Lung Cancer

Lung cancer develops when cells in the lungs change and grow uncontrollably, forming a mass called a tumor, lesion or nodule. A tumor can be benign and will not spread. A malignant tumor is considered cancerous and can spread to other parts of the body if not treated.

Your lungs are part of a group of organs and tissues known as the respiratory system that help you breathe. The respiratory system is an integrated system of organs including the lungs, trachea and bronchial tubes involved in the intake and exchange of air in your body.

The lungs contain many different types of cells. Most cells in the lung are epithelial cells. These cells line the airways and produce mucus, which lubricates and protects the lungs. The lungs also contain nerve cells, hormone-producing cells, blood cells, and structural or supporting cells.

The lungs are connected to the heart through the pulmonary arteries and veins. The pulmonary veins are the blood vessels by which oxygen rich blood is carried to the heart and then throughout the rest of the body. The pulmonary arteries are the way by which oxygen poor blood is carried back towards the lungs to regain oxygenation.

Your left and right lungs aren’t exactly the same. The lung on the left side of your body is divided into two lobes. The lung on your right side is divided into three. The left lung is also slightly smaller, allowing room for your heart. Depending on how well your lungs work, you can live without a lobe or lung.

There are two main types of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). These types grow and spread differently. It is very important for doctors to know which type of lung cancer a patient has because each type is treated differently.

Non-small cell lung cancer

About 85–90% of lung cancers are non-small cell, making it the most common type of lung cancer. non-small cell lung cancer can be broken down into two main categories: Adenocarcinoma and squamous cell.   

• Adenocarcinoma. This is the most common type of NSCLC. It's the most common type of lung cancer in nonsmokers, but it's found more often in smokers or former smokers. Adenocarcinoma comes from the cells that produce mucus. It usually grows more slowly than other types of lung cancer. 

• Squamous cell carcinoma (epidermoid carcinoma). This type of NSCLC develops more often in smokers or former smokers. Squamous cell carcinoma comes from the cells that line the airways.

Small cell lung cancer

The other, less common, type of lung cancer is called small cell carcinoma. It begins in the nerve cells or hormone-producing cells of the lungs. The term “small cell” refers to the size and shape of the cells when viewed under a microscope.

While there is no single thing that causes lung cancer, there are certain factors that make one person more likely than others to get lung cancer.

Known risk factors for lung cancer include:

• Smoking. Cigarettes are full of carcinogens. When you smoke, you inhale these cancer-causing toxins. Smoking damages the airways and small air sacs in your lungs. The more you smoke and the longer amount of time you smoke, the higher your risk is of developing lung cancer.   

• Secondhand smoke. Nonsmokers who breathe in secondhand smoke take in nicotine and toxic chemicals the same way smokers do. The more secondhand smoke exposure, the greater the risk.

• Environmental. Being exposed to radon, asbestos or diesel exhaust can increase the risk of lung cancer. These are just a few of the many environmental factors we are exposed to.

• Radiation therapy. Having previous radiation therapy to the chest area for another disease can increase your chances of developing lung cancer.

• Previous lung cancer. Those who have had lung cancer in the past are at a higher risk for developing another lung cancer later. That is why surveillance is important after lung cancer.

There are often no symptoms in the early stages of lung cancer. Symptoms do not appear until the disease is more advanced. The following are the most common symptoms of lung cancer; however, each individual may experience symptoms differently:

• Cough that worsens or does not go away.

• Chest pain that is worse with coughing, laughing or deep breathing.

• Hoarseness.

• Unexplained weight loss or loss of appetite.

• Coughing up blood or rust-colored sputum.

• Pneumonia or bronchitis that doesn’t go away or keeps coming back.

• New onset of wheezing.

The symptoms of lung cancer may resemble other medical conditions or problems. Always consult your healthcare provider for a diagnosis.

Since lung cancer doesn’t cause symptoms in the early stages, lung cancer screening has been shown to detect lung cancer early in those at risk and decrease the chance of dying from lung cancer. Those that are at high risk for lung cancer may be candidates for screening with a low-dose CT scan. This is now covered by most insurance plans for those that are eligible.  

Someone is eligible for lung cancer screening if they are:

• Age 50–80 years old, and

• Have a 20 pack-year smoking history (one pack per day for 20 years or two packs per day for 10 years), and 

• Have no symptoms of lung cancer.

How it works

1. Individuals meeting the above eligibility criteria receive a low-dose CT screening that is read and interpreted by one of our dedicated chest radiologists to ensure the most accurate results.

2. Nurse coordinators help patients navigate the screening process and discuss results with each patient.

3. Screening results are discussed by our multidisciplinary lung cancer team — the only team of its kind in the region — each week to develop a personalized plan for each patient.

There is no sure way to prevent all lung cancers, but you may be able to lower your risk for it by:  

• Not smoking or quitting if you smoke.

• Staying away from other people's smoke.

• Having your home tested for radon.

• Limiting your exposure to chemicals that can cause lung cancer, such as diesel exhaust and asbestos.

• Eating a healthy diet with lots of fruits and vegetables.

If your healthcare provider thinks you may have lung cancer, you will need certain exams and tests to be sure. Your healthcare provider will ask you about your health history, your symptoms, risk factors and family history of lung cancer or related diseases. He or she will also give you a physical exam. You may also have one or more tests.

A biopsy is the only way to confirm cancer. Small pieces of tissue are taken out from the lungs and checked for cancer cells. Your healthcare provider may perform a bronchoscopy or a needle biopsy to get a biopsy tissue sample. Your results will come back in about one week.

After a diagnosis of lung cancer, you’ll likely have other tests. These help your healthcare providers learn more about your cancer. They can help determine the stage of the cancer. The stage is how much and how far the cancer has spread (metastasized) in your body. It is one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

In the case of a cancer diagnosis, staging is the process through which disease progression is evaluated. Various tests and diagnostic procedures may be used to determine how advanced the cancer is and whether surgical therapy might be beneficial.  

The stage of both small cell and non-small cell lung cancer is described by a number, zero through four (Roman numerals I–IV).

• Stage 0: This is called in situ disease, meaning the cancer is “in place” and has not grown into nearby tissues or spread outside the lung.

• Stage I:  This is a small tumor that has not spread to any lymph nodes, making it possible for a surgeon to completely remove it. Stage I is divided into two substages, depending on the size of the tumor. Stage IA is less than 3 centimeters. Stage IB is 3–4 centimeters.

• Stage II: This describes a bigger tumor and may or may not have spread to the lymph nodes inside of the lung (hilar lymph nodes). This stage has two sub-stages, IIA or IIB, based on the size and spread. These stage cancers can sometimes be removed by surgery. Other times additional treatments are needed.

• Stage III: The cancer has spread to lymph nodes in the mediastinum (outside of the lung), and/or greater than 7 centimeters, and/or has grown into nearby structures or organs. Based on these measures it can be stage IIIA or IIIB. These tumors are difficult or impossible to remove, suggesting other treatment options.

• Stage IV: Cancer is at an advanced stage and has spread to other organs in the body or lymph nodes distant from the lung.

The treatment of lung cancer depends on the stage.

Stage I & II: This is considered early-stage lung cancer. These tumors are typically treated with surgery. We may recommend chemotherapy after surgery for some patients with stage IB tumors. For patients who cannot undergo surgery, radiation with or without chemotherapy is an alternative.

Stage III: These tumors are considered locally advanced. Treatment typically consists of chemotherapy and radiation together. Immunotherapy may also be used.  Some patients with very limited stage III tumors may also benefit from surgery after chemotherapy and radiation.

Stage IV: These tumors are considered metastatic and are typically treated with chemotherapy, immunotherapy or targeted therapy based on the individual tumor characteristics. Some patients with very limited stage IV disease (oligometastatic) may also benefit from surgery and/or local radiation treatment.

Your treatment plan choices depend on the type of lung cancer you have, test results and the stage of the cancer. The goal of treatment may be to cure you, control the cancer or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be. Other things to think about are if the cancer can be removed with surgery and your overall health.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. You may have just one treatment or a combination of treatments.

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

Cancer treatment such as chemotherapy and radiation can damage normal cells. This can cause side effects such as hair loss, mouth sores and vomiting. Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects.

Many people feel worried, depressed and stressed when dealing with cancer. Getting treatment for cancer can be tough on the mind and body. Keep talking with your healthcare team about ways to make the process easier. Work together to ease the effects of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with as many protein foods as possible.

• Drink plenty of water, fruit juices and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse.

• Signs of an infection, such as a fever.

• Side effects of treatment that affect your daily function or don’t get better with treatment.

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.