More than 2.6 million people worldwide will receive a lung cancer diagnosis this year. One of them is the pope.
On October 13, Pope Leo XIV had surgery to remove the lower right lobe of his lung because of lung adenocarcinoma, the most common type of lung cancer.
It’s a challenging diagnosis no matter who you are.
“Lung cancer is usually not symptomatic until it’s progressed to stage 3 or 4, when it’s harder to treat and cure,” says UNC Health thoracic surgeon Jason Long, MD, MPH, director of UNC Lung Cancer Screening. “That’s partly why lung cancer is the No. 1 cancer killer in the world, the country and North Carolina.”
While that fact is daunting, lung cancer screenings and new treatments are improving early diagnosis and prognosis. Dr. Long explains.
Understanding Lung Cancer Types and Risk Factors
Lung cancer can be broken down into two groups: small-cell lung cancer (about 20 percent of cases) and non-small cell lung cancer (80 percent of cases). Small-cell lung cancer tends to be extremely aggressive and spreads through the body very quickly, while non-small cell lung cancer usually grows more slowly.
Both types can be broken down into additional subtypes. The most common non-small cell lung cancer types are:
Adenocarcinoma, which grows in the lung cells that produce mucus and tends to develop in the outer lungs. This most common type of non-small cell lung cancer accounts for 40 percent of cases.
Squamous-cell carcinoma, which grows in the cells lining the central airways of the lungs. It makes up about 30 percent of cases.
Large-cell carcinoma, which could develop in any part of your lungs and tends to grow more quickly than the other non-small types. This type, along with a few rarer forms, make up the other third of cases.
Smoking tobacco is the leading risk factor for all lung cancer, but anyone who has lungs can get lung cancer.
“About 20 percent of lung cancers occur in nonsmokers,” Dr. Long says. “There are other risk factors you should discuss with your primary care provider, like age, family history, history of another cancer and exposures to asbestos, radon and secondhand smoke.”
Screening for Lung Adenocarcinoma and Other Lung Cancer
Because lung cancer is typically not symptomatic in its earliest stages, the best way to find cancerous tumors early is with chest imaging.
If you are between the ages of 50 and 80 and you currently smoke or smoked a pack a day for 20 years or more, experts recommend that you receive a low-dose CT scan every year to check your lungs for small nodules, or growths. Most nodules are benign, or noncancerous, but checking regularly allows your doctor to identify growth or changes that could indicate cancer.
Unfortunately, the current screening guidelines miss an important population: nonsmokers (Pope Leo is not known to be a smoker).
“A lot of nodules are found incidentally on a scan for a different reason, meaning that you went to your doctor or the emergency department for another reason and had a chest scan,” Dr. Long says. “By the time some people follow up to get an incidental pulmonary nodule checked out, it might have grown.”
Dr. Long is working with colleagues across UNC Health to develop the UNC Early Detection of Lung Cancer Program, which includes both recommended lung cancer screenings and identification of incidental pulmonary nodules.
Symptoms of lung cancer include:
A new persistent cough, which might produce bright red or rust-colored mucus or phlegm
Shortness of breath
Wheezing
Hoarseness
Chest, shoulder or back pain which tends to get worse when you breathe deeply
Recurrent lung infections
Unexplained weight loss
If you experience these symptoms, talk to your doctor about diagnostic chest imaging.
Diagnosing Lung Cancer
A nodule on a scan doesn’t necessarily mean you have lung cancer. Your doctor may watch the nodule over time to check for changes; if there’s concern, they may recommend a PET scan for another view of the nodule and to see if it spread into nearby tissues. Your doctor may order a robot-assisted bronchoscopy, during which they’ll guide a small tube down your trachea and into the lungs. They can take a small amount of tissue from the nodule for testing.
“This presurgical biopsy with molecular analysis is really important,” Dr. Long says. “We can check for molecular markers that can guide your treatment. In addition to immunotherapy, there are a lot of new medications that offer targeted therapy for those specific mutations.”
These tests will help your doctor confirm your diagnosis and understand your tumor. At that point, you might hear what stage of lung cancer you have, from 1 to 4, with 3 and 4 indicating spread to other parts of the body. That will help determine possible treatment.
Treatment for Lung Adenocarcinoma and Other Lung Cancer
If your cancer is found early, before it spreads throughout your lungs and body, you may be a candidate for surgery. Depending on the size and location of your tumor, your surgeon might remove a small section of the lung, an entire lobe of one lung or an entire lung.
“You have three lobes on your right lung and two on your left,” Dr. Long says. “If the tumor is in just one lobe, we can do a minimally invasive, robotic-assisted lobectomy to remove it, as opposed to a larger open surgery where you have to spread the ribs to get to the lungs. This minimally invasive approach has fewer complications and better recovery and survival.”
For stage 1 lung cancer, this surgery might be all that’s necessary. With time, your lungs will adjust to having one less lobe.
“Most people are back to normal activity and normal quality of life in three to six months,” Dr. Long says. “In the immediate post-op period, you might have pain, shortness of breath and soreness, but we encourage regular exercise after the surgery. The more function in your lungs, the better.”
With any surgery, your doctor will check nearby lymph nodes for potential spread throughout the body, and pathologists will perform additional testing for molecular markers. If you have specific genetic mutations or certain proteins in your tumors, you may take medications that target those markers.
These medications, in addition to lung cancer screening, are why survival rates are improving, especially in stage 2 and 3 lung cancer, Dr. Long says.
“You might start first with these medications, in combination with chemotherapy, and then have surgery,” he says. “About 20 percent of patients who have these treatments and then surgery have a complete response,” meaning that doctors are able to remove all of the cancer.
If surgery isn’t an option based on the size and location of the tumor, you might have a combination of targeted therapy, chemotherapy, immunotherapy and radiation.
Even when all the cancer is removed early, continued follow-up remains important.
“With lung cancer, there is a high risk of recurrence, so we recommend that people have a CT scan every six months for the first two years, then another one annually,” Dr. Long says, noting that some high-risk populations may need more frequent screenings. “Continued surveillance is important.”
Talk to your doctor about your risk for lung cancer. If you need a doctor, find one near you.The post What is Lung Adenocarcinoma? first appeared on UNC Health Talk.
