If You Have Non-Small Cell Lung Cancer

The majority of lung cancers, about 85%, consists of non-small cell lung cancer (NSCLC), a broader category of lung cancer. NSCLC includes different subtypes, each with its unique characteristics. This differentiation between the various subtypes within NSCLC highlights the importance of accurate diagnosis and tailored treatment plans. This article will focus on an overview of NSCLC and help readers recognize its symptoms and take proactive measures for early detection.

Below are common NSCLC subtypes. Click on them to read in more detail:

The common symptoms that occur in all types of lung cancer (including NSCLC) are

• Fatigue
• Shortness of breath (dyspnea)
• Persistent cough
• Coughing up blood
• Chest pain
• Back pain
• Weight loss

There are several symptoms that may differ between subtypes of NSCLC.

Shoulder pain. Pain that runs through the shoulder and arms and can spread toward the fingers. It can be caused by pancoast tumors (tumors growing on the upper parts of the lungs) that invade surrounding nerves. Due to the disruption of the nerves, such tumors may also lead to Horner syndrome, which causes drooping eyelids, facial anhydrosis (loss of sweating), and constricted pupils. The majority of pancoast tumors are NSCLC, with around half found to be adenocarcinoma. Because they are away from the windpipe (trachea), they seldom cause cough and shortness of breath. They are often missed on a chest X-ray because the tumors are often shadowed by other structures in the area like the shoulder blade, collarbone or the first rib.

Clubbing. It is a condition in which the finger ends swell and take on the shape of an upside-down spoon. While the shape of your fingers is hereditary, a sudden change in your fingers or nails' appearance may be related to lung cancer. About 5-15% of lung cancer patients have finger clubbing. Although clubbing can also be caused by other conditions, doctors may suspect lung cancer if clubbing is present with other lung cancer risk factors or symptoms during physical examination.

Change in voice (hoarseness). Tumors that press on nerves that support the vocal cord can cause a change in the person’s voice.

Wheezing when coughing. If the tumor grows near and obstructs the main airway, wheezing can be heard when breathing and coughing. Squamous cell cancer often involves the central airways.

Lung cancer is usually picked up by a detection method involving chest imaging.

Chest X-ray. This is a common method to examine the chest area used in a routine health examination or during emergency treatment after an accident. It is often the first imaging test ordered in many clinical situations. However, it may not be as sensitive as CT scans, in detecting small or early-stage lung cancers Sometimes it may lead to incidental findings of lung cancer. If a suspicious lung nodule or ‘shadow’ is spotted, a CT scan may be ordered.

Low-dose computed tomography scan (LDCT scan). Low-dose CT scans are used for lung cancer screening (hyperlink to Diagnosis of Lung Cancer). The US Preventive Services Task Force (USPSTF) recommends annual low-dose CT scan for smokers and ex-smokers who meet specific criteria. A low-dose CT scan has higher resolution than the chest X-ray, but uses a much lower radiation dose compared to a conventional CT scan. In this way, it minimizes radiation exposure while detecting more details, including lung nodules.

PET scan. It is more commonly used to determine lung cancer staging as it is useful in visualizing tumor site and lymph node involvement.

Biopsy. A lung biopsy is required to diagnose NSCLC subtypes definitively. Histological assessment of the biopsy sample helps to classify NSCLC cases into subtypes. Genomic testing on the tumor sample provides information on genetic abnormalities. Doctors plan treatments with the best outcomes based on histological subtypes or targetable mutations.

Various detection methods are now available to provide accurate diagnosis of NSCLC subtypes. This leads to more personalized treatment plans. Being well-informed about your health is crucial.

Learn more about lung biopsy here.