Immunotherapy For Lung Cancer
Immunotherapy
for lung cancer

Understanding lung cancer

There have been many exciting advances in the field of lung cancer treatment. Until the mid-2000’s, treatment options for lung cancer were mostly limited to surgery, chemotherapy and radiotherapy. Nowadays, patients with lung cancer often have newer treatment options. This section is to help you understand advances in the treatment of lung cancer using immunotherapies that boost your body’s immune system to fight cancer.

Lung cancer is the most common cancer and the leading cause of cancer death globally.18 In Hong Kong, lung cancer is the second common cancer and the most common cause of cancer-related deaths.19 In 2016, there were 4,936 new cases of lung cancer in Hong Kong, and a total of 3,780 people died from this cancer, accounting for 26.6% of all cancer deaths.19

Lung cancer is caused by lung cells growing out of control, and as the number of cells grow, they form into a tumor.20 The lungs are a pair of organs in the chest that supplies the body with oxygen and removes carbon dioxide from the body.


Symptoms of Lung Cancer

It is important to report any unusual physical feelings to a doctor. These unusual feelings can happen in conditions other than cancer too. The signs and symptoms of lung cancer can take years to develop and they may not appear until the disease is advanced.21The symptoms of lung cancer may include any of the following:23

A cough that
does not go away
A change in colour
or volume of sputum
A chest infection
slow to clear up,
even after antibiotics
Repeated bouts of
pneumonia or
bronchitis
Shortness of
breath or wheezing
Hoarseness or
a changing voice
Coughing up blood
Pain in the chest, shoulder,
or back unrelated to pain
from coughing
Difficulty swallowing
Poor appetite and
unexplained weight loss
Feeling tired all the time
Neck or facial swelling

If the original lung cancer has spread, a person may feel symptoms in other places in the body. Common places for lung cancer to spread include other parts of the lungs, lymph nodes, bones, brain, liver, and adrenal glands.21

Types of Lung Cancer

Lung cancers can be either primary or secondary. Primary is when the tumor starts to grow in the lungs first. Secondary is when it has spread from somewhere else to the lungs.24Only primary lung cancer is discussed here.

Most lung cancers are divided into two main types: Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC).21NSCLC is the most common type of lung cancer and accounts for about 85% of lung cancers.24On this section we focus on NSCLC. NSCLC includes three main subtypes based on histology:

Adenocarcinoma

This type begins near the outside surface of the lung and grows slowly. It accounts for about 40% of lung cancers and occurs mainly in current or former smokers, but it is also the most common type of lung cancer seen in non-smokers, and more frequently seen in women and the young.24,25

Squamous cell carcinoma

This type generally begins in the lining of the airway in the larger breathing tubes, and often linked to a history of smoking. It accounts for about 25-30% of lung cancers and does not spread quickly.23,25

Large cell carcinoma

This type may occur in any part of the lung. It accounts for about 10-15% of lung cancers and tends to spread quickly.23,25

NSCLC Lung Cancer Staging

Staging lung cancer is based on whether the cancer is local or has spread from the lungs to the lymph nodes or other organs.21 Because the lungs are large, tumors can grow in them for a long time before they are found.43 Even when symptoms occur, such as coughing and fatigue, people think they are due to other causes.23For this reason, early-stage lung cancer (stages I and II) is difficult to detect.

Stage 0 Cancer cells are still within the lining of the lung or bronchus, but the cells have not formed an actual tumor. This is also called carcinoma in situ.21
 
Stage I The cancer is located only in the lung and has not spread to any lymph nodes. It is less than 5cm wide and can be surgically removed.27
 
Stage II The cancer is slightly larger than stage I, between 5cm and 7cm wide, and may have spread to nearby lymph nodes or other parts of the lung. Surgery may help. Other treatments may be necessary.27
 
Stage III Cancer cells have spread to the center of the chest (mediastinum) and/or to lymph nodes beyond the same side of the chest but does not appear to have spread to other organs outside the chest. Surgery may not be possible to remove the cancer.27 Other treatments will likely be needed.
 
Stage IV This is the most advanced stage of lung cancer in which the cancer has spread to both lungs, to fluid in the area around the lungs, or to another part of the body, such as the liver or other organs. Surgery may not be an option. Although stage IV cancers are generally not curable, there are treatments available that may help patients live longer and with an improved quality of life.27
 

Lung cancer treatment
Treatment options are based on a patient’s cancer type and stage, location, molecular characteristics, and his/her overall health. The most common treatments for lung cancer are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.
Radiotherapy can be combined with immunotherapy and other cancer therapies to achieve the best treatment results.

Surgery45

The cancer is removed along with some of the healthy tissue surrounding it. There are different procedure options depending on the size, stage, and spread of the cancer. The surgeon could remove as little as a small section of the lung to removing an entire lung.

Chemotherapy45

This treatment uses one or more of over 100 drugs to kill cancer cells to keep them from growing. Sometimes it is given before surgery to possibly help shrink the tumor, or to lessen any pain a patient may have. It can also be used after surgery to possibly kill any remaining cancer cells. Chemotherapy may be given by mouth or injected into bloodstream through a vein. It is usually given in regular treatments in a hospital, clinic or in the doctor's office over a specific duration of time.

Radiation therapy45

This treatment uses energy beams similar to X-rays, but in a strong, concentrated form. Radiation therapy may target the cancer from outside of the body or can be placed inside a needle, or catheter, and placed inside of the body to help attack the cancer.

Targeted therapy45

These treatments are determined by the results of a biopsy of the cancer cells. This test is called molecular profiling or mutation testing. Details of the tumor biopsy give the doctor information on how to possibly target specific mutations, or abnormal cells. There are many types of targeted therapies that may be used. Some block growth signals in the cells so they stop getting bigger. Others block new blood supplies that may nourish and grow cancerous cells.

Immunotherapy28

Immunotherapy treatment stimulates the immune system to recognize and destroy cancer cells. Immunotherapy can be used to treat some forms of non-small cell lung cancer (NSCLC).

We focus on immunotherapy treatment for lung cancer in this webpage.

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