NSCLC: non-small cell lung carcinoma

NSCLC: description

Doctors know several types of lung cancer (medical bronchial carcinoma). First, they distinguish two major groups: non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). In small cell lung cancer, many small, densely packed cells are found under the microscope. The cells in NSCLC, on the other hand, are larger.

Small cell and non-small cell lung carcinoma differ in their course and treatment. Most lung cancer patients have a non-small cell tumor. He can be further subdivided.

Which NSCLC species are there?

Non-small cell bronchial carcinoma can arise from different cell types. Accordingly, one distinguishes the following sub-forms:

• adenocarcinomas
• squamous
• large cell carcinomas
• other non-small cell bronchial carcinomas

The most common form of NSCLC (and lung cancer in general) is squamous cell carcinoma: about 40 to 50 percent of lung cancer patients suffer from it. Second, adenocarcinoma follows with approximately 10 to 15 percent of lung cancer cases. Large cell carcinomas account for five to ten percent of all cases. The other small cell bronchial carcinomas include variants that are very rare.

How are the different types of NSCLC created?

adenocarcinomas typically grow on the pulmonary margin (peripheral). They arise from mucus-producing glandular cells of the lungs. Adenocarcinomas develop preferentially in scar tissue, which may remain after tuberculosis, for example. They attack the surrounding lymph nodes and other organs or tissues relatively early.

squamous usually consist of solid associations of degenerated cells that do not form a mucus. They usually grow centrally in the lungs, preferably at the junction of smaller airways (bronchi). A squamous cell carcinoma of the lung usually arises as a result of chronic mucosal irritation, such as tobacco smoke.

Of a Large cell carcinoma Physicians usually speak when they can identify a non-small cell lung cancer under the microscope neither as adeno nor squamous cell carcinoma. It is an exclusion diagnosis. As the name suggests, the cells of this cancer variant are strikingly large.

Special case pancoast tumor

A special form of the NSCLC is named after its discoverer Pancoast tumor. This fast-growing bronchial carcinoma arises at the lung tip. It can spread very quickly to surrounding structures such as ribs, cervical soft tissue or the nerve network of an arm. Pancoast tumors are in most cases adenocarcinomas.

NSCLC: causes and risk factors

The main trigger for non-small cell lung cancer (and other forms of lung cancer) is SmokeThe more cigarettes someone smokes a day, the higher their risk of developing a malignant tumor in the lungs.

This is especially true if you start early in life with the smoke. Adolescents are particularly sensitive to the cancer-causing substances in tobacco smoke. The same applies to girls or women. It is also particularly dangerous if someone smokes very strong cigarettes and always inhales deeply.

Besides smoking, there are other risk factors for non-small cell lung cancer (and other lung cancers). Read more about lung cancer: causes and risk factors.

NSCLC: symptoms

Lung cancer (such as non-small cell lung carcinoma) causes little discomfort in the early stages. Most patients report only nonspecific symptoms such as fatigue, coughing and chest pain. The further the tumor spreads, the more and more severe signs are added. These can be, for example, bloody sputum, shortness of breath and mild fever.

If a non-small cell bronchial carcinoma has secondary tumors (metastases) in other parts of the body, the corresponding symptoms can occur. For example, brain metastases cause headache, impaired vision and balance, confusion and / or paralysis.

You can read more about the general symptoms of lung cancer and the special symptoms of pancoast tumor in the text Lung cancer: Symptoms.

NSCLC: examinations and diagnosis

If there is a suspicion of lung cancer (such as a non-small cell lung cancer), patients should first go to the family doctor. If necessary, he will refer you to a specialist, for example to a pulmonologist (pneumologist) or a cancer specialist (oncologist).

First, the doctor will ask the patient for the exact symptoms and possible pre- or concomitant diseases. He also asks if the patient smokes or comes into contact with dangerous substances such as asbestos. Then follow a careful physical and various apparatus investigations. These include, for example, an X-ray of the chest (chest X-ray) and a computed tomography (CT). In addition, the doctor will take a tissue sample from suspicious areas in the lungs and have it analyzed in the laboratory.

Read more about necessary tests for all types of lung cancer under lung cancer: examinations and diagnosis.

NSCLC: treatment

The different NSCLC types are treated similarly in the respective tumor stages. It therefore plays less of a role for the treatment, whether it is an adeno or squamous cell carcinoma. Much more important is how far a non-small cell bronchial carcinoma has already spread in the body.

The three main therapeutic approaches are:

• Surgery to surgically remove the tumor
• Radiotherapy to kill the cancer cells
• Chemotherapy with drugs that inhibit cell division

The exact treatment plan is individually adapted to each patient. It mainly depends on the stage of the disease and the general condition of the patient. The exact therapy procedures in NSCLC are very complicated. Therefore, only a simplified overview can be given here.

Treatment in early and middle stages

If a non-small cell lung cancer is still relatively small, try to cut it out as completely as possible. For this purpose, the tumor should as little as possible invade lymph nodes and, above all, have no metastases.

At very early stages, surgery alone is often enough to completely remove the cancerous tissue. Sometimes you additionally irradiate the affected lung area. Any remaining cancer cells are killed.

If a non-small cell lung carcinoma has spread further and affects several lymph nodes, the patients will additionally receive chemotherapy (adjuvant chemotherapy) after the operation. For larger tumors, chemotherapy is sometimes used prior to surgery (neoadjuvant chemotherapy): it is designed to reduce the size of the cancerous tumor. Then the surgeon has to cut out less tissue.

Treatment in advanced stages

If a non-small cell lung cancer has already spread very strong in the body, there is hardly a chance of recovery. This is especially true when metastases have already developed. Then treat the patient palliatively. So you try to relieve his symptoms and to extend the survival time. Such therapy then consists of chemotherapy in combination with radiation.

Modern therapies for selected patients

For individual patient groups, further treatment options are possible, for example one Antibody therapy: Artificially produced antibodies are administered that are directed against certain properties of non-small cell lung cancer. For example, some of these antibodies can destroy certain features on the surface of a cancer cell or the whole cancer cell.

Also artificially produced are the so-called tyrosine kinase inhibitor (Tyrosine kinase inhibitors). These drugs are absorbed in the body by the cancer cells or by the cells of the blood vessels. Inside the cancer cells, they block signaling pathways that are important for tumor growth. Inside the vascular cells, the tyrosine kinase inhibitors also block certain signaling pathways. The result is that the vessels can not continue to grow or even perish. This impairs the blood supply to the tumor: it no longer receives enough oxygen and nutrients, which slows its growth.

Another modern therapy option is the immunotherapyEvery body has special immune checkpoints (immune checkpoints). They ensure that the immune system acts only against the sick, but not against healthy body cells. Some cancerous tumors, however, cause these checkpoints not to recognize and attack the cancerous cells. Such patients can benefit from special immunotherapeutic drugs: The so-called checkpoint inhibitors (checkpoint inhibitors) ensure that the immune checkpoints continue to function properly and attack the cancer cells more.

Note: These modern therapies are only possible if the tumor of a patient fulfills certain conditions. They are therefore only suitable for selected patients.

NSCLC: history and prognosis

Non-small cell lung cancer grows more slowly than small cell lung cancer. He therefore has the better prognosis in principle. Healing chances and life expectancy depend on the individual case, however, on how early the tumor is discovered and treated.

How well you feel Non-small cell lung carcinoma Therapy also depends on other factors. These include, for example, the general health of the patient as well as possible comorbidities such as hypertension or heart disease.

Read more about the chances of recovery and life expectancy of a bronchial carcinoma in the text lung cancer: life expectancy.