Being on the receiving end of a cancer diagnosis can be overwhelming. We all have emotional baggage when it comes to our history with the word cancer. For some of us it may be from a personal diagnosis, and for others it may be remembering a grandparent, friend, or coworker who was going through cancer treatment. Just hearing the word cancer can elicit such a fear in someone that their first reaction is fight or flight. Some may want all the information they can get their hands on and want to start treatment yesterday. Others don’t want to talk about it and try to put off the reality of the diagnosis by delaying treatment. But first you must deal with your preconceived ideas of what cancer treatment looks like and understand your own personal diagnosis of cancer.
The first thing to understand about a diagnosis of lung cancer is that today’s lung cancer isn’t yesterday’s lung cancer. The landscape of lung cancer has changed dramatically just over the past 5 years. Patients are living longer and living better with advances in treatment. There are important differences within the diagnosis of lung cancer that result in different treatment options, different side effects, and thereby different prognoses. It is important to understand the nuances of your cancer so you can be an active member of your healthcare team.
When diagnosed with cancer, you must first understand the stage. The stage of cancer is determined by the tumor (T), lymph nodes (N), and sites of metastasis (M; areas to which the cancer may have spread). Lung cancer is staged from stage I to stage IV, with subcategories within each of these stages. Early-stage lung cancers, stage I and stage II, may be surgically removed or treated with radiation depending on the patient. Some patients may require chemotherapy after surgery. Later-stage cancers, stage III and stage IV, are generally treated with a combination of chemotherapy, immunotherapy, and radiation or targeted therapy.
There are 2 broad categories of lung cancer: non–smal-cell and small cell. According to the American Cancer Society, about 10% to 15% of diagnosed lung cancers are small-cell lung cancers. This type of lung cancer tends to be more aggressive and spreads quickly. If you are diagnosed with small-cell lung cancer, it is crucial that you begin treatment as quickly as possible. For more than 2 decades, the mainstay treatment for small-cell lung cancer has been chemo and radiation, or a combination of the two. Recently, a much-anticipated advancement in the treatment of extensive-stage small-cell lung cancer has arrived. A new immunotherapy drug called atezolizumab is being combined with standard chemotherapy to improve patients’ overall survival. Even with advances in treatment, small cell lung cancer still has a poor prognosis. The most important thing to remember is that there are options, and knowing what those options are can mean all the difference.
The next broad category of lung cancer is non–small-cell lung cancer. This subtype makes up about 80% of all diagnosed lung cancers. Although this is the most common type of lung cancer seen, several different types of lung cancer fall into this category. The 2 main types are squamous cell carcinoma and adenocarcinoma. These 2 types of lung cancer are differentiated from each other by their location in the lung and the type of cells from which they originate.
In the 2019 world of oncology, the goal is to treat every cancer with exact precision, right down to that patient’s DNA. When diagnosed with locally advanced or advanced- stage squamous-cell carcinoma or adenocarcinoma, it is imperative that gene sequencing be performed on the cancer. This will enable your treating physician to personalize your therapy to your specific cancer. The results of this gene sequencing will drive what treatment your cancer is likely to respond to. The goal is to begin your treatment, whatever that may look like, with the most accurate and complete information possible. You get the biggest bang for your buck with your first treatment, so you want to make sure that it’s the right one for you.
The treatment of lung cancer has dramatically changed over the past 5+ years, and because of these advances, patients are living longer and living better lives with the diagnosis of lung cancer. When diagnosed with lung cancer, it is important to know that there is always something that can be done. You are the most important member of your healthcare team, so stay engaged and be your own advocate. More important, remember that there is always hope; hope for more time with loved ones, 1 more sunrise, or 1 more birthday.
- American Cancer Society. What Is Lung Cancer? www.cancer.org/cancer/lung- cancer/about/what-is.html. 2019. Accessed October 7, 2019.
- National Cancer Institute. For Small Cell Lung Cancer, Immunotherapy Drug Finally Brings Improved Survival.www.cancer.gov/news-events/cancer-currents-blog/2018/small-cell-lung-cancer-atezolizumab-survival.2018.AccessedOctober7,2019.