I Am a Lung Cancer Patient: What Do I Need to Know?

When one is diagnosed with lung cancer, some immediate questions they may have could be:

• What are my treatment options?
• How fast will my cancer grow?
• When will my cancer start to spread to other parts of my body?

Every individual is different, which leads to a case-by-case basis for their treatment. Cancer progression is influenced by multiple factors and, often, a combination of various factors.

This article provides information to help you understand how different factors interplay to affect your cancer progression.

• Cancer stage at diagnosis
• Types of lung cancer or specific subtypes of non-small cell lung cancer
• Ethnicity
• Individual's response to cancer treatment
• Persistence of risk factors

To determine the cancer stage, doctors look at the size of the tumor and how far it has spread. For lung cancer, the tumor, node, metastasis (TNM) system and a stage system ranging from 0 to IV are used for staging.

Staging of non-small cell lung cancer (NSCLC) follows the TNM system. Small cell lung cancer (SCLC), on the other hand, is staged as limited or extensive stages. This 2-stage system is somewhat unique due to SCLC's aggressiveness and rapidly advancing nature.

The stage of cancer determines

• Prognostic and survival information – lung cancer patients are susceptible to relapse after treatment, regardless of their initial diagnosis stage. Patients with surgically resectable NSCLC at stage 0 and I have the best prognosis. Patients with resectable NSCLC at stage II and certain stage III can undergo chemo- (and possibly immuno-), radiation and/or chemoradiation therapy with curative intent.
• Planning of treatment programs – For early-stage patients with localized tumor, treatment options often include surgery to remove the tumor. In some cases, adjuvant therapy such as chemotherapy or radiation therapy may be recommended to reduce the risk of recurrence. For advanced disease, treatment options may include chemotherapy, targeted therapy, immunotherapy, radiation therapy, and palliative care. Surgery may be considered in certain situations to alleviate symptoms or address specific complications.

It's always a good idea to get all the information you can from your doctors to understand your diagnosis and get answers to any questions or concerns you might have.

Related: Staging Of Small Cell Lung Cancer

Even for non-metastasized lung tumors, tumor size matters regarding overall survival. The larger the tumor is

• the more damage it can cause to the surroundings
• the higher the chance it can metastasize to other parts of the body

Scientists found that “a tumor size difference of even one centimeter can impact survival”. Factors that affect lung tumor growth:

• Volumetric doubling time– different types/subtypes of lung cancer have different median doubling time. It means the time it takes for a tumor to double in size. Malignant (cancerous) lesions tend to have a shorter doubling time compared to benign (non-cancerous) lesions. Rapid growth may be indicative of aggressive cancer, whereas slower growth may suggest a benign or less aggressive condition
• Growth fraction – some cancer cells may stay dormant while others grow uncontrollably. If the growth fraction is low, it means the proportion of proliferating cells (dividing and growing) is low
• Cancer stage – in lung cancer, early-stage tumors (I and II) are typically smaller and localized, while advanced stages (III and IV) involve larger tumors with more extensive local invasion or distant metastasis. As a tumor grows, it may progress through different stages based on its size, involvement of lymph nodes, and potential spread to other parts of the body.
• Genetic abnormalities or driver mutations of your cancer – your biopsy may be tested for genetic abnormalities that drugs can target, such as: ALK, EGFR and KRAS. These mutations can also drive the aggressiveness of cancer, and are often associated with poorer outcomes.

A 2016 study has shown that NSCLC progressed more rapidly among Whites than other ethnic groups in the U.S. without treatment:

Your cancer care team will work with you to create a personalized treatment plan that can help slow or even stop the growth and spread of your cancer. To ensure that the treatment plan is effective, your progress will be closely monitored through scans and tests. The cancer care team will quickly plan a second-line drug or a different therapy upon finding insensitivity or drug resistance.

Most advanced-stage cancer is considered incurable. However, treatments aiming for complete remission (no sign of disease) are available. Although it does not mean that the cancer is gone forever, there are successful stories of advanced-stage cancer fighters who extended their lifespan using targeted therapy:

• Janet Freeman-Daily, a stage 4 NSCLC survivor who remains “No Evidence of Disease” (NED) till today
• Evalynn Linnea Olson, a stage 1B lung cancer fighter for 17 years who participated in a total of six clinical trials throughout her lifetime

Eliminating risk factors for lung cancer improves the prognosis. Smoking remains the number one risk factor for lung cancer. At diagnosis, doctors will first advise smokers to quit smoking.

In order to maximize the effectiveness of cancer treatments, it’s important to remove exposure to additional lung cancer risks and make lifestyle changes that promote better health. Your cancer care team is the best resource for learning about these positive changes and how to start incorporating them.

Related: Are You At Risk For Lung Cancer?