Non-small cell lung cancer

Non-small cell lung cancer is most common in older adult smokers and ex-smokers. Small tumours in the lung are often asymptomatic, so the majority of patients have either locally advanced or metastatic disease at diagnosis.

Most common presenting symptoms are cough, chest pain, haemoptysis, dyspnoea, and weight loss.

A suspicious lung mass can be biopsied during bronchoscopy or using CT guidance. Staging studies (i.e., CT, PET, mediastinal sampling) are required to determine extent of local or regional disease and to evaluate for metastases.

Treatment depends on stage of disease, histological subtype, molecular genotype, and patient comorbidities. Treatment modalities include surgery, radiotherapy, and chemotherapy, as well as molecular-targeted therapy for specific genotypes and immunotherapy.

Lung cancer comprises a group of malignant epithelial tumours arising from cells lining the lower respiratory tract. Lung cancer is divided into two categories: non-small cell lung cancer (NSCLC) and small cell lung cancer. NSCLC accounts for more than 80% of all lung cancers.[1]Noone AM, Howlader N, Krapcho M, et al (eds); National Cancer Institute. SEER cancer statistics review, 1975-2014. September 2018 [internet publication]. https://seer.cancer.gov/archive/csr/1975_2015 There are three main types of NSCLC (adenocarcinoma, squamous cell carcinoma, and large cell carcinoma) and these are grouped into further subtypes.