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AIMS Medical Science

2022, Volume 9, Issue 2: 348-361. doi: 10.3934/medsci.2022016
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Non-small cell lung cancer: epidemiology, screening, diagnosis, and treatment

  • Division of Pulmonary & Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
  • Received: 16 January 2022 Revised: 20 May 2022 Accepted: 22 May 2022 Published: 26 May 2022

  • Lung cancer is the most common cancer worldwide and is also one of the leading causes of cancer related deaths. The 5-year survival rate depends largely on stage at diagnosis. Multiple large randomized controlled trials have demonstrated the clinical utility of lung cancer screening. Low dose computed tomography is recommended for lung cancer screening in several guidelines. Lung cancer is often diagnosed at more advanced stages owing to the nonspecific symptoms with which it presents. Diagnosis relies primarily upon imaging and biopsy. Diagnosis and staging should be performed simultaneously, if possible, by performing a biopsy at the site that will confer the highest stage. Sufficient material should be obtained to allow for molecular testing. Liquid biopsy may have a complementary role in detecting actionable mutations in non-small cell lung cancer. Treatment is predicated upon stage and may involve surgery, targeted chemotherapy, radiation therapy, immunotherapy, or some combination thereof.

    Citation: Anuj A. Shukla, Shreya Podder, Sana R. Chaudry, Bryan S. Benn, Jonathan S. Kurman. Non-small cell lung cancer: epidemiology, screening, diagnosis, and treatment[J]. AIMS Medical Science, 2022, 9(2): 348-361. doi: 10.3934/medsci.2022016

    Related Papers:

  • Lung cancer is the most common cancer worldwide and is also one of the leading causes of cancer related deaths. The 5-year survival rate depends largely on stage at diagnosis. Multiple large randomized controlled trials have demonstrated the clinical utility of lung cancer screening. Low dose computed tomography is recommended for lung cancer screening in several guidelines. Lung cancer is often diagnosed at more advanced stages owing to the nonspecific symptoms with which it presents. Diagnosis relies primarily upon imaging and biopsy. Diagnosis and staging should be performed simultaneously, if possible, by performing a biopsy at the site that will confer the highest stage. Sufficient material should be obtained to allow for molecular testing. Liquid biopsy may have a complementary role in detecting actionable mutations in non-small cell lung cancer. Treatment is predicated upon stage and may involve surgery, targeted chemotherapy, radiation therapy, immunotherapy, or some combination thereof.

    Abbreviations

    CISNET

    Cancer intervention and surveillance modeling network

         CT

    Computed tomography

         ctDNA

    Circulating tumor DNA

         EBUS

    Endobronchial ultrasound

         EBUS-NA

    Endobronchial ultrasound-guided needle aspiration

         EGFR

    Epidermal growth factor receptor

         ESTS

    European Society of Thoracic Surgeons

         EUS-NA

    Endoscopic ultrasound-guided needle aspiration

         IASLC

    International Association for the Study of Lung Cancer

         LDCT

    Low-dose computed tomography

         NCCN

    National Comprehensive Cancer Network

         NELSON

    Dutch-Belgian Randomized Lung Cancer Screening trial

         NILE

    Non-invasive versus invasive evaluation

         NLST

    National Lung Cancer Screen Trial

         NSCLC

    Non-small cell lung cancer

         PD-L1

    Programmed cell death ligand

         PET

    Positron emission tomography

         RCTs

    Randomized controlled trials

         RT

    Radiation therapy

         SEER

    Surveillance, Epidemiology and End Results

         TBNA

    Transbronchial needle aspiration

         TKI

    Tyrosine kinase inhibitor

         TNM

    Tumor-node-metastasis

         USPTF

    United States Preventative Service Task Force

         WHO

    World Health Organization
    加载中


    Authors' contributions


    All authors participated in the conception and writing of this manuscript.

    Conflict of interest


    All authors have no conflicts of interest.

    [1] Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA: Cancer J Clin 68: 7-30. https://doi.org/10.3322/caac.21442
    [2] dela Cruz CS, Tanoue LT, Matthay RA (2011) Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med 32: 605-644. https://doi.org/10.1016/j.ccm.2011.09.001
    [3] de Groot PM, Wu CC, Carter BW, et al. (2018) The epidemiology of lung cancer. Transl Lung Cancer Res 7: 220-233. https://doi.org/10.21037/tlcr.2018.05.06
    [4] Torre LA, Siegel RL, Jemal A (2016) Lung cancer statistics. Adv Exp Med Biol 893: 1-19. https://doi.org/10.1007/978-3-319-24223-1_1
    [5] North CM, Christiani DC (2013) Women and lung cancer: what is new?. Semin Thorac Cardiovasc Surg 25: 87-94. https://doi.org/10.1053/j.semtcvs.2013.05.002
    [6] Pelosof L, Ahn C, Gao A, et al. (2017) Proportion of never-smoker non-small cell lung cancer patients at three diverse institutions. J Natl Cancer Inst 109: djw295. https://doi.org/10.1093/jnci/djw295
    [7] Howlader N, Forjaz G, Mooradian MJ, et al. (2020) The effect of advances in lung-cancer treatment on population mortality. N Engl J Med 383: 640-649. https://doi.org/10.1056/NEJMoa1916623
    [8] Travis WD, Brambilla E, Nicholson AG, et al. (2015) The 2015 World Health Organization Classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol 10: 1243-1260. https://doi.org/10.1097/JTO.0000000000000630
    [9] Takamochi K, Ohmiya H, Itoh M, et al. (2016) Novel biomarkers that assist in accurate discrimination of squamous cell carcinoma from adenocarcinoma of the lung. BMC Cancer 16: 760. https://doi.org/10.1186/s12885-016-2792-1
    [10] Goldstraw P, Chansky K, Crowley J, et al. (2016) The IASLC Lung Cancer Staging Project: proposals for revision of the TNM Stage Groupings in the Forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 11: 39-51. https://doi.org/10.1016/j.jtho.2015.09.009
    [11] Doria-Rose VP, Szabo E (2010) Screening and prevention of lung cancer. Lung Cancer: A Multidisciplinary Approach to Diagnosis and Management. New York: Demos Medical Publishing 53-72.
    [12] Oken MM, Hocking WG, Kvale PA, et al. (2011) Screening by chest radiograph and lung cancer mortality: the prostate, lung, colorectal, and ovarian (PLCO) randomized trial. JAMA 306: 1865-1873. https://doi.org/10.1001/jama.2011.1591
    [13] Aberle DR, Adams AM, et al. (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365: 395-409. https://doi.org/10.1056/NEJMoa1102873
    [14] Moyer VA (2014) Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Int Med 160: 330-338. https://doi.org/10.7326/M13-2771
    [15] de Koning HJ, van der Aalst CM, de Jong PA, et al. (2020) Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 382: 503-513. https://doi.org/10.1056/NEJMoa1911793
    [16] Krist AH, Davidson KW, et al. (2021) Screening for lung cancer: US Preventive Services Task Force Recommendation Statement. JAMA 325: 962-970. https://doi.org/10.1001/jama.2021.1117
    [17] Meza R, Jeon J, Toumazis I, et al. (2021) Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: a collaborative modeling study for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality. Report No.: 20th-05266-EF-2nd ed
    [18] Toumazis I, Bastani M, Han SS, et al. (2020) Risk-based lung cancer screening: a systematic review. Lung Cancer 147: 154-186. https://doi.org/10.1016/j.lungcan.2020.07.007
    [19] Shim J, Brindle L, Simon M, et al. (2014) A systematic review of symptomatic diagnosis of lung cancer. Fam Pract 31: 137-148. https://doi.org/10.1093/fampra/cmt076
    [20] Silvestri GA, Gonzalez AV, Jantz MA, et al. (2013) Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143: e211S-e250S. https://doi.org/10.1378/chest.12-2355
    [21] Purandare NC, Rangarajan V (2015) Imaging of lung cancer: implications on staging and management. Indian J Radiol Imaging 25: 109-120. https://doi.org/10.4103/0971-3026.155831
    [22] Lababede O, Meziane MA (2018) The Eighth Edition of TNM staging of lung cancer: reference chart and diagrams. Oncologist 23: 844-848. https://doi.org/10.1634/theoncologist.2017-0659
    [23] Dorry M, Davidson K, Dash R, et al. (2021) Pleural effusions associated with squamous cell lung carcinoma have a low diagnostic yield and a poor prognosis. Transl Lung Cancer Res 10: 2500-2508. https://doi.org/10.21037/tlcr-21-123
    [24] Figueiredo VR, Cardoso PFG, Jacomelli M, et al. (2020) EBUS-TBNA versus surgical mediastinoscopy for mediastinal lymph node staging in potentially operable non-small cell lung cancer: a systematic review and meta-analysis. J Bras Pneumol 46: e20190221. https://doi.org/10.36416/1806-3756/e20190221
    [25] Sehgal IS, Agarwal R, Dhooria S, et al. (2019) Role of EBUS TBNA in staging of lung cancer: a clinician's perspective. J Cytol 36: 61-64. https://doi.org/10.4103/JOC.JOC_172_18
    [26] Schimmer C, Neukam K, Elert O (2006) Staging of non-small cell lung cancer: clinical value of positron emission tomography and mediastinoscopy. Interact Cardiovasc Thorac Surg 5: 418-423. https://doi.org/10.1510/icvts.2006.129478
    [27] Schmidt-Hansen M, Baldwin DR, Hasler E, et al. (2014) PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Database Syst Rev 2014: CD009519. https://doi.org/10.1002/14651858.CD009519.pub2
    [28] de Leyn P, Dooms C, Kuzdzal J, et al. (2014) Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg 45: 787-798. https://doi.org/10.1093/ejcts/ezu028
    [29] Rivera MP, Mehta AC, Wahidi MM (2013) Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143: e142S-e165S. https://doi.org/10.1378/chest.12-2353
    [30] Leighl NB, Page RD, Raymond VM, et al. (2019) Clinical utility of comprehensive cell-free DNA analysis to identify genomic biomarkers in patients with newly diagnosed metastatic non-small cell lung cancer. Clin Cancer Res 25: 4691-4700. https://doi.org/10.1158/1078-0432.CCR-19-0624
    [31] Guardant Health Guardant360® CDx First FDA-approved liquid biopsy for comprehensive tumor mutation profiling across all solid cancers. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-liquid-biopsy-next-generation-sequencing-companion-diagnostic-test
    [32] Ferreira D, Miranda J, Martins-Lopes P, et al. (2021) Future perspectives in detecting EGFR and ALK gene alterations in liquid biopsies of patients with NSCLC. Int J Mol Sci 22: 3815. https://doi.org/10.3390/ijms22083815
    [33] Papadimitrakopoulou VA, Han JY, Ahn MJ, et al. (2020) Epidermal growth factor receptor mutation analysis in tissue and plasma from the AURA3 trial: Osimertinib versus platinum-pemetrexed for T790M mutation-positive advanced non-small cell lung cancer. Cancer 126: 373-380. https://doi.org/10.1002/cncr.32503
    [34] FoundationOne CDxTM Technical Information. Available from: https://www.foundationmedicine.com/test/foundationone-cdx
    [35] Hartmaier R, Han JY, Ahn MJ, et al. (2020) Abstract CT303: The effect of savolitinib plus osimertinib on ctDNA clearance in patients with EGFR mutation positive (EGFRm) MET -amplified NSCLC in the TATTON study. Bioinformatics, Convergence Science, and Systems Biology. AACR 80: CT303. https://doi.org/10.1158/1538-7445.AM2020-CT303
    [36] le Pechoux C, Pourel N, Barlesi F, et al. (2022) Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial. Lancet Oncol 23: 104-114. https://doi.org/10.1016/S1470-2045(21)00606-9
    [37] Hui Z, Men Y, Hu C, et al. (2021) Effect of postoperative radiotherapy for patients with pIIIA-N2 non-small cell lung cancer after complete resection and adjuvant chemotherapy: the phase 3 PORT-C randomized clinical trial. JAMA Oncol 7: 1178-1185. https://doi.org/10.1001/jamaoncol.2021.1910
    [38] Detterbeck FC, Lewis SZ, Diekemper R, et al. (2013) Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143: 7S-37S. https://doi.org/10.1378/chest.12-2377
    [39] Ginsberg RJ, Rubinstein LV (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 60: 615-622; discussion 622-3. https://doi.org/10.1016/0003-4975(95)00537-u
    [40] Howington JA, Blum MG, Chang AC, et al. (2013) Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143: e278S-e313S. https://doi.org/10.1378/chest.12-2359
    [41] Mery CM, Pappas AN, Bueno R, et al. (2005) Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. Chest 128: 237-245. https://doi.org/10.1378/chest.128.1.237
    [42] Veluswamy RR, Ezer N, Mhango G, et al. (2015) Limited resection versus lobectomy for older patients with early-stage lung cancer: impact of histology. J Clin Oncol 33: 3447-3453. https://doi.org/10.1200/JCO.2014.60.6624
    [43] Saji H, Okada M, Tsuboi M, et al. (2022) Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet 399: 1607-1617. https://doi.org/10.1016/S0140-6736(21)02333-3
    [44] Lardinois D, de Leyn P, van Schil P, et al. (2006) ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg 30: 787-792. https://doi.org/10.1016/j.ejcts.2006.08.008
    [45] FDA approves atezolizumab as adjuvant treatment for non-small cell lung cancer. Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-atezolizumab-adjuvant-treatment-non-small-cell-lung-cancer
    [46] Ball D, Mai GT, Vinod S, et al. (2019) Stereotactic ablative radiotherapy versus standard radiotherapy in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3, open-label, randomised controlled trial. Lancet Oncol 20: 494-503. https://doi.org/10.1016/S1470-2045(18)30896-9
    [47] Nyman J, Hallqvist A, Lund JÅ, et al. (2016) SPACE—A randomized study of SBRT vs conventional fractionated radiotherapy in medically inoperable stage I NSCLC. Radiother Oncol 121: 1-8. https://doi.org/10.1016/j.radonc.2016.08.015
    [48] Francis S, Orton A, Stoddard G, et al. (2018) Sequencing of postoperative radiotherapy and chemotherapy for locally advanced or incompletely resected non-small-cell lung cancer. J Clin Oncol 36: 333-341. https://doi.org/10.1200/JCO.2017.74.4771
    [49] O'Rourke N, I Figuls MR, Bernadó NF, et al. (2010) Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev CD002140. https://doi.org/10.1002/14651858.CD002140.pub3
    [50] Spigel DR, Faivre-Finn C, Gray JE, et al. (2022) Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. J Clin Oncol 40: 1301-1311. https://doi.org/10.1200/JCO.21.01308
    [51] Jabbour SK, Lee KH, Frost N, et al. (2021) Pembrolizumab plus concurrent chemoradiation therapy in patients with unresectable, locally advanced, stage III non-small cell lung cancer: the phase 2 KEYNOTE-799 nonrandomized trial. JAMA Oncol 7: 1-9. https://doi.org/10.1001/jamaoncol.2021.2301
    [52] Reck M, Rodríguez-Abreu D, Robinson AG, et al. (2016) Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med 375: 1823-1833. https://doi.org/10.1056/NEJMoa1606774
    [53] Ettinger DS, Wood DE, Aisner DL, et al. (2022) Non–Small Cell Lung Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 20: 497-530. https://doi.org/10.6004/jnccn.2022.0025
    [54] Jasper K, Stiles B, McDonald F, et al. (2022) Practical management of oligometastatic non-small-cell lung cancer. J Clin Oncol 40: 635-641. https://doi.org/10.1200/JCO.21.01719
    [55] Soria JC, Ohe Y, Vansteenkiste J, et al. (2018) Osimertinib in untreated EGFR-Mutated advanced non-small-cell lung cancer. N Engl J Med 378: 113-125. https://doi.org/10.1056/NEJMoa1713137
    [56] Friedlaender A, Banna G, Patel S, et al. (2019) Diagnosis and treatment of ALK aberrations in metastatic NSCLC. Curr Treat Options Oncol 20: 79. https://doi.org/10.1007/s11864-019-0675-9
    [57] FDA approves first therapy for patients with lung and thyroid cancers with a certain genetic mutation or fusion. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-therapy-patients-lung-and-thyroid-cancers-certain-genetic-mutation-or-fusion
    [58] FDA approves entrectinib for NTRK solid tumors and ROS-1 NSCLC. Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-entrectinib-ntrk-solid-tumors-and-ros-1-nsclc
    [59] Wang EH, Corso CD, Rutter CE, et al. (2015) Postoperative Radiation therapy is associated with improved overall survival in incompletely resected stage II and III non-small-cell lung cancer. J Clin Oncol 33: 2727-2734. https://doi.org/10.1200/JCO.2015.61.1517
    [60] Foundation Medicine's ctDNA Monitoring Assay, FoundationOne®Tracker, Granted Breakthrough Device Designation by U.S. Food and Drug Administration. Available from: https://www.fdanews.com/articles/206649-foundation-medicines-foundationone-cancer-tracker-named-breakthrough-device
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