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Chest radiographic findings in patients with non-small cell lung cancer

By Michael Bartlett

Posted on April 30th, 2020

Once inhaled, the asbestos fibers enter the respiratory tract and they become embedded in the lung tissue due to their rough texture, causing scarring and inflammation. Inhalation of these fibers has been linked to many diseases, including lung cancer. Lung cancer due to asbestos exposure results in 4,800 deaths annually.

Exposure to asbestos increases the risk of lung cancer by as much as five times. For the purpose of treatment and prognosis, lung cancer is divided into two categories:

  • Non-small cell lung cancer
  • Small Cell lung cancer

Non-small cell lung cancer (NSCLC) - the most common type of lung cancer, occurs when a cancer-causing agent such as asbestos, triggers the growth of abnormal cells in the lung. These cells grow out of control and eventually form a mass of tissue, called a tumor. As the tumor grows, it can block or narrow the airways, obstructing airflow and causing breathing difficulties. Eventually, tumor cells can spread to nearby lymph nodes and other parts of the body.

The fibrous type of asbestos - strongly associated with the causation of non-small cell lung cancer

Histologically, NSCLC is divided into three types of cancers that originate from lung tissue:

  • Adenocarcinoma - slow-growing cancer that usually first appears in the peripheral or outside areas of the lungs
  • Squamous cell carcinoma - occurs usually in the center of the lungs
  • Large cell carcinoma - occurs anywhere in the lung tissue and grows more rapidly than adenomas or squamous cell lung carcinomas

Together, these subtypes of NSCLS make up the majority of lung cancers, accounting for 84% of all lung cancer diagnosis.

In evaluating patients with possible non-small cell lung cancer, key clinical inputs include symptom assessment, clinical exams, risk factor assessment, and imaging.

The risk of lung cancer is increased by inhaling asbestos fibers, particularly in high doses or over long periods of time. Overall, people who were exposed to asbestos as part of their occupations are two times more likely to develop lung cancer than unexposed workers.

When considering if lung cancer was caused by exposure to asbestos, medical professionals use a number of diagnostic criteria, including:

  • Examining the latency period of the development of lung cancer - for lung cancer to be determined to be asbestos-related, it must have developed at least ten years after the patient was first exposed to asbestos
  • Examining the evidence of asbestos exposure in a patient's history

The most common signs of lung cancer are coughing up blood, and difficulty breathing. These symptoms often represent advanced-stage lung cancer. If you have symptoms of or risk factors for lung cancer, you should call your doctor and request to be seen as soon as possible. Tell him/her about all circumstances, duration, and intensity under which the asbestos exposure occurred and ask for recommended screenings. Screenings have been proven effective in detecting early-stage non-small cell lung cancer. Most lung cancer patients have their diagnosis made by X-ray imaging. By studying the X-ray images, your doctor will look for any abnormal areas in the lungs.

Survival rates vary widely, depending on how far non-small cell lung cancer has spread at the time of diagnosis. Early detection of non-small cell lung cancer greatly increases the opportunity for treatment and curative intent.

Accurate staging is critical to define optimal therapeutic strategies and prognosis of NSCLS

After someone is diagnosed with non-small cell lung cancer, doctors will try to figure out if it has spread, and if so, how far. The TNM (tumor-node-metastasis) staging system from the American Joint Committee for Cancer Staging and End Results Reporting is an internationally accepted system used to characterize the extent of cancer.

The TNM staging is based on imaging findings and serves as an indicator of prognosis. The system takes into account the following key pieces of information:

  • T - describe the size and extent of the primary tumor
  • N - describes whether the cancer has spread into nearby lymph nodes
  • M - indicates the spread (metastasis ) of cancer to distant sites

Primary tumor (T) involvement is as follows:

  • Tx - Primary tumor cannot be measured or assessed
  • T0 - No evidence of tumor
  • Tis - Carcinoma in situ - a term used to define the earliest stage of cancer
  • T1, T2, T3, T4 - Size/or extension of the primary tumor

Lymph node (N) involvement is as follows:

  • Nx - Regional lymph nodes cannot be measured or assessed
  • N0 - No regional nodal spread
  • N1 - Cancer cells in lymph nodes within the lung or in lymph nodes in the area where the lungs join the airway
  • N2 - Cancer in lymph nodes: in the center of the chest on the same side as the affected lung or just under where the windpipe branches off to each lung
  • N3 - Cancer in lymph nodes: on the opposite side of the chest from the affected lung or above the collar bone or at the top of the lung

Metastatic involvement - the spread of cancer cells from the site of origin to another part of the body, as follows:

  • M0 - No metastasis
  • M1 - Distant metastasis
  • M1a - Separate tumor nodule(s) or malignant pleural effusion
  • M1b - Distant metastasis

Stages of non-small cell lung cancer and TNM terms

StageTNM termsStage description
Occult Tx, N0, M0 Lymph nodes are involved but no lung tumor is identifiable
Stage 0 Tis, N0, M0 The tumor is present in only a few layers of cells and has not grown beyond the inner lining of the lungs
Stage I T1mi, N0, M0
T1a/T1b/T1c, N0, M0
T2a, N0, M0
Cancer may be present in the underlying lung tissues but the lymph nosed remain unaffected
Stage II T2b, N0, M0
T1a/T1b/T1c,N1, M0
T2a/T2b, N1, M0
T3, N0, M0
Cancer may have spread to the nearest lymph nodes or to the chest wall
Stage III T1a/T1b/T1c, N2, M0
T2a/T2b, N2, M0
T3/T4, N1, M0
T1a/T1b/T1c, N3, M0
T2a/T2b/N3, M0
T3/T4, N2, M0
T3/T4, N3, M0
Cancer is continuing to spread from the lungs to the lymph nodes or to nearby structures and organs, such as the heart, trachea, and esophagus
Stage IV Any T, Any N, M1a/M1b/M1c Cancer has metastasized or spread beyond the lungs into other organs such as the liver, adrenal gland, kidneys, or brain

We at Environmental Litigation Group, P.C. are proud of our commitment to ensuring our clients receive the maximum compensation

If you worked in an industry such as shipbuilding, manufacturing, construction, mining, milling, particularly between the 1970s-90s, we encourage you to seek medical advice and contact our team as soon as possible. If you or a loved one is suffering from asbestos-related lung cancer and would like to bring a claim for compensation, call us today for a free, no-obligation case evaluation. At Environmental Litigation Group we've handled a vast number of cases regarding asbestos-related diseases. Simply tell us about your current condition, work history, and other potential points of exposure, and our team can do the rest.