• What is Lung Cancer?
• Detecting Lung Cancer
• Treatment
• General Questions

What is Lung Cancer? 

Like other parts of the body, the lungs are made up of many types of cells. Cells divide in an orderly, controlled way to produce more cells when more cells are needed in the body. When cells divide in an abnormal, uncontrolled way, they can form either a benign or malignant tumor.

Benign tumors are not cancerous. They are rarely life-threatening.

Malignant tumors are cancerous. Cancer cells can spread to nearby healthy cells and destroy them. The cancerous cells can also invade other parts of the body. Cancerous cells in the lungs can spread to the lymph glands which are located nearby. The cancer can also spread to other parts of the body.

Lung cancers can be divided into two types: small cell lung cancer and nonsmall cell lung cancer. The cancer cells of each type grow and spread in different ways, and they are treated differently.

Nonsmall Cell Lung Cancer

Most lung cancers are nonsmall cell. There are three main types of nonsmall cell lung cancer: squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.

• For men, squamous cell carcinoma is the most common kind of lung cancer. It does not spread as quickly as other types, and it usually starts in the bronchi.

• For women and for nonsmokers, the most common type of lung cancer is adenocarcinoma. It usually starts around the outer edges of the lungs and under the lining of the bronchi.

• A group of cancers with large, abnormal cells -- large cell carcinomas -- also usually begin around the outer edges of the lungs.

Small Cell Lung Cancer

About one fourth of the newly diagnosed lung cancer cases are small-cell carcinomas -- a type of lung cancer in which the cells are small and round. It is also sometimes called "oat cell" lung cancer. This type of cancer grows rapidly and quickly spreads to other organs.

Risk Factors

Although smoking is without question the major cause of the lung cancer epidemic, there are some others. Passive smoking is one. Exposure to other carcinogens, such as asbestos, is another. Tuberculosis can increase the risk. And, exposure to high levels of radon may also increase the risk -- especially for smokers. (Radon is a colorless, odorless gas that is emitted by decaying uranium in rocks and soil.) Recent studies have shown that genetic factors may also have a role in determining lung cancer risk.

Prevention tips:

• Quit smoking or, better yet, never start.

• If you do smoke, quitting early in life is best, but it is never to late to kick the habit and reduce your risk.

• Follow safety rules and procedures to reduce exposure to carcinogens in the workplace.

Detecting Lung Cancer

Early detection of lung cancer is difficult. When it first develops, lung cancer usually does not have any symptoms. Sometimes it is discovered when a person has a chest x-ray for another medical reason. Smokers who quit when pre-cancerous changes in their lung cells are discovered often find that the damaged tissue returns to normal. People who continue to smoke may get cancer. Chest x-rays, CT scans (a series of x-ray images assembled by a computer),and other tests are used to diagnose a tumor in the lung. X-rays and CT scans do not show whether tumors are benign or malignant.

To check for cancer, a pathologist can use a microscope to examine cells taken from the lungs. This is called a biopsy. Sometimes, cancer calls can be found in a person's sputum -- the thick fluid that is coughed up from the person's airways.

Other types of tests can also be used to diagnose lung cancer. Bronchoscopy is a test in which the doctor uses a thin, lighted tube called a bronchoscope to examine breathing passages. The tube also allows the doctor to collect some cells to examine under a microscope.

If cells cannot be reached with a bronchoscope, the doctor may insert a needle through the chest wall to withdraw a sample of cells. This procedure is called a needle aspiration. A needle can also be used to remove a sample of a fluid from the sac called pleura that surrounds the lungs. A pathologist can examine these samples for the presence of cancer cells. When the doctor can feel swelling of the lymph nodes or liver, these may also be biopsied to check for cancer cells.

In many cases, a surgical procedure called a thoracotomyor thoracoscopy is needed to diagnose lung cancer.

If lung cancer is diagnosed, additional tests may be done to determine the stage of the disease. Staging is the process of determining how much the cancer has spread and what parts of the body have been affected. These tests may include operations (mediastinoscopy), radionuclide scans or magnetic resonance imaging (MRI).

Signs and symptoms of lung cancer can include:

• A persistent cough or wheezing

• Recurring bronchitis or

• pneumonia

• Pain or weakness in a shoulder or arm

• Weight loss or loss of appetite

• Chest pain

• Shortness of breath

• Coughing up blood

• Constant fatigue

• Hoarseness

• Swelling of the neck and face

• Streaks of blood in the sputum

• A sharp decrease in blood sodium level

Any of these symptoms may also be due to other problems. Still, it is important to see a doctor if any of these problems exist.

Treatment

Surgery

Surgery is the preferred treatment for patients with non-small cell lung cancer that has not spread beyond the chest. Surgery can be part of the treatment for small cell lung cancer, but it is usually appropriate for only a small number of patients.

Lung cancer surgery is done under general anesthesia. Advances in surgical and anesthetic techniques have increased the number of patients who can have this treatment and the safety with which it can be performed. The doctor explains what will be done in the surgery and what the patient can do to ease the recovery process. Patients should not hesitate to ask what could be done to relieve pain or discomfort following the surgery. Tubes are placed in the chest to help remove fluid and air that can collect in the chest after surgery. Most patients also receive respiratory therapy after surgery. Patients may be given special exercises to strengthen muscles of the chest and arm that may be weakened by the surgery.

Chemotherapy

In chemotherapy, drugs are used to kill cancer cells. Usually, anticancer drugs are injected into a blood vessel or muscle and they flow to nearly every part of the body. The drugs are generally given in cycles, with each treatment followed by a period of recovery. Most patients receive chemotherapy as outpatients.

Side effects vary according to the drug(s) and the patients. Most chemotherapy drugs attack cells that divide rapidly, as cancer cells do. Other cells that divide rapidly include blood cells, cells in hair roots, and cells that line the digestive tract. This means that chemotherapy can temporarily cause hair loss, nausea and vomiting, bruising easily, and a susceptibility to infections.

Radiation Therapy

Radiation therapy is the use of high energy rays to damage cancer cells so they stop reproducing or growing. After radiation treatments, patients may become fatigued, and the skin near the treatment area may become discolored, itchy, and sensitive. Some patients have a dry, sore throat for a short while after treatment. Rarely, because of fibrosis or scarring from radiation treatment, some patients must limit their activities because of shortness of breath.

General Questions 

• What are the treatment options?

• What are the risks and benefits of each?

• Will I need to change my normal daily activities?

1. My doctor says there are two types of lung cancer. What are they?

Lung cancers can be divided into two types: small cell lung cancer and nonsmall cell lung cancer. The cancer cells of each type grow and spread in different ways, and the are treated differently.

Nonsmall Cell Lung Cancer: Most lung cancers are nonsmall cell. There are three types of nonsmall cell lung cancer: squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.

For men, squamous cell carcinoma is the most common kind of lung cancer. It does not spread as quickly as other types, and it usually starts in the bronchi.

For women and for nonsmokers, the most common type of lung cancer is andenocarcinoma. It usually starts around the outer edge of the lungs and under the lining of the bronchi.

A group of cancers with large, abnormal cells - large cell carcinoma - also usually begins around the outer edges of the lungs.

Small Cell Lung Cancer: About one fourth of the newly diagnosed lung cancer cases are small cell carcinomas - a type of lung cancer in which the cells are small and round. It is also sometimes called "oat cell" lung cancer. This type of cancer grows rapidly and quickly spreads to other organs.

2. How do I prevent getting lung cancer?

• Quit Smoking or, better yet, never start.

• If you do smoke, quitting early in life is best, but it is never too late to kick the habit and reduce your risk.

• Follow safety rules and procedures to reduce exposure to carcinogens in the workplace.

3. What are the risk factors for developing lung cancer?

By far, smoking tobacco causes most lung cancers. Tobacco smoke has many carcinogens - substances that damage cells. The risk of lung cancer begins to slowly decrease as soon as a person quits smoking.

Although smoking is without question, the major cause of lung cancer, there are some other causes as well. Passive smoking is one. Exposure to other carcinogens, such as asbestos, is another. Tuberculosis (TB) can increase the risk. Exposure to high levels of radon may also increase the risk - especially for smokers. (Radon is a colorless, odorless gas that is emitted by decaying uranium in rocks and soil.) Recent studies have shown that genetic factors may also have a role in determining lung cancer risk.

4. How can lung cancer be detected?

Early detection of lung cancer is difficult. When it first develops, lung cancer usually does not have any symptoms. Sometimes it is discovered when a person has a chest x-ray for another medical reason.

Smokers who quit when precancerous changes in their lung cells are discovered often find that the damaged tissue returns to normal. People who continue to smoke may get cancer. Chest x-rays, CT scans (a series of x-ray images assembled by a computer), and other tests are used to diagnose a tumor in the lung. X-rays and CT scans do not show whether tumors are benign or malignant.

5. How is lung cancer diagnosed?

To check for cancer, a biopsy (surgical removal of a small piece of tissue for microscopic examination to determine if cancer cells are present. Biopsy is the most important procedure in diagnosing cancer.) must be performed.

Sometimes cancer cells can be found in a person's sputum - the thick fluid that is coughed up from your airways.

Other types of tests can also be used to diagnose lung cancer. Bronchoscopy is a test in which the doctor uses a thin, lighted tube called a bronchoscope to examine breathing passages. The tube also allows the doctor to collect some cells to examine under a microscope. If cells cannot be reached with a bronchoscope, the doctor may insert a needle through the chest wall to withdraw a sample of cells. This procedure is called a needle aspiration/biopsy. A needle can also be used to remove a sample of fluid from the sac called the pleura that surrounds the lungs. A pathologist can examine these samples for the presence of cancer cells.

6. What are the signs and symptoms of lung cancer?

Signs and symptoms of lung cancer can include:

• A persistent cough or wheezing

• Recurring bronchitis or pneumonia

• Pain or weakness in a shoulder or arm

• Weight loss

• Chest pain

• Shortness of breath

• Constant fatigue

• Loss of appetite

• Coughing up blood

• Hoarseness

• Swelling of the neck and face

• Streaks of blood in the sputum

• A sharp decrease in blood sodium level

When the doctor can feel swelling of the lymph nodes or liver, they may also biopsy these to check for cancer cells.

In many cases, a surgical procedure called a thoracotomy or thoracoscopy is needed to diagnose lung cancer.

If lung cancer is diagnosed, additional tests may be done to determine the stage of the disease. Staging is the process of determining how much the cancer has spread and what parts of the body have been affected. These tests may include operations (mediastinoscopy), radionuclide scans or magnetic resonance imaging (MRI).

7. How is lung cancer treated?

The doctor is the best person to answer questions about treatment. The choice of treatment options for each person will depend upon the stage of the disease and the person's general state of health. Several kinds of treatment are available. Chemotherapy or a combination of chemotherapy and radiation therapy are the most common treatments for small cell lung cancer. Surgery is usually the treatment of lung cancers that are localized (i.e., have not spread). Radiation therapy and chemotherapy are often used because disease has spread by the time it is diagnosed. Some researchers are developing biological therapy for lung cancer. This type of treatment uses the body's immune system to fight cancer cells.

Surgery: Is the preferred treatment for persons with nonsmall cell lung cancer that has not spread beyond the chest. Surgery can be part of the treatment for small cell lung cancer, but is usually appropriate for only a small number of people.

Chemotherapy: These are drugs that are used to kill cancer cells. The drugs are usually given in cycles, with each treatment followed by a period of recovery. Most patients have chemotherapy as outpatients.

Chemotherapy can temporarily cause hair loss, nausea and vomiting, bruising easily, and a susceptibility to infections. Side effects vary according to the drug(s) and the patients.

Radiation Therapy: Is the use of high energy rays to damage cancer cells so the stop reproducing or growing. After radiation treatments, patients may become fatigued, and the skin near the treatment area may become discolored, itchy, and sensitive. Some patients have a dry, sore throat for a short while after treatment. 

8. Are clinical trials a part of treatment?

Yes, for some lung cancer patients, one of the options may involve a clinical trial. Clinical trials are studies conducted with the consent of patients to evaluate a new treatment.