Frequently Asked Questions
What is lung cancer?
Lung cancer occurs when the normal action of cells division becomes uncontrollable, and a mass of tissue called a tumor forms.
Malignant tumors are cancers, which can invade and damage nearby lymph nodes, tissues and organs. Cancer cells can also break away from a malignant tumor and enter the bloodstream, spreading to other parts of the body where they can form new tumors. Build up of fluid around involved lung, or plural effusion, could be an indicator of lung cancer.
It is also possible to have a non-cancerous (benign) tumor in the lung which rarely poses a threat to life. Despite that such lesions still may need to be removed to make sure that no malignancy is present in that area.
What causes lung cancer?
Research has shown that certain risks increase a person's likelihood of developing lung cancer:
- Tobacco smokers
- Secondhand exposure to tobacco smoke
- Asbestos, radon and air pollution exposure
- Being age 65 or older
- People who drink water containing arsenic
- Prior history of lung cancer
- Family history of lung cancer
What are the types of lung cancer?
Nearly all lung cancers are carcinomas – cancers that begin in the lining or glandular tissues of an organ.
Lung cancers are generally divided into two major groups: non-small cell lung cancer and small cell lung cancer. The tumor cells of each type of lung cancer grow and spread differently and each type needs different treatment.
Nonsmall cell lung cancer is the more common of the two groups. The three main types of nonsmall cell lung cancer are named for the type of cells in the tumor:
- Squamous cell carcinoma, also called epidermoid carcinoma, is the most common type of lung cancer in the United States and many other countries. This disease often begins in the bronchi, or large air tubes leading to the lungs. It usually spreads less quickly than other types of lung cancer.
- Adenocarcinoma usually begins along the outer edges of the lungs and under the lining of the bronchi. This is the most common type of lung cancer in women and in people who have never smoked. The incidence of adenocarcinomas is on the rise.
- Large cell carcinomas, which usually begin along the outer edges of the lungs, are a group of cancers with large, abnormal-looking cells.
Small cell lung cancer grows rapidly and spreads quickly to other organs. This type of lung cancer accounts for 10 percent to 20 percent of all lung cancers.
What are the symptoms of lung cancer?
At first, lung cancer usually doesn't cause symptoms. Doctors sometimes discover it in people without symptoms after a chest X-ray for another medical reason. Usually, however, lung cancer is found after the growing tumor causes symptoms to appear.
A cough, which is the most common symptom of lung cancer, is likely to occur when a tumor irritates the lining of the airways or blocks the passage of air. The person may have a “smoker's cough” that worsens.
Another symptom of lung cancer is constant chest pain. Other symptoms may include shortness of breath, wheezing, repeated bouts of pneumonia or bronchitis, coughing up blood or hoarseness.
A tumor that presses on large blood vessels near the lung can cause swelling of the neck and face. If the tumor presses on certain nerves near the lung, it can cause pain and weakness in the shoulder, arm or hand. Problems with vision could be an indirect sign of nerve involvement as well.
In addition, lung cancer symptoms may not seem related to the lungs. Like all cancers, lung cancer can cause fatigue, loss of appetite and loss of weight. If the disease spreads elsewhere, it may cause headache, pain or bone fractures.
Other signs or symptoms of lung cancer result from substances the lung cancer cells make. For example, certain lung cancer cells produce a substance that sharply reduces the level of sodium (a component of salt) in the blood. This can cause many symptoms, including confusion and sometimes even coma.
None of these, however, is a sure sign of lung cancer. Only a physician can tell whether a patient's symptoms are caused by lung cancer or another problem.
How is a lung cancer diagnosis determined?
A lung cancer diagnosis is made through a series of questions, examinations and tests. Your doctor will start by asking about personal and family medical background, as well as smoking and work history.
The physician also performs a physical examination and usually orders chest X-rays and other tests.
In addition, the doctor may order a computerized tomography (CT) scan, which is a series of X-ray images put together by a computer. These detailed pictures can reveal a tumor in the lung, but they cannot show whether the tumor is benign or malignant.
The only sure way a lung cancer diagnosis can be determined is to obtain cells from the lungs for examination under the microscope. Sometimes, cancer cells are in the sputum, a thick fluid that the patient coughs up from deep in the airways. Also, the doctor usually does a lung biopsy to remove a sample of cells from the lung.
When a lung cancer diagnosis is suspected, physicians will perform a biopsy, physicians use one of the following procedures:
- Bronchoscopy – this permits the physician to look into the breathing passages through a bronchoscope, which is a thin, flexible, lighted tube inserted through the nose or mouth under local or general anesthesia. The doctor can brush or wash cells from the walls of bronchi or snip off small pieces of tissue for study under the microscope. Depending on the location of the tumor, transbroncheal biopsy of the tumor may be performed.
- Percutaneous Needle biopsy – removal of tissue hard to reach with the bronchoscope. With the patient under a local anesthetic and using CT or X-ray fluoroscopy guidance, the doctor inserts a needle through the chest wall into the tumor to withdraw a small sample of tissue.
- Thoracentesis – an examination of fluid from the pleura (the fluid-filled sac surrounding the lungs). With the patient under local anesthesia, the physician uses a needle to remove a fluid sample and to have it checked for cancer cells.
- Mediastinoscopy – Permits surgeons to sample lymph nodes that drain the lungs and may be the first defense barrier to a tumor spread. It allows for better staging of lung cancer thus influencing treatment. Done under general anesthesia, media-stinoscopy does not require overnight stay.
- Video-Assisted Thoracic Surgery (VATS) – a minimally invasive procedure involving the introduction into the chest of a video camera that transmits a picture to a video monitor. This allows surgeons to see structures within the chest so they can remove tissue samples to have them checked for cancer. This procedure requires general anesthesia. Removal of certain lesions with this technique is a possibility as well.
- Thoracotomy – the surgical opening of the chest that requires general anesthesia, used for some patients who require surgery for a lung cancer diagnosis or for lung cancer treatment.
If the physician feels an enlarged liver or swollen lymph nodes (small bean-shaped structures that store special cells to trap cancer cells or bacteria traveling through the body), these areas may also be biopsied. The doctor may also perform a biopsy from other areas other than the lungs when cancer is suspected.
What is lung cancer staging and how is it performed?
With a diagnosis of lung cancer, physicians need to learn the stage of the lung cancer, or extent, to which the disease has progressed so they can give appropriate treatment.
Lung cancer staging is a careful process to find out whether the lung cancer has spread and, if so, to what other parts of the body.
To learn whether a patient's lung cancer has spread to the lymph nodes in the chest, physicians remove a sample of tissue either with a needle or surgically.
Surgery to biopsy lymph nodes in the chest can often be done through a small incision near the breastbone. If a thoracoscopy or a thoracotomy is planned, physicians will remove lymph nodes at that time. Patients receive general anesthesia for these operations.
Doctors may order CT scans to detect the spread of lung cancer to the lymph nodes and other parts of the body, including the brain, liver and other abdominal organs.
Radionuclide scans of the bones may also help determine whether the cancer has spread beyond the lung. For these procedures, a small amount of a radioactive substance is injected into a vein, after which a machine scans the body to reveal abnormal areas.
Radiolabeled monoclonal antibodies against lung cancer could also be used to detect the spread of the disease.
In another technique, called magnetic resonance imaging, a strong magnet linked to a computer produces images that indicate whether lung cancer has spread to the brain or spinal cord.
What are the stages of lung cancer?
Non-small cell lung cancer has four main stages:
- Stage I: Lung cancer is found in the lung, but it has not spread outside the lung.
- Stage II: Lung cancer is found in the lung and nearby lymph nodes.
- Stage III: Lung cancer is in the lung and lymph nodes in the middle of the chest.
- Stage IIIA: Lung cancer is found in lymph nodes, but only on the same side of the chest where cancer first started growing.
- Stage IIIB: Lung cancer has spread to lymph nodes on the opposite side of the chest or to lymph nodes above the collarbone.
- Stage IV: Lung cancer has spread to both lungs, into the area around the lungs, or to distant organs.
Small-cell lung cancer (SCLC) has two main stages: limited and extensive. In the the limited stage, lung cancer is only in one lung or nearby lymph nodes on the same side of the chest. The extensive stage means lung cancer has spread to other areas of the lungs and chest. Lung cancer at this stage may also spread to the fluid around the lungs (called the pleura) or other organs.
What are the main lung cancer treatment options?
Lung cancer treatment is more successful the earlier cancer is detected.
Physicians will develop a lung cancer treatment plan comprising surgery, radiation therapy, chemotherapy, or a combination of the three, and tailor it to each patient's needs.
The type of treatment plan depends on many factors, including the type of lung cancer, the size and location of the tumor and the stage of the disease. Other factors to consider are the patient's age, medical history and general health.
Patients may have just one form of treatment or a combination, depending on their needs; several specialists may work as a team to provide treatment for lung cancer.
- Surgery is performed for early-stage lung cancers when it's likely that all of the tumor can be removed. Three main types of surgery are used to treat lung cancer. The choice depends on the size, location and extent of the tumor; the general health of the patient, and other factors.
- An operation to remove only a small part of the lung is called a segmental or wedge resection.
- A lobectomy is the procedure in which the surgeon removes an entire lobe of the lung.
- Pneumonectomy is the removal of an entire lung.
- Radiation therapy like surgery, is a local treatment that kills the cancer in the treated area and is usually given five days a week for several weeks at the hospital on an outpatient basis.
- Chemotherapy is the systemic treatment with medications that kill cancer cells. This means that the medications flow through the bloodstream to nearly every part of the body. Most anticancer medications are injected into a blood vessel or a muscle; some are given by mouth. Chemotherapy is most often given in cycles – a treatment period alternating with a "rest" period.
Usually, patients have chemotherapy as outpatients: at the hospital, at the physician's office or at home. Sometimes, depending on which medications the physician orders, patients may need to stay in the hospital a few days to be monitored for side effects.
If diagnosed with lung cancer, should I get a second opinion?
Lung cancer treatment and making decisions as to what is the best treatment option once a diagnosis with lung cancer has been made can be complicated for you and your loved ones. Before starting treatment, patients might want another doctor to review the diagnosis and the treatment plan. Here are ways to find another doctor to give a second opinion:
Patients can call Thomas Jefferson University Hospital's free physician referral service at 1-800-JEFF-NOW.
Your doctor may be able to suggest a lung cancer specialist. Specialists who treat lung cancer include thoracic (chest) surgeons, radiation oncologists and medical oncologists.
Patients can obtain the names of physicians from their local medical society, a nearby hospital or a medical school.
What is the treatment of non-small cell lung cancer?
Treating non-small cell lung cancer can be approached in several ways. The choice of treatment depends mainly on the stage of lung cancer.
Surgery is the usual treatment for lung cancer patients whose cancer is in only one lung or in one lung and the closest lymph nodes. New studies are designed to assess whether additional forms of systemic therapy before or after surgery can prevent further recurrences of the cancer.
Patients who can't have surgery because of other medical problems often receive radiation therapy. Radiation therapy is also the usual treatment for patients whose cancer has spread within the chest to more distant lymph nodes or other tissues.
It has recently been shown that chemotherapy enhances the effects of radiation therapy and is now used with radiation in most instances. Some non-small cell lung cancer patients have both surgery and radiation therapy.
Chemotherapy is used to treat patients whose cancer has spread from the lung to other parts of the body. Radiation therapy is used to control specific symptoms caused by the spread of lung cancer to specific parts of the body. Although it's very difficult to control lung cancer that has spread, treatment can often shrink the tumors. This can help relieve pain and other symptoms.
What is the treatment of small cell lung cancer?
Small cell lung cancer may spread quickly. To be sure that treatment affects all cancer cells in the body, chemotherapy is used for virtually all patients, even when the disease appears to be limited to the lung and nearby lymph nodes. Usually, chemotherapy for small cell lung cancer treatment includes a combination of two or more anticancer drugs.
When small cell lung cancer appears clinically limited to the lung, treatment also includes radiation therapy. Radiation therapy is also used to treat the lung, even without evidence of cancer, to prevent tumors from forming there; this treatment is reserved for patients whose lung tumor has responded well to treatment.
Surgery combined with chemotherapy can also be part of the treatment plan for small cell lung cancer, but only for a small number of patients.
What is the latest lung cancer research being conducted?
Scientists are continuing to identify factors that increase the risk for lung cancer. Recent lung cancer research has shown that genetic factors play an important role in this disease. For example, certain genetic traits make some people very sensitive to cancer-causing agents. Smokers with these traits may be more likely than other smokers to develop lung cancer.
Researchers are also studying ways to help people lower their risk of lung cancer by using natural and laboratory-made substances to prevent or delay cancer. Because some vitamins can be dangerous if taken in large doses, it's best to get a doctor's advice before taking vitamins or other nutrients.
The earlier lung cancer is detected, the more successful lung cancer treatment is likely to be. Lung cancer research suggests that the use of low-dose CT of the chest (LDCT) can improve survival due to early detection of lung cancer by as much as 20 percent. LDCT uses X-rays to take a picture of the inside of your lungs and is able to detect lung nodules. New guidelines indicate that screening for lung cancer in high-risk patients can save lives.
Because lung cancer is also difficult to control, researchers seek more effective treatment options for the disease, plus ways to reduce the side effects of treatment and improve the quality of patients' lives.
Lung cancer is the leading cause of cancer death each year across the globe. However, lung cancer screenings and emerging technologies including biomarkers, nonsurgical approaches to biopsy, novel therapies involving radiotherapy and immunotherapy are giving hope to patients.
Are any lung cancer trials enrolling?
When laboratory research shows that a new treatment for lung cancer has promise, patients with lung cancer have the opportunity to receive the treatment in clinical trials or protocols.
By participating in a clinical trial for lung cancer, you may have the first chance to benefit from improved lung cancer treatment methods and the opportunity to make an important contribution to medical science.
To find out more about current lung cancer clinical trials that you may be able to participate in, ask your doctor or call 215-955-1661 or 1-800-JEFF-NOW.