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cancer? 9 What are the symptoms of lung cancer? 10 How common is NSCLC? 12 What causes NSCLC? 14 How is NSCLC diagnosed? 17 How will my treatment be determined? 21 What are the treatment options for NSCLC? 23 Treatment options for early (Stage I-II) NSCLC 25 Treatment options for locally advanced (Stage III) NSCLC 27 Treatment options for metastatic (Stage IV) NSCLC 32 Clinical trials 33 Supplementary interventions 35 What are the possible side effects of treatment? 49 What happens after my treatment has finished? 52 Support groups 53 References 55 Glossary WHAT’S INSIDE 3 4 Non-small-cell lung cancer Lung cancer: A summary of key information This summary is an overview of the key information provided within the NSCLC guide. The following information will be discussed in detail in the main pages of the guide. Introduction to lung cancer • Lung cancer arises from cells in the lung that have grown abnormally and multiplied to form a lump or tumour. • Non-small-cell lung cancer (NSCLC) is a type of lung cancer, which is differentiated from small-cell lung cancer (SCLC) because of the way the tumour cells look under a microscope. The three main types of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell (undifferentiated) carcinoma of the lung. They are diagnosed in the same way, but may be treated differently. • Lung cancer is the third most common cancer in Europe; NSCLC represents 85–90% of all lung cancers. Smoking is the biggest risk factor for the development of lung cancer. • In Europe, there has been a decrease in lung cancer mortality among men, while it is increasing in women – this reflects a difference in smoking trends between the sexes. Diagnosis of NSCLC • Lung cancer may be suspected if a person has symptoms such as persistent cough or chest infection, breathlessness, hoarseness, chest pain or coughing up blood. Other symptoms may be fever, appetite loss, unexplained weight loss and fatigue. • Following a clinical examination, your doctor will arrange for an x-ray and/or computed tomography (CT) scan (or might use other technologies, such as positron emission tomography [PET] CT scan or magnetic resonance imaging [MRI]) to evaluate the position and extent of the cancer. Examination of a biopsy (cells or tissue taken from the tumour) will confirm a diagnosis of NSCLC. Treatment options for NSCLC • Types of treatment include: - Surgery - Chemotherapy – the use of anti-cancer drugs to destroy cancer cells. Chemotherapy can be given alone or with other treatments. - Targeted therapy – newer drugs that work by blocking the signals that tell cancer cells to grow. - Immunotherapy – a type of treatment designed to boost the body’s natural defences to fight cancer. - Radiotherapy – the use of measured doses of radiation to damage cancer cells and stop them growing. • Combinations of different treatment types are frequently offered based on the stage and type of NSCLC and on the patient’s condition and comorbidities (additional diseases or disorders experienced at the same time). 5 ESMO Patients Guide • Cancer is ‘staged’ according to tumour size, involvement of regional lymph nodes and whether it has spread outside the lung to other parts of the body. This information is used to help decide the best treatment. • Early-stage (Stage I-II) NSCLC - Surgery is the main treatment for early-stage NSCLC. - Chemotherapy may be given after surgery (adjuvant chemotherapy) in patients with Stage II and Stage III NSCLC and in some patients with Stage IB disease. - Radiotherapy (either stereotactic ablative radiotherapy [SABR] or conventional radiotherapy) is an alternative to surgery in patients who are unable or unwilling to have surgery. - Radiotherapy may be given after surgery (adjuvant radiotherapy) in patients with Stage II and Stage III NSCLC. • Locally advanced (Stage III) NSCLC - Treatment for locally advanced NSCLC is likely to involve different types of therapy (multimodal therapy). - If it is possible to remove the tumour (i.e. the tumour is resectable), treatment options can include: ~ Induction therapy (initial treatment[s] given to shrink the tumour before a second planned treatment) consisting of chemotherapy with or without radiotherapy,