Lung Cancer

Definition
Lung cancer is the leading cause of cancer deaths in the United States, among both
men and women. It claims more lives each year than colon, prostate, lymph and breast
cancers combined.

Yet most lung cancer deaths could be prevented. That's because smoking accounts for
nearly 90 percent of lung cancer cases. Your risk of lung cancer increases with the
length of time and number of cigarettes you smoke. If you quit smoking, even after
smoking for many years, you can significantly reduce your chances of developing
lung cancer. Protecting yourself from other risk factors for lung cancer, such as
exposure to asbestos, radon and secondhand smoke, also decreases your risk.

Symptoms
Lung cancer typically doesn't cause signs and symptoms in its earliest stages. Signs
and symptoms of lung cancer typically occur only when the disease is advanced.
Signs and symptoms of lung cancer may include:

 A new cough that doesn't go away

 Changes in a chronic cough or "smoker's cough"
 Coughing up blood, even a small amount
 Shortness of breath
 Chest pain
 Wheezing
 Hoarseness
Causes

Lung cancer most commonly begins in the cells that line your lungs. Smoking causes
the majority of lung cancers — both in smokers and in people exposed to secondhand
smoke. But lung cancer also occurs in people who never smoked. In these cases, there
may be no clear cause of lung cancer. Doctors have identified factors that may
increase the risk.

How smoking causes lung cancer

Doctors believe smoking causes lung cancer by damaging the cells that line the lungs.
When you inhale cigarette smoke, which is full of cancer-causing substances
(carcinogens), changes in the lung tissue begin almost immediately. At first your body
may be able to repair this damage. But with each repeated exposure, normal cells that
line your lungs are increasingly damaged. Over time, the damage causes cells to act
abnormally and eventually cancer may develop.

Your lungs are full of blood vessels and lymph vessels, giving lung cancer cells easy
access to travel to other parts of your body. For this reason, lung cancer may spread to
other parts of your body before you experience any signs or symptoms. In many
cases, lung cancer may spread before it can even be detected in the lungs.

Types of lung cancer

Doctors divide lung cancer into two major types based on the appearance of lung
cancer cells under the microscope. Your doctor makes treatment decisions based on
which major type of lung cancer you have. The two general types of lung cancer
include:
  Small cell lung cancer. Small cell lung cancer, sometimes called oat cell carcinoma, occurs
almost exclusively in heavy smokers and is less common than non-small cell lung cancer.
 Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for several types
of lung cancers that behave in a similar way. Non-small cell lung cancers include
squamous cell carcinoma, adenocarcinoma and large cell carcinoma.

Risk factors
A number of factors may increase your risk of lung cancer. Some risk factors can be
controlled, for instance, by quitting smoking. And other factors can't be controlled,
such as your sex. Risk factors for lung cancer include:

 Smoking. Smoking remains the greatest risk factor for lung cancer. Your risk
of lung cancer increases with the number of cigarettes you smoke each day
and the number of years you have smoked. Quitting at any age can
significantly lower your risk of developing lung cancer.
 Your sex. Current or former women smokers have a greater risk of lung
cancer than do men who have smoked an equal amount. Though it isn't known
why, some experts speculate that women have a greater susceptibility to the
cancer-causing substances found in tobacco. Others believe that estrogen may
play a role. Women also are known to inhale more than men do, and they are
less likely to quit.
 Exposure to secondhand smoke. Even if you don't smoke, your risk of lung
cancer increases if you're exposed to secondhand smoke.
 Exposure to radon gas. Radon is produced by the natural breakdown of
uranium in soil, rock and water that eventually becomes part of the air you
breathe. Although unsafe levels of radon can accumulate in any building, the
greatest exposure risk most people face is at home. Radon testing can
determine whether levels are safe.
 Exposure to asbestos and other chemicals. Workplace exposure to asbestos
and other substances known to cause cancer — such as arsenic, chromium,
nickel and tar soot — also can increase your risk of developing lung cancer,
especially if you're a smoker.
 Family history of lung cancer. People with a parent, sibling or other first-
degree relative with lung cancer have an increased risk of the disease.
 Excessive alcohol use. Drinking more than a moderate amount of alcohol —
no more than one drink a day for women or two drinks a day for men — may
increase your risk of lung cancer.
Tests and diagnosis
Screening
Doctors aren't sure whether you should undergo screening for lung cancer. Even if
you have an increased risk of lung cancer — for instance, if you're a smoker — it isn't
clear that a chest X-ray or computerized tomography (CT) scan can be beneficial.
Some studies show that these tests can find cancer earlier, when it may be treated
more successfully. But other studies find that these tests often reveal more benign
conditions that require invasive testing and expose people to unnecessary risks.

Screening for lung cancer is controversial among doctors. Studies are ongoing to
determine what types of tests may be helpful and who would benefit from lung cancer
screening. In the mean time, talk with your doctor if you're concerned about your risk
of lung cancer. Together you can determine strategies to reduce your risk and decide
whether screening tests are appropriate for you.

Diagnosis
If there's reason to think that you may have lung cancer, your doctor can order a
number of tests to look for cancerous cells and to rule out other conditions. In order to
diagnose lung cancer, your doctor may recommend:

 Imaging tests. An X-ray image of your lungs may reveal an abnormal mass or nodule. A CT
scan can reveal small lesions in your lungs.
 Sputum cytology. If you have a cough and are producing sputum, looking at the sputum
under the microscope can sometimes reveal the presence of lung cancer cells. Before the
test, you may be asked to breathe a mildly irritating mist to help you produce more sputum.
  Tissue samples (biopsy). A sample of abnormal cells may be removed in a procedure called a
biopsy in order to diagnose lung cancer. Your doctor can perform a biopsy in a number of
ways, including bronchoscopy, in which your doctor examines abnormal areas of your
lungs using a lighted tube that is passed down your throat and into your lungs;
mediastinoscopy, in which an incision is made at the base of your neck and surgical tools
are inserted behind your breastbone to take tissue samples; and needle biopsy, in which
your doctor uses X-ray or CT images to guide a needle through your chest and into a
suspicious lump or nodule to collect cells. A biopsy sample may also be taken from lymph
nodes or other areas where cancer has spread, such as your liver.

Staging
Once your lung cancer has been diagnosed, your doctor will work to determine the
extent, or stage, of your cancer. Your cancer's stage helps your doctor decide what
treatment is most appropriate. Staging tests may include imaging procedures that
allow your doctor to look for signs that cancer has spread beyond your lungs, such as
magnetic resonance imaging (MRI), positron emission testing (PET) and bone scans.
Not every test is appropriate for every person, so talk with your doctor about which
procedures are appropriate for you.

Stages of non-small cell lung cancer

 Stage I. Cancer at this stage has invaded the underlying lung tissue but hasn't spread to the
lymph nodes.
 Stage II. This stage cancer has spread to neighboring lymph nodes or invaded the chest
wall.
 Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes in the center of
the chest.
 Stage IIIB. The cancer has spread locally to areas such as the heart, blood vessels, trachea
and esophagus — all within the chest — or to lymph nodes in the area of the collarbone or
to the tissue that surrounds the lungs within the rib cage (pleura).
 Stage IV. The cancer has spread to other parts of the body, such as the liver, bones or brain.

Stages of small cell lung cancer

 Limited. Cancer is confined to one lung and to its neighboring lymph nodes.
 Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have
invaded both lungs, more remote lymph nodes or other organs.

Complications
Lung cancer can cause complications, such as:

 Fluid in the chest (pleural effusion). Lung cancer can cause fluid to
accumulate in the space that surrounds the lungs in the chest cavity (pleural
space). Pleural effusion can result from cancer spreading outside the lungs or
in reaction to lung cancer inside the lungs. Fluid accumulating in the chest can
cause shortness of breath. Treatments are available to drain the fluid from your
chest and reduce the risk that pleural effusion will occur again. Cancer that
spreads to the pleura is considered inoperable, so surgery isn't an option for
treatment.
 Cancer that spreads to other parts of the body (metastasis). Lung cancer
often spreads (metastasizes) to other parts of the body — most commonly the
opposite lung, brain, bones, liver and adrenal glands. Cancer that spreads can
 cause signs and symptoms, including pain, nausea, headaches or others based
on what organ is affected. In some cases, treatments are available for isolated
metastasis, but in most cases, the goal of treatment for metastasis is only to
relieve signs and symptoms.
 Death. Unfortunately, survival rates haven't improved for people diagnosed
with lung cancer. In most cases, the disease is fatal. Almost 60 percent, or
three out of every five people, diagnosed with lung cancer die within a year.
Keep in mind, however, that this number includes people diagnosed with all
types of lung cancer at all stages of the disease. People diagnosed at the
earliest stages have the greatest chances for a cure. Your doctor can discuss
more relevant statistics about your chances for survival with you.

Treatments and drugs

You and your doctor choose a cancer treatment regimen based on a number of factors,
such as your overall health, the type and stage of your cancer, and your own
preferences. Treatment options typically include one or more treatments, including
surgery, chemotherapy, radiation therapy or targeted drug therapy.

In some cases you may choose not to undergo treatment. For instance, you may feel
that the side effects of treatment will outweigh the potential benefits. When that's the
case, your doctor may suggest comfort (palliative) care to treat only the symptoms the
cancer is causing, such as pain.

Treatment options for non-small cell lung cancers

Stage Common options
I Surgery
II Surgery, chemotherapy, radiation
IIIA Combined chemotherapy and radiation, sometimes surgery based on results of treatment
IIIB Chemotherapy, sometimes radiation
IV Chemotherapy, targeted drug therapy, clinical trials, supportive care
Treatment options for small cell lung cancers
Stage Common options
Limited Combined chemotherapy and radiation, sometimes surgery
Extensive Chemotherapy, clinical trials, supportive care

Surgery
During surgery your surgeon works to remove the lung cancer and a margin of
healthy tissue. Procedures to remove lung cancer include:

 Wedge resection to remove a small section of lung that contains the tumor along with a
margin of healthy tissue
 Lobectomy to remove the entire lobe of one lung
 Pneumonectomy to remove an entire lung

If you undergo surgery, your surgeon may also remove lymph nodes from your chest
in order to check them for signs of cancer. If your lymph nodes contain cancer cells,
this usually indicates that cancer has spread, even if cancer hasn't been detected
outside of your chest.

Lung cancer surgery carries risks, including bleeding and infection. Expect to feel
short of breath after lung surgery. Your lung tissue will expand over time and make it
easier to breathe. You may also feel pain in the muscles of your chest and in your arm
on the side where you had the operation. Your doctor may recommend physical
therapy or a rehabilitation program to help you restore your strength and range of
motion.

Chemotherapy
Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may
be administered through a vein in your arm (intravenously) or taken orally. A
combination of drugs usually is given in a series of treatments over a period of weeks
or months, with breaks in between so that your body can recover.

Chemotherapy can be used as a first line treatment for lung cancer or as additional
treatment after surgery. In some cases, chemotherapy can be used to lessen side
effects of your cancer.

Radiation therapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer
cells. Radiation therapy can be directed at your lung cancer from outside your body
(external beam radiation) or it can be put inside needles, seeds or catheters and placed
inside your body near the cancer (brachytherapy).

Radiation therapy can be used alone or along with other lung cancer treatments.
Sometimes it's administered at the same time as chemotherapy. Radiation therapy can
also be used to lessen side effects of lung cancer.

Targeted drug therapy

Targeted therapies are newer cancer treatments that work by targeting specific
abnormalities in cancer cells. Targeted therapy options for treating lung cancer
include:

 Bevacizumab (Avastin). Bevacizumab stops a tumor from creating a new blood supply.
Blood vessels that connect to tumors can supply oxygen and nutrients to the tumor,
allowing it to grow. Bevacizumab is usually used in combination with chemotherapy and is
approved for advanced and recurrent non-small cell lung cancer. Bevacizumab carries a
risk of severe bleeding.
 Erlotinib (Tarceva). Erlotinib blocks chemicals that signal the cancer cells to grow and
divide. Erlotinib is approved for people with advanced and recurrent non-small cell lung
cancer that haven't been helped by chemotherapy. Erlotinib side effects include a skin rash
and diarrhea.

Clinical trials
Clinical trials are studies of new lung cancer treatment methods. You may be
interested in enrolling in a clinical trial if lung cancer treatments aren't working or if
your treatment options are limited. The treatments studied in a clinical trial may be
the latest innovations, but they don't guarantee a cure. Carefully weigh your treatment
options with your doctor. Your participation in a clinical trial may help doctors better
understand how to treat lung cancer in the future.

Supportive (palliative) care

When treatments offer little chance for a cure, your doctor may recommend you avoid
harsh treatments and opt for supportive care instead. If you're receiving supportive
care, your doctor may treat any signs and symptoms you experience to make you feel
more comfortable, but you won't receive treatment aimed at stopping your cancer.
Supportive care allows you to make the most of your final weeks or months without
enduring treatment side effects that can negatively impact your quality of life.

Prevention
There's no sure way to prevent lung cancer, but you can reduce your risk if you:

 Don't smoke. If you've never smoked, don't start. Talk to your children about
not smoking, so they can understand how to avoid this major risk factor for
lung cancer. Many current smokers began smoking in their teens. Begin
conversations about the dangers of smoking with your children early, so they
know how to react to peer pressure.
 Stop smoking. Stop smoking now. Quitting reduces your risk of lung cancer,
even if you've smoked for years. Talk to your doctor about strategies and stop-
smoking aids that can help you quit. Options include nicotine replacement
products, medications and support groups.
 Avoid secondhand smoke. If you live or work with a smoker, urge him or her
to quit. At the very least, ask him or her to smoke outside. Avoid areas where
people smoke, such as bars and restaurants, and seek out smoke-free options.
 Test your home for radon. Have the radon levels in your home checked,
especially if you live in an area where radon is known to be a problem. High
radon levels can be remedied to make your home safer. For information on
 radon testing, contact your local department of public health or a local chapter
of the American Lung Association.
 Avoid carcinogens at work. Take precautions to protect yourself from
exposure to toxic chemicals at work. In the United States, your employer must
tell you if you're exposed to dangerous chemicals in your workplace. Follow
your employer's precautions. For instance, if you're given a face mask for
protection, always wear it. Ask your doctor what more you can do to protect
yourself at work. Your risk of lung damage from these carcinogens increases
if you smoke.
 Eat a diet full of fruits and vegetables. Choose a healthy diet with a variety
of fruits and vegetables. Food sources of vitamins and nutrients are best.
Avoid taking large doses of vitamins in pill form, as there may be unknown
harms. For instance, researchers hoping to reduce the risk of lung cancer in
heavy smokers gave them beta carotene supplements. Results showed the
supplements actually increased the risk of cancer in smokers.
 Drink alcohol in moderation, if at all. Limit yourself to one drink a day if
you're a woman or two drinks a day if you're a man. Anyone age 65 and older
should drink no more than one drink a day.
 Exercise. Aim to achieve at least 30 minutes of exercise on most days of the
week. Check with your doctor first if you aren't already exercising regularly.
Start out slowly and continue adding more activity. Biking, swimming and
walking are good choices. Add exercise throughout your day — park farther
away from work and walk the rest of the way or take the stairs rather than the
elevator.

Coping and support

A diagnosis of lung cancer is devastating. It may take some time to come to terms
with your feelings. When you're ready, you can take steps to take control of your
situation. Taking an active role in your health care may make you feel more
empowered in coping with lung cancer. Try to:

 Learn all you can about lung cancer. Find out everything you can about
your lung cancer — the type, the stage, your treatment options and their side
effects. The more you know, the more active you can be in your own care.
Write down your questions and ask them at your next appointment. Ask your
health care team about additional sources of information. The National Cancer
Institute will answer questions from the public. You can reach them at 800-4-
CANCER, or 800-422-6237, or contact the American Cancer Society (ACS) at
800-227-2345.
 Take an active role in your treatment. Although you may feel tired and
discouraged, don't let others — including your family or your doctor — make
important decisions for you. Take an active role in your treatment and work
with your doctors to make your health care decisions.
 Build a strong support system. A strong support system helps you cope with
everyday difficulties, such as fatigue and pain. Friends and family are worried
about you and want to help, so learn to accept help when you need it. Staying
connected with friends and family helps them cope with your illness and it
gives you a chance to talk about your hopes and fears. Sometimes you'll feel
like your friends and family can't understand your feelings if they've never had
 cancer. In these cases, support groups — both in your community and on the
Internet — can be a good source for practical information and unique support.
You may also find that you develop deep and lasting bonds with people who
are going through the same things you are.
 Set reasonable goals. Having goals helps you feel in control and can give you
a sense of purpose. But don't choose goals you can't possibly reach. You may
not be able to work a 40-hour week, for example, but you may be able to work
at least half the time. In fact, many people find that continuing to work can be
helpful.
 Take time for yourself. Eating well, relaxing and getting enough rest can help
combat the stress and fatigue of cancer. Also, plan ahead for the downtimes
when you may need to rest more or limit what you do.
 Stay active. A diagnosis of cancer doesn't mean you have to stop doing the
things you enjoy. For the most part, if you feel well enough to do something,
go ahead and do it. It's important to stay involved with life.

Alternative medicine
If your doctor has told you that your lung cancer can't be cured, you may be tempted
to turn to complementary and alternative medicine for answers. Flashy Web sites
claim cures are available at clinics in foreign countries, and secret herbal remedies
seem to offer hope at a time when you feel you have few treatment options. But
alternative lung cancer treatments aren't backed by scientific research, so there's no
evidence that these therapies work. And, in many cases, the side effects of these
treatments are unknown.

Alternative lung cancer treatments may be expensive and require travel to distant
places. Consider how you want to spend the time you have remaining. You may
prefer to spend your time at home with friends and family, rather than a faraway place
where you have no support system.

Rather than forgoing mainstream cancer treatments, using complementary and

alternative treatments along with care from your doctor may be a reasonable option.
Work with your doctor to determine what complementary and alternative treatments
may help relieve any signs and symptoms you experience. Your doctor can help you
weigh the benefits and risks of complementary and alternative treatments.

The American College of Chest Physicians reviewed available complementary and

alternative treatments and found some therapies may be helpful for people with lung
cancer, including:

 Acupuncture. During an acupuncture session, a practitioner inserts small

needles into precise points on your body. Acupuncture may relieve pain and
ease cancer treatment side effects, such as nausea, vomiting and dry mouth,
but there's no evidence that acupuncture has any effect on your cancer.
Acupuncture can be safe when done by a certified practitioner. Ask your
doctor to recommend someone in your community. But acupuncture isn't safe
if you have low blood counts or take blood thinners.
 Hypnosis. Hypnosis is a type of therapy that puts you in a trance-like state
that can be relaxing. Hypnosis is typically done by a therapist who leads you
through relaxation exercises and asks you to think pleasing and positive
thoughts. Hypnosis may reduce anxiety, nausea and pain in people with
cancer, and it may improve appetite.
 Massage. During a massage, a massage therapist uses his or her hands to
apply pressure to your skin and muscles. Massage can help relieve anxiety,
distress, fatigue and pain in people with cancer. Some massage therapists are
specially trained to work with people who have cancer. Ask your doctor for
names of massage therapists in your community. Massage shouldn't hurt. Your
massage therapist shouldn't put pressure anywhere near your tumor or any
surgical wounds. Don't have a massage if your blood counts are low or if
you're taking blood thinners.
 Meditation. Meditation is a time of quiet reflection in which you focus your
mind on something, such as an idea, image or sound. Meditation may reduce
stress and improve quality of life in people with cancer. Meditation can be
done on your own, or there may be instructors in your community. Ask for
recommendations from your health care team or friends and family.
 Yoga. Yoga combines gentle stretching movements with deep breathing and
meditation. Yoga may help people with cancer sleep better. Yoga is generally
safe when taught by a trained instructor, but don't do any moves that hurt or
don't feel right. Many fitness centers offer yoga classes. Ask your friends and
family for opinions on yoga classes they've taken.