If you have non-small cell lung cancer (NSCLC), we will help you understand more about it—including how to know what type of NSCLC you have and how it impacts your treatment options. This will help you and your doctor choose the best treatment options.
You are not alone. We are here to help provide the information and connections you need to navigate your disease.
What is a biomarker?
A biomarker is a substance that doctors can measure in tissue, blood, or other body fluids, like spit. Biomarkers are changes in a cell’s genes (parts of DNA) or proteins that cause cancer to grow. These mutations are called “driver mutations” because they cause (or “drive”) cancer growth.
What are the different types of lung cancer?
There are two types of lung cancer: non-small cell lung cancer (NSCLC), which affects about 85% of people diagnosed with lung cancer, and small-cell lung cancer (SCLC), which affects about 15% of people diagnosed with lung cancer.
Both NSCLC and SCLC are diagnosed according to the way the cancer cells look under a microscope (also called cancer histology). Histology is one way we classify (group) the different types of lung cancer.
What are the types of non-small cell lung cancer (NSCLC)?
Based on histology (what your cancer looks like under a microscope), there are several types of NSCLC. The most common types of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. There are also other types of NSCLC that aren’t as common.
Are there other ways to classify types of lung cancer?
There are other ways to group types of lung cancer. In addition to knowing the histology of your cancer, it is important to know if your cancer has biomarkers, which are mutations (changes or errors) that cause cancer cells to grow. Biomarkers are also called “driver mutations” because they cause or “drive” cancer growth.
Not all lung cancers have known biomarkers. Scientists have found a number of biomarkers and are still looking for more.
So far, we know the most about biomarkers in adenocarcinoma, but researchers are trying to learn more about possible biomarkers in squamous cell lung cancer and small cell lung cancer.
You should know your histology and possible biomarkers because it may impact your treatment options.
What is lung adenocarcinoma?
Lung adenocarcinoma (sometimes referred to as “adeno”) is a type of non-small cell lung cancer (NSCLC). About 40% of people with NSCLC have adenocarcinoma.
Researchers have found many biomarkers or “driver mutations” in NSCLC adenocarcinoma. This helps scientists create targeted therapies, a type of treatment that targets biomarkers (mutations in cells) that cause cancer to grow.
Biomarkers found in adenocarcinoma with FDA-approved targeted therapies are listed below. LUNGevity has created Patient Gateways to provide you with tailored information about these specific biomarkers.
Learn more about lung adenocarcinoma, how it is diagnosed, and current treatments.
What is squamous cell lung cancer?
Squamous cell lung cancer (sometimes referred to as “squamous”) is a type of non-small cell lung cancer (NSCLC). About 30% of people with NSCLC have squamous cell lung cancer.
While researchers have found “driver mutations” or biomarkers in squamous cell NSCLC, they are still working to develop effective targeted therapies for squamous cell NSCLC. Nevertheless, you should talk to your doctor about comprehensive biomarker testing to help guide your treatment plan. Some patients’ tumors may even contain mixed histology, meaning they may have both adenocarcinoma and squamous cell NSCLC. Because of this, some patients with squamous cell NSCLC may also test positive for biomarkers more commonly found in adenocarcinoma NSCLC, which is why it is so important that all patients have biomarker testing done.
Learn more about squamous NSCLC, how it is diagnosed, and current treatments.
What is large cell lung cancer?
Large cell lung cancer is a type of non-small cell lung cancer (NSCLC). Only a small percentage of people with NSCLC have large cell lung cancer.
Learn more about large cell NSCLC, how it is diagnosed, and current treatments.
How do I know if my NSCLC has a biomarker?
Your doctor will do biomarker testing (also called comprehensive genomic profiling or molecular testing) to check for biomarkers. There are two types of biomarker testing: tissue biopsy and liquid biopsy.
During a tissue biopsy, doctors will take a tissue sample from your lung cancer to test for biomarkers. During a liquid biopsy, doctors will take a blood sample to look for cancer cell DNA circulating in your blood. Currently, tissue biopsies are the standard of care if you have enough tissue, but liquid biopsies are an important tool that can provide valuable information in some cases. Researchers are working to improve liquid biopsies so that they can become as accurate as tissue biopsies in the future.
Learn more about biomarker testing and types of biopsies.
What if I don’t have a biomarker?
Some people diagnosed with lung cancer will not have a known biomarker in their cancer. This is important information to know as some treatment options for NSCLC work better for people without biomarkers.
Some people might have a biomarker that does not have a treatment option yet. Scientists are working to create new treatments to target known biomarkers that currently do not have a treatment.
Whether you have a biomarker or not, knowing more about the type of lung cancer will help your doctor provide the best possible treatment options.
When should I be biomarker tested?
Biomarker testing may be appropriate:
- When your doctor thinks you have lung cancer and recommends a biopsy to check
- When your doctor has diagnosed you with lung cancer
- When your lung cancer recurs (comes back) or progresses (continues to spread) after treatment
How is NSCLC treated?
The treatment options for non-small cell lung cancer vary based on where the lung cancer is located within the lungs and the stage (whether the cancer has spread or not) of your NSCLC diagnosis. Plan to work with your doctor to decide on the treatment that is best for you, based on your type and stage of NSCLC and your biomarkers.
Below are some common treatment options for people with NSCLC lung cancer.
Chemotherapy
Chemotherapy is a treatment that uses drugs to stop the growth of cancer cells. Chemotherapy also attacks healthy cells.
Targeted therapy
Targeted therapy is a type of treatment that finds and attacks certain parts of cancer cells and the signals sent to cancer cells that cause them to grow uncontrolled. They prevent the growth of cancer cells only, and do not harm healthy cells.
A targeted therapy works to control a specific biomarker, so it can only treat patients with that specific biomarker.
Targeted therapy attacks cancer cells only, and leaves healthy cells alone
Immunotherapy
Immunotherapy is a type of treatment that helps your immune system find and attack lung cancer. It is already a standard of care treatment for patients with NSCLC.
Many of the FDA-approved immunotherapies target another type of biomarker called PD-1/PD-L1. Because research has found PD-L1 biomarkers along with NSCLC mutations in patient tumor samples, clinical trials are now learning if immunotherapy works to treat different types of NSCLC mutations. Other clinical trials are underway to look at combinations of targeted therapy and immunotherapy for treatment of various NSCLC subtypes. However, it is important to wait for biomarker testing results before initiating treatment for NSCLC because in some cases it can be harmful to start immunotherapy if driver mutations are present.
Clinical trials
Talk with your doctor about taking part in a clinical trial for a new, possible treatment. Clinical trials are an important option for people with NSCLC because these trials offer access to the newest treatment approaches, not available otherwise because they are still being tested..
For example, researchers are currently testing cancer vaccines and lab-made immune system cells (cells that find and attack cancer) that will target driver mutations in NSCLC.
Palliative care
Palliative care does not treat lung cancer directly. The goal of palliative care is to improve your quality of life while receiving treatment. It helps to prevent or eliminate the symptoms and side effects you may feel because of the disease or the treatments. It also helps you manage emotional, social, practical, and spiritual problems you may face.
Talk with your doctor
Talk with your doctor to understand your type of NSCLC and any known mutations in your tumor cells. Using this information, create a treatment plan together. Bring a pen and paper or use your cell phone to write down your questions and your doctor’s answers. You might start with these questions:
- What type of lung cancer do I have?
- What is the stage of my lung cancer and what does this mean for my treatment?
- Did I have comprehensive biomarker testing – which biomarkers did you check for? If not, can you order it?
- What are my treatment options?
- What biomarkers do I have?
- Is immunotherapy an option for me?
- Should I consider enrolling in a clinical trial?
- What are the possible side effects of these treatments?
Tip: Print these questions out and fill in the answers with your doctor. Having this sheet on hand can help you to remember the conversation and plan for any next steps.