Good news, two-year mortality has decreased in Francegoing from 79% in 2000 to 74% in 2010, then to 52% in 2020, according to results, not yet consolidated (KBP-2020-CPHG study)presented on Sunday January 29, 2023, on the occasion of the French language pulmonology congress in Marseille. One-year survival has increased from 40% in 2000 to 55% in 2020.
Lung cancer: how many cases in France?
Lung cancer is not uncommon; it is even the third most common cancer in France, with 46,363 new cases recorded in 2018. But beware: “there is not one lung cancer, but several: it is a very heterogeneous disease“, immediately warns us Pr. Nicolas Girard, pneumo-oncologist at the Institut Curie.
Indeed: while, as their name suggests, all lung cancers initially develop in the lungs, “the cancerous tumor itself can develop from different lung cells, resulting in very specific “types” of cancer” remarks the specialist.
What are the types of lung cancer?
The most frequent lung cancer (it represents around 85% of cases in France) is non-small cell lung cancer : the malignant tumor then develops thanks to the anarchic multiplication of the cells of the glandular epithelium of the lung tissues (which are located on the outer surface of the lung) or of the epithelial cells of the lung tissues (which line the inside of the lung ).
Then comes the small cell lung cancer (which represents 15% of cases in France and which is also called Small Cell Bronchial Cancer or CBPC) which develops from the neuroendocrine cells of the bronchi.
Lung cancer: what are the risk factors?
To know. Lung cancer affects a majority of men “although this disease is on the rise in women” remarks Pr. Nicolas Girard. The age at diagnosis is around 67 years for men, 65 years for women. “Lung cancer is very rare in children“says the pneumo-oncologist.
What are the risk factors for lung cancer? Unsurprisingly, “the” main risk factor for lung cancer, it’s tobacco. “Smoking is involved in approximately 80% of cases, and is the cause of the vast majority of small cell lung cancers” emphasizes Prof. Nicolas Girard.
“In smokers, the risk of developing lung cancer increases exponentially and is acquired over time. Clearly: quitting smoking “blocks” the progression of the risk but does not allow it to come down“explains the specialist.
However, in France, 15% of lung cancers occur in non-smokers: “there are other risk factors that are rarer, in particular occupational exposure to certain heavy metals, asbestos, arsenic, etc.” notes Prof. Nicolas Girard.
Lung cancer: symptoms?
Unfortunately, in the majority of cases, lung cancer starts silently: there are no symptoms. Rarely, one can observe the appearance of a chronic cough, sometimes bloody sputum (hemoptysis), difficulty breathing (dyspnea or shortness of breath), repeated respiratory infections (bronchitis, pneumonia, etc.), loss of appetite or weight loss.
“In approximately 70% of patients, lung cancer is diagnosed at the metastatic stage, i.e. late, when the cancer has spread to organs other than the lungs.“explains Prof. Nicolas Girard. In the case of lung cancer, we can thus observe the development of metastases in the brain, liver, bones or even the adrenal glands.“These metastases give symptoms”depending on their location“: it may in particular be a question of bone pain, seizures, paralysis…
Lung cancer: towards organized screening?
“In France, there is unfortunately no organized screening for lung cancer: this is however the case in England, the Netherlands, Belgium, Canada and the United States.“remarks the pneumo-oncologist.
“French health authorities tend to adhere to this old belief that patients are “responsible” for their lung cancer because they have smoked: however, we now know that smoking is an addiction, therefore a disease.“According to the specialist, this organized screening would however reduce lung cancer mortality by around 25% in men and 40% in women.
Pr. Nicolas Girard recommends lung cancer screening for people at risk: “you are at risk if you are over 50 and have smoked for/have been smoking for over 25 years.“This screening takes the form of a chest CT scan.
Read also: Lung cancer: specialists call for the generalization of screening by scanner
Lung cancer: how is it diagnosed?
The diagnosis of lung cancer takes place in several stages: in addition to the chest scan (“lung x-ray is useless in case of lung cancer” underlines Pr. Nicolas Girard), the doctor will prescribe an extension assessment in order to know if there are metastases: these can be observed using a PET scanpossibly supplemented with a MRI of the brain. “The diagnosis of lung cancer is confirmed with the help of a biopsy“adds the specialist.
Lung cancer: what treatments?
If the cancer is detected before the metastatic stage, surgery can be considered:concretely, this consists of removing the tumor and supplementing with chemotherapy“explains the specialist. The risk of relapse is high (it is around 50% within 5 years) but the survival rate is high; around 60% – 70% at 5 years.
“In metastatic lung cancer, the genetic test is absolutely essential” says Pr. Nicolas Girard. The objective is to know if there is a targetable anomaly in the genes of the cancerous tumor: “if the genetic test highlights a targetable anomaly, we will be able to resort to a targeted treatment which will “turn off” the effects of the genetic mutation. If no particular anomaly is brought to light, treatment consists of immunotherapy which will “reactivate” the patient’s immune defenses against the cancer. This immunotherapy can be supplemented with a chemotherapy.“
Attention ! “When there is a targetable anomaly, immunotherapy is ineffective: that’s what genetic testing is all about! The problem is that you have to look for genetic abnormalities to identify them. At present, the health authorities recommend the search for at least 4 anomalies out of the ten most frequent anomalies. Thus, still too many patients are treated with immunotherapy when a targeted treatment could have been possible.“
[Mise à jour, 12 avril 2022] For the first time, an international phase 3 study (CheckMate-816) conducted in 358 patients with non-metastatic “non-small cell” lung cancer, shows the benefits of a combination of immunotherapies with chemotherapy, administered before surgery. Approved in March 2022 in the United States by the FDA, this new treatment significantly improves survival and reduces the risk of recurrence and death by almost 40%. Learn more about this major breakthrough against lung cancer.
Lung cancer: what is the life expectancy?
The rate of survival of lung cancer patients depends on the stage of the disease. “It is around 30 % if the cancer is metastatic and treated with immunotherapy; he is a bit higher with targeted therapy“replied the pneumo-oncologist.
Thanks to Prof. Nicolas Girard, pneumo-oncologist at the head of the Institut du Thorax Curie – Montsouris.
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Read also :
- Lung cancer: a web series to better understand the disease
- Blood test could predict lung cancer 5 years before diagnosis
