Decoding the Many Types of Lung Cancer

A lung cancer survivor shares her story of understanding her complex disease and finding a treatment plan to match.
PUBLISHED November 21, 2018
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When Lori Morris was diagnosed with stage 4 lung cancer in January 2018, she knew she didn’t fit most preconceived notions of who is impacted by the disease. The 54-year-old entertainment executive from California was an active non-smoker.

“I was struggling for air during exercise, but my primary care physician told me it was asthma,” said Morris. “Lung cancer never crossed my mind. I assumed there was only one cause for lung cancer – smoking – and only one kind of person who gets lung cancer, and that wasn’t me.”

As Lori started her treatment journey, she learned that lung cancer isn’t just one disease and it can affect anyone. In fact, there are many types of lung cancer, and treatment is not one-size-fits-all.

Different types of lung cancer are identified by where the cancer cells originate, what they look like and their genetics.

The two main types of lung cancer are non-small cell lung cancer (NSCLC, which makes up 85 percent of cases) and small cell lung cancer (SCLC, which makes up 15 percent of cases) NSCLC is further divided into three main subtypes – adenocarcinoma, squamous cell and large cell – though some people with NSCLC have rare or unspecified subtypes of the disease. 

Oncologists use testing to look for genetic mutations and other biomarkers that also define the type of lung cancer. More than half of lung cancers have known mutations that are the result of an acquired (not inherited) genetic alteration that may cause the cancer to grow. Common lung cancer mutations occur in the Anaplastic Lymphoma Kinase (ALK), Epidermal Growth Factor Receptor (EGFR) and ROS1 genes. In addition, many people have lung cancer cells with protein biomarkers, such as PD-L1, that prevent the immune system from recognizing and attacking the cancer cells.4

Lori was diagnosed with NSCLC and found out she was among the approximately five percent of people with NSCLC whose cancer cells have a mutation in the ALK gene. This means that of the 234,000 people diagnosed with lung cancer in the U.S. this year, she is one of about 9,900 who are ALK-positive. People with ALK-positive lung cancer are often younger and have either never smoked or smoked lightly. 

A better understanding of the different types of lung cancer has led to new breakthroughs in medicine that have enabled doctors to personalize treatment for the individual characteristics of a tumor. For example, if genetic testing reveals that a person’s tumor has a specific mutation, they may receive a treatment known as a targeted therapy.  The fact that Morris’ cancer was ALK-positive meant she was a candidate for a medicine that targeted her specific mutation to help prevent the cancer from progressing.

Immunotherapies have also shown promise for different types of lung cancer, including advanced forms of NSCLC and SCLC. These treatments go after protein biomarkers like PD-L1 that work with the immune system to fight against cancer, regardless of whether there are mutations or not.

“When I first started practicing as an oncologist more than 25 years ago, lung cancer was thought of as a single disease, and treatments were limited to surgery, radiation and chemotherapy,” said Alan Sandler, M.D., vice president, global head, Lung and Head/Neck Cancer at Genentech. “A better understanding of the biology of lung cancer has allowed us to develop new approaches, tests and medicines that are personalized to a patient’s specific type of cancer. Our goal is to build on the significant progress that has been made in recent years, and to identify effective treatment options for all people with lung cancer.”  

Dr. Sandler stresses the importance of talking to your doctor about personalized therapy for lung cancer and seeking out additional information through support and advocacy groups.

Even though everyone’s lung cancer journey is unique, support from lung cancer advocacy organizations such as LUNGevity, Bonnie J. Addario Lung Cancer Foundation and the Lung Cancer Alliance, or patient groups for people with a similar type of cancer such as the ROS1ders, ALK Positive and EGFR Resisters, or from general lung cancer advocacy organizations, can help patients and their loved ones navigate challenges.

For more information about the different types of lung cancer, visit www.gene.com/topics/lung-cancer.
 
[i] American Cancer Society. Lung cancer (non-small cell) detailed guide. https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html. Accessed October 3, 2018.
[ii] American Cancer Society. What is non-small cell lung cancer? https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/what-is-non-small-cell-lung-cancer.html. Accessed October 3, 2018.
[iii] The Clinical Lung Cancer Genome Project (CLCGP) and Network Genomic Medicine (NGM). (2013). A genomics-based classification of human lung tumors. Science Translational Medicine, 5(209), 209ra153.
[iv] Villalobos, P. & Wistuba, I. I. (2017). Lung Cancer Biomarkers. Hematology/oncology clinics of North America, 31(1), 13-29.
[v] Chia, P. L., Mitchell, P., Dobrovic, A. & John, T. (2014). Prevalence and natural history of ALK positive non-small-cell lung cancer and the clinical impact of targeted therapy with ALK inhibitors. Clinical epidemiology, 6, 423-32. doi:10.2147/CLEP.S69718
[vi] American Cancer Society. Key statistics for lung cancer. https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html. Accessed October 10, 2018.
[vii] Lung Cancer Foundation of America. What is ALK Positive Lung Cancer? And what are the options for treatment?  https://lcfamerica.org/research-grants/therapies/alk-positive-lung-cancer/. Accessed October 26, 2018. 
[viii] American Cancer Society. (October 1, 2018). Targeted therapy drugs for non-small cell lung cancer. https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/targeted-therapies.html. Accessed October 17, 2018
[ix] American Cancer Society. (August 8, 2016). What is cancer immunotherapy? https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/what-is-immunotherapy.html. Accessed October 11, 2018
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