Lung Cancer in Nonsmokers and Never Smokers

Causes of Non/Never Smoker Lung Cancer

Nonsmoker lung cancer is believed to occur from a genetic mutation that occurs during a person’s lifetime. In rare instances, this mutation may be inherited. However, cancer is a complex disease involving the interaction of many factors, and associating a single cause with a tumor does not fully explain why a person develops lung cancer. Aside from a person’s genetic susceptibility, several factors are suspected to play a role in developing non-smoker lung cancer, including:

• Breathing in someone else’s smoke (second-hand smoke) 
• Exposure to radon, a naturally occurring gas in our environment
• Prolonged exposure to specific pollutants, such as asbestos or diesel exhaust

Symptoms for nonsmoker lung cancer are the same as those experienced by smokers with lung cancer. They include:

• Breathing problems (coughing, wheezing, shortness of breath, coughing up blood)
• Recurring lung infections
• Weight loss 
• Fatigue
• Pain

Women are more likely to be diagnosed with this specific cancer than men, and it’s not uncommon for this lung cancer to be discovered after it has spread to other parts of the body. This is in part because lung cancer often has no symptoms during the earliest stages. Also, preventative screening is currently not recommended for non/never smokers. At this time, it’s believed that the benefits of detecting cancer early do not outweigh the risks of exposing otherwise healthy patients to potentially unnecessary medical procedures and imaging.

Diagnosing Non/Never Smoker Lung Cancer

At UChicago Medicine, advanced diagnostic testing is used to identify and analyze lung cancer. For every patient, doctors have access to:

• Cell-free DNA analysis, a minimally-invasive test used to detect genetic material (DNA) shed by your tumor’s cancer cells into your blood.
• Genetic testing that involves next-generation sequencing of 1,200 genes that may be involved in your cancer.
• Endobronchial ultrasound, which involves inserting a thin tube with a camera into the lungs to examine and potentially sample tissue.
• Peripheral bronchoscopy, co-designed by UChicago Medicine researchers, that uses a flexible tube with a camera capable of reaching distant areas that were previously unreachable; this allows doctors to obtain enough tissue to accurately diagnose early lung cancer. 
• Imaging, including dual-energy chest X-rays, CT, PET scans and MRIs.

A multidisciplinary tumor board made up of several specialists will determine the precise type and stage of your cancer. Most nonsmoker lung cancer tumors are non-small cell lung cancer (adenocarcinomas or squamous cell carcinomas), though they can also be small cell lung cancer or other less common types of cancer. 

Treatment of Non/Never Smoker Lung Cancer

Our multidisciplinary team of thoracic surgeons, medical oncologists, radiation oncologists, pulmonologists, pathologists, radiologists and interventional radiologists meet weekly to ensure the most effective care for each patient. Diagnostic information is used to create a precise molecular profile of your cancer and a personalized treatment plan.

Depending on the type and stage of the cancer, treatment may involve:

• Surgery (open, minimally invasive and robotic)
• Radiation, including stereotactic body radiotherapy, which delivers targeted radiation to kill cancer cells while sparing nearby healthy tissue
• Immunotherapy, which are drugs that tap into your immune system to help it improve the way it identifies and kills cancer cells
• Targeted therapies attack specific parts of cancer cells to slow the growth and spread of cancer
• Chemotherapy, which is medication that can be used alone or with other treatments to treat cancer that has spread beyond the initial site
  

Lung Cancer Clinical Trials