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(windpipe). • Bronchi (tubes that go to each lung). • Lungs. Anatomy of the respiratory system, showing the trachea, bronchi and lungs. As we breathe in, air passes from our nose or mouth, through the trachea, bronchi and bronchioles, before it reaches tiny air sacs called alveoli – this is where oxygen from the air passes into the bloodstream (see inset image). 8 Non-small-cell lung cancer What is lung cancer? Lung cancers typically start in the cells that line the bronchi and parts of the lung such as the bronchioles or alveoli. There are two main types of primary lung cancer: • Small-cell lung cancer (SCLC): This type gets its name from the small size of the cells that it is composed of when viewed under a microscope. • Non-small-cell lung cancer (NSCLC): This is the more common type of lung cancer, and accounts for 80–90% of all lung cancers (Planchard et al., 2018). - This guide will focus exclusively on NSCLC. What subtypes of NSCLC are there? The three main histological subtypes of NSCLC are: • Adenocarcinoma: About 40% of all lung cancers are adenocarcinomas. These tumours start in mucusproducing cells that line the airways. • Squamous cell carcinoma (SCC): About 25–30% of all lung cancers are SCC. This type of cancer develops in cells that line the airways and is usually caused by smoking. • Large cell (undifferentiated) carcinoma: This type makes up around 10–15% of all lung cancers. It gets its name from the way that the cancer cells look when they are examined under a microscope. 9 ESMO Patients Guide What are the symptoms of lung cancer? The most common symptoms of lung cancer, including NSCLC, are: • Persistent cough. • Coughing blood. • Chest infection that won’t go away or keeps coming back. • Chest or shoulder pain that won’t go away. • Difficulty breathing/breathlessness. • Hoarseness or lowering of the voice. • Wheezing. Other, non-specific symptoms, may include: • Fever. • Loss of appetite. • Unexplained weight loss. • Feeling extremely tired. You should see your doctor if you experience any of these symptoms. However, it is important to remember that these symptoms are common in people who do not have lung cancer; they may also be caused by other conditions. 10 Non-small-cell lung cancer How common is NSCLC? Lung cancer represents the third most common cancer in Europe In 2018, the number of new cases of lung cancer diagnosed in Europe was estimated at more than 470,000 (Ferlay et al., 2018): • 312,000 new cases in men. • 158,000 new cases in women. In Europe, lung cancer is the second most common cancer in men (after prostate cancer) and the third most common in women (after breast and colorectal cancer) (Ferlay et al., 2018). Incidence rates of lung cancer are higher in more developed countries than in less developed countries; these variations largely reflect the differences in the stage and degree of the tobacco epidemic (Torre et al., 2015). In Europe, there has been a decrease in lung cancer mortality among men, while it is increasing in women – this reflects the difference in smoking prevalence trends between the sexes (Malvezzi et al., 2016; Planchard et al., 2018). The majority of cases of lung cancer are diagnosed in patients aged 65 years and over, and the median age at diagnosis is 70 years. NSCLC is the most common type of lung cancer, representing 85–90% of all lung cancers 11 ESMO Patients Guide SOUTHERN EUROPE 43.1 / 15.7 WESTERN EUROPE 43.3 / 25.7 WESTERN AFRICA 2.4 / 1.2 SOUTH AMERICA 16.8 / 10.2 CARIBBEAN 23.5 / 14.2 SOUTHERN AFRICA 26.0 / 8.9 MIDDLE AFRICA 3.8 / 2.3 WESTERN ASIA 38.8 / 7.8 NORTHERN AFRICA 16.9 / 3.4 EASTERN AFRICA 3.4 / 2.2 POLYNESIA 52.0 / 24.6 AUSTRALIA/ NEW ZEALAND 28.4 / 24.0 SOUTH EASTERN ASIA 26.3 / 9.6 MELANESIA 17.1 / 8.9 SOUTH CENTRAL ASIA 9.4 / 3.4 CENTRAL AND EASTERN EUROPE 49.3 / 11.9 NORTHERN EUROPE 34.0 / 26.9 NORTHERN AMERICA 39.1 / 30.7 CENTRAL AMERICA 7.2 / 4.5 EASTERN ASIA 47.2 / 21.9 The map shows estimated numbers of new cases of lung cancer diagnosed in 2018 per 100,000 people of each region’s population (Ferlay et al., 2018). male female 12 Non-small-cell lung cancer What causes NSCLC? Smoking