Learn About Lung Cancer
Pulmonologists are often among the first medical specialists to diagnose lung cancer. Once you or a loved one is diagnosed with lung cancer, it is important for your pulmonologist to engage a full team of specialists to provide you with access to a complete range of the latest treatment options.
Of Americans with advanced cancer who do not receive anticancer therapy, more than half have lung cancer. That is why it is critical to seek an integrated medical team that might consist of your primary care physician, pulmonologist, oncologist, radiologist, pathologist, and thoracic surgeon. These medical experts together can successfully determine the best care possible for your specific type of lung cancer.
Lung cancer is usually classified as “small cell” and “non-small cell” types. Non-small cell cancers account for 85%, and both usually occur in smokers. However, adenocarcinoma, a form of non-small cell cancer, may also occur in people who never smoked.
The different types of cancer behave differently in the body. Treatment decisions are based in part on the type of cancer and the stage. Staging is a way of describing the extent of cancer– is it still limited to one lung, or has it spread? Health-care teams plan treatment, in part, according to the stage of cancer.
Small cell lung cancer 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.
The stages of non-small cell lung cancer are:
- Stage I: The cancer is limited to one part of one lung. It hasn’t spread anywhere else.
- Stage II: The cancer is in one lung and nearby lymph nodes.
- Stage III: Cancer is in the lungs and the lymph nodes in the middle of the chest. The term Stage IIIA usually describes lung cancer that has spread to lymph nodes on the same side of the chest as the cancer, or that may have spread to 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 either the other lung or to another part of the body.
Although the rate of diagnosis of lung cancer is decreasing in men, these rates are increasing in women. This trend is explained by the changing pattern of cigarette smoking over the past 30 years.
Early lung cancer usually does not cause noticeable symptoms. Unfortunately, many times it is discovered after it is too late to be cured.
Sometimes lung cancer is discovered on an x-ray or other test that’s being performed for another reason, such as a respiratory infection. Pulmonologists can play a key role in the prompt diagnosis, staging, and treatment of patients with lung cancer.
Because lung cancer affects the lungs, the most noticeable symptoms of lung cancer are often persistent cough or shortness of breath. Other symptoms may include:
- Coughing up blood
- Chest, shoulder, or back pain
- Changes in the voice, especially hoarseness
- Recurring lung infections (such as pneumonia or bronchitis)
- 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
- Unexpected blood clots or bleeding
- Unsteady movement
- Memory loss
- Swelling of the neck or face
Any unusual or unexplained symptom should be checked out by a health-care provider. Everyone coughs sometimes, but a cough that persists–especially if it’s accompanied by other symptoms, such as blood-tinged sputum and overall weakness–should always be evaluated. Lung cancer is best treated when caught early.
Smoking is the number one cause of cancer. The American Cancer Society estimates that 80% to 85% of all lung cancer cases in the United States are related to smoking. Exposure to secondhand smoke is also a well-documented cause of lung cancer. More than 3,000 nonsmoking adults die of lung cancer each year as a result of breathing secondhand smoke.
Any kind of smoking seems to increase the risk of lung cancer. Smoking cigarettes, cigars, and pipes have all been linked to lung cancer. Smoking marijuana may also increase the risk of lung cancer, especially in young people.
Some claim that inhaling e-cigarettes (“vaping” ) may be a safer alternative to cigarette smoking and that it may help tobacco smokers to quit. On the other hand, some believe that e-cigarettes may introduce young people to start smoking tobacco. Much more research is needed to find the answers to these questions. Until those studies are in, most local authorities are restricting sale and use of e-cigarettes the same as tobacco products
Lung cancer can run in families. Researchers are learning that certain genetic mutations–genes that work differently than the “normal” versions of those genes–are linked to lung cancer. People who have those mutations may be more likely to get lung cancer than people who have the “normal” genes. Having one of these genes may be a reason why nonsmokers develop the disease.
Exposure to other harmful substances can also cause lung cancer. Radon is a naturally-occurring odorless, tasteless, invisible radioactive gas. People who are exposed to high levels of radon are much more likely to get lung cancer than people with low levels of exposure. In fact, radon exposure is a leading cause of lung cancer in nonsmokers. Radon levels can be high not only in underground mines but also in tightly sealed, poorly ventilated homes.
Exposure to asbestos, a mineral-based substance that was once used in insulation and building construction, can cause lung cancer, especially in smokers. Air pollution has also been linked to the development of lung cancer.
Smoking is the single greatest risk factor for lung cancer; regular exposure to secondhand smoke also increases the risk. The risk of developing lung cancer seems to be dose-dependent: the more you smoke (more cigarettes, more years), the greater your risk. Quitting smoking decreases your risk of lung cancer.
Other risk factors for lung cancer include:
- A history of cancer in another part of the body. People who have had cancer in a different place, such as breast, colon, or prostate cancer, are at increased risk of having lung cancer.
- Age. Lung cancer risk increases with age. Only about 10% of lung cancer cases occur in people younger than 50 years old.
- Family history. If one of your parents or siblings has had lung cancer, your risk of developing lung cancer may be increased.
- Prior radiation therapy. Radiation is an important cancer treatment, but radiation to the chest area, especially for treatment of another cancer, seems to increase the risk of developing lung cancer.
- Exposure to radon and/or industrial chemicals. Radon, asbestos, arsenic, beryllium, and uranium have all been linked to lung cancer. Anyone who has worked with these substances may be at increased risk of developing lung cancer.
- Other lung disease. According to the Lung Cancer Alliance, diseases such as emphysema, chronic bronchitis, chronic obstructive pulmonary disease (COPD), and TB may increase lung cancer risk by 50% to 100%. In addition, scarring of the lungs from other diseases may set the stage for developing lung cancer.
Having more than one risk factor for lung cancer further increases your odds of developing lung cancer. For instance, a smoker with asbestos exposure has around four times the risk of developing lung cancer as a smoker without asbestos exposure, and eighty times the risk compared with someone who neither smoked nor was exposed to asbestos.
If you are at increased risk for lung cancer, ask your health-care provider about cancer screening with a CT scan. It’s important to remember, though, that these scans do not find all lung cancers, and sometimes they raise false alarms when a abnormal finding may look like cancer but turns out to be something else. If a suspicious abnormality is discovered, your medical provider may recommend repeating the scan in several months to see if it disappears, or to perform more tests right away if it looks more worrisome. Your health-care provider can help you weigh the risks and benefits of screening for lung cancer.
Complications of lung cancer can affect the entire body. Persistent cough and shortness of breath are the most common symptoms, but other common complications of lung cancer include:
- Collapsed lung
- Chest pain
- Coughing up blood
- Unexplained weight loss
- Blocked airways
- Repeated lung infections
- Fluid buildup around the lungs or heart
These complications can also cause fatigue and discomfort. Your health-care provider can help you manage complications that may arise as a result of lung cancer.
Preparing For Your Appointment
Whether you are preparing for your first appointment with a primary care physician or preparing for an appointment with a cancer specialist, take the time to prepare for an informative discussion about lung cancer. You should also consider bringing a trusted friend or loved one to the appointment. They may remember details of this visit that you may have forgotten or misunderstood, correctly, especially related to explanations about your condition and the plans to proceed.
Also, remember that your pulmonologist is just one part of the multi-disciplinary approach to lung cancer care. The following specialists are also fundamental to your team:
- Medical oncologist: Specializes in treating cancer with chemotherapy (drugs that kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide) or other medications, such as targeted therapy and oral (in pill form) chemotherapy.
- Radiation oncologist: Specializes in treating cancer with radiation therapy (the use of high-energy x-rays or other particles to kill cancer cells).
- Thoracic surgeon: Specializes in operations on the heart, lungs, esophagus, and other organs in the chest to remove cancerous tissue.
Your medical 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 your symptoms changed, or have you noticed new symptoms over time? Does anything relieve your symptoms? Make them worse?
- Information about smoking. A complete description of smoking habits is very important. Did you ever smoke? If so, when did you start? How many packs of cigarettes did you typically smoke, and for how long? If you stopped, when?
- Work history. A complete description of all the jobs you had is also important, even if the job was decades ago. People with work exposure to asbestos may develop lung cancer long after they stopped being exposed.
- Complete list of your medications, supplements, and vitamins. Include all prescription and over-the-counter medications and supplements, even herbal and natural remedies. If possible, bring the bottles and containers with you to your appointment, so your health-care provider can see exactly what you’re taking.
- Your medical history. Have you had cancer? What kind? What sort of treatment did you undergo? Your health-care provider will also want to know about any lung and breathing problems you’ve had in the past. If you have medical records at another clinician’s office, ask to have copies sent to your current health-care provider.
- Medical records. Bring all the medical records you can get your hands on. This will be very helpful for your health-care provider to plan what tests to do. If you can bring copies of old x-rays, it’s very important that you do. Comparing current films with old ones tells the clinician a lot about the likelihood that there is a lung cancer; if it has been there for several years without changing, it’s probably NOT lung cancer.
- Family history. Has anyone in your family ever been diagnosed with lung cancer? Does anyone else in your family have a history of lung or breathing problems?
- Questions. Write down any questions you may have, so you don’t forget to ask them when you’re at your appointment.
Diagnosing Lung Cancer
Your health care team will ask you lots of questions about your health and medical history and perform a thorough physical examination. They will also order some tests to figure out what’s causing your symptoms. If the tests suggest cancer, additional tests will be done to learn as much as possible about the potential cancer. Test results will help your health-care provider arrive at an accurate diagnosis and develop a treatment plan, which will include an integrated medical team that will deliver the best care for your situation. Your integrated medical team should always include a pulmonologist, medical oncologist, radiation oncologist and thoracic surgeon.
Tests that may be used to look for and learn more about the lung cancer include:
- Chest x-rays. A chest x-ray is a painless test that allows your clinician to look at what’s going on in your lungs and airways. Chest x-rays can help health-care providers see lumps, nodules, spots, or other abnormal areas in the lungs, but there’s no way to tell from a x-ray whether any of these are cancerous or not. If your chest x-ray is suspicious for lung cancer, additional tests will be required.
- CT scans. A CT scan (sometimes called a “CAT scan”) uses x-rays to create cross-sectional pictures of the body. CT scans can be used to look for lung abnormalities, with more detailed pictures of the size and location of abnormalities spotted in a chest x-ray.
- Positive-emission tomography (PET scan). This imaging test uses injection of radioactive substance to provide information about tumors and abnormal growths in the lungs and other parts of the body, showing up as “hot spots” on the scan. PET scans can also be used to tell if a tumor is growing or shrinking.
- Sputum test. If you’re coughing up mucus, your health-care provider will probably send a sample to the lab for analysis. The lab can check the mucus for cancerous cells. A sputum test isn’t the best test for lung cancer because it’s possible to have lung cancer but not have any cancerous cells in the sputum.
- Bronchoscopy. A bronchoscope is a thin, flexible tube that contains a tiny video camera. The tube is passed through your nose or mouth, down through your windpipe (trachea) and into your lungs. A bronchoscopy allows health-care providers to see what is happening inside your airways and lungs. Providers can also take small tissue samples (biopsies) and send them to a lab to see if they’re cancerous.
- Endobronchial ultrasound. This test is sometimes used during bronchoscopy to diagnose lung cancer or to determine if it has spread. During the test, the bronchoscope has an ultrasound probe on the end, so physicians can “see” structures inside and outside the lungs. Physicians can also get lung tissue and fluid samples from the lungs and nearby tissues via the bronchoscope, and the tissue and fluid can be analyzed for cancer. Endobronchial ultrasound is not available at all hospitals and medical centers.
- Fine needle aspiration. If an x-ray or CT scan reveals a suspicious mass or possible tumor in the lungs, a radiologist may use a thin needle to take a sample of the abnormal area and sent to a lab to see if there are cancer cells.
- Core needle biopsy. A core needle biopsy can also be used to determine whether or not a mass is cancerous. Core needle biopsies provide a bigger sample than fine needles.
- Surgical lung biopsy. Depending on the location of the suspected tumor (or tumors), surgery may be the best way to get a good tissue sample. The tissue is analyzed to see if it’s cancerous.
- Thoracentesis. In this test, a hollow needle is inserted into the chest to remove fluid from the space around the lungs. The fluid can be sent to a lab and checked for the presence of cancer.
- Biomarker testing. Tumor tissue removed during a biopsy procedure can be tested for several biomarkers, features of cancer cells that can give the doctor speciﬁc information about the tumor. Biomarker testing gives health-care providers more information about your lung cancer. That information is important, because all lung cancers are not the same. Biomarker testing can help your health-care provider decide what types of treatment will likely be most effective for you.
These tests are also used to determine the stage of lung cancer, which will inform your health care team about the optimal treatment plan.
Lung cancer treatment depends on what kind of lung cancer you have, its stage, and which biomarkers, if any, are present in your cancer. Your health-care team will also consider your overall health and wishes when planning your treatment.
Some of the most common treatments for lung cancer include:
Surgery. Each lung is divided into sections, or lobes. The right lung has three lobes: the upper, middle, and lower lobes. The left lung has just two lobes, the upper and lower. If the cancer is in only one lobe of one lung, surgery can remove the cancer and offers the highest rate of cure. Depending on the location and size of the lung cancer, surgeons may remove just part of a lobe (this kind of surgery is called a segmentectomy, or “wedge” resection), an entire lobe (lobectomy), or an entire lung (pneumonectomy). A person can survive with just one lung.
Sometimes surgical removal of a cancer can be done with thoracoscopy, where instruments are inserted into the chest and guided by a small camera. When the size and location of the tumor make this possible, thoracoscopy has the advantages of smaller incisions than with standard surgery, and shorter recovery times. Ask your medical team if you are eligible for thoracoscopy.
Surgery may also be used to treat advanced lung cancer, either as part of a combined approach with other forms of therapy, or to relieve symptoms like shortness of breath from fluid accumulation around the lung.
Chemotherapy. Chemotherapy uses medication to kill cancer cells. Most chemotherapy drugs are given directly into the veins through an IV line, although some come in pill form. If chemotherapy is going to be delivered through the veins, clinicians will often surgically implant a special “port” into the upper part of a patient’s chest before chemotherapy treatment begins. The port leads into a major vein; health-care providers can easily and reliably access the port to deliver IV chemotherapy. Ports and other types of long-term IV access are commonly used for chemotherapy because treatment often extends over many weeks. A port or long-term IV access allows patients to avoid an IV “stick” every time they go for chemotherapy.
Chemotherapy is the treatment of choice for small cell lung cancer but is also used commonly to treat non-small cell lung cancers in stages II, III, and IV.
Chemotherapy can be used alone or in conjunction with other cancer treatments. Sometimes, chemotherapy is used before surgery to shrink tumors and make them easier to remove surgically. Sometimes, chemotherapy is used after surgery to treat any remaining cancer.
Targeted therapy is a relatively new form of chemotherapy for patients with cancers that have specific features that make them vulnerable to specific drugs. Biomarker testing is very helpful to see whether these drugs will be effective.
Radiation Therapy. Radiation therapy uses high-energy x-rays or other forms of radiation to kill cancer cells. Radiation can be administered in several different ways, but most involve a source outside of the patient. During treatment, the patient is positioned on a special treatment table while a machine delivers invisible radioactive beams through the skin to the cancer.
Because radiation can harm healthy tissue, the radiation oncology team will carefully measure and mark the spot that should receive radiation. Each time you have treatment, the beams will be aimed at this precise spot. Each treatment only takes a few minutes. Radiation therapy for lung cancer is usually given several days each week for several weeks. The schedule is always customized to the patient and the type, size, and location of the cancer. Your health-care team will customize the plan for radiation depending on the type, size, and location of the cancer with the goal of eliminating as much cancer as possible with minimal side effects. Precise planning is important because radiation can damage normal tissue along with killing cancer cells.
Other treatment options may be used in certain situations.
Radiofrequency ablation uses heat to kill cancer cells, delivering heat through a thin, needle-like probe through the skin near the cancer. Photodynamic therapy (PDT) uses a special light delivered through a bronchoscope to cancer cells inside the breathing tubes; laser beams may be delivered through a bronchoscopy to kill cancer cells to open blocked airways, and cryosurgery uses extreme cold to kill cancer cells. Your health-care team will be able to discuss these options and whether they would be right to treat your type of cancer.
Lung cancer treatments have side effects. Cancer treatment may include fatigue, nausea, and vomiting; loss of appetite; weakness; hair loss; sores in the mouth and/or at the site of radiation treatment; decreased immunity; memory problems; pain and discomfort; diarrhea or constipation; and skin rashes. The side effects you experience will depend on what treatments you receive and how your body responds to the treatments.
Also, remember that side effects may be eased using medication before you even begin treatment. (It’s common, for instance, to give antinausea medication before chemotherapy.) Ask your health-care providers about the possible side effects of your lung cancer treatment, and ask what you can do to help manage any side effects. Be sure to report any side effects to your health-care provider. Your health-care provider can’t help you feel better if he or she doesn’t know what’s going on with you.
Managing Lung Cancer
There’s no magic cure for lung cancer, but there are some things you can do at home to increase your comfort and improve your overall health.
If you smoke, quit. It’s not easy to stop smoking, but your health-care team can help by prescribing medication to help you stop smoking and referring you to local classes and support groups that will help you stop smoking.
Get plenty of rest. Adequate rest decreases stress, increases feelings of well-being, and may enhance your immune system. Many people find cancer treatment to be exhausting. You may find, for instance, that you feel wiped out after chemotherapy or radiation. Listen to your body and rest when tired. It’s OK to be active when you feel good, but healing takes time and energy.
Eat a healthy diet. It’s not easy to eat well–or even eat at all–if cancer treatment interferes with your appetite and sense of taste. But adequate calories and nutrients help support healing. Tell your health-care team if eating has become a challenge for any reason. Your provider may be able to prescribe medication that can help. (Some medications, for instance, stimulate appetite. Others ease mouth sores.) He or she may also recommend supplements to help you maintain your nutrition. Many cancer centers have dieticians on staff, as well. A dietician can help you figure out an eating plan that fits your needs and personal preferences.
Get emotional, spiritual, and psychological support
Few things hit harder than a diagnosis of cancer. You may feel stunned, angry, upset, sad, frightened, or overwhelmed–or feel all of those emotions at once. It’s completely normal.
Anxiety and depression may begin to negatively affect your work or relationships, and that might be time for some professional help. Talk about your feelings with your health-care team. Your provider can assess you for clinical depression and prescribe medication to help you or refer you to a professional counselor or mental health professional. Some patients find that conversations with a spiritual or religious advisor to be very helpful.
This can be a stressful time for the entire family. Try to remember that your family members may feel as overwhelmed as you. Support groups can help both patients and families. Talking to other people who have had or are living with lung cancer can be very helpful. The Lung Cancer Alliance maintains a list of online and in-person support groups. CancerCare also has lists of support groups, as well as online phone counseling with social workers who specialize in cancer care. Many hospitals and health care organizations host lung cancer support groups too. Ask your health care team if there’s one near you.
Talking about end-of-life issues isn’t easy, but most people, especially those with severe disease, are happy when they do. Ask your health-care team to describe different medical scenarios and alternatives. Take some time to think through what you would want if your illness continues to progress. It’s a good idea for everyone, and especially someone with a severe illness, to talk with family and close friends along with someone on your medical team about your options and what you would want to do if your cancer continues to progress despite treatment. It’s also important not just for people with a serious illness, but probably for everyone, to appoint someone as your health care agent, or “proxy,” to express your wishes about health care if you cannot speak for yourself. A health-care provider, hospital, or an attorney can assist you with arranging this.
Living with cancer is hard. Be kind to yourself, accept offers of help, and try to stay positive.
Interested in connecting to the lung cancer community on social media? Join the conversation at #lcsm.