Lung Cancer

What Is Lung Cancer?

Lung cancer starts in the lungs when abnormal cells begin growing uncontrollably. These cells grow and form cancer. At some point the cancer may spread outside the lung to other parts of the body. The American Lung Cancer Society reports lung cancer as the leading cause of cancer-related deaths — more than colon, breast and prostate cancers combined — in the U.S. and the world. Early detection greatly improves treatment outcomes, especially when the disease is found before it spreads. The American Cancer Society estimates the lifetime risk of developing lung cancer as one in 16 men and one in 17 women.

A person's chance of surviving lung cancer depends a lot on the stage of the cancer when it is found. When this cancer is diagnosed early, before it has spread outside the lungs, it is often easier to treat and may be cured. As the cancer spreads to nearby lymph nodes or other parts of the body, treatment becomes more difficult and survival rates decrease. This is why early detection through screening is so important.

The National Cancer Institute reports a 5-year lung cancer survival rate of about 65.5% for cancer that has not moved, or metastasized, outside the lungs. This cancer is considered cured if you have had clear scans for five years. For many people, early diagnosis and treatment leads to cancer remission. Remission means the cancer is under control and symptoms have lessened or disappeared.

The average age of lung cancer diagnosis is about 70 years old, according to the American Cancer Society. The majority of diagnoses occur in people over age 55 and less than 2% of diagnoses are made in people under age 45.

Lung Cancer Causes

Although smoking tobacco remains the leading cause, other causes of lung cancer besides smoking include exposure to cancer-causing agents. These can include:

• Asbestos
• Diesel exhaust
• Radon gas
• Silica dust,
• Toxic metals,
• Other chemicals and fumes in the environment or workplace

Sometimes a family history of the disease also can play a role.

Risk Factors

Ongoing exposure to environmental and other factors increases your risk for lung cancer. Having more than one risk factor increases your chance of developing lung cancer. For example, if you smoke and are exposed to asbestos, then your risk is greater than if you only had one risk factor.

Asbestos exposure: This naturally occurring fiber that was previously mined and milled in the U.S. From 1900 to the 1970s, asbestos was used in commercial and residential building materials, home appliances, automotive parts, laboratory furniture, paper products and textiles. When asbestos fibers are inhaled, they can be trapped in the lungs. This can cause inflammation and lead to cancer.

Genetic predisposition: If you have a parent or sibling with lung cancer, it doesn’t mean you’ll develop the disease, but it may increase your risk. About 8% of cases have an inherited component.

Radiation therapy. If you previously received radiation therapy in the chest area can increase your risk.

Radon exposure: This radioactive, colorless, odorless gas can enter your home or workplace through soil, building materials, water or outside air. When inhaled, radon decays and turns into radioactive particles that can damage lung cells and cause lung cancer. Test your home for radon. If you have high levels, there are systems that can make your house safer. Learn more about radon.

Secondhand smoke. Over time, breathing in smoke from burning tobacco products and smoke exhaled by other people increases your risk.

Smoking: The longer you smoke tobacco and the more often you smoke, the greater the chance that you will develop lung cancer. You can dramatically reduce your risk by giving up smoking. In fact, within minutes after smoking your last cigarette, the body starts to heal itself. Learn how here.

Lung Cancer Types

There are three main types and several subtypes of lung cancer. Your oncologist will diagnose the type and subtype. An accurate diagnosis will determine the best treatment to target your exact cancer.

Non-Small Cell Lung Cancer: About 85% of all cases are non-small cell lung cancer (NSCLC). There are three main subtypes of NSCLC. Your oncologist will identify your subtype and create a treatment plan for your specific cancer.

The three subtypes of NSCLC are:

• Squamous cell carcinomas: About 35% of NSCLC is this subtype.
• Adenocarcinomas: About 55% of NSCLC are this subtype. This type occurs mostly in people who smoke or used to smoke. It can develop in nonsmokers.
• Large cell undifferentiated carcinoma: Only about 10% of cases are this is a rare type of NSCLC.

Small Cell Lung Cancer: Fifteen percent of all cases are small cell lung cancer (SCLC). It is a faster growing, more aggressive type of cancer. This type usually only develops in people with a history of smoking for many years.

Carcinoid Lung Tumors: These are a rare and slow-growing type.

How Lung Cancer Spreads

Cancerous cells can break away or spread from the primary tumor and travel through the body to other areas and form new tumor deposits. This is called metastasis. Lung cancer cells travel through the lymphatic system or bloodstream and most commonly reach the brain, bones, liver, lymphatic system and adrenal glands. NSCLC often spreads slowly and usually moves to nearby lymph nodes before going to distant areas. SCLC grows fast and spreads to distant organs early.

Lung Cancer Prevention

Reducing your risk is the best way to prevent cancer from developing. These tips can help protect your health:

• Stop smoking. This is the single most impactful change you can make to improve your health and prevent cancer.
• Avoid inhaling harmful substances. Secondhand smoke, asbestos, radon, among other things, are known to cause cancer.
• Eat healthy. Eating mostly fruit and vegetables can help reduce your risk of developing cancer.
• Exercise. Aerobic exercises and strength training can help you maintain a healthy weight.
• Participate in a lung cancer screening program if you have a smoking history. Early detection saves lives.

Lung Cancer Symptoms

Lung cancer symptoms vary depending on the location and size of the tumor. Some people have no symptoms in the early stages, which is why screening is important for people at high risk. Early signs can look like a chest cold or mild flu and should be evaluated by a doctor.

• Bone pain
• Chest pain that worsens with deep breathing or coughing
• Cough that does not go away
• Coughing up blood
• Fatigue or feeling tired for unknown reason
• Headaches
• Hoarseness
• Loss of appetite
• Persistent respiratory infections
• Recurrent pneumonia
• Shortness of breath
• Swollen lymph nodes
• Unexplained weight loss
• Wheezing

See your doctor immediately if you notice any of these lung cancer symptoms:

• A cough lasting more than 3 weeks.
• Coughing up blood.
• Persistent chest pain.
• Shortness of breath.

Early evaluation can lead to earlier diagnosis and better outcomes.

Lung Cancer Diagnosis

Lung cancer is a complicated disease. There are different types and causes. You may have no symptoms or a variety of symptoms. Sometimes there are gene mutations. An accurate diagnosis is critical to successful treatment and the best possible outcomes. Early detection significantly expands your options for treatment and increases survival rates. Cancer that is detected after symptoms begin is more challenging to treat.

Lung Cancer Screening

A low-dose screening CT scan is the gold standard way to screen for lung cancer. This screening identifies spots on the lungs. A spot on the lung is also called a nodule, lesion or mass. Screening increases your chances of finding cancer early, when it is often curable. Nearly 90% of all lung nodules are not cancerous. Suspicious nodules are further evaluated for cancer.

Screening is recommended if you do not have lung cancer symptoms and meet the following criteria:

• 50 to 80 years old
• Currently smoke or a former smoker who quit within the last 15 years
• Have 20 pack years of smoking (number of packs smoked daily multiplied by years smoked)

Breathing and Exercise Tests

Pulmonary function test: Though not used to diagnose lung cancer, this test shows how well your lungs work. Lung function tests are often used after a diagnosis to determine if your lungs are healthy enough for surgery, for radiation treatment. Pulmonary function tests are also used to monitor lung function during cancer treatment.

Imaging Tests

Chest CT Scan: A low-dose chest CT scan provides detailed images of the lungs. This is the gold standard way to identify suspicious nodules.

Chest X-ray: Sometimes a lung nodule is found by accident when a doctor is looking for something else. For example, if you fell and hurt your ribs, you might have an X-ray. If a lung nodule is found on an X-ray, your doctor will have the lung nodule evaluated.

Pet CT Scan: This scan can evaluate a lung nodule, stage cancer, target and monitor treatment. It also can check if cancer has returned.

Diagnostic Procedures

Bronchoscopic Biopsy: A bronchoscopy is a small tube (bronchoscope) with a tiny video camera on the end. It is placed in the nose and guided into the lungs. Sometimes, a computer-assisted guidance system directs it to the lung nodule. A biopsy of the lung nodule is taken and examined by a pathologist.

CT-Guided Fine Needle Aspiration: During this type of biopsy, a thin needle is inserted through numbed skin and is guided to the lung nodule by CT scans. A tissue sample is collected through the needle and sent to pathology for analysis.

Lung Biopsy: A biopsy is a procedure that takes a tissue sample from the lung nodule. The sample is sent to a pathologist to examine under a microscope. A biopsy determines if the cells are normal, abnormal or cancer cells. It also can stage cancer and determine if it has spread and where it has spread. Examining a tissue sample by biopsy also can look for molecular changes that can occur in some lung cancers. Molecular testing helps target your cancer with the right treatment. There are different ways to do a lung biopsy.

Video Assisted Thoracoscopic Surgery (VATS): Occasionally a surgical biopsy of the lung nodule must be done. VATS is performed in an operating room. You are admitted to a hospital for this procedure. During the surgery, a small incision is made between the ribs. The lung is deflated and a small camera is inserted into the chest cavity. The nodule is biopsied or removed. A pathologist will analyze the biopsy.

Molecular Tests

Molecular or biomarker testing looks at lung nodule biopsy or blood to identify specific DNA mutations, gene rearrangements or protein levels. Molecular testing can help determine whether targeted therapies are appropriate.

Lung Cancer Stages

Immediately after diagnosis, the cancer is staged. The process of staging uses imaging, biopsies and the TNM system. The TNM system is a universal system that doctors use to map cancer.

• “T” stands for tumor. It looks at size and if the cancer has moved into other areas of the lung.
• “N” indicates nodes and determines if the cancer has spread into nearby lymph nodes.
• “M” means metastasis and indicates if the cancer has spread to other parts of body.

Lung Cancer Stages

Lung Cancer Treatment

Treatment depends on the stage, type and your overall health. Cancer treatments can include chemotherapy, immunotherapy, radiation therapy and/or surgery. Targeted therapies focus on specific genetic mutations within cancer cells and may be recommended for certain patients with NSCLC.

The goal of lung cancer treatment is to remove the cancer from your body, stop the cancer from multiplying and growing, or encourage the body’s white blood cells to fight the cancer cells. Your oncologist will consider many factors to determine the best lung cancer treatment plan for you such as:

• Age
• General health
• History of any past cancer treatments and/or heart disease
• Where the cancer has spread
• Specific type of cancer you have
• Stage of the cancer
• Supportive care of symptoms needed
• Tumor genetic analysis (when appropriate)
• Where the cancer is located

Lung Cancer Treatments by Stage

Chemotherapy

Chemotherapy uses a combination of medications to kill cancer cells. It can be taken by mouth or injected. Chemotherapy for lung cancer follows a specific schedule that is based on years of research that determined the best dose and timing of treatment. It is important to receive the prescribed dose of chemotherapy for your lung cancer at the scheduled time. This will give you the best chance to benefit from treatment. Targeted chemotherapy can be used for certain lung cancer mutations.

Chemotherapy is often given in “cycles” that last approximately three weeks depending on the type of chemotherapy used:

• The number of cycles, usually four to six, together add up to one whole treatment.
• Chemotherapy is usually given several times during a cycle. When the cycle is complete, your body has time to rest before another cycle starts.

Common side effects for lung cancer chemotherapy include:

• Digestive issues
• Fatigue
• Hair loss
• Low blood cell counts
• Neuropathy
• Skin and nail changes

Immunotherapy

Immunotherapy helps your immune system recognize and attack cancer cells, even those that outsmart the immune system by hiding. Immunotherapy drugs are given intravenously every two to three weeks to stimulate your own white blood cells to attack the cancer. Due to the increase in immune cell function, these drugs can cause side effects that are different from those seen with chemotherapy. These can include fatigue, skin changes, digestive issues and muscle or joint pain.

Radiation Therapy

Radiation therapy is used to kill cancer cells and keep them from growing in areas where the radiation was done. The dose is calculated so you receive radiation aimed only at the tumor. Radiation therapy works best when you receive it without interruption. It is given either every weekday or just a few treatments. Side effects from this treatment can include fatigue, skin changes, esophagitis, hair loss and digestive issues.

Surgery

Different types of surgery can be used if the cancer hasn’t spread or is limited to one tumor.

• Segmentectomy: Removes the tumor and a small part of the lung.
• Lobectomy: Removes the tumor and a larger part of the lung, called a lobe.
• Pneumonectomy: Removes the tumor and an entire lung.

Targeted Therapies

Targeted therapies treat lung cancer using medicines designed to find and attack specific cancer cells while largely leaving healthy cells alone. Genetic testing checks for specific mutations and helps select the safest and most effective targeted drugs.

General Side Effects of Cancer Treatment

Lung cancer treatments can cause side effects because they damage healthy cells while they are attacking the cancer cells. Side effects can vary based on the type of cancer you have and the type of treatment you receive. Before you begin treatment, it is important to talk with your oncologist about the possible side effects that may occur. During and after lung cancer treatment, inform your doctor about the side effects that you experience. Talk with your oncologist about ways to manage and treat your side effects.

Changes to Lung Cancer Treatment Plan

The treatment plan developed by your team seeks to give you the best result. Following this plan increases the chances that the treatment will work as well as planned. However, sometimes changes to your chemotherapy schedule are unavoidable, for example:

Low White Blood Cell Count: Your bloodwork is checked just before cancer treatment to see your blood counts. If your white blood cell count is too low, your cancer doctor may delay treatment. Receiving therapy would lower your white count even more. White blood cells fight infections. Giving you therapy while your white blood cell count is low could increase your risk for infection.

Infection: If you have a fever or are feeling sick, your therapy may be delayed until you feel better. This is done for your safety, so you can recover from the infection.

Toxicity: If your dose of chemotherapy causes side effects severe enough to delay treatment, your oncologist may lower your dose. This may make it safer for you. If you are too sick or weak to receive chemotherapy, your treatment will be delayed. If your doctor is concerned about how cancer treatment may affect your heart, a cardio-oncologist can prevent or treat cardiotoxicity.

Lung Cancer Prognosis

The prognosis or outlook for your cancer depends on the type, stage at diagnosis, overall health and response to treatment. Another factor is whether your cancer has specific genetic mutations that can be targeted with therapy. Lung cancer survival rates have increased steadily over the last 40 years, learn how from the American Cancer Society.

In general, people diagnosed at earlier stages have better outcomes because treatment can begin before the cancer spreads to other parts of the body.

Survival by Stage

Lifestyle Management

The more you know about your lung cancer, the easier it will be to manage. Managing your health improves quality of life. Talk with your oncologist if you have questions or concerns about your treatment plan. Write down any questions about managing cancer to ask at your next appointment.

Having a healthy lifestyle is important for everyone, especially if you have cancer. Use these lifestyle tips to help improve your health.

• Exercise regularly as directed by your oncologist. If you feel tired from treatment, your exercise plan can be changed based on how you are feeling. A physical therapist can be helpful in planning an exercise program, learning breathing techniques and addressing non-medication pain management strategies.
• Eat a well-balanced diet and drink plenty of fluids. Ask your oncologist about seeing a registered dietitian. A registered dietitian can be helpful when thinking of strategies to address nutrition issues related to cancer treatment.
• Get a flu shot every year in the fall. Get a pneumococcal vaccine as recommended by your health care provider.
• Give up smoking and avoid exposure to passive smoke. Smoking while receiving cancer treatment makes the treatment less effective. It also makes it harder for you to tolerate the treatment and increases the risk of complications.

Follow these links to find more information and resources for living with cancer and lung cancer.

Clinical Trials

Clinical trials help determine new treatment options for diseases and conditions. Patients with lung cancer have access to clinical trials and should speak with their oncologists to determine which trials might work best for them.

When to See a Specialist

If you or a loved one is at risk for lung cancer, ask about screening. At National Jewish Health in Denver, Colorado, we have one of the nation’s leading lung cancer screening programs. It consistently finds more early-stage cancers than the national average. Call 303.270.2551 to find out if you are eligible for a screening.

If you have had a positive screening, are experiencing symptoms or have been diagnosed, it is important to see an oncologist who has experience with lung cancer. Our lung cancer treatment program has been consistently recognized as one of the top programs in the nation by US News & World Report. It is one of the region’s most experienced programs led by physicians who are nationally known for lung cancer expertise. Use the button below to make an appointment.