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Metastatic Non Small Cell Lung Cancer

Nsclc That Has Spread To Only One Other Site

Management of Metastatic Non-small Cell Lung Cancer

Cancer that is limited in the lungs and has only spread to one other site is not common, but it can sometimes be treated with surgery and/or radiation therapy to treat the area of cancer spread, followed by treatment of the cancer in the lung. For example, a single tumor in the brain may be treated with surgery or stereotactic radiation, or surgery followed by radiation to the whole brain. Treatment for the lung tumor is then based on its T and N stages, and may include surgery, chemo, radiation, or some of these in combination.

Role Of Immunotherapy In Non

Immunotherapy is a breakthrough treatment in oncology that uses the bodys own natural defense system to fight off cancer. Some cancer cells share characteristics with healthy cells and thus the immune system cannot differentiate between the bodys normal and abnormal cells . It is believed that immunotherapy works by boosting the immune system so that it can target cancer cells and stop or slow the growth of cancer cells, by preventing cancer cells from spreading to other parts of the body, or by helping the immune system increase its effectiveness . Data has shown that improved survival is associated with a strong antitumor immune response. Higher numbers of CD4+ T cells, CD8+ T cells, natural killer cells, and/or dendritic cells are associated with better patient survival .

New strategies in immunotherapy are targeting immune-modulating mechanisms that help tumor cells defend themselves against the immune system . This approach targets immune checkpoint pathways, which includes the blockade of the inhibitory receptors cytotoxic T-lymphocyte-associated antigen 4 and programmed cell death-1 and its ligand, PD-L1. These immune checkpoints are used by the immune system to maintain self-tolerance and regulate the immune response in the body to protect tissues from damage as the immune system launches a response to a pathogen . Immune checkpoint pathways can be dysregulated by tumor resistance mechanisms.

Table 1

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The best way to cite this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Non-Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .

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Cell Motility And Migration

Rather than remaining stationary, many tumor cells turned to a nomadic lifestyle. Tumor cell migration often depends on the crosstalk of different mechanisms. In order to move around in its extracellular matrix , tumor cells must make changes to themselves and cooperate with other cell types present in the local microenvironment. Better cell motility grants malignant cells enhanced potency to invade normal tissues, as well as a heightened chance of entering vasculature .

Where Does Lung Cancer Spread

Metastatic Non

Common Sites of Lung Cancer Metastases

One of the biggest concerns among people with lung cancer is that the cancer may spread to other parts of the body. This is known as metastasis and occurs in around 40% of newly diagnosed people.

When lung cancer is diagnosed, doctors will perform tests to see if metastasis has occurred. Although this can occur in any part of the body, there are several sites where it is more common.

Verywell / JR Bee

The article details the five sites where lung cancer most commonly spreads as well as the symptoms it can cause in each location and what can be done to treat it. It also offers insights into the prognosis of metastatic lung cancer.

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Furthers Tests After Diagnosis

If tests show you have non-small cell lung cancer, your specialist will arrange further tests. Some of these help with the staging of lung cancer.

  • Mediastinoscopy

    A mediastinoscopy is sometimes done instead of an EBUS or EUS. It lets the doctor look at the area in the middle of your chest and nearby lymph nodes. You have it under a general anaesthetic.

  • Thoracoscopy

    A thoracoscopy lets the doctor look at the lining of the lungs . It is usually done under a general anaesthetic.

  • MRI scan

    An MRI scan uses magnetism to build up a detailed picture of areas of your body.

  • Molecular testing

    Your doctors may arrange more detailed tests on cancer cells taken during a biopsy or surgery. They look for certain gene changes in the cancer cell. This can show if the cancer cell is making an abnormal protein or has too much of a certain protein.

    The results can tell your doctor if certain targeted or immunotherapy drugs are likely to work for you.

    Sometime doctors take a blood sample and look for pieces of cancer cells and of the tumour DNA. This is called a liquid biopsy. It is rarely done and still being researched. It may tell them more about the genetics of the cancer and help with treatment decisions.

  • Breathing tests

    If your treatment plan involves having surgery or radiotherapy your doctor will arrange breathing tests and exercise tests. These help doctors see how well your lungs are working. You may also have tests to check how well your heart is working.

See also

Treating Stage Ii Nsclc

People who have stage II NSCLC and are healthy enough for surgery usually have the cancer removed by lobectomy or sleeve resection. Sometimes removing the whole lung is needed.

Any lymph nodes likely to have cancer in them are also removed. The extent of lymph node involvement and whether or not cancer cells are found at the edges of the removed tissues are important factors when planning the next step of treatment.

After surgery, the removed tissue is checked to see if there are cancer cells at the edges of the surgery specimen. This might mean that some cancer has been left behind, so a second surgery might be done to try to remove any remaining cancer. This may be followed by adjuvant treatment with chemotherapy , possibly followed by adjuvant immunotherapy with atezolizumab for up to a year. Another option is to treat with radiation, sometimes with chemo.

Even if positive margins are not found, adjuvant chemo is usually recommended after surgery to try to destroy any cancer cells that might have been left behind. As with stage I cancers, newer lab tests now being studied may help doctors find out which patients need this adjuvant treatment and which are less likely to benefit from it.

For stage II cancers that are larger than 4 centimeters across, another treatment option is immunotherapy with nivolumab along with chemotherapy before surgery. Additional therapy after surgery might be needed depending on what is found at the time of surgery.

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Stage 4 Lung Cancer Survival Rate And Quality Of Life

Lung cancer becomes more serious and difficult to treat as it progresses. Advanced or metastatic lung cancers of any kind tend to have very low survival rates.

One way to estimate life expectancy when battling cancer is to consider the five-year relative survival rate for that type of cancer. A five-year relative survival rate shows the likelihood that a person with a specific type and stage of cancer would live for at least five years after the diagnosis, compared with people who don’t have cancer. The rate includes the life expectancy of patients who are still in treatment and those who have finished treatment and have no further evidence of disease.

  • Patients with metastatic non-small cell lung cancer thats spread to distant organs or regions of the body have a five-year relative survival rate of 8 percent, according to ACS. Stage 4 non-small cell lung cancer that has spread regionally has a five-year relative survival rate of 37 percent.
  • For metastatic small cell lung cancer thats widespread in the body, the five-year relative survival rate is 3 percent. For patients with stage 4 small cell lung cancer that has spread regionally, the five-year relative survival rate is 18 percent.

Clinical Significance Of Strip2 Expression In Nsclc

Metastatic Non Small Cell Lung Cancer

To evaluate the clinical significance of STRIP2 in NSCLC, a tissue microarray containing 189 NSCLC samples and their match noncancerous lung samples was performed to detect the expression levels of STRIP2 by immunohistochemistry staining. The values were scored in a standard manner as described previously . In total, 138 NSCLC samples were classified into the high STRIP2 expression group, while 51 samples were classified into the low STRIP2 expression group . Further correlation analysis demonstrated that higher STRIP2 levels were correlated with clinicopathological features of patients with NSCLC including poor tumor differentiation , advanced TNM stage , positive of lymph node metastasis and positive of cancer thrombus . However, there was no association with sex, age, smoking history, tumor size and histological type. Moreover, NSCLC patients with high STRIP2 expression manifested a shorter overall survival and recurrence-free survival than patients with low STRIP2 expression .

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Strip2 And Igf2bp3 Coordinate Nsclc Progression Partially Through Tmbim6

TMBIM6, known as Bax inhibitor-1, was overexpressed and played oncogene roles in multiple cancers . As expected, knockdown of TMBIM6 suppressed NSCLC cell proliferation, migration, invasion and promoted cell apoptosis . To evaluate whether TMBIM6 was required for the effect of STRIP2-IGF2BP3 on NSCLC progression, we knocked down TMBIM6 expression in PC9 cells, and then overexpressed STRIP2 or IGF2BP3 in these cells. Strikingly, TMBIM6 knockdown partly abrogated the promoting effects of STRIP2 overexpression and IGF2BP3 overexpression on cell proliferation, migration and invasion . In addition, the correlations between STRIP2 or IGF2BP3 and TMBIM6 were analyzed and showed that STRIP2 and IGF2BP3 expression levels were positively correlated with TMBIM6 level . And immunohistochemistry analysis of 48 pairs NSCLC and their matched adjacent normal lung tissues indicated that increased STRIP2 expression was associated with high IGF2BP3 and TMBIM6 levels . Furthermore, NSCLC patients with high three signatures expression manifested a shorter overall survival and disease-free survival than patients with low three signatures expression . Overall, these results indicate that STRIP2 and IGF2BP3 promote NSCLC progression partially through TMBIM6, suggesting the STRIP2/IGF2BP3/TMBIM6 axis is critical to NSCLC pathogenesis and the prognosis of patients with NSCLC.

Fig. 10

Dna Repair Deficiency In Nsclc

Deficiencies in DNA repair underlie many forms of cancer. If DNA repair is deficient, the frequency of unrepaired DNA damages increases, and these tend to cause inaccurate translesion synthesis leading to mutation. Furthermore, increased damages can elevate incomplete repair, leading to epigenetic alterations.

Mutations in DNA repair genes occasionally occur in cancer, but deficiencies of DNA repair due to epigenetic alterations that reduce or silence DNA repair-gene expression occur much more frequently in cancer.

Epigenetic gene silencing of DNA repair genes occurs frequently in NSCLC. At least nine DNA repair genes that normally function in relatively accurate DNA repair pathways are often repressed by promoter hypermethylation in NSCLC. One DNA repair gene, FEN1, that functions in an inaccurate DNA repair pathway, is expressed at an increased level due to hypo-, rather than hyper-, methylation of its promoter region in NSCLC.

Epigenetic promoter methylation in DNA repair genes in NSCLC


Staging is a formal procedure to determine how developed the cancer is, which determines treatment options.

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Treatment For Metastatic Non

For NSCLC that has metastasized, treatment can depend on where and how far the cancer has spread, certain characteristics of the cancer cells like proteins or genes, and your general health.

This stage of cancer is difficult to treat. Many treatments aim to relieve symptoms and prolong life, and are less about curing the cancer.

Treatments can include:

Small Cell Lung Cancer Stage 4

Hepatectomy for rapidly growing solitary liver metastasis from non ...

The second most-common type of lung cancer after NSCLC is small cell lung cancer . SCLC is not typically grouped into numbered stages. Instead, its identified as limited stage or extensive stage.

  • With limited-stage SCLC, the cancer is present in one lung and may have spread to lymph nodes near that lung, but its contained to one side of the chest. If the lung has multiple tumors, the cancer may not be in the limited stage.
  • Extensive-stage SCLC is similar to stage 4 NSCLC in that it is metastatic. SCLC is considered extensive if it has spread throughout the original lung, into the other lung or faraway lymph nodes, or to any other areas of the body.

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How Lung Cancer Spreads

Lung cancer spreads when cancer cells break off from the primary tumor and travel through the bloodstream or lymphatic system. The lymphatic system is a network of vessels and organs that collects, carries, and filters substances from the body, including cancer cells.

The most common areas for lung cancer to spread are:

Less commonly, lung cancer can spread to the stomach, intestines, pancreas, eyes, skin, kidneys, or breast.

Different stages of the disease indicate how much the cancer has grown and spread. Local spread is known as stage 2. Metastasis occurs when cancer spreads to distant sites. Unlike early-stage cancer that may be cured, metastatic cancer cannot and is instead managed.

The risk of metastatic lung cancer can also vary by the cancer type. This includes the more common non-small cell lung cancer and the less common small cell lung cancer .

If cancer spreads to other parts of the body, it is still referred to by the site of the primary tumor. For example, if lung cancer spreads to the bone, it is called “lung cancer metastatic to bone” rather than “bone cancer.”

Treating Stage I Nsclc

If you have stage I NSCLC, surgery may be the only treatment you need. This may be done either by taking out the lobe of the lung that has the tumor or by taking out a smaller piece of the lung . At least some lymph nodes in the lung and in the space between the lungs will also be removed and checked for cancer.

Segmentectomy or wedge resection is generally an option only for very small stage I cancers and for patients with other health problems that make removing the entire lobe dangerous. Still, most surgeons believe it is better to do a lobectomy if the patient can tolerate it, as it offers the best chance for cure.

For people with stage I NSCLC that has a higher risk of coming back , adjuvant chemotherapy after surgery may lower the risk that cancer will return. But doctors arent always sure how to determine which people are likely to be helped by chemo. New lab tests that look at the patterns of certain genes in the cancer cells may help with this. Studies are now being done to see if these tests are accurate.

After surgery, the removed tissue is checked to see if there are cancer cells at the edges of the surgery specimen . This could mean that some cancer has been left behind, so a second surgery might be done to try to ensure that all the cancer has been removed. Another option might be to use radiation therapy after surgery.

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How Is The Stage Determined

The staging system most often used for NSCLC is the American Joint Committee on Cancer TNM system, which is based on 3 key pieces of information:

  • The size and extent of the main tumor : How large is the tumor? Has it grown into nearby structures or organs?
  • The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes?
  • The spread to distant sites : Has the cancer spread to distant organs such as the brain, bones, adrenal glands, liver, or the other lung?

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.

The system described below is the most recent version of the AJCC system, effective as of January 2018.

NSCLC is typically given a clinical stage based on the results of a physical exam, biopsy, and imaging tests . If surgery is done, the pathologic stage is determined by examining tissue removed during the operation.

Staging for NSCLC can be complex, so ask your doctor to explain it to you in a way you understand.

There Are Three Ways That Cancer Spreads In The Body

Immunotherapy in Metastatic NSCLC

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

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