Lung Adenocarcinoma

Symptoms, Treatment, and Prognosis of Lung Adenocarcinoma

Mature woman being examined by doctor
Lung adenocarcinoma is the most common type of lung cancer in women. BSIP/UIG/Universal Images Group/Getty Images

Lung adenocarcinoma is a form of non-small cell lung cancer, the most common type of lung cancer. Non-small cell lung cancers account for 80 percent of lung cancers, and of these, roughly 50 percent are adenocarcinomas.You may also hear lung adenocarcinoma referred to as "non-squamous carcinoma of the lungs."

Lung Adenocarcinoma – Overview

Lung adenocarcinomas usually begin in tissues that lie near the outer parts of the lungs (periphery) and may be present for a long time before they cause symptoms and are diagnosed.

Adenocarcinoma is the most common form of lung cancer found in women  and is often found in never smokers and non-smokers. It is also the most common type of lung cancer in people under the age of 45 and the most common type of lung cancer among Asians. While lung cancer is decreasing in men and leveling off in women, it is increasing in young, never-smoking women.

Overall, lung adenocarcinoma has accounted for an increased percentage of lung cancers in recent years, whereas another form of non-small cell lung cancer, squamous cell carcinoma, has been decreasing.

Symptoms of Lung Adenocarcinoma

Because lung adenocarcinoma often begins in the outer parts of the lungs, well-known symptoms of lung cancer such as a chronic cough and coughing up blood may be less common until later in the disease. Early signs and symptoms of lung adenocarcinoma that may be overlooked may include fatigue, mild shortness of breath, or achiness in your back, shoulder, or chest.

Since the symptoms are often vague, and this cancer often occurs in people not expected to develop lung cancer such as young people and never smokers, the diagnosis is often delayed for many weeks to months.

Diagnosis

Lung cancer is often first suspected when abnormalities are seen on an x-ray, yet it's important to note that a chest x-ray is not sufficient to rule out the diagnosis.

In fact, it's thought that around 25 percent of people with lung adenocarcinoma have a "normal" chest x-ray at the time of diagnosis. Further evaluation may include:

Depending upon the results, your doctor will usually want to obtain a sample of tissue to confirm the diagnosis and will order further tests to check to see if your cancer has spread. In addition to lung tissue biopsies, a new blood test called a liquid biopsy was approved in 2016 for detecting lung cancer with EGFR mutations.

Molecular Profiling (Gene Testing) in People with Lung Adenocarcinoma

One of the most exciting recent advances in lung cancer treatment has been the discovery of genetic mutations in cancer cells (mutations in genes which result in abnormal proteins which drive the growth of cancer), that in turn can be treated with medications that "target" those mutations. If you have been diagnosed with adenocarcinoma, talk to your doctor about genetic profiling -- tests that check for EGFR mutations, ROS1 rearrangements, and ALK rearrangements.

 New guidelines recommend that all patients with this type of lung cancer have molecular profiling (gene testing.)

Next generation sequencing refers to the ability to check lung cancers for not just one or two mutations, but a large number of different driver mutations. Advances in laboratory methods have made this not just a wonderful concept, but a reality.

Stages

Lung adenocarcinoma is broken down into 4 stages:

  • Stage 1 – The cancer is localized within the lung and has not spread to any lymph nodes
  • Stage 2 – The cancer has spread to lymph nodes or the lining of the lungs, or is in a certain area of the main bronchus
  • Stage 3 – The cancer has spread to tissue near the lungs
  • Stage 4 – The cancer has spread (metastasized) to another part of the body

Causes

Smoking is the most common cause of lung cancer overall, but many people diagnosed with adenocarcinoma of the lungs have never smoked. The most common cause in non-smokers is exposure to radon in the home. Lung adenocarcinoma is a multifactorial disease, meaning that several factors may work together to cause or prevent cancer. Learn more about the causes of lung cancer in non-smokers.

Treatment Options for Lung Adenocarcinoma

Depending upon the stage, treatment for lung adenocarcinoma may include surgery, chemotherapy, targeted therapies, immunotherapy, radiation therapy, or a combination of these. Many clinical trials are in progress looking for new ways to treat this cancer and to help decide which treatments are most effective. According to the National Cancer Institute, people with some stages of lung cancer should consider taking part in clinical trials. Be your own advocate. Studies suggest that people who take an active part in researching and understanding their lung cancer may have better outcomes. Connect with one of the major lung cancer organizations and online lung cancer communities. At the 2015 World Lung Cancer Conference in Denver we met several lung cancer survivors who are alive only because of clinical trials they learned about through being active in one of these communities.

  • Surgery may offer a chance for a cure  when lung adenocarcinoma is caught in the early stages. Surgery may be used alone with very early cancers or followed by "adjuvant" chemotherapy in those who have cancers which may have spread, but which cannot be detected with imaging methods currently available.

  • Chemotherapy may be used alone, in conjunction with radiation therapy, or following surgery for lung cancer. Examples of chemotherapy medications that may be used include Alimta (pemetrexed) or Platinol (cisplatin).

  • Targeted Therapies are medications that are designed to attack cancer specifically. Because they work by targeting proteins on cancer cells, blocking signals that tell a cell to divide, or normal cells that have been “hijacked” by a tumor in its attempt to grow, they may have fewer side effects than traditional chemotherapy. Examples of targeted therapies used with adenocarcinoma include Tarceva (erlotinib), Iressa (gefitinib), and Gilotrif (afatinib) for people with EGFR mutations, and Xalkori (crizotinib) and Zykadia (ceritinib) for people with ALK rearrangements and Xalkori for people with ROS1 rearrangements. Other targeted therapies are being used in clinical trials.

  • Radiation Therapy may be used to treat cancer or to control symptoms related to the spread of cancer. A special type of radiation called stereotactic body radiotherapy (SBRT) may be used, instead, with a curative intent. SBRT may be used for small cancers in the lung cancer for which surgery cannot be done due to the location of the tumor. SBRT is also being used for isolated brain metastases for lung adenocarcinoma, and in this setting, has sometimes resulted in long-term survival even for those with stage IV disease.

  • Immunotherapy is an exciting new treatment being used for some people with lung cancer. In essence, this treatment works by harnessing our own immune system to fight off cancer. The medication Opdivo (nivolumab) and Keytruda (pembrolizumab) were approved in 2015 for the treatment of lung cancer, and other medications are currently being studied in clinical trials.                                                

Prognosis

The 5-year survival rate for lung cancer overall is sadly only about 18 percent. For those diagnosed in the early stages of the disease, the prognosis is much better. Keep in mind that these are statistics based on data beginning at least 5 years ago. There have been more lung cancer medications approved in the 4 years between 2011 and 2015 than there were in the 40 years preceding this. In addition, check out the tips on what you can do yourself to improve lung cancer survival.

Coping

A diagnosis of lung cancer is frightening and you may feel very alone. Allow your loved ones to support you. Many people have no idea how to react towards someone who is diagnosed with cancer. Letting people know specific things they can do to help may ease their anxiety, as well as fill your need for extra support at this time. Consider joining a lung cancer support group ​or support community either through your cancer center or online. And be true to yourself. No matter what others have experienced or recommend, only you know what is best for you.

For Family and Friends

If it is your loved one who has been diagnosed with lung cancer, check out the article when your loved one has lung cancer, as well as these tips for supporting a loved one with lung cancer. And, since the stigma of lung cancer affects anyone with lung cancer, check out these tips on what NOT to say to someone with lung cancer.

Lung Cancer in Women, Non-Smokers, and Young Adults

Lung adenocarcinoma is the most common form of lung cancer in women, non-smokers, and young adults.  Learn more about this in the following articles:

Sources:

American Cancer Society. Cancer Facts and Figures 2014. Atlanta: American Cancer Society; 2014. http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf

American Cancer Society. Lung Cancer (Non-Small Cell.) Non-Small Cell Lung Cancer Survival Rates by Stage. 03/04/15. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-survival-rates

Dacic, S. Molecular genetic testing for lung adenocarcinomas: a practical approach to clinically relevant mutations and translocations. Journal of Clinical Pathology. 2013 June 25. (Epub ahead of print)

Devarakonda, S., Morgensztern, D., and R. Govindan. Genomic alternations in lung adenocarcinoma. Lancet Oncology. 2015. 16(7):e342-51.

DiBardino, D., Saqi, A., Elvin, J. et al. Yield and Clinical Utility of Next-Generation Sequencing in Selected Patients With Lung Adenocarcinoma. Clinical Lung Cancer. 2016. 17(6):517-522.e3.

Hsu, L., Liu, K., Tsai, M., Wu, C., Feng., A., Chu, N., and S. Kao. Estrogen adversely affects the prognosis of patients with lung adenocarcinoma. Cancer Science. 2014 Oct 22. (Epub ahead of print)

Lindeman, N. et al. Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK Tyrosine Kinase Inhibitors: Guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association of Molecular Pathology. Journal of Thoracic Oncology. 2013. 8(7):823-859.

Sheth, S. Current and emerging therapies for patients with advanced non-small cell lung cancer. American Journal of Health-System Pharmacy. 2010. 67(1 Suppl 1):S9-14.

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