What is Lung Cancer

Lung cancer forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

• Small cell: The cells of small cell lung cancer look small under a microscope. About 1 of every 8 people with lung cancer has small cell lung cancer.
• Non-small cell: The cells of non-small cell lung cancer are larger than the cells of small cell lung cancer. Most (about 7 of every 8) people diagnosed with lung cancer have non-small cell lung cancer. It doesn't grow and spread as fast as small cell lung cancer, and it's treated differently.

Lung cancer is the leading cause of cancer death in both men and women. Lung cancer is the second most common cancer in the United States, after skin cancer. The number of new cases and deaths from lung cancer is highest in black men.

Risk Factors

Smoking is the main cause of lung cancer, especially non-small cell lung cancer. Exposure to secondhand smoke and environmental exposures, such as radon and workplace toxins, also increase your risk.

The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer. If a person has stopped smoking, the risk becomes lower as the years pass.

When smoking is combined with other risk factors—such as secondhand smoke, asbestos and arsenic exposure, and air pollution—the risk of lung cancer is increased. A family history of cancer can also be a risk factor for lung cancer.

Early Detection is the Key

In 2005, Dusty Donaldson experienced tenderness and pain in her neck that didn't go away over several months. When her doctor couldn't detect any physical cause, and the pain continued, Donaldson decided more had to be done. "The pain was persistent, and so was I."

Today, she's thankful for her persistence. Ultrasound and CT scans found something suspicious in her right lung. That turned out to be a five-centimeter cancerous tumor between the upper and middle lobes of her lungs. It was an early-stage cancer and had not spread to other parts of her lungs or her body.

Donaldson, who had quit smoking 26 years before her diagnosis, had not even considered that she might have lung cancer.

"I was really surprised at the time to find out that lung cancer is the number one cause of cancer deaths in men and women. More people die from lung cancer than from all the others combined," Donaldson says. "Lung cancer death rates are the equivalent of a 747 jumbo jet crashing to the ground every single day."

Surgeons removed almost two-thirds of her lung and treated her with chemotherapy for three months. Today, she remains cancer free and has made a commitment to help others understand lung cancer and the need for early detection.

I'm compelled to find others and share with them information regarding screening," she says. "Early detection is key to survivorship," she adds. "There's not a single soul on this earth who doesn't need to know about lung cancer. People who don't know they are at risk, need to know that there are other risk factors—genetics, radon, and other things that can cause lung cancer."

The 2011 National Cancer Institute's National Lung Screening Trial showed the importance of detecting lung cancer early. The trial also showed for the first time an effective screening approach for a high-risk population.

"Now thanks to the National Lung Screening Trial, we know screening can be more effective than anything else," says Donaldson. "People who are at great risk don't have to consider themselves doomed to lung cancer. They can have early detection, get treated early, and hopefully live a long and healthy life."

Lung Cancer: Symptoms, Diagnosis, Treatments & Research

Symptoms

X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.

Possible signs of non-small cell lung cancer include a cough that doesn't go away and shortness of breath. Check with your doctor or other health professional if you have any of the following problems:

• Chest discomfort or pain.
• A cough that doesn't go away or gets worse over time.
• Trouble breathing.
• Wheezing.
• Blood in sputum (mucus coughed up from the lungs).
• Hoarseness.
• Loss of appetite.
• Weight loss for no known reason.
• Feeling very tired.
• Trouble swallowing.
• Swelling in the face and/or veins in the neck.

Diagnosis

Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung cancer. Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the same time. Some of the following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.
• Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
• Chest X-ray: An X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can go through the body, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Lung biopsy. The patient lies on a table that slides through the computed tomography (CT) machine, which takes X-ray pictures of the inside of the body. The X-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.
• Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Treatments

Certain factors affect prognosis (chance of recovery) and treatment options.

• The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
• The type of lung cancer.
• Whether there are symptoms such as coughing or trouble breathing.
• The patient's general health.

For patients with advanced non-small cell lung cancer, current treatments do not cure the cancer. The treatment that's right for you depends mainly on the type and stage of lung cancer. You may receive more than one type of treatment.

Surgery

Surgery may be an option for people with early-stage lung cancer. The surgeon usually removes only the part of the lung that contains cancer. Most people who have surgery for lung cancer will have the lobe of the lung that contains the cancer removed. This is a lobectomy. In some cases, the surgeon will remove the tumor along with less tissue than an entire lobe, or the surgeon will remove the entire lung. The surgeon also removes nearby lymph nodes.

Radiation Therapy

Radiation therapy is an option for people with any stage of lung cancer:

• People with early lung cancer may choose radiation therapy instead of surgery.
• After surgery, radiation therapy can be used to destroy any cancer cells that may remain in the chest.
• In advanced lung cancer, radiation therapy may be used with chemotherapy.

The NCI booklet Radiation Therapy and You (www.cancer.gov/cancertopics/coping/radiation-therapy-and-you) has helpful ideas for coping with radiation therapy side effects.

Chemotherapy

Chemotherapy may be used alone, with radiation therapy, or after surgery.

Chemotherapy uses drugs to kill cancer cells. The drugs for lung cancer are usually given directly into a vein (intravenously) through a thin needle. Newer chemotherapy methods, called targeted treatments, are often given as a pill that is swallowed.

You'll probably receive chemotherapy in a clinic or at the doctor's office. People rarely need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

• When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired.
• Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
• Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your healthcare team can give you medicines and suggest other ways to help with these problems.

The NCI booklet Chemotherapy and You (www.cancer.gov/cancertopics/coping/chemotherapy-and-you) has helpful ideas for coping with chemotherapy side effects.

Targeted Therapy

People with non-small cell lung cancer that has spread may receive a type of treatment called targeted therapy. Several kinds of targeted therapy are used for non-small cell lung cancer. One kind is used only if a lab test on the cancer tissue shows a certain gene change. Targeted therapies can block the growth and spread of lung cancer cells.

Depending on the kind of drug used, targeted therapies for lung cancer are given intravenously or by mouth.

Lung Cancer Research

• The large-scale National Lung Screening Trial, supported by the National Cancer Institute (NCI), has shown that screening current or former heavy smokers with low-dose helical computed tomography (CT) decreases the risk of dying from lung cancer. That finding was only for heavy smokers.
• Another recent study showed that low-dose nicotine does not enhance lung cancer development. This suggests that nicotine replacement therapy is safe for former smokers.
• Results of a 2011 research trial revealed that annual chest X-ray screening of people ages 55 to 74 years does not reduce lung cancer deaths compared with usual care.
• Researchers have identified genetic regions that predispose Asian women who've never smoked to lung cancer. The finding provides evidence that lung cancer between smokers and never-smokers can differ on a fundamental level.

Questions to Ask Your Health Professional

Tests

• What type of lung cancer do I have?
• Has the cancer spread from the lung? If so, to where?
• May I have a copy of test results?

Surgery

• What kind of surgery do you suggest for me?
• How will I feel after surgery?
• If I have pain, how can we control it?
• How long will I be in the hospital?
• Will I have any lasting side effects?
• When can I get back to my normal activities?

Radiation Therapy

• When will treatment start? When will it end? How often will I have treatments?
• How will I feel during treatment? Will I be able to drive myself to and from treatment?
• What can I do to take care of myself before, during, and after treatment?
• How will we know the treatment is working?
• What side effects should I expect? What should I tell you about?
• Are there any lasting effects?

Chemotherapy or Targeted Therapy

• Which drug or drugs do you suggest for me? What will they do?
• What are the possible side effects? What can we do about them?
• When will treatment start? When will it end? How often will I have treatments?
• How will we know the treatment is working?
• Will there be lasting side effects?

Smoking and Lung Cancer: It's Never Too Late to Quit

Because most people who get lung cancer were smokers, you may feel that doctors and other people assume that you are or were a smoker (even if you aren't or weren't). Whether or not you were a smoker, it's important for you to protect your body now from smoke. Avoid secondhand smoke from smokers near you.

If you smoke, talk with an expert about quitting. It's never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.