Non small cell lung cancer overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Non-small cell lung cancer (NSCLC) is any type of epithelial lung cancer other than small-cell lung cancer (SCLC). Non-small cell lung cancer may be classified according to the WHO histological classification system into 3 main types: squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Other less common subtypes, include: adenosquamous lung carcinoma, pulmonary sarcomatoid carcinoma, carcinoid tumors of lung, and carcinomas of the lung of salivary gland type. NSCLC arises from the epithelial cells of the lung of the central bronchi to terminal alveoli. Genes involved in the pathogenesis of non-small cell lung cancer include EGFR, KRAS, HER2, BRAF, and ALK. The main cause of non-small cell lung cancer is DNA damage. Non-small cell lung cancer is the leading cause of cancer-related death among both men and women, and the most common cancer among the adult population in the United States. These tumors account for about 85% of all lung cancers. The incidence rate of non-small cell lung cancer is approximately 42.6 per 100 000 individuals in the United States. NSCLC tumors are relatively insensitive to chemotherapy, compared to small cell carcinoma. When possible, they are primarily treated by surgical resection with curative intent, although chemotherapy is increasingly being used both pre-operatively (neoadjuvant chemotherapy) and post-operatively (adjuvant chemotherapy).

Historical Perspective

Non-small cell lung cancer was first described by Thomas Venner of London in 1620.

Classification

Non-small cell lung cancer may be classified according to the WHO histological classification system into 3 main types: squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Other less common subtypes, include: adenosquamous lung carcinoma, pulmonary sarcomatoid carcinoma, carcinoid tumors of lung, and carcinomas of the lung of salivary gland type.

Pathophysiology

Non-small cell lung cancer arises from the epithelial cells of the lung of the central bronchi to terminal alveoli, which are normally involved in the protection of the airways. Non-small cell lung cancer is an invasive and rapidly growing cancer which may metastasize to different organs of the body. Genes involved in the pathogenesis of non-small cell lung cancer include EGFR, KRAS, HER2, BRAF, and ALK. On gross pathology, findings will depend on the histological type. On microscopic histopathological analysis non-small cell lung cancer demonstrate large cells with abundant cytoplasm and no stippled chromatin.

Causes

The primary cause of non-small cell lung cancer is DNA damage and genetic mutations in EGFR, KRAS, ALK, HER2, and BRAF genes.

Differentiating Non Small Cell Carcinoma of the Lung from other Diseases

Non-small cell lung cancer must be differentiated from other diseases that cause chronic cough, weight loss, hemoptysis, and dyspnea among adults such as tuberculosis, pulmonary fungal disease, and secondary metastases.

Epidemiology and Demographics

Non-small cell lung cancer is the most common cancer among the adult population in the United States. These tumors account for about 85% of all lung cancers. The incidence rate of non-small cell lung cancer is approximately 42.6 per 100 000 individuals in the United States. The incidence of non-small cell lung cancer increases with age; the median age at diagnosis is between 40 to 75 years. Males are more commonly affected with non-small cell lung cancer than females. The male to female ratio is approximately 1.5 to 1.

Risk Factors

Common risk factors in the development of non small cell lung are smoking, family history of lung cancer, high levels of air pollution, radiation therapy to the chest, radon gas, asbestos, occupational exposure to chemical carcinogens, and previous lung disease.

Screening

According to the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

References

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