Not a smoker, not even 35: The lung cancer case that challenges common assumptions

When a 31-year-old non-smoker female patient was coughing up blood and suffering from persistent chest pain, a lung cancer diagnosis was not what she had in mind. Yet a lifetime non-smoker from a family of non-smokers had an 8x7 centimetre tumor in the upper part of her left lung. Tests revealed adenocarcinoma that had spread to nearby lymph nodes within the chest, which fortunately did not spread to distant organs.This case demonstrates that we cannot assume a patient will not develop lung cancer simply because they are young or a non-smoker. The treating medical got an advanced molecular testing indicating an Epidermal Growth Factor Receptor (EGFR) mutation which results in the overexpression of epidermal growth factor and encourages tumor growth. There is an increasing incidence of these mutations among young patients and non-smoking women. This was necessary in order to create the appropriate treatment plan for her.The patient received targeted EGFR therapy prior to undergoing surgery and chemotherapy in order to shrink the tumor. The treatment resulted in a significant response, allowing surgeons to subsequently perform a minimally invasive Video-Assisted Thoracoscopic Surgery (VATS) to remove the affected portion of the lung and surrounding lymph nodes."There are two things to note from this case," explained Dr Arvind Kumar, Chairman, Chest Surgery & Lung Transplant, Medanta Gurugram. "First, lung cancer is not just a smoker's disease. Second, using molecular diagnostics to identify genetic mutations allows for treatment based on the biology of the cancer. In this particular case, using targeted therapy, chemotherapy and a minimally invasive surgery produced positive results."Despite the challenges posed by the tumour's size and location, complete tumour removal was achieved. It’s been two years post the treatment, and the patient has not experienced any recurrence of cancer and is enjoying a normal life.