Current clinical understanding and effectiveness of portopulmonary hypertension treatment
Why Test For EGFR Mutations In Non-Small-Cell Lung Cancer? - WebMD
If you have non-small-cell lungcancer (NSCLC), your doctor can use comprehensive biomarker testing to see if it has certain mutations they can target with treatment.
The test is done during or after your diagnosis. Certain mutations can be "drivers" of your lung cancer. That means they're the main cause of your cancer growth and cell division.
Epidermal growth factor receptor (EGFR) mutation is one biomarker doctors look for during testing.
EGFR is a protein on the surface of your cells that delivers signals to them telling them to grow. When it's mutated, it tells your cells to grow and divide too much, causing cancer.
Testing for EGFR helps your doctor choose a therapy that's more likely to control your specific cancer. That's the first step in precision medicine -- medicine that's matched closely with your type and stage of lung cancer.
What's a Biomarker?It's any molecule doctors can measure in your tissues, blood, or other bodily fluids. If a test shows you have a biomarker, it can be a sign that something in your body isn't working the way it should.
A biomarker can help your doctor better understand:
EGFR mutations show up as deletions (parts are missing), insertions (extra segments are present), or point mutations (only a few small nucleotides are affected) in your EGFR gene.
Who Should Get Biomarker Testing for EGFR?About 10%-15% of all lung cancers in the U.S. Have EGFR mutations. Although anyone with lung cancer can have an EGFR mutation, they usually happen in NSCLC adenocarcinomas. People with EGFR mutations also tend to be women and have little to no smoking history.
Your doctor may recommend testing if:
It's important for anyone with a lung cancer diagnosis – or suspected lung cancer – to ask their doctor whether biomarker testing for EGFR is a good option.
Your doctor can use the same tissue from your initial biopsy to both diagnose lung cancer and test for mutations.
If your doctor didn't do biomarker testing on your tissue during diagnosis, there may be enough left for testing without having to do a second biopsy.
Another option is a liquid biopsy, which is a blood test. Liquid biopsies are quicker and less invasive than biopsies. But they may not be as sensitive for picking up results in earlier-stage cancers. A liquid biopsy can help your doctor:
The EGFR mutation was the first biomarker researchers discovered they could find and target in lung cancer. The first targeted therapy for lung cancer worked by finding and attacking this mutation.
Drugs called EGFR inhibitors can block the signal from EGFR that tells your cells to grow. Some of these drugs can be used to treat EGFR-positive NSCLC.
Biomarker testing not only tells your doctor whether you have an EGFR mutation, but also what type. This helps them narrow down the type of treatment to use on your cancer.
Your doctor may prescribe TKIs if you have certain rare types of EGFR mutations.
EGFR-positive NSCLC has many different FDA-approved drug options. Often the cancer adapts over time to treatment and stops responding to it. Your doctor can usually switch you to another drug once one stops working.
Before switching, your doctor will likely ask you to do another biopsy to see if other biomarkers are present. This will help them decide which treatment may work best for you next.
Questions to Ask Your DoctorTo best understand the goal of your EGFR testing, ask your doctor:
Once you have your results, go over them with your doctor. They'll help you find out:
Testing For Lung Cancer: Getting Lung Cancer Diagnosis - Health
A healthcare provider may use several diagnostic measures, including a physical exam and imaging tests, to check for lung cancer. Lung cancer will not show up in blood work, but your results can indicate signs of a possible health concern. These tests can help a healthcare provider understand your symptoms, the type of cancer you have, and the severity of your condition.
Lung cancer occurs when cells in the lungs grow out of control and become cancerous. As the condition progresses, the cancer cells can spread to the lymph nodes, brain, and other organs in the body. It's a good idea to get tested if you think you may be at risk for developing lung cancer or have symptoms. The disease can spread quickly.
A healthcare provider may consult with a team made up of a pulmonologist (who treats lung diseases) and an oncologist (who treats cancer) to rule out other conditions and provide you with an official diagnosis. Getting tested for lung cancer can be scary. Receiving an early diagnosis can help you get started on treatment sooner.
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A healthcare provider will start your appointment by learning about your medical history and performing a physical exam. This first step helps them understand your symptoms and look for potential signs of lung cancer. A healthcare provider may ask: Do you have a worsening cough? Have you had trouble breathing? Are you coughing up blood or losing weight without trying? What other symptoms do you have? How long have you been experiencing symptoms? Does anyone in your family have lung cancer? Do you currently smoke or have a personal history of tobacco use? Have you had any recent respiratory (lung-related) infections? It's also common for a healthcare provider to ask about your lifestyle habits, like diet and exercise. Exposure to toxins can also increase your risk of developing lung cancer, so they may want to learn about your occupation and place of work. Some workplaces can have elevated levels of radon, asbestos, or secondhand smoke in the air. A healthcare provider will then perform a routine physical exam, which will likely include: Checking your chest, stomach, and extremities (hands and feet) for pain, weakness, or swelling Measuring your vital signs (e.G., temperature, heart rate, blood pressure) Taking your temperature Learning about your medical history and performing a physical exam are not enough to diagnose you with lung cancer. These steps can help a healthcare provider figure out how to move forward and order additional testing if needed. Blood tests alone cannot diagnose lung cancer. Blood work can help a healthcare provider get an overall sense of your general health, so it's standard practice to get blood tested. Your blood test will generally show a complete blood count (CBC). This test can point to any concerns in the number of white blood cells, red blood cells, platelets, and other cell types. A healthcare provider can order blood chemistry tests for further evaluation if something in your blood tests doesn't look normal. A blood chemistry test examines the cells in your organs. This test can look at the function of your liver, kidneys, and other major organs. Abnormal test results can mean the cancer has spread to areas outside of the lungs. If you receive a cancer diagnosis, you may be asked to come in for blood testing regularly. Routine blood tests can help a healthcare provider understand how your treatment is working and monitor your overall health status. Imaging tests create detailed pictures of your lungs by using sound waves, magnetic fields, or X-rays. These tests can detect if you have cancer cells or a tumor, how far the cancer has spread, and whether or not treatment is working. A healthcare provider may order one or more of the following imaging tests: Type of Imaging Test Description Bone scan Determines if the cancer has spread to your bones Chest X-ray Takes radiographic pictures to check the structure of the organs in the chest Computed tomography (CT) scan Combines several X-ray images to show a more detailed visual of the lungs, potential tumors, and enlarged lymph nodes Magnetic resonance imaging (MRI) Uses magnets and radio waves to take images of the soft tissue in your chest to check if the cancer has spread to other organs Positron emission tomography (PET) scan Injects a safe radioactive material intravenously (with an IV) to look for chemical changes to your cells and organs Blood and imaging tests can give a healthcare provider a better sense of your health. An official lung cancer diagnosis requires laboratory tests that look at your lung cells. There are several types of lab tests that a healthcare provider may use to make a lung cancer diagnosis and check to see how far the cancer has spread. Tests for Diagnosis A lab technician will perform tests by using a sample of your lung cells under a microscope. Some lab tests that a healthcare provider may order to confirm a lung cancer diagnosis include: Biopsy: This uses a needle to take a sample of your lung tissue. A lab technician will then view the sample under a microscope to check for cancer cells. Bronchoscopy: This looks at the inside of your lungs with a thin, flexible tube that is attached to a camera. A bronchoscopy checks for tumors or blockages in your airways. Sputum cytology: A healthcare provider will ask you to cough up a sample of your sputum (mucus from your lungs) to check if your mucus contains cancer cells. Thoracentesis: Some people may have pleural effusion, or fluid build-up around the lungs. A healthcare provider can perform this test by numbing the skin and inserting a small needle or catheter into the chest to drain a sample of fluid. A lab technician can test the fluid to determine what is causing the build-up. Tests for Cancer Spread If a healthcare provider finds cancer cells, they will likely order additional testing to see if the cancer has metastasized (spread). Lab tests can show where cancer cells have spread and help inform treatment options. These tests insert a thin tube attached to a tiny light and camera inside your body. This helps inspect cancer cells in different organs and structures. A healthcare provider may order one or more of the following tests: Endobronchial ultrasound: This procedure moves the tube down the neck to check for cancer cells around the breastbone and in between the lungs. Endoscopic esophageal ultrasound: This ultrasound passes the tube down your throat to search nearby lymph nodes for cancer cells. Mediastinoscopy or mediastinotomy: This exam puts the tube behind the breastbone to check for cancer cells in the mediastinum, which includes the heart, esophagus (throat), and trachea (windpipe). Thoracoscopy: This test inserts the tube under your shoulder blades to check for cancer cells that have spread outside of the lungs and into the chest. A healthcare provider may order a lung function test, or pulmonary function test (PFT), after they make a lung cancer diagnosis. A lung function test can show how well your lungs are working. There are several types of lung function tests, but they all generally have the same instructions. You'll breathe in and out of a tube connected to a machine that measures your airflow. This test tells a healthcare provider whether it's safe to have lung surgery. Surgery may be a treatment option, depending on the type of cancer you have. The lung function test informs how much of the lung a surgeon can remove, if needed, for your treatment plan. A healthcare provider will determine what stage of lung cancer you are in if you receive a diagnosis of lung cancer. Staging is based on where your cancer cells are and the size of your tumor. Your cancer stage will inform treatment options. The stages of cancer for SCLC and NSCLC are different. The stages of SCLC are: Limited stage: Cancer cells are present in the lungs. Extensive stage: Cancer cells have spread beyond the lungs into other lymph nodes and organs. The stages of NSCLC are numbered and include: Stage 0: Cancer cells are present in the lining of the lungs but have not spread to the lung tissue. Stage 1: The cancer cells have developed into a small tumor, or less than 3 centimeters (cm). Stage 2: The tumor is larger than 3 cm, and cancer cells have spread to nearby lymph nodes. Stage 3: Cancer cells have spread to nearby organs in the chest. Stage 4: The tumor can be any size, and cancer cells have spread to the lung tissue and nearby or distant organs. Lung cancer symptoms can sometimes mimic other conditions. A healthcare provider will also use testing to rule out other conditions, including: Condition Description Bronchitis Infection of the bronchial tubes in the lungs Granuloma Non-cancerous inflammation of the lungs Hamartoma Non-cancerous growth of abnormal lung cells Pleural effusion (caused by other conditions) Fluid build-up in and around the lungs Pneumonia Inflammation in one or both lungs caused by bacteria, fungi, or viruses Pneumothorax Air build-up between the outside of the lung and within the pleural cavity (the space between your lungs and chest cavity), which can cause the lungs to collapse partially or completely Tuberculosis Bacterial infection in the lungs Lung cancer symptoms can vary depending on the type of cancer, the location, and the stage of cancer. It's good practice to get tested if you think you may be at risk for lung cancer or begin to experience symptoms. A healthcare provider will work with a pulmonologist and oncologist during your diagnostic process to run different tests. Common exams for lung cancer include a physical exam and blood and imaging tests. These tests can help confirm a diagnosis and rule out other conditions. Lung cancer is an aggressive condition, and getting tested can be scary. It's OK to feel overwhelmed. Remember that an early diagnosis can help you manage your condition and find a treatment plan that is right for you. Thanks for your feedback! 7 Sources Health.Com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Cancer Society. Early detection, diagnosis, and staging. Centers for Disease Control and Prevention. What is lung cancer? American Cancer Society. Tests for lung cancer. American Cancer Society. Lung cancer risk factors. National Cancer Institute. Lung cancer—patient version. Thomas KW. Patient education: Lung cancer risks, symptoms, and diagnosis (beyond the basics). In: Midthun DE, Vora SR, eds. UpToDate; UpToDate; 2024. American Lung Association. Lung cancer staging.Lung Cancer: Overview Of Non-Small Cell And Small Cell Types - WebMD
It's cancer that starts in your lungs and can spread to other parts of your body. Although it's the top cause of cancer deaths for U.S. Men and women, it's also one of the most preventable kinds, by not smoking and avoiding other people's secondhand smoke.
The disease almost always starts in the spongy, pinkish gray walls of the lungs' airways (called bronchi or bronchioles) or air sacs (called alveoli).
There are more than 20 kinds of lung cancer. The two main types are non-small-cell lung cancer and small-cell lung cancer.
Adenocarcinoma is the most common kind of NSCLC. It makes up 40% of lung cancer cases. It mainly happens in people who smoke or who used to. It's also the No. 1 type of lung cancer among nonsmokers.
More women get it than men. People with this type tend to be younger than those with other kinds.
Adenocarcinoma can spread to the lymph nodes, bones, or other organs such as the liver.
Squamous cell carcinoma usually starts in the lung's largest branches, which doctors call the central bronchi.
This type accounts for 30% of lung cancers, and it's more common in men and people who smoke. It may form a cavity within the tumor. It often involves the larger airways. It may make you cough up some blood.
Squamous cell carcinoma can also spread to the lymph nodes, bones, and other organs such as the liver.
Large-cell carcinomas are a group of cancers with large cells that tend to start along the lungs' outer edges. They're rarer than adenocarcinoma or squamous cell carcinoma, making up 10%-15% of lung cancers. This type of tumor can grow faster and often spreads to nearby lymph nodes and distant parts of the body.
This is the most aggressive form of the disease. It usually starts in the large, central bronchi. Almost all people who get it are smokers. It spreads quickly, often before symptoms appear. Many times, it spreads to the liver, bone, and brain. Small-cell lung cancer makes up 10%-15% of lung cancers.
The outlook for someone with lung cancer depends on a lot of things, including what type they have, their overall health, and how advanced the disease is when doctors find it.
Smoking is the biggest reason. It's responsible for about 85% of all cases.
Quitting cuts the risk. Former smokers are still slightly more likely to get it than nonsmokers.
There are also other reasons. Some genetic glitches may put some people at higher risk.
Secondhand tobacco smoke is also a cause. People who live with someone who smokes are 20% to 30% more likely to get lung cancer than those who live in a smoke-free home. People exposed to radiation therapy can also have a higher risk.
Some other chemicals are risky, too. People who work with asbestos or are exposed to uranium dust or the radioactive gas radon are more likely to get lung cancer, especially if they smoke.
Lung tissue that was scarred by a disease or infection, such as scleroderma or tuberculosis, becomes at risk for tumors in that tissue. Doctors call this a scar carcinoma. The risk is also higher in people that have pulmonary fibrosis or HIV infection.
Some researchers think that diet may also influence your risk. But that's not clear yet.
There often aren't any symptoms in the early stages. For other people, red flags that can be linked to lung cancer include:
Talk to your doctor if you have those lung cancer symptoms. There could be other explanations.
A type of CT scan, called spiral or helical low-dose CT scanning, has helped to find the disease early in smokers and former smokers when combined with other tests.
The U.S. Preventive Services Task Force recommends an annual low-dose CT scan for adults ages 50 - 80 with a 20-pack-year history of smoking who currently smoke or who have quit within the past 15 years.
Treatment depends on what type of lung cancer you have and how advanced it is.
Sometimes, doctors can do surgery to remove a tumor if the disease hasn't spread. You may also get radiation, chemotherapy, targeted therapy, or immunotherapy.
If your lung cancer is advanced -- for instance, if it has spread to distant parts of your body -- there are still treatments that can control the disease and prevent further symptoms. You might get radiation and chemotherapy to shrink tumors and help control symptoms.
Pain management is also key. At any point in your treatment, tell your doctor if you're in pain.
If your doctor mentions "palliative care," that includes helping you feel comfortable, managing pain, and improving your life as much as possible. It's not the same as hospice care, which focuses on preparing for the end of life.
Pay attention to your emotions, too. Dealing with cancer is hard. It's normal to feel a lot of strong emotions, including fear, anger, and sadness. It can help to talk with a counselor or join a support group to help you work through those feelings and face the many challenges that come with a cancer diagnosis.
Before recommending which treatment or combination of treatments is right for you, your doctor will determine how advanced your lung cancer is, a process called staging. This usually involves getting a CT scan of the chest and abdomen, and possibly a PET scan. You may also get a bone scan, a CT or MRI scan of the brain, and other tests.
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