Lung cancer is cancer that usually starts in the lining of the bronchi
(the main airways of the lungs), but can also begin in other areas of
the lungs, including the bronchioles, or alveoli. It is the leading cause
of cancer death in both men and women. In 2013, about 228,000 new cases
of lung cancer are expected, according to the American Cancer Society.What
is lung cancer?
Lung cancers are believed to develop over a period of many years.
Nearly all lung cancers are carcinomas, a cancer that begins in the lining
or covering tissues of an organ. The tumor cells of each type of lung
cancer grow and spread differently, and each type requires different treatment.
Lung cancers are generally divided into 2 types:
Non-small cell lung cancer
This type is much more common than small cell lung cancer, accounting for
about 85% to 90% of lung cancers. The 3 main kinds of non-small cell lung
cancer are named for the type of cells in the tumor:
Squamous cell carcinoma (also called epidermoid carcinoma). It often begins in the bronchi near the middle of the lungs.
Adenocarcinoma. This type usually begins along the outer edges of the lungs. It is the
most common type of lung cancer in people who have never smoked.
Large cell carcinomas. These are a group of cancers with large, abnormal-looking cells. These
tumors may begin anywhere in the lungs and tend to grow quickly.
Small cell lung cancer
This type is sometimes called oat cell cancer because the cancer cells
may look like oats when viewed under a microscope, grows rapidly and quickly
spreads to other organs. There are two stages of small cell lung cancer:
Limited. In this stage, cancer is generally found in only 1 lung. There may also
be cancer in nearby lymph nodes on the same side of the chest.
Extensive. In this stage, cancer has spread beyond the primary tumor in the lung
into other parts of the body.
It is important to find out what kind of lung cancer a person has. The
different types of carcinomas, involving different regions of the lung,
may cause different symptoms and are treated differently.
What are the symptoms of lung cancer?
The following are the most common symptoms for lung cancer. However, each
individual may experience symptoms differently.
Lung cancer usually does not cause symptoms when it first develops, but
symptoms often become present after the tumor begins growing. A cough
is the most common symptom of lung cancer. Other symptoms include:
Constant chest pain
Shortness of breath
Recurring lung infections, such as pneumonia or bronchitis
Bloody or rust-colored sputum
A tumor that presses on large blood vessels near the lung can cause swelling
of the neck and face
A tumor that presses on certain nerves near the lung can cause pain and
weakness in the shoulder, arm, or hand
Fever for unknown reason
Like many other cancers, lung cancer can cause:
Other symptoms can be caused by substances made by lung cancer cells, which
is referred to as a paraneoplastic syndrome. For example, certain lung
cancer cells produce a substance that causes a sharp drop in the level
of sodium in the blood, which can cause many symptoms, including confusion
and sometimes even coma.
None of these symptoms is a sure sign of lung cancer. Only a doctor can
tell whether a patient's symptoms are caused by cancer or by another
problem. Consult your doctor for a diagnosis.
What are the risk factors for lung cancer?
A risk factor is anything that increases a person's chance of getting
a disease, such as cancer. Different cancers have different risk factors.
Several risk factors make a person more likely to develop lung cancer:
Additional risk factors include:
Secondhand smoke. This refers to breathing in the smoke of others.
Radon. A radioactive gas that cannot been seen, tasted, or smelled. It is produced
by the natural breakdown of uranium. High levels of radon may be found
in some homes or other buildings, especially basements.
Talc. While no increased risk of lung cancer has been found from the use of cosmetic
talcum powder, some studies of talc miners and millers suggest a higher
risk of lung cancer and other respiratory diseases from their exposure
to industrial-grade talc. Talcum powder is made from talc, a mineral which,
in its natural form, may contain asbestos; however, by law, all home-use
talcum products (baby, body, and facial powders) have been asbestos-free
Cancer-causing agents in the workplace, including:
Personal or family history of lung cancer
Air pollution. In some cities, air pollution may slightly increase the risk of lung cancer.
How is lung cancer diagnosed?
In addition to a complete medical history to check for risk factors and
symptoms, and a physical examination to provide other information about
signs of lung cancer and other health problems, procedures used to diagnose
lung cancer (or to help determine if it has spread) may include:
Chest X-ray. This procedure looks for any mass or spot on the lungs.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer
technology to produce horizontal, or axial, images (often called slices)
of the body. A CT scan shows detailed images of any part of the body,
including the bones, muscles, fat, and organs such as the lungs. CT scans
are more detailed than general X-rays.
Sputum cytology. A study of phlegm (mucus) cells under a microscope.
Thoracentesis. A hollow needle is inserted through the skin in the chest wall to remove
fluid, which is then sent to the lab to be checked for cancer cells.
Needle biopsy. A thin, hollow needle is guided into the mass while the lungs are being
viewed on a fluoroscopy or CT scan, and a sample of the mass is removed
and evaluated in the pathology laboratory under a microscope.
Bronchoscopy. The examination of the bronchi (the main airways of the lungs) using a
flexible tube (bronchoscope) passed down the mouth or nose. Bronchoscopy
helps to evaluate and diagnose lung problems, assess blockages, obtain
samples of tissue and/or fluid, and/or to help remove a foreign body.
Endobronchial ultrasound. An exam in which a bronchoscope with a small ultrasound transducer on
its tip is passed down the windpipe to look at lymph nodes in the mediastinum
(the space between the lungs). If enlarged lymph nodes are seen, a small
needle can be passed down the bronchoscope and through the wall of the
airway to get samples of the nodes for testing.
Mediastinoscopy. A process in which a small cut is made in the neck so that a tissue sample
can be taken from the lymph nodes (mediastinal nodes) along the windpipe
and the major bronchial tube areas to evaluate under a microscope.
Thoracoscopy. A procedure in which a small cut is made in the side of the chest wall
through which a small tube with a video camera on the end is inserted.
This allows the doctor to look at the outer part of the lungs and chest
wall and to sample any abnormal areas for viewing under a microscope.
MRI, PET, or bone scans. These procedures are done to determine if the cancer has spread from where
it started into other areas of the body.
Other tests and procedures may be used as well.
Treatment for lung cancer
Specific treatment for lung cancer will be determined by your doctor based on:
Your age, overall health, and medical history
The type of lung cancer
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Depending on its type and stage, lung cancer may be treated with surgery,
chemotherapy or other medications, radiation therapy, local treatments
such as laser therapy, or a combination of treatments. Combination treatment
or multimodality treatment refers to having more than 1 type of treatment.
Treatment for lung cancer includes 1 or more of the following:
Surgery. Surgery is part of the treatment for early stage lung cancers. The type
of surgery depends on the size and location of the tumor in the lung,
the extent of the cancer, the general health of the patient, and other
factors. Many surgeries are done with a long incision in the side of the
chest, known as a thoracotomy. Some early stage tumors may be treated
with video assisted thoracic surgery (VATS), which uses several small
incisions (instead of 1 large one) and special long surgical tools. Types
of surgery include:
Segmental or wedge resection. Removal of only a small part of the lung.
Lobectomy. Removal of an entire lobe of the lung.
Pneumonectomy. Removal of an entire lung.
Sleeve resection. Removal of a piece of bronchus, after which the lung
is reattached to the remaining part of the bronchus.
Radiation therapy. Radiation therapy is the use of high-energy radiation to kill cancer cells
and to shrink tumors. Radiation may also be used with chemotherapy to
treat lung cancer. There are 2 ways to deliver radiation therapy:
External radiation (external beam therapy). A treatment that precisely sends high levels of radiation directly to the
cancer cells. The machine is controlled by the radiation therapist. Since
radiation is used to kill cancer cells and to shrink tumors, special shields
may be used to protect the tissue surrounding the treatment area. Radiation
treatments are painless and usually last a few minutes.
Internal radiation (brachytherapy, implant radiation). Radiation is given inside the body as close to the cancer as possible.
Substances that produce radiation, called radioisotopes, may be swallowed,
injected, or implanted directly into the tumor. Some of the radioactive
implants are called seeds or capsules. Internal radiation involves giving
a higher dose of radiation in a shorter time span than with external radiation.
Some internal radiation treatments stay in the body temporarily. Other
internal treatments stay in the body permanently, though the radioactive
substance loses its radiation within a short period of time. In some cases,
both internal and external radiation therapies are used.
Chemotherapy. The use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy
works by interfering with the cancer cell's ability to grow or reproduce.
Different groups of drugs work in different ways to fight cancer cells.
The oncologist will recommend a treatment plan for each individual. Chemotherapy
may be given before other treatments, after other treatments, or alone
for lung cancer.
Photodynamic therapy (PDT). A type of laser treatment that involves injecting photosensitizing chemicals
into the bloodstream. Cells throughout the body absorb the chemicals.
The chemicals collect and stay longer in the cancer cells than in the
healthy cells. At the right time, when the healthy cells surrounding the
tumor may already be relatively free of the chemical, the light of a laser
can be focused directly on the tumor. As the cells absorb the light, a
chemical reaction destroys the cancer cells. For lung cancer, the light
is delivered through a bronchoscope (a small, flexible tube with a light
on the end) that is inserted through the mouth or nose.
Targeted therapy. These are drugs that target specific parts of cancer cells or nearby cells
that help them grow. So far, these drugs have only been found to be useful
for some non-small cell lung cancers. For example, as cancers grow, they
form new blood vessels which nourish them. Research aimed at blocking
the growth of these blood vessels has led to the development of medications
called antiangiogenesis medications. Bevacizumab is 1 of these medications.
It has been found to be helpful in prolonging the survival of some patients
with advanced lung cancer. It is used with the standard chemotherapy regimen.
Medications with other specific targets, such as crizotinib, erlotinib,
and cetuximab, may also be useful.
There are specific names for the order in which treatment is given. Neoadjuvant
treatment refers to having radiation or chemotherapy before surgery. Having
one or both of these before surgery may help shrink the tumor, as a smaller
tumor is easier to take out in surgery.
Chemotherapy or radiation soon after surgery is called adjuvant treatment.
The goal of adjuvant treatment is to kill any cancer cells that may be
left after the surgery. Even if there is no sign of cancer cells, your
doctor may suggest adjuvant treatment, as it may lower the risk that the
cancer will come back or spread.
Clinical trials are being conducted on prevention and treatment options
for lung cancer, including photodynamic therapy and chemoprevention.