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Non-Small Cell Lung Cancer Types, Risks, Diagnosis, and Treatment

Lung cancer is the second most common type of cancer in both men and women. It's also the leading cause of cancer death in the U.S.

But there's good news, too. A decline in smoking rates means that fewer Americans get lung cancer. And doctors have made huge strides in diagnosing and treating it.

There are two main types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). About 85% of all lung cancer cases are NSCLC.

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Types of Non-Small Cell Lung Cancer

The name NSCLC for this group of cancers refers to how the cancer cells look under a microscope.

Small cell lung cancer cells look like oats. Doctors call lung cancer cells that don't have this distinct oat shape NSCLC as a broad umbrella category.

Different types of NSCLC may grow and spread in similar ways. Treatments and outlook may also be about the same among NSCLC types.

There are three subtypes of NSCLC:

Adenocarcinomas are the most common type of lung cancer. They make up about 40% of all NSCLCs and about one-third of all lung cancers.

They form in the bronchioles, the small airways at the outer edges of the lungs. These tumors grow in the mucus-producing cells that line the small airways.

While overall lung cancer cases are down, lung cancers among people who've never smoked are on the rise. These cases of adenocarcinomas are likely due to a genetic mutation in the tumor.

Adenocarcinomas often grow more slowly than other lung cancers, which can lead to earlier detection and better outcomes.

Squamous cells are flat cells that line the inside of the lung's airways. Squamous cell lung carcinomas start inside these cells.

These tumors tend to form near the bronchi, the lungs' main airways.

Like other types of lung cancer, smoking is a strong link to squamous cell lung carcinomas . They account for about 25% to 30% of all lung cancers.

About 10% to 15% of NSCLCs are large cell carcinomas. Your doctor may also call this type of cancer undifferentiated carcinoma.

Large cell carcinomas can form anywhere in the lungs.

These tumors often grow quickly and spread outside the lungs. This makes them hard to treat.

Non-Small Cell Lung Cancer Risk Factors

Doctors have found several risk factors that may increase the chance of getting lung cancer.

These include:

  • Smoking. Smoking is by far the #1 risk factor for lung cancer. People who smoke more cigarettes and people who have smoked for a long time are at higher risk. You can significantly reduce your risk of lung cancer if you quit smoking, regardless of how long you've smoked.
  • Secondhand smoke. This risk occurs when you breathe in smoke often just by being near someone else while they smoke.
  • Radon. You can't see, taste, or smell this naturally occurring gas. Radon can occur in rocks, soil, and water and then enter buildings through the foundation and collect in the air inside. People who live or work in a building with radon can eventually get lung cancer.
  • Radiation therapy to the chest. Prior radiation to the chest may increase your risk of lung cancer.
  • History of lung cancer. If you had lung cancer before, your risk of getting it again is higher, especially if you smoke. You're also at risk of lung cancer if any close relatives have had lung cancer. That includes your parents, siblings, and children.

Some workplaces may contain substances that increase lung cancer risk. This includes asbestos, arsenic, diesel fumes, silica, and chromium.

Talk to your doctor about a lung cancer screening if you have any risk factors on this list. Screening is especially crucial for people who currently smoke or did in the past.

Your doctor can also help you quit smoking.

Non-Small Cell Lung Cancer Diagnosis

If your doctor thinks you may have lung cancer, they'll order various tests to confirm a firm diagnosis.

First, your doctor will perform a physical exam and ask you about any symptoms. They'll ask about your health history. Be sure to tell them if any close relatives have had cancer.

Tests to help confirm a lung cancer diagnosis 

Except for blood work, noninvasive tests don't break the surface of the skin or enter the body.

  • Lab tests. These will commonly include blood and urine tests.
  • Sputum cytology. This tests a sample of mucus that you cough up from your lungs.
  • Chest x-rays. This simple imaging tests give your doctor an easy way to get a snapshot of what's happening inside your lungs.
  • PET/CT scan. These are two types of imaging tests. First, you'll have a CT scan to create 3D pictures of your lungs, other organs, and tissues. Next, you'll have a PET scan, which provides even more detail, to search for any lung masses or abnormalities.

A crucial step in lung cancer diagnosis is for your doctor to take a small tissue sample from your chest or lungs.

There are many different ways to get lung tissue samples, such as:

  • Needle biopsy. Your doctor will place a needle through the chest wall to remove small samples of lung tissue or fluid. You will receive local anesthesia.
  • Transbronchial biopsy. Your doctor will insert a thin, lighted scope called a bronchoscope through your mouth to look directly at your airways. They can also use this scope to collect tissue samples or sputum.
  • Video-assisted thoracic surgery (VATS) biopsy. After you receive general anesthesia, your doctor will insert a scope through the chest wall. They can also remove lung nodules this way.

Your doctor will choose what type to use based on your unique case.

Next, a pathologist will look at your lung tissue under a microscope in the lab. Their job is to make the official diagnosis.

Today's standard of care means that all people who receive a lung cancer diagnosis should also have molecular testing.

Doctors will use a blood or lung tissue sample for these special tests of markers for:

  • Genetic response to targeted therapies.
  • Potential response to immunotherapy.

These test results will give your doctor critical data for planning your ideal treatment for lung cancer.

Non-Small Cell Lung Cancer Treatment

UPMC Hillman Cancer Center's care team works closely to create a complete treatment plan for your type and stage of lung cancer.

Treatments for NSCLC may include:

Contact Us About Lung Cancer Care

To learn more about lung cancer care or to make an appointment, you can: