It is an undeniable fact that lung cancer can be caused by tobacco use. According to Cancer Research UK, a nonprofit organization based in the United Kingdom, smoking is the primary cause of both 72% of lung cancer cases and 86% of lung cancer deaths. According to the Centers for Disease Control and Prevention (CDC), smoking is linked to up to 90% of lung cancer deaths in the US. Lung cancer risk can be significantly decreased by quitting smoking or, better yet, by never starting to smoke. Smoking is not a cause of lung cancer in all cases, though. Furthermore, non-smoking related lung cancer cases are increasing while smoking-related lung cancer cases are beginning to decline. A disease known as cancer occurs when certain body cells proliferate out of control and invade other bodily regions. Any cancer that affects the lung tissue, bronchi (airways), or trachea (windpipe) is classified as lung cancer. Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are the two primary forms of lung cancer. Approximately 80%–85% of lung cancer cases are NSCLC. NSCLC can be classified into three primary types: large cell carcinoma, where cells appear larger than typical when examined under a microscope; squamous cell carcinoma, which tends to grow near the center of the lungs and starts in the flat cells that cover the airway surface; and adenocarcinoma, which begins in the mucus cells lining the airways.
As a whole, in the U. S. the estimated 5-year survival rate for non-small cell lung cancer (NSCLC) is 28%, which indicates that 28% of patients with NSCLC are expected to survive five years after diagnosis. On the other hand, survival rates are constantly rising. Lung cancer has historically afflicted more men than women. Women’s smoking rates peaked in the U.S. S. as these women grew older, the incidence of lung cancer rose in the 1960s. There has been an alarming increase in lung cancer cases among younger women (ages 30-49) in recent years. The term “EGFR+ lung cancer” refers to a type of lung cancer, typically an adenocarcinoma, that is brought on by a mutation in the protein known as “EGFR,” which is involved in the growth and division of healthy cells rather than smoking. The gene becomes mutated, telling cells to divide continuously, which results in cancerous tumors. According to the American Lung Association (ALA), 10–15 percent of lung cancers in the United States have an EGFR+ mutation. S. The two most prevalent EGFR mutations are the EGFR L858R point mutation, which modifies a single nucleotide (small unit of DNA), and the EGFR 19 deletion, which results in a portion of the gene being absent. The Exon 20 insertion mutation, which accounts for 4–10% of EGFR+ lung cancer cases, is less frequent. Women are more likely than men to develop this kind of lung cancer. Additionally, younger individuals, those who have never smoked, and those who have smoked lightly in the past are more likely to receive a diagnosis than heavy smokers. Thus, it may share some of the blame for the observed increases.
Numerous lung cancer patients experience negative stigma related to their alleged lifestyles. MNT designed the collage, and Rankin took the photos for the See Through the Symptoms campaign. Images courtesy of EGFR+ UK. Prof. Robert Rintoul is a professor of thoracic oncology at the University of Cambridge’s Department of Oncology. K. , an honorary consultant respiratory physician at the Cambridge-based Royal Papworth Hospital NHS Foundation Trust, stated to Medical News Today: “Many individuals with EGFR+ status do not consider lung cancer as a possible cause of their symptoms because they are either light or never smokers. “Oh, it can’t be that bad; I’ve never smoked.”. When the disease does manifest, these patients frequently do so at a later stage and with more advanced symptoms. Lung cancer is no longer a disease exclusive to smokers; at present, 15% of all cases of lung cancer that we diagnose (regardless of EGFR status) are never smokers. As per the CDC, 20 percent or more of lung cancer cases in the U.S. S. are identified among non-smokers. Prof. Regardless of smoking history, Rintoul recommended that everyone be aware of the symptoms, which include: a persistent cough lasting longer than three weeks; recurrent chest infections; blood in the cough; weight loss; unexplained fatigue; chest pain; and unexplained dyspnea. EGFR+ survivor Dr. Gini Harrison, a psychologist and research trustee at EGFR+ UK, issued a warning, pointing out that not everyone experiences these common symptoms, especially in the case of EGFR+ lung cancer.
“I was forty years old. After giving birth to my son in February 2021, I experienced excruciating shoulder pain almost immediately. And that was it. My only symptom was that. No wheezing, no breathing problems—none at all. She informed us that my GP [primary care physician] believed it was likely tendonitis brought on by improper breastfeeding posture. Furthermore, she stated that many of us only exhibit musculoskeletal symptoms at diagnosis, such as shoulder, chest, or back pain. Her unusual symptoms contributed to the nine months it took to diagnose her cancer. Funding for lung cancer research is scarce. Despite being the second most common cancer in women and the most common cancer in men, it receives relatively little funding when considering the total cost of cancer. Lung cancer accounts for 14% of all cancer cases and 18% of all cancer deaths worldwide, but between 2016 and 2020, only 53% of all cancer research funding was allocated to lung cancer research. Is it possible that this is a result of the stigma attached to lung cancer? Considering that 80–90% of people who pass away from lung cancer had smoked in the past, and smoking is frequently blamed for the disease, this could be a factor.
It is imperative, however, that this perspective shift, according to Dr. Harrison: “We need to raise awareness that lung cancer can happen to anyone with lungs, regardless of smoking status.”. Eliminating this stigma would increase awareness, support, funding for research, visibility, and knowledge, all of which should eventually improve symptom detection and early identification, treatment options, and survival rates. The prognosis for lung cancer is better the earlier it is identified. A person with NSCLC who is diagnosed at an early, or localized, stage has a 65 percent chance of surviving for five years, according to the American Cancer Society. However, only 9% of those whose cancer has spread to other parts of their bodies prior to diagnosis have a chance of surviving for an additional five years. Nevertheless, as Dr. Harrison indicated, the prognosis is getting better for people with lung cancer of all kinds. People are living far longer these days than they did a few years ago thanks to targeted therapies. When you look up the statistics on Google after receiving a diagnosis, the appalling results you find are shocking. However, those figures are incredibly outdated. She noted that they haven’t considered the targeted therapies. The cancer’s stage determines the course of treatment for NSCLC. Early detection allows for complete removal of the cancer with no need for follow-up treatments when treated with surgery, photodynamic therapy (PDT), laser therapy, or brachytherapy (internal radiation). The furrier the diagnosis of cancer, the later it comes.
Treatment options for lung cancer in its later stages include surgery, radiation therapy, immunotherapy (drugs that boost the immune system’s ability to fight cancer), and/or chemotherapy. To target therapy, gene mutations in the tumors will be examined. Tyrosine kinase inhibitors, or TKIs, are a class of medications used to treat EGFR+ lung cancer. TKIs block the enzymes that activate proteins like EGFR. Tacrieva (erlotinib), Gilotrif (afatanib), Iressa (gefitinib), Vidimpro (dacomitinib), and Tagrisso (osimertinib) are the five TKIs that are approved for the treatment of EGFR+ lung cancer. Patients with EGFR mutations in NSCLC can significantly increase their chances of survival and quality of life with these drugs. Nevertheless, other gene mutations may impact their effectiveness, and tumors may develop resistance to them. The duration of the medications’ effectiveness varies from patient to patient, according to EGFR+ UK. In the event that the cancer develops resistance and grows or spreads, medical professionals will perform genetic testing to determine the specific mutation that has taken place. They will then frequently try radiation therapy or chemotherapy, which many people will respond well to, or another TKI. Genetic testing revealed that Dr. Harrison’s cancer was Exon 20, which is resistant to TKIs. Since there were no specific treatments for Exon 20 at the time of my diagnosis, they chose chemotherapy and radiation because it was a relatively local treatment.
Although she still has some long-term effects from her several months of chemotherapy and radiation therapy, she no longer has any evidence of cancer: “What has happened is the top of my lung has collapsed, as a result of the radiation, and my ribs just keep breaking, but it’s not cancer!” Recent advancements in EGFR+ lung cancer research have been made despite funding shortages. A study conducted earlier in 2023 discovered that glioblastoma, the most common type of brain tumor, has been linked to the development of CD70, a gene that promotes cell survival and invasiveness. This gene may be a potential therapeutic target for patients with resistant EGFR+ lung cancer. Although research on this topic is still in its early stages, another study has hypothesized that a vaccine could prevent the development of common lung tumors driven by EGFR mutations by stimulating immune cells. Dr. Elene Mariamidze of Todua Clinic in Tbilisi, Georgia, stated at the ESMO Congress 2023 that “we are entering an era of personalised medicine in NSCLC where we are using combinations of novel, targeted agents, and it will be essential to know the whole mutational burden of each patient at diagnosis so we can properly plan the most effective and least toxic approach.” Targeted, combined therapies appear to be the most promising route. The optimal mix of immunotherapy and chemotherapy, or targeted treatment, for individual patients is what will shape lung cancer care in the future. Marcia K. Horn, the Intern’s president and CEO, is a juris doctor.
“The PAPILLON clinical trial data were announced at the recent ESMO Congress in Madrid, and our patients and care partners who are members of the Exon 20 Group were ecstatic,” she said. The PAPILLON data indicates that amivantamab plus the chemotherapy doublet of pemetrexed/ALIMTA plus carboplatin is now the new first-line treatment for patients with EGFR exon 20 insertion mutations. She continued, “It is imperative that our patient population has access to such a game-changing first-line therapy.”. The intention, according to EGFR+ UK, is for EGFR mutant lung cancer to develop into a long-term, chronic condition that can be managed. The care a person receives, however, varies depending on where they live, as Dr. Harrison explained to MNT: “New discoveries are made on a regular basis, but even though there are numerous clinical trials located in the U.S. Few of them have locations in the U.S. K. , and access to medications is far worse here. “There is a huge disparity in care, both within the U.S. K. and between various nations. She said, “It’s incredibly frustrating.”. “Importantly, patient advocacy is crucial. Our job at the charity is to empower patients to advocate for themselves by educating and guiding them. However, things are looking up. People are living longer these days. Dr. Harrison told us that he knew someone who is still alive 34 years after being diagnosed.
REFERENCES:
https://www.medicalnewstoday.com/articles/things-you-may-not-know-about-egfr-positive-lung-cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431055/
https://www.yalemedicine.org/conditions/lung-cancer-in-nonsmokers
https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm
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