancer.

Individualization of the therapeutic strategy to the exact subtype of lung cancer

For metastatic cancers in particular, the therapeutic strategy is adapted to the exact subtype of cancer, determined on the biopsy by histological examination but also by molecular biology, the objective of which is to study the DNA of the cancer cells to establish the exact identity card. Thus, if a mutation is found on the DNA, the best treatment will be an oral targeted therapy; if the PD-L1 protein is present on a majority of cancer cells, the best treatment will be immunotherapy alone ; if the PD-L1 protein is rare, the best treatment will be a combination of chemotherapy and immunotherapy. Treatment is also individualized according to the patient's general and nutritional status and other health problems. This is called "à la carte" treatment, which allows us to offer the patient the best treatment for his or her disease and for him or herself.

Early supportive care

In metastatic cancer (stage IV), early supportive care has been shown to improve both quality of life and life expectancy. Supportive care consists of the treatment of the patient's symptoms, but also of the care of the patient as a whole, including psychological and social care if necessary. Sometimes, the patient is brought to meet with a team specialized in supportive care. There is still much progress to be made, particularly in terms of management strategies
particularly in management strategies at early and more advanced stages of the disease.
For this reason, inclusion in clinical research trials must always be considered.

Symptoms

The most common symptoms of lung cancer combine both respiratory problems and an unexplained deterioration in the general condition of the patient.
Symptoms can include :

Persistent cough

Shortness of breath

Hoarseness or lowering of the voice

Unusual and persistent fatigue

Presence of blood in the sputum

Loss of appetite

Fever

Unexplained weight loss

Respiratory tract infection

Severe acute or chronic unexplained pain

Diagnostic Process

The diagnosis of lung cancer can be made by different examinations.
The choice of examinations will be made according to the characteristics of the cancer :
- Its location
- Its histological type (the type of cells involved)
- Its stage (degree of extension)

In order to have a complete diagnosis, the characteristics of the cancer will be looked for
thanks to different examinations :

An imaging workup with X-ray, chest CT, brain CT or MRI and PET scan.

Histological diagnosis : following a biopsy, the anatomopathologist will analyze the tissues to define the type, the histological subtype of the cancer and to highlight the presence of biological markers, prognostic factors of the response to the treatment (PDL1..). This biopsy can be done by fibroscopy, by puncture under scanner or by surgical techniques. 

Complet blood tests can be perform. Molecular analysis to look for potential mutations in the DNA of cancer cells that could guide treatment.

Risk factors

The risk factors for lung cancer are multiple and different.

The first risk factor is tobacco, considered the first factor involved in the development of lung cancer and responsible for 8 out of 10 lung cancers.

Environmental or occupational factors have an impact on the development of bronchial cancers. These include asbestos, diesel exhaust, hydrocarbons, etc. 

There is no risk of hereditary transmission of lung cancer.

Treatments

Since tobacco is responsible for 8 out of 10 lung cancers, the first part of the treatment will be to stop smoking.

Then, treatments will be chosen 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 by surgery) or not
  • Specific molecular alterations: ALK, EGFR, ROS1
  • The patient's general condition and other health problems

Therapeutic strategies for "non-small cell" bronchial cancers may include surgery, chemotherapy, radiotherapy, targeted molecular therapy (in case of specific molecular alteration), and immunotherapy.

For small-cell bronchial cancers and its highly concealed nature, surgery is rarely performed. Therapeutic choices also take into account the irradiable nature of the tumor and include chemotherapy, radiotherapy and immunotherapy.