Lung Cancer Facts
The lungs are a pair of sponge-like organs that work with the ribs and chest muscles to move air in and out of the body, bringing in oxygen (energy) and getting rid of carbon dioxide (waste).
Lung cancer takes years to develop. It results from the uncontrolled growth of abnormal cells in one or both lungs. These cancer cells form lumps and disrupt the lung and/or the breathing tubes (bronchus), at times interfering with their normal function. Unfortunately, it is often not discovered until it has spread (metastasized) throughout the body.
Sometimes, however, lung cancer is detected earlier through a chest X-ray or other exam that has been conducted for an unrelated reason.
Lung cancer is a leading cause of cancer death for both men and women. It accounts for a third of all cancer deaths in our country. Each year, more Americans die of lung cancer than of colon, breast, and prostate cancers combined. Since the year 1984, lung cancer has killed more American women yearly than breast cancer. Close to 90 percent of lung cancers are smoking related.
Listen to the latest news, issues, and breakthroughs in lung cancer research and treatment presented by SCCA expert physicians on the Patient Power Radio Show.
Types of Lung Cancer
There are two main types of lung cancer: non-small cell (accounting for 80 percent of all lung cancers) and small cell (accounting for the remaining 20 percent).
Non-small cell lung cancer is classified into three main categories:
- Adenocarcinomas, which arise from the mucus glands
- Squamous cell, or epidermoid carcinomas, which are usually located in the bronchial tubes
- Large cell carcinomas, which are more commonly found near the lung surface.
Small cell lung cancer, for the most part, grows and spreads quickly. There are two stages of the disease: limited and extensive.
Mesothelioma is another less common type of chest cancer. This cancer effects the lining of the lungs, called the pleura, and is often linked to asbestos exposure.
Staging
Staging is the process of finding out how far the cancer has spread. This is very important because your treatment and the outlook of your recovery depend on the stage of your cancer.
Accurate staging is probably the most important part of lung cancer treatment, because it allows the most appropriate therapy to be chosen and can help avoid ineffective or incorrect therapy. However, it is important to verify X-ray findings that suggest more advanced cancer, as the X-rays can sometimes be wrong.
At SCCA, the lung cancer team has a methodical and scientific approach to lung cancer staging that gives the benefit of the doubt to the patient rather than the cancer when there is any uncertainty in staging. This allows many patients to have a more aggressive therapy with a goal of cure when that may not have seemed possible on initial X-ray evaluations.
Methods which may be used to help stage your cancer include:
- Chest CT scan
- Positron Emission Tomography (PET scan)
- Possible brain scan
- Biopsies of lymph nodes or suspicious areas seen on X-rays
Non-small cell Lung Cancer Stages
Stage I and II
Non-small cell lung cancer (NSCLC) is stage one (I) or two (II) if a surgeon can completely remove it. Stage I cancer has not spread to the lymph nodes. Stage II cancer may involve lymph nodes found within the lung and can be removed with the section of cancer in the lung.
Stage III
Stage three (III) NSCLC is difficult to remove and may not be removable at all.
Sub stage three-A (IIIA) is used when cancer has spread to the center of the chest to the lymph nodes on the same side as the lung cancer, and stage three-B (IIIB) when the cancer has spread to the lymph nodes on the opposite side of the chest.
Stage IV
Stage four (IV) NSCLC has spread to different lobes of the lung, or elsewhere in the body.
Small Cell Lung Cancer
Almost all small cell lung cancers spread outside the lung before they are discovered. Surgery is usually not possible so patients receive chemotherapy treatment. Some may receive radiation therapy. Staging this disease helps doctors determine the best course of treatment.
Limited Stage small cell lung cancer is located on one side of the chest and involves one region of the lung and lymph nodes. One-third of small cell lung cancer patients have limited stage.
Extensive Stage has spread outside the lungs and possibly of the chest. Most patients are treated with chemotherapy only.
Advanced Lung Cancer
Despite treatment, lung cancer may come back. If cancer reappears in the lung, it is a local recurrence. Lung cancer cells can also travel through the lymph system or through the blood to reach other parts of the body, such as the bones. This is metastatic lung cancer.
Although tumors appear in distant sites—such as the lymph nodes, liver, bones or brain—it is not a new cancer, it is a recurrence of the original lung cancer. In some cases, your lung cancer may have already metastasized, or spread, by the time you discover that you have lung cancer.
Metastatic lung cancer is generally seen as an incurable disease, but new treatments may put your cancer in remission and give you a good quality of life for a prolonged period of time.
If you have recurrent or metastatic lung cancer, SCCA can offer you new medical procedures and treatments, as well as access to clinical trials, that your community doctor may not know about. No one at SCCA will tell you that a diagnosis of metastatic lung cancer is not serious, but there is hope.
There are a number of new treatments that can be used against recurrent or advanced lung cancer, and one of these treatments may keep your disease under control, including chemotherapy or radiation—or a combination of these treatments. Surgery is rarely used to treat metastatic lung cancer.
Your treatment will depend on a number of factors, including the type of treatment you have received in the past, and the symptoms you are experiencing with the new cancer.Your doctors may offer you radiation therapy or chemotherapy to relieve pain and other symptoms and improve your quality of life.
Symptoms
The signs and symptoms of lung cancer can take years to develop and are often confused with less serious symptoms that are often thought to be related to tobacco usage alone. These symptoms may include any of the following:
- a persistent cough that lasts for more than two weeks
- a chest infection that doesn't get better
- recurrent pneumonia or bronchitis
- shortness of breath
- coughing up of blood
- chest discomfort
- loss of appetite
- loss of weigh
- neck and facial swelling
- aching joints
Most lung cancers are diagnosed when tumors grow and begin to interfere with lung function. Fluid can collect in the lung or around the lung.
Diagnosis
There are several tools used to diagnose lung cancer. A doctor may order a chest X-ray, as well as a sputum cytology (a microscopic examination of the mucus in the lungs).
A biopsy must be performed in order to confirm the presence of lung cancer. A number of methods can be used. In a bronchoscopy, a thin, lighted tube is inserted in the mouth or nose and down the windpipe into breathing passages. In a needle aspiration, a needle is inserted through the chest wall into the tumor, usually under the guidance of X-ray imaging. In a thoracentesis, a needle is used to remove fluid surrounding the lungs. In a thoracotomy, the chest is surgically opened. In a bone marrow biopsy, a needle is used to remove a small piece of bone, usually from the back of the hip bone.
If the biopsy confirms that cancer is present, your doctor will need to determine whether the disease has spread. Several methods are used to determine the stage of the disease, including: a computed tomography (CT) scan (an X-ray machine linked to a computer which creates a series of detailed pictures of areas inside the body); a magnetic resonance imaging (MRI) scan (a magnet connected to a computer which uses radio frequency waves to make detailed pictures of areas inside the body); a positron emission tomography (PET) scan (a method of imaging the body's physiologic functions by scanning for a radioactive substance that may collect in cancer cells); and a mediastinoscopy (a lighted scope inserted through an incision in the neck to access chest lymph nodes that may contain cancer).
Risk Factors
Nearly 90 percent of all lung cancer cases are related to tobacco use, and approximately half of all continuing smokers will die from a disease caused by smoking. Cigarette smoke contains more than 4,000 chemicals, many of them cancer-causing substances (carcinogens) that damage the cells in the lungs. Over time the damaged cells become cancerous. Lung cancer occurs most frequently among people over 50 who have smoked for many years. Former tobacco users who stop smoking lessen their risk of developing a lung cancer over time. We can help you quit smoking with our Smoke Free Life Program. Too often, however, cancer will still develop in former smokers, years after they have kicked the habit.
Other risk factors include: exposure to radon, asbestos, and some organic chemicals; radiation exposure from occupational, medical or environmental sources; air pollution; tuberculosis; and exposure to certain industrial substances, such as arsenic. Tobacco use combined with one of these other risk factors can increase the risk of developing lung cancer in an exponential manner.