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Types of lung cancer

It is important to know the type of lung cancer you have. The most effective and appropriate treatment for you will vary depending on what type (pathology) of lung cancer you have, as different types of lung cancer respond best to different treatments.

The type of lung cancer you have will determine your treatment options

There are several different types of lung cancer, made up of different types of abnormal cells. In general, lung cancer is split into two main categories: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).

Learning all I could about the type of cancer my husband has helped me understand things much better and grab a little bit of control in my life.

Gill

Non-small cell lung cancer

Approximately 85 in every 100 people with lung cancer have non-small cell lung cancer. This makes it the most common type of the disease.

Types of non-small cell lung cancer

Adenocarcinoma is a type of non-small cell lung cancer (NSCLC). It is a little more common in women and is also the most common type of lung cancer amongst people under 45.

More frequently seen in the outer parts of the lung, adenocarcinoma develops from a particular type of cell that produces mucus (phlegm) and can lead to a chronic cough. It accounts for approximately 50% of all cases of NSCLC.

This type of lung cancer tends to grow quite quickly and often arises in the larger air passages. It has a tendency to spread outside the lung at an earlier stage.

This is the most common type of primary lung cancer in the UK and often forms in the larger, more central airways.

All types of NSCLC are potentially suitable for surgery if they are diagnosed at an early enough stage.

I was diagnosed with stage 1A non-small cell lung cancer. I couldn’t have been more shocked. Fortunately, because of my age and health, I could have surgery to remove the affected lobe. 12 months on, I’m cancer free.

Pat, Living with lung cancer
Pat, doing the Wirral Walk after having lung cancer surgery

Lung cancer mutations

Within these categories, some NSCLC can be seen to have specific characteristics (called mutations) that show up in the genes within the cancer cells. The most common mutations of non-small cell lung cancer are called:

EGFR (epidermal growth factor receptor) is a protein found on the surface of cancer cells as well as normal cells. Mutations in the EGFR gene cause cancer cells to have too much of the EGFR protein, which leads them to grow faster.

EGFR-positive NSCLC is considered to be a genetically distinct form of lung cancer. It is detected in about 10-15% of cases of NSCLC. It is most common in people with adenocarcinoma, non-smokers, people of Asian origin and women.

In the UK, patients diagnosed with NSCLC are now routinely tested for gene mutations such as EGFR.

As with cases of NSCLC, if the disease is diagnosed at an early enough stage, before it has spread to other parts of the body, there is a better chance that it may be treated with curative intent. In such cases, surgery to remove the tumour would be the preferred option, although radiotherapy and chemotherapy are sometimes used.

When lung cancer has spread beyond the chest, it may no longer be possible to treat with curative intent. EGFR tumours usually respond well to treatment with targeted therapies as well as conventional cancer therapies.

These treatments are given in tablet form and often have much less in the way of side effects when compared with conventional cancer treatments. In recent years there have been major developments in targeted therapies for EGFR lung cancer.

Kathy was diagnosed with stage 4 lung cancer in 2013

I was eligible for a new targeted therapy called osimertinib. For me, it has been a dream come true. The drug is keeping my cancer in check and, just as importantly, it has given me my life back. I have a few minor side effects and loads of energy. I had to give up work but, with a packed social calendar, I don’t know how I’d fit it in now anyway!

Kathy, living with EGFR+ lung cancer

ALK positive lung cancer (often written as ALK+) is a rare form of the disease that occurs in around 3-5% of patients diagnosed with NSCLC.

ALK belongs to a family of proteins called receptor tyrosine kinases (RTKs), which are involved in the growth of cells. In patients found to be ALK positive, the ALK protein is abnormally active and can drive the growth of cancer cells.

The ALK gene rearrangement is a genetic alteration within lung tissue cells that causes them to grow abnormally and, ultimately, behave as cancer cells.
Younger patients — usually 55 and under — who have never smoked are most likely to be diagnosed as being ALK positive.

Amanda is living with ALK+ positive lung cancer

GPs haven’t really heard of my type of lung cancer. I’ve got an ALK rearrangement which is a type of mutation. I am a GP in the army and none of my colleagues have heard of that kind of lung cancer.

Amanda, living with ALK+ lung cancer

In the UK, patients diagnosed with NSCLC now have their tumours routinely tested for the ALK gene rearrangement.

As with most cases of NSCLC, if the disease is diagnosed at an early enough stage, before it has spread to other parts of the body, there is a better chance that it may be treated with curative intent. In such cases, surgery to remove the tumour would be the preferred option, although radiotherapy and chemotherapy are sometimes used.

When lung cancer has spread beyond the chest, it may no longer be possible to treat with curative intent. Tumours that are ALK positive usually respond well to treatment with targeted therapies as well as conventional cancer therapies.

These treatments are given in tablet form and often have much less in the way of side effects when compared with conventional cancer treatments. In recent years there have been major developments in targeted therapies for ALK positive lung cancer.

ROS1 positive (sometimes written as ROS1+) is a rare form of the disease which occurs in around 1–2% of NSCLC patients.

In this type of the disease, the lung cancer cells contain changes affecting the gene responsible for a protein called ROS1.

ROS1 belongs to a family of proteins called receptor tyrosine kinases (RTKs), which are involved in the growth of cells. In patients found to be ‘ROS1-positive’, the ROS1 protein is abnormally active and can drive the growth of cancer cells.

The ROS1 gene rearrangement is a genetic alteration within lung tissue cells that causes them to grow abnormally and, ultimately, behave as cancer cells.
In the UK, patients diagnosed with NSCLC now have their tumours routinely tested for gene mutations and rearrangements such as ROS1.

As with most cases of NSCLC, if the disease is diagnosed at an early enough stage, before it has spread to other parts of the body, there is a better chance that it may be treated with curative intent. In such cases, surgery to remove the tumour would be the preferred option, although radiotherapy and chemotherapy are sometimes used.

When lung cancer has spread beyond the chest, it may no longer be possible to treat with curative intent. Tumours that are ROS1-positive usually respond well to treatment with targeted therapies as well as conventional cancer therapies.

These treatments are given in tablet form and often have much less in the way of side effects when compared with conventional cancer treatments. In recent years there have been major developments in targeted therapies for ROS1-positive lung cancer.

Small cell lung cancer

Around 15 of every 100 people with lung cancer have small cell lung cancer.

This type of lung cancer is made up of small round cells that form fleshy lumps and usually start in the larger airways.

The small cell lung cancer cell reproduces and grows very quickly. It may spread to the lymph nodes and/or other organs in the body.

Small cell lung cancer is generally more responsive to chemotherapy treatment than other treatments. However, radiotherapy may also be used.

In rare cases this type of lung cancer can be surgically removed. Small cell lung cancer often reoccurs within a short space of time, so it is usual for you to attend regular check-ups to ensure any recurrence is found quickly.

Graham was diagnosed with small cell lung cancer in 2014

When I was first diagnosed we were obviously shocked. Then we realised that wasn’t the way to do things, so I decided to just get on with it, to get on with living, ‘to keep on keeping on’.

Graham, living with small cell lung cancer

Other types of lung cancer

There are a variety of other cancers that can affect the lungs, but most of them are rare. Mesothelioma, pancoast and carcinoid tumours are three of the more common types.

It is closely associated with a history of asbestos exposure either through work or contact with a person in the asbestos industry. It generally affects older males and may take 35-40 years from the date of first exposure for the cancer to develop. The cancer cells usually positioned in the lining of the lung and often produce fluid. This may require draining from time to time, but may improve breathing.

Mesothelioma can be difficult to treat as it is often found when it is at an advanced stage. Patients should therefore discuss treatment options with their cancer doctor or lung cancer nurse specialist. Treatment may include chemotherapy, radiotherapy or surgery. Please note that financial compensation from the government may be available if lung damage from exposure to asbestos is proven.

This rare tumour grows at the top of the lung. Treatment is usually the same as the NSCLC and will depend on where the tumour is, the size of it and whether it has spread to other parts of the body.

This is a rare tumour disease of the lung which is generally less aggressive than other types. The tumour develops from a special type of cells in the lung called neuroendocrine cells.

Many carcinoid tumours can be cured by surgery but some are more aggressive and can spread to other parts of the body. In this case treatment with chemotherapy may be required.

Other tumours are so rare that current information is best given by your doctor or lung cancer nurse specialist. These unusual types of lung cancer include:

  • Hamartoma
  • Bronchial gland tumours
  • Lymphoma
  • Pleural fibroma
  • Sarcoma.

It is important to know the type of lung cancer you have. The most effective and appropriate treatment for you will vary depending on what type (pathology) of lung cancer you have, as different types of lung cancer respond best to different treatments.

For example, some patients’ tumours test positive for an EGFR, ALK or ROS1 mutation when examined under a microscope. If they then receive a drug treatment matched to that mutation, they gain more benefit than from standard chemotherapy.