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Tractable tumors

Lung cancer

Lung cancer may develop in all the different cells of the lung parenchyma and may create a mass that obstructs normal air-flow or causes lung or bronchial bleeding.

There are two main types of disease, depending on the cell from which the tumor originates. Moreover, lungs can be the site of metastases originating from other types of cancer.

There are two main types of lung cancer: small-cell lung cancer and non-small cell lung cancer. Both types originate in the epithelial tissue that lines lung structures.

The small cell lung cancer originates from the larger diameter bronchi and is made up of small cells. It generally appears in smokers and its prognosis tends to be worse than that of non-small cell lung cancer, since the disease tends to spread rapidly to other organs.

The non-small cell tumor is divided into three types:

• Spinocellular carcinoma, also called squamous cells lung carcinoma, originates from the cells that line the respiratory tract (25-30% of lung tumors)
• Adenocarcinoma develops from cells that secrete mucus and is located at the level of the bronchi (35-40% of lung tumors)
• Large cell lung carcinoma may appear in different areas of the lung and has a tendency to grow and spread rather rapidly (10-15% of lung tumors)

In the remaining 5% of cases, lung cancer does not originate from the epithelium, but from different tissue cells such as neuroendocrine cells (pulmonary carcinoid of neuroendocrine origin) or lymphatic tissue (pulmonary lymphoma).

The best treatment strategy against lung cancer is based on the type of disease, tumor stage and the patient’s general health conditions.

For small-cell lung cancer, treatment primarily consists of chemotherapy and radiation therapy, the surgical option being adopted only during the early stage of the disease.

Non-small cell lung cancer is treated according to the stage of the disease and the histological type (adenocarcinoma or squamous cell carcinoma). This type of lung cancer is particularly difficult to treat during the advanced stage, and cancer immunotherapy represents a significant advance in this field.

Indeed, while chemotherapy has long stood as the only possible treatment, despite its limited efficacy and remarkable side effects, immunotherapy drugs are increasingly showing good results for the treatment of both metastatic non-small cell squamous carcinoma and against non-small cell non-squamous carcinoma.

Future perspectives: recent evidences have documented the efficacy of immunotherapy also in other contexts of the disease, as in the preoperative phase (neoadjuvant immunotherapy), or in association with traditional oncological treatments (chemotherapy and radiotherapy).