CONDITIONS

Lung Cancer

What Is Lung Cancer

Lung cancer is any cancer that begins in the lungs; and is the leading cancer killer in both men and women in the United States.  It is the leading cause of cancer death in women, according to the American Lung Association.  To understand the impact of lung cancer: lung cancer causes more deaths than the next three most common cancers combined (colon, breast, and pancreatic).

There are more than 200,000 new cases of lung cancer each year and an estimated 159,260 Americans are expected to die from lung cancer in 2014, accounting for approximately 27 percent of all cancer deaths, according the American Lung Association.

There are two main types of lung:

  • Non–small cell lung cancer is the most common type, accounting for 80% to 90% of all lung cancer. Non–small cell lung cancer is broken up into three subtypes:
    • Squamous cell carcinoma
    • Adenocarcinoma
    • Large cell carcinoma
  • Small cell lung cancer accounts for 10% to 20% of all lung cancer. Small cell lung cancer grows quickly and usually spreads beyond the lungs before it is noticed. It usually affects heavy smokers and is very rare in people who don’t smoke.

Less common types of lung cancer include carcinoid tumors, which accounts for 1 out of every 50 to 100 lung cancers. Carcinoid tumors grow slowly and can usually be cured with surgery. 

Cancers that start somewhere else but spread to the lung are not thought of as lung cancer. Cancers from different parts of the body grow differently and need different treatments.

What Causes Lung Cancer

The number one risk factor for lung cancer is smoking. This risk increases the more and the longer you smoke, and it decreases when you quit or cut back. Other risk factors include exposure to:

  • Secondhand smoke
  • Asbestos
  • Radon gas
  • Radiation
  • Cancer-causing chemicals such as uranium, beryllium, coal products, gasoline, vinyl chlorite, and diesel exhaust

Your risk also increases if you live somewhere with a lot of air pollution or a high level of arsenic in the water.

In addition, your genes can play a role. If a close family member has lung cancer, your risk is higher as well.

Risk Factors For Lung Cancer

The number one risk factor for lung cancer is smoking. This risk increases the more and the longer you smoke, and it decreases when you quit or cut back. Other risk factors include exposure to:

  • Secondhand smoke
  • Asbestos
  • Radon gas
  • Radiation
  • Cancer-causing chemicals such as uranium, beryllium, coal products, gasoline, vinyl chlorite, and diesel exhaust

Your risk also increases if you live somewhere with a lot of air pollution or a high level of arsenic in the water. In addition, your genes can play a role. If a close family member has lung cancer, your risk is higher as well.

Diagnosing Lung Cancer

Your doctor will start with a physical exam and ask you questions about your symptoms, your breathing, your smoking, and your medical history. If your doctor suspects lung cancer, you may need other tests, such as:

  • Imaging tests, such as a chest x-ray, CT scan, or MRI
  • Sputum cytology to look for cancer cells
  • Biopsy of your lung tissue
  • Complete blood count
  • Boone scan
  • Samples of fluid from around your lungs

If your doctor finds cancer, he or she will perform more imaging tests to find out the size of the tumor and whether it has spread outside the lung where it began.

Symptoms of Lung Cancer

In its earliest stages, lung cancer may not cause any symptoms. As the disease progresses, it may cause:

  • A cough that doesn’t go away
  • Coughing up blood
  • Wheezing or shortness of breath
  • Chest pain
  • Unexplained weight loss
  • Headache
  • Extreme tiredness

Late-stage lung cancer may cause: 

  • Pain or tenderness in your bones or joints
  • Swelling or paralysis of the face, or drooping eyelids
  • Hoarseness or other voice changes
  • Trouble swallowing
  • Muscle weakness
  • Problems with your fingernails or toenails

Other diseases may cause these symptoms as well, so don’t panic before you speak with your doctor.

Prognosis

Lung cancer is the most common cause of cancer death in the United States, killing more people than breast cancer, prostate cancer, ovarian cancer, and colon cancer combined. People do survive lung cancer, but more than 150,000 Americans die from this condition every year.

For stage I lung cancer–that is, a tumor smaller than 2 inches across that hasn’t spread to the lymph nodes, 5-year survival is 31% for small cell lung cancer and 49% for non–small cell lung cancer. The odds get worse if the cancer spreads, dropping below 15% if it invades the nearby organs (stage III) or crosses to the other lung or further parts of the body (stage IV).

Keep in mind, however, that these numbers are averages. What you’re going through is yours alone, and new treatments are developing every year. Don’t give up, and be sure to talk to your medical team about your best way to beat the odds.

Living With Lung Cancer

A diagnosis of lung cancer can be devastating. What’s more, the disease and its treatment can sap your energy and make it hard for you to cope. It’s important to find people to talk with, to help you through this burden. Speak openly with friends and family, but don’t lay the burden on them alone. There’s no shame in seeking out help from a counselor, a clergy member, or a cancer support group. 

It also helps to learn about the disease and to talk with your health care team–to learn about your own situation, to tell them your wishes and your concerns, and also to let them know if you are having side effects. 

If you smoke, it’s also important to quit now. Smoking can make your treatment less effective, and quitting now may improve your odds. Talk to your healthcare team; they can tell you about the benefits of quitting, and they can give you treatments to help you quit.

You can read more about tools to help you quit smoking in the Prevention section of this page and in the Quitting Smoking page of this Web site.

Screening

Routine screening for lung cancer is a relatively new practice and still controversial. Some evidence suggests that screening may save lives. Other studies found that screening may do more harm than good, turning up benign conditions and false positives, leading to invasive follow-up tests. If you’re a smoker or ex-smoker aged 55 or over, or if you’ve had frequent exposure to other substances that cause lung cancer, talk with your doctor about the risks and benefits of having a yearly computed tomography (CT) scan of your lungs.

Prevention

To protect yourself from lung cancer, the most important thing you can do is to quit smoking. If you don’t smoke, don’t start. Quitting smoking can be challenging, but there are more tools than ever to help you quit, including support groups, nicotine replacement therapy, and help lines in all 50 states where experts can help you build a tailored program that suits your needs. You can even get an app for your smartphone to help you quit. 

Other steps you can take include avoiding secondhand smoke, having your home tested for radon, and avoiding contact with other carcinogens.

Common Treatment

There are several treatment options available for people with lung cancer. You can work with your doctor to find the best treatment plan for you based on the type of cancer you have, how far advanced it is, your overall health, and your personal preferences. Standard treatments for lung cancer include: 

  • Surgery
  • Medications, such as chemotherapy and targeted therapy
  • Radiation therapy

Surgery aims to remove the cancer and the surrounding tissue. This is typically done when the cancer has not spread beyond the lung and the nearby lymph nodes. Types of surgery for lung cancer include:

  • Wedge resection to remove the small part of the lung that includes the tumor
  • Segmental resection, which removes a larger piece of the lung
  • Lobectomy to remove an entire lobe of the lung. A lobe is about a third of the right lung or half of the left, which is smaller to make room for the heart. Pneumonectomy to remove an entire lung 

The surgeon may also remove nearby lymph nodes for biopsy to see if the cancer has spread.

Risks of surgery include bleeding and infection. If you have surgery on your lungs, you can expect some shortness of breath at first, until your lung expands to fill the empty space. 


Medical treatment for lung cancer includes chemotherapy and targeted therapy.

Chemotherapy uses drugs to attack cancer cells aggressively and stop them from growing. Chemotherapy may be used:

  • Before surgery to shrink a tumor
  • After surgery to wipe out any remaining cancers
  • Alone or with radiation or targeted treatments for small cell lung cancer or more advanced non–small cell lung cancer

Because it is so aggressive, chemotherapy also kills some healthy cells with the cancer. Chemotherapy is given in cycles, with a break in between to reduce the damage, but it can still cause serious side effects, such as hair loss, extreme nausea, and a weakened immune system. Most of these side effects go away after treatment is finished.

Targeted therapy is a term for newer treatments that work against a specific weakness in cancer cells. These include:

  • Angiogenesis inhibitors such as Avastin (bevacizumab), which cut off the blood supply to the tumor by stopping the growth of new veins and arteries. Angiogenesis inhibitors are usually given in combination with chemotherapy. Side effects include bleeding, blood clots, and high blood pressure.
  • EGFR inhibitors such as Tarceva (erlotinib) to block a protein called epidermal growth factor receptor (EGFR), which signals cancer cells to grow and divide. Side effects include skin rash and diarrhea.
  • ALK inhibitors such as Xalkori (crizotimib) to block the ALK gene, which allows cancer cells to grow out of control and outlast normal cells. Side effects include nausea, blurred vision, and double vision.

EGFR inhibitors and ALK inhibitors are only used for non–small cell lung cancer, and only if you have the gene or protein they are meant to block.

New treatments are also under development, and you may be able to benefit from an experimental treatment if you enroll in a clinical trial. Taking part in a clinical trial may help you and also benefit future generations. 


Radiation therapy uses x-rays or other high-energy beams or particles to kill cancer cells. Like chemotherapy, radiation may be given before or after surgery, or as a primary treatment in more advanced cancer. Newer methods of radiation therapy may improve the chance of success or reduce side effects by targeting the tumor more precisely. For instance, stereotactic radiotherapy fixates on a small tumor and bombards it from all sides at once. 

Side effects of radiation therapy include nausea and vomiting, weight loss, fatigue, and a rash on the spot where the radiation is administered. These side effects usually end after treatment is finished.

Complementary and Alternative Treatment

When it comes to cancer, Western medicine is generally regarded as being the gold standard of care. Having said that, treatments considered “alternative” have actually become part of the regular course of treatment for cancer—bridging a philosophical divide.  Symptom relief, and alleviation of discomfort and pain from side effect of treatment are the main targets of complementary treatments. The American College of Chest Physicians recommends considering treatments such as:

  • Yoga
  • Meditation
  • Massage
  • Hypnosis
  • Acupuncture

Care Guide

Finding out you have lung cancer can be overwhelming. Don’t be afraid to seek out emotional support from your loved ones, a support group, or a counselor or clergy member.

If you smoke, it’s also important to quit, for the best chance of a positive outcome. You can read more about ways to quit smoking in the Prevention section of this page and in the Quitting Smoking page of this Web site.

If you suffer from shortness of breath, remember to relax and focus on your breathing. Sit or stand in whatever position works best for you. It may help to lean forward. If shortness of breath makes you tired, it’s OK to cut out less important tasks so you can focus on the things that matter most.

There are also palliative treatments, specialized medical care, which provides relief from the pain, symptoms and stress of an illness.

When To Contact A Doctor

Call your doctor if you have any signs or symptoms that worry you. As well, if you smoke and you’re having trouble quitting, contact your doctor to help you stop.

Questions For Your Doctor

Treating lung cancer may take more than one type of specialist. The doctors on your health care team may include: 

  • A medical oncologist, who specializes in cancer treatment
  • A radiation oncologist, who specializes in radiation therapy for cancer
  • A surgical oncologist, who specializes in blood diseases
  • Other health care workers, such as an oncology nurse, a dietitian, and a social worker

Your primary care doctor can direct you to the specialists you need. Alternately, the National Cancer Institute can help you find a treatment center near you. Call 1-800-4-CANCER or you can also find a doctor through one of these sites:

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What type of lung cancer do I have?
  • May I see my chest x-ray or CT?
  • Will I need to come in for more tests?
  • What treatment do you recommend?
  • What are the side effects?
  • What can I do to increase my chance of surviving?
  • Is there anything else I should know about lung cancer?

Resources

Other useful resources to help you learn about lung cancer can be found at:

National Cancer Institute

American Cancer Society

If you find it hard to stop smoking, you can find resources at:

SmokeFree.gov

American Cancer Society Guide to Quitting Smoking

http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-toc

Other Resources:

Mesothelioma Cancer Alliance

Pleural Mesothelioma