ABOUT LUNG CANCER

ABOUT LUNG CANCER

Understand the basics of lung cancer, diagnosis and different treatment options


Lung Cancer Overview

Lung cancer is one of the most common cancers and leading cause of cancer death globally and in Hong Kong.1,2 In 2014, there were 4,674 new cases of lung cancer in Hong Kong, and a total of 3,866 people died from this cancer, accounting for 28.0% of all cancer deaths.3 See About Lung Cancer Video.






1. GLOBOCA. Lung Cancer - Estimated incidence, mortality and prevalence worldwide in 2012. Section of Cancer Surveillance (19/12/2016). Available at: http://globocan.iarc.fr/old/FactSheets/cancers/lung-new.asp. Accessed 17 Jan 2017.

2. Lung cancer. Hong Kong Centre for Health Protection. 15 April 2016. Available at: http://www.chp.gov.hk/en/content/9/25/49.html.  Accessed 9 Feb 2017.

3. Overview of Hong Kong Cancer Statistics 2014. Hong Kong Cancer Registry, Hospital Authority. Nov 2016. Available at: http://www3.ha.org.hk/cancereg. Accessed 17 Jan 2017.

What is Lung Cancer?

Lung cancer is caused by lung cells growing out of control. As the number of cells grow, they form into a tumour.4 The lungs are a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body. They have two parts, the right and the left. The right lung has three lobes, while the left lung has two lobes. Lung’s major passages and structures include the windpipe (trachea), bronchi, bronchioles, and alveoli.5

Many lung cancers start in the cells lining the bronchi. These cells increase to form a tumour which may cause a blockage in the lung and give rise to breathing problems. When lung cancer progresses, it can grow into surrounding structures, spread into lymph nodes that surround the bronchi and to other parts of the body as well.5 See Types and Staging of Lung Cancer section for more information.






4. Lung Cancer (Non-Small Cell). American Cancer Society. Oct 2016. Available at: https://old.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf. Accessed 9 Feb 2017.

5. Understanding cancer of the lung - Caring for people with cancer. Irish Cancer Society. 2014 Edition. Available at: https://www.cancer.ie/sites/default/files/content-attachments/understanding_lung_cancer.pdf. Accessed 9 Feb 2017.


Symptoms of Lung Cancer

It is important to report any unusual physical feelings to a doctor. These unusual feelings can happen in conditions other than cancer too. The signs and symptoms of lung cancer can take years to develop and they may not appear until the disease is advanced.4


The symptoms of lung cancer may include any of the following:5


- A cough that does not go away

- A change in colour or volume of sputum

A chest infection slow to clear up, even after antibiotics

Repeated bouts of pneumonia or bronchitis

Shortness of breath or wheezing

Hoarseness or a changing voice

Coughing up blood

Pain in the chest, shoulder, or back unrelated to pain from coughing

Difficulty swallowing

Poor appetite and unexplained weight loss

Feeling tired all the time

Neck or facial swelling


If the original lung cancer has spread, a person may feel symptoms in other places in the body. Common places for lung cancer to spread include other parts of the lungs, lymph nodes, bones, brain, liver, and adrenal glands.6






4. Lung Cancer (Non-Small Cell). American Cancer Society. Oct 2016. Available at: https://old.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf. Accessed 9 Feb 2017.

5. Understanding cancer of the lung - Caring for people with cancer. Irish Cancer Society. 2014 Edition. Available at: https://www.cancer.ie/sites/default/files/content-attachments/understanding_lung_cancer.pdf. Accessed 9 Feb 2017.

6. Symptoms of Lung Cancer. Lung Cancer 101. Lungcancer.org, USA 2017. Available at: http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/266-sy. Accessed 9 Feb 2017.


Lung Cancer Risk Factors

A risk factor is anything that affects a person’s chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, cannot be changed.7


Having a risk factor, or even several, does not mean that a person will get the disease. And some people who get the disease may have few or no known risk factors. Several lung cancer risk factors can make a person more likely to develop the disease.7


Lung cancer risk factors may include:7


- Tobacco smoke

- Secondhand smoke

- Exposure to radon

- Exposure to asbestos

- Exposure to other cancer-causing agents in the workplace 

  • Radioactive ores such as uranium
  • Inhaled chemicals or minerals such as arsenic, beryllium, cadmium, silica, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas, and chloromethyl ethers
  • Diesel exhaust

- Air pollution

- Arsenic in drinking water

- Previous radiation therapy to the lungs

- Personal or family history of lung cancer






7. Lung Cancer Prevention and Early Detection. American Cancer Society. Feb 2016. Available at: https://old.cancer.org/acs/groups/cid/documents/webcontent/acspc-039558-pdf.pdf. Accessed 15 Mar 2017.

Types and Staging of Lung Cancer

Lung cancers can be either primary or secondary. Primary is when the tumour starts to grow in the lungs first. Secondary is when it has spread from somewhere else to the lungs.5 Only primary lung cancer is discussed here.


Most lung cancers are divided into two main types: Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC).5 Staging lung cancer is based on whether the cancer is local or has spread from the lungs to the lymph nodes or other organs. Because the lungs are large, tumors can grow in them for a long time before they are found. Even when symptoms occur, such as coughing and fatigue, people think they are due to other causes.8 For this reason, early-stage lung cancer (stages I and II) is difficult to detect.8






5. Understanding cancer of the lung - Caring for people with cancer. Irish Cancer Society. 2014 Edition. Available at: https://www.cancer.ie/sites/default/files/content-attachments/understanding_lung_cancer.pdf. Accessed 9 Feb 2017. 

8. Types and Staging of Lung Cancer. Lung Cancer 101. Lungcancer.org, USA 2017. Available at: http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/268-types_and_staging. Accessed 9 Feb 2017.

Non-Small Cell Lung Cancer (NSCLC)

NSCLC is the most common type of lung cancer and accounts for about 85%of lung cancers.4 NSCLC includes 3 main subtypes based on histology:


1. Adenocarcinoma: This type begins near the outside surface of the lung and grows slowly. It accounts for about 40% of lung cancers and occurs mainly in current or former smokers, but it is also the most common type of lung cancer seen in non-smokers, and more frequently seen in women and the young.4,5


2. Squamous cell carcinoma: This type generally begins in the lining of the airway in the larger breathing tubes, and often linked to a history of smoking. It accounts for about 25-30% of lung cancers and does not spread quickly.4,5


3. Large cell carcinoma: This type may occur in any part of the lung. It accounts for about 10-15% of lung cancers and tends to spread quickly.4,5






4. Lung Cancer (Non-Small Cell). American Cancer Society. Oct 2016. Available at: https://old.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf. Accessed 9 Feb 2017.

5. Understanding cancer of the lung - Caring for people with cancer. Irish Cancer Society. 2014 Edition. Available at: https://www.cancer.ie/sites/default/files/content-attachments/understanding_lung_cancer.pdf. Accessed 9 Feb 2017.

Stage 0

Cancer cells are still within the lining of the lung or bronchus but the cells have not formed an actual tumour. This is also called carcinoma in situ.9






9. Understanding Lung Cancer. Juravinski Cancer Centre, Hamilton Health Sciences, Canada. May 2014. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/LungCancerJCC-th.pdf. Accessed 9 Feb 2017.

Stage I

The cancer is located only in the lung and has not spread to any lymph nodes. It is less than 5cm wide and can be surgically removed.9,10



9. Understanding Lung Cancer. Juravinski Cancer Centre, Hamilton Health Sciences, Canada. May 2014. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/LungCancerJCC-th.pdf. Accessed 9 Feb 2017.

10. Living with a diagnosis of lung cancer. freetobreathe.org, USA 2014. Available at: http://www.freetobreathe.org/images/uploads/
2014_Living_With_A_Diagnosis_of_Lung_Cancer_Web.pdf. Accessed 9 Feb 2017.

Stage II

The cancer is slightly larger than stage I, between 5cm and 7cm wide, and may have spread to nearby lymph nodes or other parts of the lung. Surgery may help. Other treatments may be necessary.9,10




9. Understanding Lung Cancer. Juravinski Cancer Centre, Hamilton Health Sciences, Canada. May 2014. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/LungCancerJCC-th.pdf. Accessed 9 Feb 2017.

10. Living with a diagnosis of lung cancer. freetobreathe.org, USA 2014. Available at: http://www.freetobreathe.org/images/uploads/
2014_Living_With_A_Diagnosis_of_Lung_Cancer_Web.pdf. Accessed 9 Feb 2017.

Stage III

Cancer cells have spread to the center of the chest (mediastinum) and/or to lymph nodes beyond the same side of the chest, but does not appear to have spread to other organs outside the chest. Surgery may not be possible to remove the cancer.9,10 Other treatments will likely be needed.




9. Understanding Lung Cancer. Juravinski Cancer Centre, Hamilton Health Sciences, Canada. May 2014. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/LungCancerJCC-th.pdf. Accessed 9 Feb 2017.

10. Living with a diagnosis of lung cancer. freetobreathe.org, USA 2014. Available at: http://www.freetobreathe.org/images/uploads/
2014_Living_With_A_Diagnosis_of_Lung_Cancer_Web.pdf. Accessed 9 Feb 2017.

Stage IV

This is the most advanced stage of lung cancer in which the cancer has spread to both lungs, to fluid in the area around the lungs, or to another part of the body, such as the liver or other organs. Surgery may not be an option. Although stage IV cancers are generally not curable, there are treatments available that may help patients live longer and with an improved quality of life.9,10



9. Understanding Lung Cancer. Juravinski Cancer Centre, Hamilton Health Sciences, Canada. May 2014. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/LungCancerJCC-th.pdf. Accessed 9 Feb 2017.

10. Living with a diagnosis of lung cancer. freetobreathe.org, USA 2014. Available at: http://www.freetobreathe.org/images/uploads/
2014_Living_With_A_Diagnosis_of_Lung_Cancer_Web.pdf. Accessed 9 Feb 2017.

Small Cell Lung Cancer (SCLC)

SCLC is much less common and accounts for about 10-15% of lung cancer.11 They tend to grow more quickly than NSCLC tumors. Usually, SCLC is more responsive to chemotherapy than NSCLC.8






8. Types and Staging of Lung Cancer. Lung Cancer 101. Lungcancer.org, USA 2017. Available at: http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/268-types_and_staging. Accessed 9 Feb 2017.

11. Key Statistics for Small Cell Lung Cancer. American Cancer Society. Last Revised: January 5, 2017. Available at: https://www.cancer.org/cancer/small-cell-lung-cancer/about/key-statistics.html. Accessed 9 Feb 2017.

Limited Stage

In this stage, cancer is found on one side of the chest, involving just one part of the lung and nearby lymph nodes. Treatment for limited-stage SCLC generally involves both chemotherapy and radiation therapy.9,10



9. Understanding Lung Cancer. Juravinski Cancer Centre, Hamilton Health Sciences, Canada. May 2014. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/LungCancerJCC-th.pdf. Accessed 9 Feb 2017.

10. Living with a diagnosis of lung cancer. freetobreathe.org, USA 2014. Available at: http://www.freetobreathe.org/images/uploads/
2014_Living_With_A_Diagnosis_of_Lung_Cancer_Web.pdf
. Accessed 9 Feb 2017.

Extensive Stage

In this stage, cancer has spread to other regions of the chest or other parts of the body. As with other advanced cancers, extensive-stage SCLC is generally not curable, but there are treatments available that may help patients live better and longer.9,10



9. Understanding Lung Cancer. Juravinski Cancer Centre, Hamilton Health Sciences, Canada. May 2014. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/LungCancerJCC-th.pdf. Accessed 9 Feb 2017.

10. Living with a diagnosis of lung cancer. freetobreathe.org, USA 2014. Available at: http://www.freetobreathe.org/images/uploads/
2014_Living_With_A_Diagnosis_of_Lung_Cancer_Web.pdf. Accessed 9 Feb 2017.

Diagnosis and Treatment Options

A series of tests are necessary to diagnose lung cancer. Further testing then identify the type and stage of the cancer, which help determine treatment options. 

Diagnosing

Chest X-ray

A chest X-ray will be done to check the state of lungs. If anything looks abnormal on the X-ray, more tests can be arranged. 






5. Understanding cancer of the lung - Caring for people with cancer. Irish Cancer Society. 2014 Edition. Available at: https://www.cancer.ie/sites/default/files/content-attachments/understanding_lung_cancer.pdf. Accessed 9 Feb 2017.

Sputum Cytology

Sputum is coughed up from the lungs. Then some of it is put under a microscope to see if there are any abnormal cells. This test is useful for finding tumors that may be growing in the airways of the lungs.12






12. Tests for non-small cell lung cancer. American Cancer Society. 05/16/2016. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 9 Feb 2017.

Computed Tomography (CT) Scan

Known as CT or CAT scans, this test gives a more detailed picture than chest X-rays. CT scans can detect extremely small tumors and can give three-dimensional imaging of the tumor. CT scans can also help determine if the tumor has spread to lymph nodes surrounding the lungs.12






12. Tests for non-small cell lung cancer. American Cancer Society. 05/16/2016. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 9 Feb 2017.

Magnetic Resonance Imagining (MRI) Scan

Like CT scans, MRI scans provide detailed images of soft tissues. But MRI scans use radio waves and strong magnets instead of X-rays. MRI scans are most often used to look for possible spread of lung cancer to the brain or spinal cord.12






12. Tests for non-small cell lung cancer. American Cancer Society. 05/16/2016. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 9 Feb 2017.

Positron Emission Tomography (PET) Scan

A type of imaging scan that is used to tell if lung cancer has spread to other parts of the body. For this test, a form of radioactive sugar (known as FDG) is injected into the blood. Because cancer cells in the body are growing quickly, they absorb more of the radioactive sugar. This radioactivity can be seen with a special camera.12






12. Tests for non-small cell lung cancer. American Cancer Society. 05/16/2016. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 9 Feb 2017.

Biopsies

For an even closer examination of the abnormal growth, a small sample is removed by either: a needle; a long thin tube; or surgery. This way, doctors can view it under a microscope to confirm the presence of cancer and to determine the kind of lung cancer.5






5. Understanding cancer of the lung - Caring for people with cancer. Irish Cancer Society. 2014 Edition. Available at: https://www.cancer.ie/sites/default/files/content-attachments/understanding_lung_cancer.pdf. Accessed 9 Feb 2017.

Bronchoscopy

This is an examination of the inside of the lung airways. An optical instrument with a lighted tip is passed through the trachea and the bronchi to see whether there is a growth. Cell samples (biopsies) are taken for examination.12






12. Tests for non-small cell lung cancer. American Cancer Society. 05/16/2016. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 9 Feb 2017.

Mutation Tests

Mutation tests (also known as molecular profiling) are very specific and look for certain changes in a person's cancer genes. In these cases, a small piece of the cancer is taken and run tests on it to find out a patient's tumour cells mutation status.12






12. Tests for non-small cell lung cancer. American Cancer Society. 05/16/2016. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 9 Feb 2017.

Treatment Options

Treatment options are based on a patient’s cancer type and stage, location, molecular characteristics, and his/her overall health. The most common treatments for lung cancer are surgery, chemotherapy, radiation therapy, and targeted therapy.

Surgery

The cancer is removed along with some of the healthy tissue surrounding it. There are different procedure options depending on the size, stage, and spread of the cancer. The surgeon could remove as little as a small section of the lung to removing an entire lung.13


- Side effects: Some bleeding or risk of infection is possible. Shortness of breath is to be expected but may improve over time. Patients should consult with their doctors about the relevant side effects.13 






13. Types of treatments. LVNG With Lung Cancer. AstraZeneca. LivingWith 2016. Available at: https://www.lvng.com/about-lung-cancer/types-of-treatment.html. Accessed 9 Feb 2017.

Chemotherapy

This treatment uses one or more of over 100 drugs to kill cancer cells to keep them from growing. Sometimes it is given before surgery to possibly help shrink the tumor, or to lessen any pain a patient may have. It can also be used after surgery to possibly kill any remaining cancer cells. Chemotherapy may be given by mouth, or injected into bloodstream through a vein. It is usually given in regular treatments in a hospital, clinic or in the doctor's office over a specific duration of time.13 


- Side effects: Some side effects include loss of hair, not feeling hungry, nausea/vomiting, infections, being tired, diarrhea, or constipation. Patients should consult with their doctors about the relevant side effects.13






13. Types of treatments. LVNG With Lung Cancer. AstraZeneca. LivingWith 2016. Available at: https://www.lvng.com/about-lung-cancer/types-of-treatment.html. Accessed 9 Feb 2017.

Radiation Therapy

This treatment uses energy beams similar to X-rays, but in a strong, concentrated form. Radiation therapy may target the cancer from outside of the body or can be placed inside a needle, or catheter, and placed inside of the body to help attack the cancer.13


- Side effects: Side effects may vary depending on where and how the radiation is given. They include some hair loss where treatment was, tiredness, nausea/vomiting, and skin changes such as a mild rash, blisters, or peeling. These will usually go away after the treatment is over.13






13. Types of treatments. LVNG With Lung Cancer. AstraZeneca. LivingWith 2016. Available at: https://www.lvng.com/about-lung-cancer/types-of-treatment.html. Accessed 9 Feb 2017.

Targeted Drug Therapy

These treatments are determined by the results of a biopsy of the cancer cells. This test is called molecular profiling or mutation testing. Details of the tumor biopsy give the doctor information on how to possibly target specific mutations, or abnormal cells. There are many types of targeted therapies that may be used. Some block growth signals in the cells so they stop getting bigger. Others block new blood supplies that may nourish and grow cancerous cells.13


- Side effects: The most common side effects of targeted therapy include diarrhea, some liver problems, skin rash, dry skin, problems with wounds healing and blood clotting, and high blood pressure. Patients should consult with their doctors about the relevant side effects.13






13. Types of treatments. LVNG With Lung Cancer. AstraZeneca. LivingWith 2016. Available at: https://www.lvng.com/about-lung-cancer/types-of-treatment.html. Accessed 9 Feb 2017.

Immunotherapy

These new treatments work by boosting body's own natural defenses to fight cancer. It is one of the most exciting new approaches for treating several types of cancer, including lung cancer. Keep in mind that these treatments are still new, therefore more research must be done to understand which people are most likely to benefit and how best to use the treatments.14   


Side effects: Because immunotherapies work by enhancing or turning on the immune system, they can sometimes cause immune system to become overactive and attack normal tissues or organs.14






14. Immunotherapy. freetobreathe.org, USA. Last updated 10/2016. Available at:  http://www.freetobreathe.org/lung-cancer-info/treatment/treatment-options/immunotherapy. Accessed 9 Feb 2017.


About Lung Cancer Video

- Lung cancer is one of the most common cancers and leading cause of cancer death globally and in Hong Kong.1,2


- In 2012, about 1.8 million new cases are diagnosed worldwide,over 600,000 cases in China,more than 10,000 cases in Taiwan,15 and over 4,500 cases in Hong Kong.16


- Worldwide, lung cancer causes more than 1.6 million deaths each year.17 In Hong Kong, it accounts for 28% of all cancer deaths, with around 3,900 deaths in 2014.3


Click the video below to learn more about the burden of lung cancer. 



1. GLOBOCA. Lung Cancer - Estimated incidence, mortality and prevalence worldwide in 2012. Section of Cancer Surveillance (19/12/2016). Available at http://globocan.iarc.fr/old/FactSheets/cancers/lung-new.asp. Accessed 17 Jan 2017.

2. Lung cancer. Hong Kong Centre for Health Protection. 15 April 2016. Available at: http://www.chp.gov.hk/en/content/9/25/49.html.  Accessed 9 Feb 2017.

3. Overview of Hong Kong Cancer Statistics 2014. Hong Kong Cancer Registry, Hospital Authority. Nov 2016. Available at: http://www3.ha.org.hk/cancereg. Accessed 17 Jan 2017.

15. Record number of people diagnosed with cancer in Taiwan. CNA. Dec 2016. Available at: http://www.chinapost.com.tw/taiwan/national/national-news/2015/04/15/433672/Record-number.htm. Accessed 17 Jan 2017.

16. Lung Cancer in 2012. Hong Kong Cancer Registry, Hospital Authority. Last updated: Nov 2016. Available at http://www3.ha.org.hk/cancereg/pdf/factsheet/2012/lung_2012.pdf. Accessed 17 Jan 2017.

17. IASLC. Lung Cancer Fact Sheet - 2016 - Asia. Available at: https://www.iaslc.org/lung-cancer-fact-sheet-2016-asia. Accessed 17 Jan 2017.

About Lung Cancer Mutations


About Lung Cancer Mutations

Medical studies have discovered that the growth of some lung cancers depends on the presence of certain genetic mutations in the cancer.18 Many types of gene mutations such as EGFR, ALK, KRAS and ROS mutations have been found in lung cancer.19






18. Understanding lung cancer - A guide for people with cancer, their families and friends. Cancer Council Australia 2014.
19. Targeted therapy for lung cancer - A guide for the patient. Lung Cancer Alliance. 2016. Available at: http://www.lungcanceralliance.org/Educational%20Materials/Targeted%20Therapy_Brochure_dig.pdf. Accessed 9 Feb 2017.

EGFR Mutation in Lung Cancer

EGFR (epidermal growth factor receptor) mutation is the most common type of gene mutation in lung cancer.21 EGFR mutations are present in the tumours of 30-40% of Asian and 10-20% of non-Asian patients with advanced NSCLC.22 Among all gene mutations, EGFR mutation has the highest prevalence rate in NSCLC patients, especially in Asian population.20 For people with advanced NSCLC, it is especially important to know whether their cancer cells have mutated EGFRs (mutation-positive), and understand available treatment options for EGFR-mutated lung cancer. New cancer treatments and medicines are always being developed so it is essential to know if one of them could be an option for treating the disease. See About EGFR-Mutated Lung Cancer for more information.






20. Korpanty GJ, et al. Biomarkers That Currently Affect Clinical Practice in Lung Cancer: EGFR, ALK, MET, ROS-1, and KRAS. Front Oncol. 2014:11;4:204.

21. Gazdar AF. Activating and resistance mutations of EGFR in non-small-cell lung cancer: role in clinical response to EGFR tyrosine kinase inhibitors. Oncogene. 2009;28(Suppl 1):S24–S31.

22. Li L, et al. Epidermal growth factor receptor mutation analysis in cytological specimens and responsiveness to gefitinib in advanced non-small cell lung cancer patients. Chin J Cancer Res. 2015;27(3):294-300.

ALK Mutation in Lung Cancer

About 5% of NSCLCs have a rearrangement in a gene called anaplastic lymphoma kinase (ALK).4  This change is most often seen in non-smokers (or light smokers) who have the adenocarcinoma subtype of NSCLC.4  The ALK gene rearrangement produces an abnormal ALK protein that causes the cells to grow and spread.4 ALK mutation test can help find out if the tumour has developed the mutation.4 Nowadays, drugs that target the ALK mutation are available for first- and second-line treatment.4





4. American Cancer Society. Lung Cancer (Non-Small Cell). Available at: https://old.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf. Accessed 17 Jan 2017.