When Non–Small Cell Lung Cancer Spreads: What to Expect
Recognizing the Symptoms of Metastatic NSCLC
Many cases of NSCLC are not discovered until after the cancer has metastasized. But careful attention to early symptoms can lead to early diagnosis, when treatment is more likely to be effective.
Symptoms of NSCLC include a cough that does not go away, coughing up blood, and chest pain that gets worse with deep breathing or laughing. Weight loss, loss of appetite, shortness of breath, and fatigue are also possible indications of NSCLC, but they can also be caused by other conditions. None are specific to NSCLC, which is why diagnosis is often delayed.
As with many other cancers, the danger increases when NSCLC spreads. Tumor cells can break away from tumors in the lungs and travel through the bloodstream to other parts of the body. Metastatic NSCLC cells, Dr. Graham says, are most likely to spread to lymph nodes in the middle of the chest, the liver, adrenal glands, bones, and possibly the brain.
Symptoms of metastatic NSCLC depend on the area of the body the cancer has spread to. If it has spread to the bones, it can cause bone pain in the back or hips. If they spread to the brain, these errant cells can also cause headaches, weakness, numbness of an arm or leg, dizziness, and seizures.
If NSCLC spreads to the liver, it can lead to yellowing of the skin and eyes, and if it spreads to the skin or lymph nodes, it can cause lumps near the surface of the body, according to the American Cancer Society. Lung cancer that has spread to the adrenal glands often causes no symptoms, but you may experience dizziness, weakness, and fatigue.
What Are the Treatment Options?
While there’s currently no cure for metastatic NSCLC, treatments are available that can ease your symptoms and help you live longer and feel better — what Taofeek Owonikoko, MD, an oncologist at the Winship Cancer Institute of Emory University in Atlanta, refers to as the quantity and quality of life.
Treatment options depend on many factors, including the areas the cancer has spread to and the particular characteristics of the cancer. Ten years ago, patients’ cells were examined to see whether they had small-cell lung cancer or NSCLC. “Now we want to find the specific alterations in the cancer cell,” says Dr. Owonikoko. “If there are specific mutations, the particular treatment would be dictated by that.”
For example, doctors will now order tests to determine whether the cancer cells have mutations in three genes — known as EGFR, ALK, and ROS1.
“We have specific targeted therapies that will take advantage of changes associated with those genetic markers,” says Graham. “They offer a treatment opportunity we wouldn’t have otherwise.” Each of those genes is associated with a pathway in the cells that spurs cancer growth.
Doctors can now treat those cancers with drugs to block the pathways and therefore slow growth rather than having to turn immediately to more invasive surgery, radiation, or chemotherapy.
Such treatments are known as targeted therapies because they are directed at a particular genetic target.
Some people are also candidates for immunotherapy, one of the newest and most significant advances in the treatment of metastatic NSCLC (and other cancers).
Cancer cells have devised all kinds of clever biological tricks to hide from the body’s immune system, which would otherwise attack them. Immunotherapy, using drugs called checkpoint inhibitors, makes the cancer cells visible to the immune system, which is then mobilized into action.
Treatment of cells in the bones, liver, brain, and elsewhere might require conventional cancer treatments that is, surgery, radiation, or chemotherapy.
The Outlook for Metastatic NSCLC
The length of time a person with metastatic NSCLC will live, and what kind of life he or she will have, are related to the particular mutations that are present in their tumor cells, and whether the effects of the mutations are able to be treated with immunotherapy.
Because of advancements in treatment, survival rates for people with metastatic NSCLC are improving. Those who respond to treatment can live four or five years, says Owonikoko. “Overall, the prognosis has improved,” he says, “but it’s still not where we want it to be.” Clinical trials are constantly being conducted to find ways to improve treatments and quality of life for people with metastatic NSCLC — ask your doctor whether you may be a candidate for such a trial.
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