Just as almost no one orders a plain old “coffee” anymore, no one has plain old “lung cancer.” “Lung cancer” is what they think you may have when your doctors see some suspicious cells, a mass that doesn’t respond to antibiotics, and/or symptoms such as persistent cough, shortness of breath, wheezing, weight loss, or pain. By the time they are analyzing the tissue from the first biopsy, however, it is already something else. Additional tests, such as a PET scan and genetic testing, add more details to the picture. “Lung cancer” is actually an umbrella term for a wide array of diseases.
For example: I have probably-stage-IV ROS1-positive adenocarcinoma of the lung, a non-small-cell lung cancer or NSCLC.
To explain some of those terms:
Probably Stage IV: All cancers are classified into stages, numbered from 0 to IV. The “stage” is a measure of how far the cancer has progressed. The stage is determined using several diagnostic tools, but one of the most important is the PET scan, which shows areas of the body where cells are dividing rapidly. Stage I cancer is small and contained; Stage IV cancer has spread (or “metastasized,” to use the technical term) to other organs (or, in the case of lung cancer, the other lung).
In my case, we think the cancer probably invaded the bones of my rib cage, making it stage IV, but we don’t know for sure. I could have just broken some ribs coughing, which is something that happens. Or I could have broken ribs coughing because they were already weakened by cancer metastases. We’ll never know because a healing fracture and a bony metastasis look a lot a like on a PET scan. The only way to know for sure if I have or have had bone metastases would have been a bone biopsy, which my doctors said was too invasive for the information we would get from it. I got the “probably stage IV” at my surgical consult in January 2013, when the surgeon interpreted my PET scan results and other imaging studies.
Non-small-cell lung cancer, or NSCLC: Lung cancer comes in two major varieties, small-cell and non-small-cell. 85 to 90 percent of lung cancers diagnosed are non-small-cell. They classified my cancer as NSCLC in the pathology lab, around New Year’s Day 2013, by analyzing cells from my first biopsy under the microscope.
Adenocarcinoma: There are further subtypes of NSCLC, including squamous cell carcinoma, adenocarcinoma, and large cell or undifferentiated carcinoma. Adenocarcinoma is the most common lung cancer diagnosis in nonsmokers, is more common in women than in men, and is more common in younger people than other types. This classification also came from the pathology lab.
ROS1-positive: This is the most recent and most hopeful news about my cancer. I learned it in August 2013 as a result of genetic testing on tissue from my third biopsy. ROS1 is a genetic mutation in my cancer cells. It’s a rare one; some of the more common mutations are EGFR, ALK, and KRAS. The medication I am currently taking, crizotinib, also known by the brand name Xalkori, actually attacks my cancer at the molecular level.
Note: some of the wording in these definitions is paraphrased from information at the following useful websites: www.cancer.org, the website of the American Cancer Society, www.mskcc.org, the website of Memorial Sloan-Kettering Cancer Center, and www.mayoclinic.org, the website of Mayo Clinic. Any errors, of course, are my own!