Non-small cell lung cancer (NSCLC) is one of the most common forms of lung cancer, characterized by a variety of morphological and biological characteristics. NSCLC includes several subtypes, the most significant of which are adenocarcinoma, squamous cell carcinoma and large cell carcinoma. Unlike small cell lung cancer, NSCLC progresses more slowly and requires an individual approach to treatment. This disease is associated with a poor prognosis, especially in the late stages, when the diagnosis is made after the tumor has spread to other organs and systems. NSCLC requires a comprehensive approach to diagnosis and therapy, which includes both surgical methods and chemotherapy and radiotherapy.
History of the disease and interesting historical facts
The history of non-small cell lung cancer began with the first publications on lung cancer in the late 19th century. However, the most significant attention to this disease was attracted by the beginning of the study of the effects of smoking on human health in the mid-20th century. In the 1950s, the first epidemiological studies were conducted that established a link between smoking and the occurrence of lung cancer. In 1964, the famous "Report on Smoking and Health" was published, which strongly outlined the problems associated with tobacco smoking, including NSCLC. This led to a sharp increase in attention to lung cancer in both the scientific and public spheres. Interestingly, the guilt of tobacco in the occurrence of non-small cell lung cancer was confirmed by many subsequent studies that demonstrated an increase in the risk of NSCLC with increasing duration and frequency of smoking.
Epidemiology
According to the World Health Organization (WHO), lung cancer caused the death of more than 1.8 million people worldwide in 2020, with NSCLC accounting for about 85% of all cases. In Russia, according to statistics, the incidence of lung cancer remains high, with NSCLC observed in more than 70% of all patients seeking cancer care. The aging population, lifestyle changes, and the spread of smoking among young people are the main factors contributing to the spread of this disease. According to statistics, men suffer from NSCLC 2-3 times more often than women, but the proportion of women with adenocarcinoma has been steadily increasing in recent years, which is associated with an increase in the number of female smokers.
Genetic predisposition to this disease
Research suggests that NSCLC may have a genetic predisposition associated with certain mutations in oncogenes and tumor suppressors. For example, mutations in the EGFR, KRAS, ALK, and ROS1 genes are common in patients with adenocarcinoma and influence treatment choices. Mutations in the TP53 gene are also common in different subtypes of NSCLC. Population-based studies suggest that inherited mutations may increase the risk of lung cancer in people with a family history and may identify subgroups of patients with particular abuse issues that require specialized approaches.
Risk factors for the development of this disease
The risk of developing NSCLC is determined by many factors, including both chemical and physical agents. The main risk factors include:
- Tobacco smoking is the single most significant risk factor, accounting for more than 85% of all lung cancer cases.
- Passive smoking increases the risk of disease in non-smokers.
- Exposure to radon, a colorless, tasteless gas produced by the breakdown of uranium in soil and rocks.
- Occupational exposure to carcinogenic substances such as asbestos, arsenic and other chemicals.
- Air pollution, including emissions from vehicles and industrial plants.
These factors can be enhanced in combination, and, for example, a smoker with a hereditary predisposition has a significantly higher risk of developing NSCLC.
Diagnosis of this disease
NSCLC diagnosis begins with a thorough patient history and physical examination. The main symptoms that doctors pay attention to include:
- A persistent cough that may get worse over time.
- Cough with sputum production, sometimes mixed with blood.
- Shortness of breath and difficulty breathing.
- Chest pain, especially when taking a deep breath.
- General loss of strength, weight loss, loss of appetite.
Laboratory tests include a complete blood count and biochemical analysis, which may show signs of inflammation or anemia. Radiological examinations, such as chest X-rays and computed tomography, can reveal the presence of tumors and their size. An important diagnostic step is bronchoscopy with biopsy for histological examination. Differential diagnosis should be made with chronic obstructive pulmonary disease, pneumonia and other lung diseases.
Treatment
Treatment of NSCLC depends on the stage of the disease and its morphological type. The main approaches to therapy include:
- Surgical treatment, which may include tumor resection, segmentectomy, or pneumonectomy, depending on the extent of the process.
- Pharmacological treatment, including chemotherapy, is usually used in later stages or when there is metastasis. Drugs such as platinum-containing agents are used.
- Immunotherapy, more recent approaches use checkpoint inhibitors such as nivolumab and Pembrolizumab.
- Targeted therapy that targets specific molecules, such as EGFR inhibitors.
- Radiotherapy may be used as an adjunct to control symptoms or for localized tumors.
These methods can be combined depending on the clinical situation.
List of medications used to treat this disease
In the treatment of NSCLC, various groups of drugs are used:
- Platinum-containing drugs: carboplatin, cisplatin.
- Taxanes: docetaxel, paclitaxel.
- EGFR inhibitors: gefitinib, erlotinib.
- ALK inhibitors: crizotinib, alectinib.
- Immunotherapy drugs: nivolumab, pembrolizumab.
When choosing medications, specific mutations and the characteristics of each individual patient should be taken into account.
Disease monitoring
NSCLC is monitored through regular examinations, including clinical tests, radiological examinations, and patient assessment. Prognosis depends on the stage of the disease, cell type, presence of metastases, and the patient's overall health. Complications may include recurrence of the disease, metastases, and respiratory failure in advanced cases.
Age-related features of the disease
NSCLC has different clinical features depending on the age group. In older people, the disease often manifests itself atypically, which complicates early diagnosis. Young patients, as a rule, have adenocarcinomas with a better prognosis. In addition, people over 65 often have concomitant diseases, which can complicate treatment.
Questions and Answers
- What are the main symptoms of non-small cell lung cancer? The main symptoms include a persistent cough, coughing up blood-tinged sputum, shortness of breath, chest pain and general weakness.
- How is NSCLC diagnosed? NSCLC is diagnosed through medical history, radiological examinations (X-ray, CT), bronchoscopy and histological examination.
- What are the risk factors for NSCLC? Major risk factors include tobacco smoking, passive smoking, exposure to carcinogens and air pollution.
- What treatments are available for NSCLC? Treatment includes surgery, chemotherapy, immunotherapy and targeted therapy.
- What are the survival rates for NSCLC? The prognosis depends on the stage of the disease, but in general survival is significantly reduced in later stages, especially if metastases are present.
