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Lung Cancer

Lung cancer is one of the cancers whose treatment options have changed most over the past decade. It falls into two main groups, non-small cell and small cell, and treatment is planned according to that distinction and to the molecular features of the tumour.

  • 85% share of non-small cell lung cancer
  • EGFR/ALK gene changes that determine targeted therapy
  • PD-L1 marker that guides the immunotherapy decision

What is lung cancer?

Lung cancer begins when cells in the lung tissue start to multiply without control. There are two main groups: non-small cell lung cancer, seen in roughly 85 per cent of patients (adenocarcinoma, squamous cell carcinoma), and small cell lung cancer, which follows a faster course.

Smoking is the most important risk factor, yet lung cancer also occurs in people who have never smoked, particularly the adenocarcinoma type. Targetable gene changes such as EGFR and ALK are more common in this group, and that directly affects the treatment options.

Two main types and staging

The treatment decision follows from establishing first the type, then the stage.

  1. NSCLC

    Non-small cell lung cancer

    This is the most common group. In early stages it can be treated with surgery or radiotherapy. In advanced disease, treatment is planned as targeted drugs, immunotherapy or chemotherapy combinations according to molecular test results and the PD-L1 level.

  2. SCLC

    Small cell lung cancer

    It grows faster and tends to spread early, so surgery is rarely suitable. Chemotherapy is the basis of treatment, and immunotherapy is now added to it. Radiotherapy joins the plan depending on how far the disease has spread.

  3. Staging

    Why does stage matter?

    Staging shows whether the disease is confined to the lung or has spread to the lymph nodes or other organs. PET-CT and brain MRI are used for this purpose, and the result is the key information that decides between surgery and drug treatment.

Treatment approaches

In early stage lung cancer treatment usually begins with surgery; drug treatment and radiotherapy may be added before or after the operation. For early stage patients who are not fit for surgery, stereotactic radiotherapy is an option.

In advanced disease, molecular tests set the direction of treatment. If one of the changes in EGFR, ALK, ROS1, BRAF, KRAS G12C, RET or MET is found, targeted drugs come to the fore. Where no such change is present, immunotherapy is given alone or together with chemotherapy according to the PD-L1 level.

Molecular testing and screening

Two subjects have become steadily more decisive in lung cancer: the genetic profile of the tumour, and screening of people at risk.

  1. Molecular test

    Why at the time of diagnosis?

    In advanced non-small cell lung cancer, molecular tests change the choice of treatment directly. If the tissue sample is not sufficient, these changes can also be looked for in a liquid biopsy taken from blood. Starting treatment without waiting for the result may delay a more effective option.

  2. Screening

    Who should be screened?

    In people within a certain age range who have a heavy smoking history, screening with low dose lung CT can catch the disease at an early stage. Whether screening is appropriate is decided by individual risk assessment; a plain chest X-ray is not sufficient for this purpose.

Frequently Asked Questions

I have never smoked. Can I still get lung cancer?

Yes. A proportion of lung cancer cases occur in people who have never smoked. The adenocarcinoma type and targetable gene changes such as EGFR and ALK are more common in this group, which means the treatment options are different too. Symptoms such as a persistent cough or breathlessness should be assessed even without a smoking history.

Can lung cancer be removed completely with surgery?

If the disease is confined to the lung and respiratory capacity is adequate, surgery can be performed with the aim of cure. In advanced disease the basis of treatment is drug therapy. Which applies is decided by staging investigations and an assessment made together with thoracic surgery.

Can targeted drugs be used in every patient?

No. Targeted drugs are effective only in patients whose tumour carries the relevant gene change, which is why molecular tests are needed before treatment begins. In patients without such a change, immunotherapy and chemotherapy come to the fore.

Has immunotherapy replaced chemotherapy?

Not in every patient. Immunotherapy has taken an important place in lung cancer treatment, but whether it is used alone or together with chemotherapy is decided by the PD-L1 level, the tumour type and the patient's general condition. There are also situations where both are used together.

Does stopping smoking still help after diagnosis?

Yes. Stopping smoking after diagnosis has a favourable effect on response to treatment and on tolerating it, and reduces the risk of complications after surgery. Taking support during the process markedly improves the chance of success.