Last Updated 05/18/2020
Author:The CHEST Foundation
About Lung Cancer
- Lung cancer is the second-most common cancer among both men and women.
- Non–small cell lung cancer (NSCLC) represents 80% to 90% of all lung cancer cases each year.
- Small cell lung cancer (SCLC) represents 10% to 20% of all lung cancer cases each year.
- Smoking is the number one cause of lung cancer.
Lung cancer is the second-most common cancer among both men and women. Cancer refers to a process in which abnormal cells grow out of control. Lung cancer is difficult to diagnose when it’s in early stages, so it’s important to see a pulmonologist—a doctor specially trained to diagnose and treat lung diseases—as soon as you suspect a problem. After a lung cancer diagnosis, your pulmonologist will assemble a team of specialists so that you have the full range of the latest treatment options. Together, these medical experts can determine the best treatment for your specific type of lung cancer.
How Lung Cancer affects the body
Different types of lung cancer often affect the body differently. Treatment is based on the type of cancer and the stage of cancer. The stage refers to how widespread in your body the cancer is. Is it in one area of the lung, or has it spread? Staging lung cancer is critical because treatments can vary depending on the stage.
The stage of your lung cancer also affects the disease’s projected outcome—its prognosis. People with lower-stage cancers, where the cancer is more localized, tend to have better outcomes than people with advanced-stage cancers.
By understanding where the lung cancer is and how and where it spreads, your health care team can create a treatment plan specialized for you.
NSCLC represents 80% to 90% of all lung cancer cases each year. NSCLC appears in three types:
- Adenocarcinoma, the most common type of NSCLC
- Squamous cell carcinoma, which accounts for about 25% of NSCLC cases
- Large cell carcinoma, which accounts for about 10% of NSCLC cases
SCLC represents 10% to 20% of all lung cancer cases each year. SCLC tumors tend to grow more quickly than NSCLC tumors. These tumors may initially be more responsive to chemotherapy.
What Causes Lung Cancer?
Smoking is still the number one cause of lung cancer. In fact, smoking is the cause of many other cancers, as well. The American Cancer Society estimates that 80% to 85% of all lung cancer cases in the United States are linked to smoking—and this includes people who have quit smoking.
Any kind of smoking seems to increase the risk of lung cancer. Cigarettes, cigars, and pipes have all been linked to lung cancer. Smoking marijuana may also increase the risk, especially in young people. Exposure to secondhand smoke increases the risk, as well. It’s estimated that secondhand smoke causes more than 3000 lung cancer deaths each year among nonsmoking adults.
Researchers are learning that certain genetic mutations are linked to lung cancer. Mutations are changes in genes that make them work differently than their “normal” versions. People who have those mutated genes may be more likely to get lung cancer. Having one of these genes may be why some nonsmokers get lung cancer.
Other harmful substances can cause lung cancer, including radon and asbestos. Radon is a naturally occurring odorless, tasteless, invisible, radioactive gas. People exposed to high radon levels are more likely to get lung cancer. In fact, radon exposure is a leading cause of lung cancer in nonsmokers.
Exposure to asbestos, a mineral-based substance once used in insulation and building construction, can cause lung cancer, especially in smokers. Air pollution has also been linked to lung cancer.
Lung cancer is the second most common cancer among men and women. It is when abnormal lung cells grow out of control. Lung cancer is difficult to diagnose in early stages. It is important to see a pulmonologist – a doctor who is specially trained to diagnose and treat lung diseases and conditions – as soon as you suspect a problem.
This patient education guide, infographic, and other collateral pieces are generously supported by Lungevity, Go2Foundation and The Society of Thoracic Surgeons.
Symptoms of Lung Cancer
In its early stages, lung cancer usually doesn’t have noticeable symptoms. Many times, it’s discovered later. Even then, good treatment options are available. Sometimes, lung cancer appears on a chest X-ray; a computed tomography (CT) scan; or a test that’s done for something else, such as for a lung infection. Pulmonologists are key in the early diagnosis, staging, and treatment of lung cancer. Symptoms of lung cancer can affect the whole body. Persistent cough and shortness of breath are the most common symptoms, but some people also:
- Cough up blood
- Experience chest, shoulder, or back pain
- Notice voice changes, especially hoarseness
- Have repeated lung infections (such as pneumonia or bronchitis)
- Have difficulty swallowing
Sometimes, lung cancer spreads beyond the lungs to other parts of the body. Symptoms that may be seen when lung cancer has spread include:
- Unexplained weight loss
- Bone or joint pain
- Unexplained broken bones
- Blood clots or bleeding
- Unsteady movement or seizures
- Memory loss
- Neck or face swelling
Tell your health care provider about any symptoms that don’t go away or are unusual. Everyone coughs sometimes, but a cough that persists—especially with other signs, such as blood in the mucus or unexplained pain—should always be checked out. Like all cancers, lung cancer is best treated when it’s caught early.
Many symptoms of lung cancer aren’t specific. They can be the result of other medical problems not related to lung cancer. For example, people who have chronic obstructive pulmonary disease (COPD) can have a chronic cough and repeated infections. See your provider for an accurate diagnosis if you have any of these symptoms.
What are the risk factors for Lung Cancer?
Smoking is the single greatest risk factor for lung cancer. Regular exposure to secondhand smoke also increases the risk. The risk of your getting lung cancer seems to be dose-dependent—in other words, the more you smoke (more cigarettes, more years), the greater your risk. Research shows that quitting smoking at any time of your life decreases your risk.
Other risk factors for lung cancer include:
- A history of cancer in another part of the body. People with a history of head and neck cancer or esophageal cancer, both of which are associated with tobacco use, are at higher risk for lung cancer. People who have had breast, colon, or prostate cancer are also at increased risk.
- Age. Lung cancer risk increases as you age. Only about 10% of cases occur in people younger than age 50.
- Family history. If one of your parents, a brother, or a sister has had lung cancer, your risk may increase.
- Prior radiation therapy. Radiation is an important cancer treatment. However, radiation to the chest area, especially for the treatment of another type of cancer, seems to increase the risk for lung cancer.
- Exposure to radon, asbestos, or industrial chemicals. Radon, asbestos, arsenic, beryllium, and uranium have all been linked to lung cancer. If you have worked with these toxins, you may have an increased risk for lung cancer.
- Other lung disease. COPD, interstitial lung disease, and tuberculosis may increase the risk for lung cancer. Scarring of the lungs from other diseases may set the stage for lung cancer, as well.
Having more than one risk factor increases your chances of developing lung cancer. A smoker with asbestos exposure has about 4 times the risk of developing lung cancer as a smoker without no exposure to asbestos. It’s 80 times the risk compared with someone who neither smoked nor was exposed to asbestos
Diagnosing Lung Cancer
If you are at increased risk for lung cancer, ask your health care provider about screening with a low-dose CT scan of your chest. Your provider can talk to you about the risks and benefits of the scan. Chest CT scans don’t find all lung cancers. Sometimes, they even raise false alarms. But if screening shows something suspicious, your provider may want to repeat the scan right away or in several months to see if the abnormalities have disappeared or changed.
Lung cancer has the lowest 5-year survival rate of all common cancers, but the survival rate is more than 50% when the cancer is detected at an early stage and is limited to one area of the lung. This is why early screening is so important.
To diagnose your cancer, your health care team has to address three main issues:
- What type of lung cancer is it?
- Where is it located?
- What do we do about it?
It’s important to answer the first two questions as quickly as possible. Tests to find the answers must be done correctly, which means that they may take a little longer. The best treatment plan for you depends on accuracy in the diagnosis of your cancer.
Your health care team will ask you many questions about your health. They will take a full medical history. They will also perform a physical exam. They will order tests to find what’s causing your symptoms. If the tests suggest cancer, they will order additional tests. Test results help your medical team get an accurate diagnosis and stage. Only then can they develop a treatment plan for you.
Whether you’re going to see a primary care physician or a cancer specialist, prepare for your visit. Consider bringing a friend or loved one with you to the appointment. That person may remember details of the visit that you later forget or misunderstood. Some people record their appointments with a mobile phone or audio recorder. Take notes during your visit. Bring questions about any diagnosis or treatment information that may be confusing to you.
Your health care team will want to know as much as possible about your symptoms, overall health, and medical history. Before your appointment, gather:
- Information about your symptoms. What symptoms are you having? When did they start? Have they changed? Have you noticed new ones? Does anything relieve your symptoms? Does anything make them worse?
- Information about smoking. A complete description of smoking habits is important. Did you ever smoke? If so, when did you start? How many packs of cigarettes did you typically smoke in a day or week? How long did you smoke? If you quit, when?
- Work history. A complete description of your jobs is also important, even if the job was years ago.
- Complete list of medications, supplements, and vitamins you take. Include all prescription and over-the-counter medications and supplements, including herbal and natural remedies. If possible, bring the containers with you. That way, your provider can see exactly what you’re taking.
- Your medical history. Have you had cancer before? What kind? What treatment did you undergo? Your provider will want to know about any lung and breathing problems you’ve had. If you have medical records at another clinic, have copies sent to your pulmonologist.
- Medical records. Bring all your medical records, especially any copies of old chest X-rays. Comparing current and old X-rays tells the provider about the likelihood of lung cancer. These records help your provider determine which tests are needed. If suspicious tissue has been there for several years without changing, it’s probably not lung cancer.
- Family medical history. Has anyone in your family been diagnosed with lung cancer? Does anyone in your family have a history of lung or breathing problems?
- Questions. Write down your questions so that you don’t forget to ask them during your appointment.
Types of Lung Cancer Biopsies
Open Lung Biopsy
Tests and diagnosis
Many tests can be used to look for and learn more about an abnormality found during an appointment:
- Chest X-rays. A chest X-ray is painless. Doctors look at your lungs and airways. Chest X-rays can show spots (nodules) or other abnormal areas. There’s no way to tell from an X-ray whether any are cancerous, but if your chest X-ray looks suspicious, your doctor can order more tests.
- CT scans. A CT scan (sometimes called a “CAT scan”) uses X-rays to create cross-sectional pictures. These images provide more detailed pictures of the size and location of abnormalities found on a chest X-ray.
- Positive-emission tomography (PET) scan. In this test, a radioactive sugar is injected into your blood stream. A PET scan provides data about whether something seen on a CT scan is metabolically active (that is, whether it’s changing or growing). PET scans can tell if a tumor is spreading from the primary site to other parts of the body.
- Bronchoscopy. A bronchoscope is a thin, flexible tube that contains a tiny video camera. The tube is passed through your nose or mouth. It goes down through your windpipe (trachea) into your lungs. Bronchoscopy enables the doctor, usually a pulmonologist or thoracic surgeon, to see inside your air passages. The doctor can also take small tissue samples (biopsies) and fluid samples, then send them to a lab so that they can be checked for cancer.
- Navigational bronchoscopy. This kind of bronchoscopy uses a GPS-like system to locate and biopsy lung nodules safely and accurately that are beyond the reach of conventional bronchoscopy.
- Endobronchial ultrasound. This test is sometimes used during bronchoscopy. It not only diagnoses lung cancer but can also see if the cancer has spread to the lymph nodes (which is important for staging the cancer). The bronchoscope has a soundwave probe on the end. Doctors can locate and see masses and lymph nodes next to the airway but not within the lung. Doctors then use needles to biopsy the mass or lymph nodes to check for cancer. Endobronchial ultrasound is not offered at all hospitals and medical centers.
- Needle biopsies. If a CT scan shows a suspicious mass or nodule, a radiologist—that is, a doctor who specializes in radiology, or diagnostics that rely on radioactive techniques—can use a CT scan to biopsy the abnormality. Samples can be taken through small or large needles to provide sufficient material for diagnosis.
- Surgical lung biopsy. Depending on the location of the suspected abnormality or tumor, surgery is sometimes best for getting a good tissue sample.
- Ultra sound-guided thoracentesis. This test may be done if abnormal fluid has collected between the chest wall and the lung, an area known as the pleura. (Pleural effusion also describes fluid collection from the pleura.) In this test, the fluid is found in real time with an ultrasound machine. The doctor marks the skin on the chest, then numbs the area. He or she inserts a needle into the space around the lung and removes fluid. The fluid is then sent to a lab to check for cancer.
- Medical thoracoscopy. This test may be done to biopsy the inside layer of the chest, called the pleura. This test is used when thoracentesis doesn’t provide a diagnosis. Medical thoracoscopy is performed under anesthesia and ultrasound guidance. A small camera is inserted into the chest cavity to inspect and take biopsies of the pleura. The test is safe and accurate. Patients may go home the same day. The test may also relieve the symptoms of fluid buildup.
- Biomarker testing. Tumor tissue from a biopsy can be tested for certain features of cancer cells, or biomarkers. Biomarkers give speciﬁc information about the tumor and your lung cancer. Personalized information is important because not all lung cancers are the same. Biomarker testing helps your doctor decide which treatment is best for you.
These tests not only identify lung cancer but also help determine its stage—information that helps your health care team plan your treatment.
Treating Lung Cancer
Lung cancer treatment depends on the type of lung cancer and the stage of lung cancer. Some of the most common treatments for lung cancer include:
- Surgery. Surgery is the initial treatment of choice. Each lung is divided into sections, called lobes. The right lung has three lobes: upper, middle, and lower. The left lung has just two lobes: upper and lower. Surgery may be able to remove the cancer. In these cases, surgery has the highest cure rate.
- Chemotherapy. Chemotherapy uses medications to kill cancer cells. Most chemotherapy drugs are given directly into the veins through an intravenous (IV) line. Some chemotherapy medications come in pill form (oral chemotherapy). In advanced NSCLC, chemotherapy can be used alone or with other cancer treatments.
- Chemotherapy with radiation therapy (RT) is the treatment of choice for SCLC that is limited to a defined area of the chest. A defined area can be safely targeted with radiation.
- Radiation therapy. RT uses high-energy X-rays or other forms of radiation to kill cancer cells. It can be delivered in several ways. In most cases, the patient lies on a special treatment table. A machine delivers invisible radioactive beams through the skin to the cancer.
- Radiation can harm healthy tissue. The radiation oncology team will carefully measure and mark the spot to focus the radiation. During treatment, the beams will be aimed at that precise spot. Each treatment takes only a few minutes.
- Stereotactic body radiation therapy (SBRT) focuses and intensifies each dose of radiation so that it causes less damage to the healthy tissue near the tumor. Throughout the treatment, the strength and direction of the radiation are constantly adjusted to targets any changes in the tumor (such as it getting smaller) and spares healthy tissue. SBRT delivers several doses, usually 3 to 5 treatments (1 treatment per day).
- Immunotherapy. This is a new therapy in NSCLC that uses drugs to make the immune system stronger. Immunotherapy is a type of biologic therapy that helps the body fight the cancer by enhancing the body’s immune response and stopping lung cancers from escaping the immune system. It doesn’t target cancer cells directly. Instead, it trains the immune system to recognize cancer cells, then selectively target and kill them.
- Targeted therapies. Targeted cancer therapy uses drugs to attack cancer cells, including some kinds of lung cancers. Researchers have learned more about the changes in cells that cause cancer. Drugs have been developed that directly target some of these changes. These drugs target specific parts of cells and signals that proteins send to cells that cause them to grow and divide uncontrollably.
Your health-care team will discuss these options and whether they are right for your type of cancer.
Not everyone has side effects from lung cancer treatment, and progress has been made in create less toxic chemotherapy. Some chemotherapy medications do have severe side effects, however, including:
- Loss of appetite
- Hair loss
- Mouth sores
- Sores at the site of radiation treatment
- Decreased immunity (resistance to other illness or disease)
- Memory problems
- Pain and discomfort
- Diarrhea or constipation
- Skin rashes
Side effects depend on which treatments you receive and how your body responds to them.
Side effects can be eased with medication before you even start chemotherapy. It’s common for the health care team to give antinausea medication before chemotherapy, for example. Ask your health care team about the possible side effects of your treatment. Ask what you can do to help manage them. Report any side effects to your team throughout your treatment. They can’t help you feel better if they don’t know what you’re experiencing.
Living with Lung Cancer
There’s no magic cure for lung cancer, but you can do things at home to be more comfortable and improve your overall health:
- If you smoke, quit. It’s not easy to stop smoking. Your health care team can prescribe medication to help you quit or refer you to local classes and support groups. Quitting smoking will keep you healthier.
- Get plenty of rest. Rest reduces stress, increases feelings of well-being, and may strengthen your immune system (the body’s natural ability to fight disease). Many people find cancer treatment exhausting. You may feel wiped out after chemotherapy or RT. Listen to your body: Rest when you feel tired. It’s okay to be active when you feel good. Healing takes time and energy.
- Stay active and exercise. You may not feel like doing it, but exercise is helpful. Studies now show that exercise can help reduce lung cancer symptoms and side effects. It can also improve quality of life. Talk to your health care team about finding a safe program for you. Try to be active every day—even if it’s just a walk.
- Eat a healthy diet. It’s not easy to eat well. It’s hard to eat at all if cancer treatment affects your appetite and sense of taste. Getting enough calories and nutrients supports healing. Tell your health care team if eating becomes a challenge.
Your provider may prescribe medication to stimulate your appetite. Other medications relieve mouth sores or soothe nausea. Your provider may also recommend nutritional supplements. Many cancer centers have nutritionists on staff to help create an eating plan that meets your needs.
- Get emotional, spiritual, and psychological support. Few things are more difficult than a cancer diagnosis. You may feel stunned, angry, upset, sad, frightened, or overwhelmed. Sometimes, you may feel all of these emotions at once. This is completely normal.
Talk about your feelings with your health care team. Your provider can assess you for clinical depression. If appropriate, he or she can prescribe medication or refer you to a counselor or mental health professional. Some patients find a spiritual or religious advisor helpful.
Don’t forget that a diagnosis of lung cancer can be stressful for the entire family. Your family members may feel as overwhelmed as you do. Support groups can help both patients and families. Talking to others who have had or are living with lung cancer can help.
Many hospitals and health care organizations host lung cancer support groups. Ask your health care team about support options near you.
How Lung Cancer affects the body
Different types of lung cancer often behave differently in the body. Treatment is based on the type of cancer and the stage of cancer. The stage is the extent of cancer. Is it in one area of the lung, or has it spread? Staging lung cancer is critically important. Treatments can vary depending on the stage.
Lung cancer’s projected outcome, the prognosis, is also impacted by the stage. Lower stages, where the cancer is more localized, have a better outcome than advanced stages.
By understanding where the lung cancer is, and how and where it spreads, the medical team can create a specialized treatment plan based on the type and stage.
The stages of NSCLC are:
Stage I: The cancer is in one part of one lung. It hasn’t spread.
Stage II: The cancer is in one lung and nearby lymph nodes within that lung, called the hilar.
Stage III: The cancer is in one lung and the lymph nodes between the two lungs in the middle of the chest.
Stage IIIA: Describes lung cancer that has spread to lymph nodes on the same side of the chest as the cancer. It could also be cancer that has directly invaded adjacent structures like the chest wall, esophagus, or heart.
Stage IIIB: Means that the cancer has spread from the lungs to the lymph nodes on the opposite side of the chest or above the collarbone.
Stage IV: The cancer has spread to the space around the lungs (the pleura), the other lung, or to another part of the body, such as the brain, bones, liver or adrenal glands. The term “metastasis” is used in Stage IV cancer. This is when the cancer has spread beyond its original site in the lung to other, more distant parts of the body.
SCLC has two stages:
Limited Stage: The cancer is found in just one part of a lung and nearby lymph nodes.
Extensive Stage: The cancer has spread to other parts of the chest or body. It is likely that SCLC will soon have a four-stage system. This system better predicts outcomes.
For more lung cancer resources, finding support, and getting answers, please visit our partners:
There are many places to get support dealing with lung cancer. Local and online groups can help you find answers to your questions and provide assistance. Your health care team will likely know the support groups in your local area. Online resources include:
- American Cancer Society
- American Lung Association Lung Cancer Support Groups
- The Better Breathers Clubs and American Lung Association
- Bonnie J. Addario Lung Cancer Foundation
- Lungevity Foundation
- National Cancer Institute at the National Institutes of Health
Your health care team
- Family practitioners and internists are doctors who have completed a residency in family medicine or internal medicine. They often find your cancer first.
- Pulmonologists are doctors who specialize in diagnosing and treating lung diseases. They also treat breathing problems caused by cancer or its treatment.
- Pathologists are doctors who specialize in identifying diseases. They use a microscope to look at tissue samples taken during a biopsy. The pathologist will diagnose the type of cancer and how advanced it is (its stage).
- Thoracic surgeons (chest surgeons) are doctors who specialize in surgery on the lungs and other organs inside the chest. A thoracic surgeon treats cancers of the lung, esophagus, and chest wall. Some have special training in treating cancer by using surgery.
- Oncologists are doctors who specialize in treating cancer.
- Diagnostic or interventional radiologists are doctors who specialize in diagnosing disease with imaging tests, including X-ray, magnetic resonance imaging (MRI), CT scanning, PET scanning, and ultrasound. Interventional radiologists use imaging tests to guide them in biopsies.
Your health care team may have some or all of these health care professionals:
- Oncology nurses specialize in treating and caring for people with cancer.
- Patient navigators are trained, culturally sensitive health care workers. They provide support and guidance throughout the cancer care process.
- Respiratory therapists evaluate and treat people with breathing problems or other lung disorders.
- Social workers talk with people and their families about their emotional or physical needs. They also help them find support.
- Registered dieticians use diet and nutrition to keep the body healthy. They help improve nutritional health.
Questions to ask your health care provider
- Should I be screened for lung cancer?
- Which procedure will be used to diagnose my disease?
- Can we have my tumor tested?
- How will the tissue be removed?
- How severe is my lung cancer?
- What type of lung cancer do I have?
- What stage is my lung cancer?
- Is the cancer located anywhere else in my body?
- Do I need more tests?
- Are there any biomarkers in my tumor?
- What is my prognosis?
- What are my treatment options?
- What are the risks and benefits of my treatment options?
- What are the possible side effects to my treatment?
- How soon do I need to decide on a treatment?
- How much will treatment cost?
- How do I stay healthy?
- Where can I turn for support?
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