Lung Cancer

INTRODUCTION

Lung Cancer, malignancy of the lungs that is the leading cause of cancer deaths for both men and
women in the United States and Canada. About 90 percent of all lung cancer occurs in current or
former smokers. The American Cancer Society estimates that 164,000 new cases of lung cancer
are diagnosed annually in the United States and an estimated 157,000 people die from the disease
each year. According to the Canadian Cancer Society, 20,600 new cases of lung disease are
diagnosed in Canada annually, and the disease causes 17,700 deaths a year.
There are four main types of lung cancer, which tend to arise in different parts of the lung and
differ in characteristics and behavior. Squamous cell carcinoma accounts for 20 percent of all lung
cancer. It frequently begins toward the central part of the lung in the bronchial tubes, which are the
major airways that lead into the lungs. About 40 percent of lung cancers are adenocarcinomas,
cancers that originate on the outer edges of the lungs and under the lining of the bronchial tubes.
Small-cell carcinoma spreads more rapidly than any other type of lung cancer. It is characterized by
small cells that may be shaped like either oat grains or rods and makes up about 20 percent of
lung cancer cases. Ten percent of all cases are large-cell carcinomas, cancers characterized by
large, abnormal cells that usually begin along the outer edges of the lung.
Lung cancer often spreads, or metastasizes, through the bloodstream or lymphatic system to other
tissues. More than 50 percent of people newly diagnosed for lung cancer already show signs of
cancer elsewhere in the body. Conversely, some cancers detected in the lung are actually cancers
that have metastasized from other parts of the body to the lungs. These are not considered lung
cancers. For example, if breast cancer spreads to the lung, it is still considered breast cancer. It
does not look or behave like a cancer that starts in the lung.

II

RISK FACTORS

Cigarette smoking is the single greatest cause of lung cancer. Up to 90 percent of lung cancer
patients are smokers, and most of the remainder have been exposed to secondhand smoke. The
great majority of lung cancer cases could be prevented and thousands of lives could be saved each
year if people quit smoking.
Other environmental factors linked to a higher incidence of lung cancer include prolonged exposure
to certain workplace substances, such as arsenic, asbestos, and high doses of ionizing radiation,
such as that emitted by uranium (see Radiation Effects, Biological). Long-term exposure to air
pollution, which is largely composed of the remains of burned petroleum and coal, may also
increase the risk of lung cancer. One constituent of indoor air pollution, naturally occurring radon
gas, a colorless, odorless gas that silently seeps from the earth in some regions, poses a special
danger to cigarette smokers.
Not all heavy smokers develop lung cancer, suggesting that heredity may also play a role in lung
cancer development. Some people seem to inherit an inability to break down certain types of
cancer-causing chemicals, making them more susceptible to disease. Exposure to tobacco smoke,
for example, may cause key cancer prevention genes to malfunction in these people. For instance,
a tumor suppressor gene called FHIT prevents the growth and spread of tumors. Many people with
lung cancer inherit a mutated form of this gene that fails to perform this job. The tumor suppressor

gene p53 also prevents tumor growth, and researchers have learned that a mutated form of the
p53 gene fails to block the growth of cancerous tumors.
Some studies indicate that women are twice as likely as men to develop lung cancer. Researchers
have found a gene called GRPR that causes abnormal cell growth in people exposed to cigarette
smoke. The gene is more active in women than in men and it may explain why females are more
susceptible to lung cancer.

III

SYMPTOMS AND DIAGNOSIS

The symptoms of lung cancer are not usually apparent during early stages of the disease. The first
symptoms to appear are often similar to those of other, nonmalignant respiratory ailments. The
patient may develop a persistent cough, or find that a chronic smokers cough is worsening. Other
symptoms include chest pain, shortness of breath, hoarseness, bloody sputum (fluid coughed up
from the respiratory tract), and frequent bouts of bronchitis or pneumonia. Sometimes, the first
symptoms of lung cancer are bone pain, headaches, dizziness, or other signs that the disease has
metastasized.
A physician who suspects lung cancer may use a chest X ray to view the lungs and locate any
tumors. Computed tomography, a series of X-ray images combined by a computer, may be used to
pinpoint the tumors approximate size and location. To further evaluate cancerous cells, the
physician must examine them under a microscope. In a procedure known as a biopsy, the physician
removes a small tissue sample from the tumor. Sometimes a microscopic analysis of cells
contained in the sputum will also help confirm a diagnosis.
A diagnostic technique called bronchoscopy enables the physician to visually examine the patients
bronchial tubes. In this procedure, the physician feeds a bronchoscope, a thin, fiber optic tool
equipped with a light and magnifying device, through the patients mouth and down into the
trachea and bronchial tubes to view the lungs. The bronchoscope can be fitted with a tiny cutting
tool, enabling the physician to obtain samples of cells for later microscopic examination.

IV

TREATMENT

The course of treatment depends on the type of lung cancer, the size and location of the tumor,
the stage of disease, and the age and general health of the patient. If there is no evidence that the
disease has spread beyond the lung, the tumor can be removed using one of several surgical
procedures. In a resection, only a small part of the lung is removed. The left lung is composed of
two lobes, the right lung of three; the removal of an entire lobe is called a lobectomy. Removal of
an entire lung is called a pneumonectomy. Following surgery, radiation treatment and
chemotherapy (anticancer drugs) may be used to ensure that the entire tumor is eliminated.
Unfortunately, fewer than 50 percent of lung cancer patients are candidates for surgery because
their cancer has spread to other parts of the body. In these cases, patients may receive
chemotherapy or radiation treatment or a combination of both, depending on the severity of the
illness.
Lung cancer patients must be monitored regularly following treatment, even if no signs of cancer
persist. Second lung cancers develop in a significant number of survivors.
Gene therapythe use of genes to replace defective genes or supersede their actionsis an
emerging treatment for lung cancer and other diseases with genetic components. Preliminary
results from experiments using gene therapy for lung cancer, first reported in 1996, have found

that replacing defective p53 tumor suppressor genes with normal p53 genes shrank or stopped the
growth of some lung tumors.

PROGNOSIS

According to the American Cancer Society, 41 percent of people diagnosed with lung cancer
survive one year after diagnosis; only 14 percent survive five years. If the cancer is discovered
while still localized, the five-year relative survival rate is about 50 percent, but only 15 percent of
lung cancers are discovered at this stage.
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