- 5 Important Things to Know About Lung Cancer
- Lung Cancer Types
- Lung Nodules
- Non-Small Cell Lung Cancer
- Small Cell Lung Cancer
- Types of Chest Wall Tumors
- Metastasized Cancer
- Carcinoid Tumors
- Mediastinal Tumors
- The signs and symptoms
- Who is at risk
- Diagnosing lung cancer
- The stages of lung cancer
- Treating lung cancer
- The importance of research
- Lung cancer: what you need to know
- What are the main types of lung cancer?
- What are the symptoms of lung cancer?
- What causes lung cancer?
- Who gets lung cancer in Australia?
- What are the risk factors for lung cancer in Australia?
- How is lung cancer diagnosed?
- Treatment for lung cancer
- What questions should I ask about treatment?
- What is the outcome for someone with lung cancer?
- Can lung cancer be prevented?
- Just Diagnosed With Lung Cancer: Answers from an Expert
- Lung Cancer: Five Things You Need to Know
- What Is Non-Small-Cell Lung Cancer?
5 Important Things to Know About Lung Cancer
In 2017, an estimated 222,500 people in the United States will be diagnosed with lung cancer – and while that makes it the second most common type of cancer, it will cause more deaths than any other type. And more deaths than colon, breast and prostate cancers combined.
At AstraZeneca, our scientists are working furiously to find important new treatments for lung cancer, with the hope of curbing these devastating statistics. Here is what you need to know about how researchers are approaching lung cancer.
There is more than one type of lung cancer.
It’s easy to think that lung cancer is one disease, but in truth, there are many different types. This starts with two main categories: non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC).
NSCLC is the most common type, accounting for about 80% to 85% of all lung cancers, while SCLC accounts for about 15% to 20%.
Then, there are more subtypes: NSCLC can be adenocarcinoma, squamous cell carcinoma, or large cell carcinoma – each subtype starts from different types of lung cells.
Within each subtype, there are four main stages of lung cancer.
Lung cancer stage is determined by tumor size and whether it has grown to nearby areas, lymph nodes, or other organs. Some of these stages have second names, which can make lung cancer research news confusing. For example, “locally advanced” lung cancer is typically Stage III. And cancer that is “metastatic” – meaning it has spread or metastasized – is Stage IV.
And then there are biomarkers.
Lung cancer biomarkers are unique traits of lung cancer that can help determine what types of medicines the cancer is most ly to respond to. These can be mutations, or specific types of proteins and molecules that are present in a person’s tumor or blood.
Biomarkers can be identified through testing – sometimes called “genetic testing” or “diagnostic testing” – to help determine the treatment approach for each patient.
And since lung cancer can change and mutate over time, it’s often important to test more than once to ensure doctors are keeping up with the cancer.
Personalized medicine means treating each patient the details of their disease.
These diverse types, stages and subsets of lung cancer make every patient’s tumor and experience unique. “Personalized medicine” is a way of creating and selecting treatments that are designed to treat specific types of lung cancer. When it comes to lung cancer, one size does not fit all.
AstraZeneca is researching personalized medicines in a broad range of lung cancers.
At AstraZeneca, we’re leveraging our expertise in lung cancer and building on our existing medicines to investigate important new treatments across different types of lung cancer. We currently have over 32 ongoing clinical trials looking at many different stages, lines of treatment, and types of disease.
Our vision is to one day eliminate cancer as a cause of death. With hard work and a deep-rooted determination to follow the science of the disease, we are committed to making that vision a reality.
Follow AstraZeneca’s news to find out how we are progressing toward our goal of changing the lung cancer treatment paradigm.
Lung Cancer Types
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- The most common types of lung cancer include lung nodules, non-small cell lung cancer, small cell lung cancer and mesothelioma.
- Rare lung cancers often don't originate in the lung.
- Rare lung cancers vary according to size, recommended treatment options and rate of metastasis.
The most common types of lung cancer are those found right in the lungs. Other rarer types of cancer may also occur in the lungs and chest wall.
Lung nodules are small masses of tissue. They may be benign, precancerous or metastatic tumors that have spread from other parts of the body. Generally, a larger nodule is more ly to be cancerous than a smaller one.
Lung nodules are often found when a patient is being tested for unrelated symptoms, such as abdominal pain or an injury.
Non-Small Cell Lung Cancer
Non-small cell lung cancer is the most common type of lung cancer. It grows and spreads more slowly than small cell lung cancer. The three main kinds of non-small cell lung cancer are named for the type of cells in the tumor:
- Adenocarcinoma is the most common type of lung cancer in the United States and usually begins along the outer sections of the lungs. It is also the most common type of lung cancer in people who have never smoked.
- Large cell carcinomas are a group of cancers with large, abnormal-looking cells. These tumors may begin anywhere in the lungs and tend to grow quickly.
- Squamous cell carcinoma is also called epidermoid carcinoma. It often begins in the bronchi near the middle of the lungs.
For non-small cell lung cancers that have not spread beyond the lung, surgery is used to remove the cancer. Surgery may also be used in combination with radiation therapy and chemotherapy in cancers that are more advanced. These treatments can also be given prior to surgery to shrink tumors and prevent the spread of cancer cells through the blood stream. This is called neoadjuvant therapy.
Small Cell Lung Cancer
Almost all cases of small cell lung cancer are due to cigarette smoking. It is a fast-growing cancer that spreads much more quickly than other types of lung cancer. There are two different types of small cell lung cancer:
- Small cell carcinoma (oat cell cancer; most small cell lung cancers are of the oat cell type)
- Combined small cell carcinoma
Surgery is most commonly used in non-small cell lung cancers and less frequently in small cell lung cancer, which tends to spread more quickly to other parts of the body.
Chemotherapy is the most common treatment for small cell lung cancer, as these medicines circulate throughout the body killing lung cancer cells that may have spread outside of the lung.
Radiation therapy is frequently used in combination with chemotherapy when the tumor is confined to the lung and other areas inside of the chest. Radiation therapy may also be used to prevent or treat the development of small cell lung cancer that has spread to the brain (metastasis).
In radiation therapy, precisely targeted X-rays are used to destroy localized cancer cells. Radiation therapy can be used to prevent tumor recurrence after surgery, to treat tumors in patients who are not candidates for surgery or to treat tumors causing symptoms in other parts of the body.
Mesothelioma is a rare cancer of the chest lining, most often caused by asbestos exposure. It accounts for about 5 percent of all lung cancer cases. Mesothelioma develops over a long period time, from 30 to 50 years between exposure to asbestos and getting the cancer.
Most people who develop mesothelioma worked in places where they inhaled asbestos particles.
Once mesothelioma has been diagnosed, it is staged, which tells the patient and doctors how large the tumor is and where is has progressed beyond the initial site.
Chemotherapy, radiation and surgery can all be part of the treatment for mesothelioma. Combined approaches that utilize these therapies together — particularly using chemotherapy prior to surgery, as well as new drugs that specifically target mesothelioma cells — are currently being tested.
Lung cancer specialists at Johns Hopkins use surgery, radiation, chemotherapy or all three to treat mesothelioma.
Chest wall tumors are rare. other cancers, tumors found in the chest wall may be malignant or benign. Malignant tumors must be treated. Benign tumors will be treated depending on where they are located and the symptoms they cause. If a tumor presses against a lung so that a patient can't breathe, for example, then it must be treated.
Types of Chest Wall Tumors
Tumors found in the chest wall are also categorized by whether they are primary tumors (starting in the chest wall) or metastatic tumors (spread to the chest wall from cancer that started elsewhere, such as in the breast). All metastatic tumors are malignant. In children, most chest wall tumors are primary, while they are more often metastatic in adults. Primary tumors start in the bones or muscles located in the chest wall.
Sarcomas — tumors that start in bone or muscle tissue, or more rarely in other types of tissue — are the most common type of primary tumor found in the chest wall.
Some cancers in the lung are the result of pulmonary metastasis — cancer that began in another part of the body and spread to the lung through the lymphatic system or bloodstream. Almost any cancer can metastasize to the lung. Some cancers that often spread to the lung are:
Carcinoid tumors are rare cancers that most often appear in the stomach or intestines. However, they sometimes start in the lung. Carcinoid tumors can be classified as either typical or atypical.
- Typical carcinoids grow slowly and don't often spread beyond the lungs. Nine 10 lung carcinoids are typical carcinoids.
- Atypical carcinoids grow faster and are slightly more ly to spread outside the lungs.
Carcinoid tumors are also sometimes categorized by where they start in the lung:
- Central carcinoids form in the bronchi, which are the large airways located near the center of the lungs. Most lung carcinoid tumors start there. These carcinoids are almost always typical carcinoids.
- Peripheral carcinoids develop in the smaller airways on the edges of the lungs and they too are almost always typical carcinoids.
Lung carcinoid tumors are most often treated by surgery. Chemotherapy and radiation therapy may be used as adjunct therapies or if surgery is not possible.
Mediastinal tumors are rare tumors that develop in the mediastinum, the area of the chest that separates the lungs. It is surrounded by the breastbone in front and spine in the back.
They can be benign or cancerous, forming from any tissue that exists or passes through the chest cavity. Most mediastinal tumors in children are benign while many mediastinal tumors in adults are cancerous. Because they are located in the chest cavity where the heart and major arteries are or near the spinal cord in back, both benign and malignant tumors must be treated.
There are several types of mediastinal tumors:
Germ cell tumors: These cancers are very treatable and often curable. They develop from reproductive cells and are more often found in the reproductive systems of both men and women. When found outside the reproductive system, they may also be called extragonadal germ cell tumors. How these cells move from the reproductive system to the mediastinum is not currently known.
Lymphomas: These malignant tumors start in the lymphatic system and include Hodgkin's lymphoma and non-Hodgkin's lymphoma.
The lymphatic system is a complex network of capillaries, thin vessels, valves, ducts, nodes and organs that helps to protect and maintain the fluid environment of the body by filtering and draining lymph.
In rare case, lymphoma can originate in the lungs.
Teratomas: These malignant tumors are made of cysts that contain one or more layers of embryonic cells. The layers are called ectoderms, mesoderms and endoderms.
A rare cancer, teratomas occur most often in young men in their twenties and thirties. The tumors are most often located in the chest area. By the time the cancer is diagnosed, they have often spread.
A number of other cancers are often associated with these tumors, including:
- Acute myelogenous leukemia (AML)
- Embryonal rhabdomyosarcoma (ERMS)
- Malignant histiocytosis
- Myelodysplasia (MDS)
- Small cell undifferentiated carcinoma
Thymomas: Thymomas and thymic carcinoma are rare cancers in which cancerous cells form on the outside of the thymus, a small organ in the upper chest that makes white blood cells.
Thymomas are rarely malignant, grow slowly and don't often spread beyond the thymus.
Thymoma is linked with myasthenia gravis and other autoimmune diseases (diseases that cause the immune system to attack healthy cells and tissue).
Thymic carcinomas grow more quickly and have usually spread by the time the cancer is diagnosed. People with thymoma often have autoimmune diseases as well.
Lonny Yarmus, clinical chief of the Division of Pulmonary and Critical Care Medicine, gives a brief overview on lung cancer screening, including lycandidates and whether or not screenings arecovered by insurance.
Nearly 250,000 Americans are diagnosed with lung cancer each year. Lung cancer, all cancers, is a disease of the genes. Normal cells experience changes in the genetic code. These changes are known as mutations and cause cells to grow abnormally, resulting in a tumor.
It is true that some lung cancers happen when a gene changes by chance. However, only 10 percent of patients with lung cancer have never smoked cigarettes. Cigarette smoke is full of chemicals that cause gene mutations and is inhaled directly into the lung. That is why cigarette smoking causes lung cancer.
The signs and symptoms
Cancer causes symptoms by growing and then spreading to other places within the body. Just the flu, cancer may cause symptoms because your body’s immune system knows there is something in your body that should not be there. This can result in:
- loss of appetite
- reduced energy
- weight loss
As cancer grows in the lung or airways, it can begin to cause more symptoms. Once lung cancer has started to cause symptoms it is usually at an advanced stage of disease and difficult or impossible to cure. Those symptoms include:
- shortness of breath
- chest pain
- streaks of blood in mucus when coughing
Who is at risk
If you are an adult who smokes cigarettes or has a history of heavy smoking you are at high risk of developing lung cancer. Heavy smoking is defined as more than one pack of cigarettes per day for 30 years, or the equivalent (2 packs a day for 15 years, etc.).
In addition to quitting cigarettes, you should not wait for symptoms to develop. Discuss a lung cancer screening with your doctor before symptoms develop. A lung cancer detected with screening is usually at an early stage and easier to cure.
Diagnosing lung cancer
When lung cancer is diagnosed, a type and a stage are determined. There are two types of lung cancers – non-small cell and small cell. We determine the type of lung cancer by taking a piece of the cancer through what is known as a biopsy. It is then looked at under a microscope.
The most important determination is whether the lung cancer is “small cell” or not. Small cell lung cancers are fast growing and spread easily so that every patient needs chemotherapy, and few patients can have surgery.
For lung cancer that is not small cell, it is often important to test the biopsy tissue for proteins and gene mutations, which help to define what type of lung cancer is present. Important types of non-small cell lung cancer include adenocarcinoma, squamous carcinoma, large cell neuroendocrine carcinoma, and other lung cancers defined by specific gene mutations.
Most patients with lung cancer require a positron emission tomography (PET) scan to determine the stage of disease. During the PET scan, the doctor injects radioactive sugar into a vein, which then travels throughout your body and collects in cancerous tumors to help the doctor detect where the cancer is located. It can also identify whether it has spread to other areas of the body.
The stages of lung cancer
There are four stages of lung cancer:
Stage 1 – The cancer is only located in the lung and has not spread elsewhere in the body.
Stage 2 – The cancer is in the lung and nearby lymph nodes.
Stage 3 – The cancer is in the lung and lymph nodes in the middle of the chest (Stage 3 is further broken down by stage a or stage b, depending on whether it has spread to the other side of the chest or above the collar bone).
Stage 4 – The cancer has spread to both lungs, to the fluid around the lungs, or to other parts of the body. This is the most advanced stage.
Treating lung cancer
The treatment of lung cancer depends on the type of lung cancer and the stage of disease at the time of diagnosis. While lung cancer is treatable at any stage, it is not always curable.
For early stage lung cancer, surgery or radiation can cover all of the cancer and get rid of it completely. Drug therapy can be combined with surgery or radiation to improve the chance of a cure.
For stage 4, drug therapy all by itself can control the lung cancer, but is not intended to get rid of the cancer completely.
For small cell lung cancer, almost all patients are treated with chemotherapy, and some with radiation therapy. For lung cancer that is not small cell, early stage tumors, either stage 1 or 2, are most often treated with surgery. Stage 3 non-small cell lung cancers require a combination of chemotherapy, radiation, and possibly surgery.
Stage 4 lung cancers are primarily treated with drug therapy, which can be directed at the gene mutation in the cancer, immune therapy, or traditional chemotherapy.
In general, stage 4 disease is difficult or impossible to cure because it has spread to multiple locations through the bloodstream and can’t be removed completely by surgery, or radiation.
Lung cancer is most often caused by tobacco smoke, which causes many gene mutations in the cancer. These gene mutations make the lung cancer cells different than normal cells, and more able to be recognized as abnormal by the immune system.
In order to grow, most lung cancers must evade the immune system. A new class of drugs has been discovered which can help the immune system fight cancer.
These immune checkpoint inhibitors are able to block the cancer’s ability to hide from the immune system.
For patients who never smoked cigarettes but develop lung cancer, very often their cancer is driven by a single gene mutation. For these patients, a treatment known as “gene targeted therapy” blocks the growth signal from theses mutations.
Both gene targeted therapies and immune therapies are in common use for stage 4 lung cancer. Research is underway to test whether these new drugs can help patients with earlier stages of disease.
The importance of research
The discovery of immune therapies and gene targeted therapies have resulted in much longer life and better quality of life for patients with stage 4 lung cancer.
Incredible progress has been made in the last 10 years in discovering new and better drugs for patients with stage 4 lung cancer. However, even the best current drugs do not cure stage 4 disease.
This is why patients should consider participating in new drug trials and experimental treatments.
New drug trials are designed to help patients, but they are experimental, and it is uncertain how well a new drug will work, or the side effects it will cause.
A patient who goes on an experimental drug trial is going on an adventure with their doctor to try something new and hoping it will be better than standard treatment.
Not every patient has this type of adventurous spirit, and most patients stick with tried and true drug treatments.
If we are going to find a cure for stage 4 lung cancer it will take a great deal of effort including the participation of patients, doctors and scientists to develop new and better treatments through clinical trials.
Until then, we will continue to fight lung cancer with the newest and most appropriate methods available for our patients. Learn more about the Lifespan Cancer Institute.
Lung cancer: what you need to know
Lung cancer is a growth of abnormal cells inside the lung. These cells grow in an uncontrolled way and clump together to form a cluster or growth, known as a tumour. If the abnormal cells begin growing in the lung, it is called primary lung cancer. When cancer spreads to the lungs from another place it is called secondary lung cancer.
Lung cancer is one of the most common cancers in the world. Many cases of lung cancer are strongly associated with smoking.
What are the main types of lung cancer?
There are two main types of primary lung cancer – each starts in different types of cells in the lungs.
- Non-small cell lung cancer: This is the most common type of lung cancer, and accounts for over 80 per cent of cases. It usually spreads more slowly than small cell lung cancer. There are several types of non-small cell lung cancer including squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
- Small cell lung cancer: Not as common as non-small cell lung cancer, causing about 12–15 per cent of lung cancer cases. The cancer cells are smaller in size than non-small cell lung cancer cells. It almost always occurs in heavy smokers.
What are the symptoms of lung cancer?
Lung cancer can be hard to diagnose in the early stages because there are usually no symptoms to start with. Sometimes lung cancer is discovered by chance, such as when a chest X-ray is done for another reason.
Many people with lung cancer eventually develop symptoms including:
- A new cough that doesn’t go away
- A different type of cough to one a person may usually have
- Coughing up blood
- Hoarseness or wheezing
- Shortness of breath or increased breathlessness during exertion
- Chest and/or shoulder pain
- Weight loss without trying
- Loss of appetite
- Repeated lung infections
- Swelling of the face or neck.
If the lung cancer has already spread to other parts of the body, it may cause symptoms such as bone pain or headaches.
These symptoms can also be caused by other medical conditions so it’s important to discuss them with a doctor.
What causes lung cancer?
Smoking is the major cause of lung cancer. Tobacco smoke contains many toxic (poisonous) substances that damage the lining of the lungs and airways.
Up to 90 per cent of cases of the disease are caused by smoking (cigarettes, pipes and cigars) or by prolonged exposure to second-hand tobacco smoke (passive smoking).
However, it is not known why one smoker develops lung cancer while another does not.
Lung cancer can also occur in people who never smoked or have never been exposed to second-hand smoke. In these cases, it can be hard to work out what causes the disease. It may be linked to occupational exposure to asbestos.
The greater the exposure to asbestos at work, the greater the risk of lung cancer. This risk is even greater among smokers.
Other occupational exposures that have been associated with lung cancer include contact with the processing of steel, nickel, chromium, exposure to arsenic and coal gas, and exposure to radiation.
Who gets lung cancer in Australia?
Lung cancer is uncommon in younger people but the risk of developing lung cancer increases significantly after the age of 50. In Australia, the chances of a person developing lung cancer by their 85th birthday is one in 17.
In Australia, lung cancer is the fifth most common cancer. It is the leading cause of death due to cancer. More than 12,000 Australians are diagnosed with lung cancer each year, and over 7,000 people in Australia die from the disease each year.
The longer a person smokes and the more cigarettes they smoke, the higher the risk of developing lung cancer.
What are the risk factors for lung cancer in Australia?
Risk factors that increase the chance of getting lung cancer include:
- Smoking or a past history of smoking: especially cigarettes, but also pipes or cigars. The risk is greatest for people who began smoking early in life, people who are or used to be a heavy smoker and those who smoked for many years
- Passive smoking – exposure to second-hand smoke
- A personal or family history of lung cancer
- Exposure to asbestos
- Exposure to radon (a naturally occurring radioactive gas that can build up inside houses in some areas)
- Heavy exposure to other toxic substances in the workplace such as radioactive compounds (e.g. uranium), chromium compounds, silica, nickel, arsenic, tar, diesel exhaust fumes, paint
- Exposure to industrial air pollution
- Radiotherapy treatment to the chest
- History of certain lung diseases such as tuberculosis (TB), chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis.
How is lung cancer diagnosed?
If lung cancer is suspected, the doctor will order several tests to check for cancerous cells or tumours in the lungs and airways. These may include:
- Chest X-ray: This may show an abnormal mass or growth
- CT scan, MRI or PET scan: These scans can reveal small lesions that may not be visible on X-ray
- Sputum test: In someone who is coughing up sputum (also called mucus or phlegm), the doctor will obtain a sample of sputum and send it to the laboratory to test for cancer cells
- Biopsy: A biopsy involves taking a small sample of tissue from the airways or lungs and sending it to the laboratory to check for cancer cells. This is often done using a special instrument called a bronchoscope. A bronchoscope is a thin, flexible tube that can be inserted into the mouth or nose and passed down the throat to examine the airways and lungs. The procedure is known as a bronchoscopy.
The doctor may also order tests and scans to see if the cancer has spread to other parts of the body.
Treatment for lung cancer
The type of lung cancer treatment depends on many factors, including:
- The type of cancer (e.g. small cell or non-small cell lung cancer)
- Where the cancer first began growing in the body (e.g. if it started in the lungs or spread to the lungs from elsewhere)
- What the cancer cells look under a microscope
- What stage the cancer is (e.g. how advanced it is when diagnosed, whether the cancer cells have spread beyond the lung and, if so, how far they have spread)
- How bad the symptoms are
- A person’s overall general health.
Depending on the factors above, treatment may include:
- Surgery: Surgery may be done to remove the part of the lung affected by cancer. The amount of lung tissue removed depends on how much of the lung is affected by cancer. In some cases, a person may have an entire lung removed (called a pneumonectomy), or a large section (lobe) of the lung removed (called a lobectomy), or a small section of lung removed (called a wedge or segmental resection). The aim of surgery is to get rid of all the cancer cells if possible. Surgery offers the best hope of a cure for non-small cell cancer if it hasn’t spread to other parts of the body. Surgery is not often used in the treatment of small cell cancer.
- Chemotherapy: This is a course of anti-cancer medicine given to destroy cancer cells. Chemotherapy works by disrupting the growth of cancer cells. The medicine is often given intravenously (IV) through a vein or as tablets.
- Radiotherapy: This is a course of high energy rays, given to kill or shrink the cancer. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in or near the tumour (internal or implant radiation or brachytherapy). External radiation is most commonly used to treat lung cancer.
- Laser treatment: Lasers use high-intensity light to shrink or destroy tumours. This can help to control the growth of cancer cells and unblock airways obstructed by a tumour. While it does not cure the cancer, it can provide symptom relief.
- Targeted therapy (biologic drugs): Some newer drugs have been developed that specifically target some of the abnormalities found in cancer cells. Some of these therapies only work in people who have certain genetic mutations. Cancer cells can be tested in a laboratory to see if they are suitable for targeted therapy.
- Clinical trials: Some people may be able to take part in trials of new treatments for lung cancer. Cancer Australia has a website with current Australian cancer trials that are recruiting in Australia.
What questions should I ask about treatment?
People should discuss the available treatment options with their doctor so that together, they can decide what the most appropriate treatments are for their situation.
It is important to know whether the aim of treatment is to try to cure the cancer or to relieve symptoms. This decision is usually the cell type, where the cancer cells are located, and whether there has been any spread beyond the lung tissue itself. It is also important to ask about any risks and potential side effects of the proposed treatment so that you know what to expect.
What is the outcome for someone with lung cancer?
The outcome for someone with lung cancer depends on:
- the type of cancer they have;
- how far it has spread;
- the person’s overall health; and
- suitability for surgery.
The results of treatment are best when the cancer is detected and treated early. People who have surgery or early-stage lung cancer have the best chance of a cure.
The survival rate for someone with lung cancer that has spread outside the chest is lower. Unfortunately, because most small cell lung cancers have spread by the time they are diagnosed, survival rates are low.
The aim of treatment for incurable lung cancer is to relieve symptoms and maintain a good quality of life. This type of treatment is called palliative care.
Can lung cancer be prevented?
You can greatly reduce the chances of developing lung cancer by:
- Never smoking
- Stopping smoking if you currently smoke
- Trying to avoid or minimise exposure to second-hand smoke
- Avoiding asbestos exposure and exposure to other cancer-causing substances such as radon (a naturally occurring radioactive gas)
- Maintaining a healthy lifestyle: eat a healthy diet and do regular physical activity.
1. Australian Government – Australian Institute of Health and Welfare (AIHW). Lung cancer (updated January 2016) http://www.aihw.gov.au/cancer/lung/. Accessed May 2016. 2. Cancer Council Australia.
Lung cancer (updated March 2016) http://www.cancer.org.au/about-cancer/types-of-cancer/lung-cancer.html . Accessed May 2016.
3. Australian Government. Cancer Australia. Lung cancer (updated December 2015) https://lung-cancer.
canceraustralia.gov.au. Accessed May 2016.
Just Diagnosed With Lung Cancer: Answers from an Expert
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Dr. Jyoti D. Patel is Professor of Medicine and Director of Thoracic Oncology at the University of Chicago and is the Cancer.Net Associate Editor for lung cancer.
Lung cancer is responsible for more cancer deaths than any other cancer in men and women. In fact, it claims more than 150,000 American lives every year. Despite these astonishing numbers, many people know very little about this disease. This is what everyone should know about lung cancer.
Anyone can get lung cancer.
In fact, 1 in 16 people in the United States will be diagnosed in their lifetime—that’s a new diagnosis every 150 seconds! And although smoking is the most common cause of lung cancer, almost two-thirds of all new diagnoses are in people who have never smoked or are former smokers. In fact, up to 30,000 Americans who have never smoked get lung cancer every year.
Symptoms of lung cancer can be nonspecific. Lung cancer may not produce noticeable symptoms in the early stages, and many people aren’t diagnosed until the disease has advanced. But people who develop any of the following problems should see a health care provider who can evaluate these symptoms and develop a diagnostic plan:
- A new cough that does not go away
- Changes in a chronic cough
- Shortness of breath or you are more easily winded
- Pain in the chest area
- Persistent wheezing
- A raspy or hoarse voice
- Unplanned weight loss
- Bone pain
- Worsening headaches
Screening for lung cancer can save lives. As with many other cancers, a key to surviving lung cancer is catching it in its earliest stages, when it is most treatable. For patients who have small, early-stage lung cancer, the cure rate can be as high as 80% to 90%.
Cure rates drop dramatically as the tumor becomes more advanced and involves lymph nodes or other parts of the body. Screening with low-dose spiral computed tomography (CT) scan has been proven to reduce lung cancer deaths in people at high risk for lung cancer.
In fact, the National Lung Screening Trial found a 20% reduction in deaths from lung cancer among current or former heavy smokers who were screened with low-dose spiral CT, compared to those screened with a chest X-ray.
Because CT scans can also give “false-positive” results—by mistaking scar tissue or noncancerous lumps for cancer—they’re recommended only for people at high risk. In these individuals, the benefits of early detection outweigh the risks of potential false positives. Lung cancer screening is recommended for people who meet these criteria:
- Between 55 and 80 years old
- At least a 30 pack-year smoking history (1 pack-year is the same as smoking 1 pack of cigarettes every day for an entire year)
- Good health and no signs of lung cancer
- No CT scan in the past year
There are different kinds of lung cancer. About 80% to 85% of lung cancer diagnoses are non-small cell lung cancer (NSCLC), and there are 3 main subtypes:
- Adenocarcinoma. This is the most common subtype of cancer, but also much more common in people who never smoked, younger patients, and women.
- Squamous cell cancer. This is more commonly linked to a history of smoking. It develops in the airways of the lungs.
- Large cell carcinoma. This is an uncommon type of lung cancer, accounting for less than 10% of cases
Small cell lung cancer (SCLC) accounts for around 10% to 15% of all lung cancers and very rarely develops in someone who has not smoked.
Targeted therapies work. Up to a quarter of lung cancer tumors carry a genetic mutation—a genomic “glitch” that is driving the cancer’s growth—that may be targeted with available medications. This type of cancer treatment is called targeted therapy.
All patients with advanced adenocarcinoma should have their tumors tested for genetic mutations such as EGFR, ALK, ROS1, and BRAF. And, because there are new and emerging targets being found in research, it is reasonable to do wider testing to look for other mutations as well.
Oral medicines for patients with some of mutations are highly effective; they can shrink tumors significantly, work for a long time, and provide people with lung cancer with a good quality of life.
Immunotherapy helps people with a broad range of lung cancers live longer. Immunotherapy is type of cancer treatment that works by boosting or activating your immune system, so it recognizes and kills cancer cells.
Researchers are investigating 4 main kinds of immunotherapies for lung cancer: checkpoint inhibitors, monoclonal antibodies, therapeutic vaccines, and adoptive cell therapy. Four immunotherapy drugs, all checkpoint inhibitors, have been approved to treat NSCLC.
For patients with tumors with high levels of a biomarker called PD-L1, pembrolizumab (Keytruda) works better than chemotherapy as a first therapy. For tumors with low or no expression of PD-L1, drugs such as atezolizumab (Tecentriq) and nivolumab (Opdivo) can be effective as second treatments.
Sometimes, combining immunotherapy and chemotherapy initially may also improve outcomes. Recent research also showed that giving the checkpoint inhibitor durvalumab (Imfinzi) after radiation therapy improved the time until the cancer progressed in people with locally advanced NSCLC.
There are a number of clinical trials that are also investigating how immunotherapy can be combined with surgery for patients with early-stage, curable lung cancer.
Early palliative care for people with advanced lung cancer improves outcomes. People with lung cancer who receive palliative or supportive care as part of their treatment are shown to be more satisfied with their treatment, have better symptom management, and live longer.
Palliative care is a plan that prevents and treats suffering and addresses the physical, intellectual, emotional, social, and spiritual needs that are unique to each patient.
Palliative care gives patients control of their care by giving them the opportunity to tell doctors and nurses what kind of treatment they want or may not want to receive.
Lung cancer is tough, but we are making headway through discoveries from clinical trials. We have made tremendous advances in our understanding of cancer biology. These gains have a direct impact on people with cancer.
Unfortunately, only 3% of Americans with cancer participate in clinical trials, so often we don’t have enough information to generalize what we learn from clinical trials to patients who are not as well represented in trials, such as older adults and those with other medical problems.
Read other blog posts about recent research on lung cancer.
You’re not in this alone. The lung cancer community is growing. Many people have been touched by lung cancer. It affects more than 220,000 Americans every year. There are lots of active support groups for patients and family caregivers, so no one has to face a lung cancer diagnosis alone.
Lung Cancer: Five Things You Need to Know
Medically reviewed by Pasi A. Jänne, MD, PhD
Lung cancer develops in the tissue of the lung, usually in the cells that line the air passages. Here are some common questions about the disease, answered by Pasi A. Jänne, MD, PhD, Director of Dana-Farber’s Lowe Center for Thoracic Oncology.
What are the types of lung cancer?
There are several types of lung cancer:
- Non-small cell — Non-small cell lung cancer is named for the size of the cells when viewed under a microscope. It begins when epithelial cells inside the lining of the lungs grow rapidly or uncontrollably, often forming a tumor. This is the most common form of lung cancer.
- Small cell — Small cell lung cancer is also named for the size of the cells when viewed under a microscope. Affecting approximately 15 percent of lung cancer patients, it typically starts in the bronchial.
- Mesothelioma — Although it is not technically a lung cancer, mesothelioma shares many of the same symptoms as lung cancer. Malignant mesothelioma is a disease in which cancer cells form in the linings of the organs, most often the pleura and sometimes the peritoneum.
What are the risk factors for lung cancer?
The Centers for Disease Control and Prevention (CDC) estimates 90 percent of lung cancers are caused by cigarette smoke. However, there are also other risk factors:
What are the symptoms of lung cancer?
Some of the more common symptoms include a cough that does not go away, trouble breathing, chest discomfort, wheezing, hoarseness and streaks of blood in mucus. Other symptoms can include loss of appetite, weight loss for no reason, and unusual tiredness.
Patients with mesothelioma may notice lumps, pain or swelling in their abdomen, or pain under the rib cage.
Pasi Janne, MD, PhD, Director of the Lowe Center for Thoracic Oncology at Dana-Farber.
How do doctors diagnose lung cancer?
When lung cancer is suspected, patients typically have a CT scan, MRI, or PET/CT scan to produce a detailed image of their lungs.
If a mass is detected, either a fine needle biopsy, core needle biopsy, bronchoscopy, or endobronchial ultrasound (EBUS) will be done to remove a piece of tissue from a node or tumor. If necessary, surgeons may remove a tissue sample.
If so, a pathologist will examine the tissue to determine whether cancer is present and, if so, the type and stage of the cancer.
What are the treatment options for lung cancer?
Treatment options are determined in part by the type of lung cancer and how advanced it is. For non-small cell lung cancer, patients in early stages first undergo surgery to remove tumors and may need no further treatment. For more advanced cases, patients are ly to have combination treatment with surgery, chemotherapy, and radiation.
Stage IV non-small cell lung cancer is widespread when diagnosed and very difficult to cure.
Treatment options include surgery, chemotherapy, and – for patients whose tumors have certain common gene mutations – targeted therapies such as ALK or EGFR inhibitors.
All lung cancer patients at Dana-Farber have their cancer analyzed for several genetic alterations; the results of which can help identify whether a targeted therapy is most the appropriate treatment.
The newest type of treatment for metastatic non-small cell lung cancer is immunotherapy; for example, the drug pembrolizumab (Keytruda) might be an option as a first-line treatment.
Patients with small cell lung cancer typically have chemotherapy and/or radiation therapy. This is because the disease often does not have symptoms and is diagnosed at a more advanced stage where surgery would not have an impact on the progress of the cancer. Chemotherapy and/or radiation are also often the first steps for more advanced stages of non-small lung cancer.
A combined approach of surgery, radiation therapy, and chemotherapy is used to treat mesothelioma, as there is not one universally accepted standard for treatment of the disease.
Learn more about treatment from the Lowe Center for Thoracic Oncology at Dana-Farber.
What Is Non-Small-Cell Lung Cancer?
About 80% of people who have lung cancer have non-small-cell lung cancer. NSCLC usually spreads more slowly than small-cell lung cancers.
Both cancers affect the lungs and have similar symptoms, but they’re treated differently.
There are three main categories of NSCLC:
Adenocarcinoma: This is the most common type. It usually spreads more slowly than others, and it's more ly to be found earlier. It's often linked to a history of smoking, but it is also the most common type of lung cancer seen in nonsmokers.
It starts in the cells that make mucus, and it’s usually found in the outer parts of your lung.
Squamous cell (epidermoid) carcinoma: This starts in the lining of the airways in the lungs. About a quarter of all lung cancers are this type. It's often linked to a history of smoking.
Large-cell (undifferentiated) carcinoma: This fast-growing cancer can be in any part of the lung. Because it spreads quickly, it can be harder to treat. About 10% of lung cancers are this type.
Most lung cancers are linked to smoking. Many people who get lung cancer either smoke or have been around people who smoke.
Other things that make lung cancer more ly include:
- Air pollution
- Radiation treatments to your chest or breast
- Family history of lung cancer
- Mineral and metal dust
You may not have any. NSCLC might be found during an X-ray or other exam you may have for something else.
If you do have symptoms, they can include:
- Chest pain
- A cough that doesn’t go away or gets worse
- Trouble breathing
- Coughing up blood or mucus
- Hoarseness or other voice changes
- Weight loss or little appetite
- Feeling weak or tired
- Trouble swallowing
If the cancer spreads to other parts of your body, you might have:
- Back or bone pain
- Yellow skin or eyes (jaundice)
- Blurred vision
- Dizziness or balance problems
- Loss of bowel or bladder control
Your doctor will do an exam and ask you questions about your symptoms. They’ll ask whether you smoke or have been around people who smoke. You might need tests to look for tumors in your lungs and to see whether the cancer has spread.
Tests might include:
- Lab work, including blood, tissue, and urine tests
- Imaging tests X-rays, MRIs, PET scans, and ultrasounds
- Sputum cytology, a check of your mucus for cancer cells
- Thoracentesis, a procedure where fluid is taken from the space between the lining of your chest and your lung. The fluid is then checked for cancer cells.
- Biopsy, where your doctor will remove a small piece of tissue to look for cancer cells
what your doctor finds, your cancer will be assigned a stage. It takes into account three things you may hear called TNM:
- Tumor — the size of the main tumor
- Node — if the tumor has spread to the lymph nodes
- Metastasis — whether the cancer has spread (metastasized) to any other places on your body
These three things are used together to determine the lung cancer stage: I, II, III, or IV. Some stages are subdivided into A and B. The lower the stage, the better your chances for recovery.
There are many of them for non-small-cell lung cancer. They're the spread of the cancer, as well as your overall health.
Surgery: If you have early-stage cancer, your doctor will probably suggest you have surgery to remove it. You could have all or part of your lung removed.
Radiation: This can kill the cancer cells left after surgery or may be the main treatment in place of surgery. It uses high-energy rays to target cancer cells.
Radiofrequency ablation: High-energy radio waves are used to heat the tumor. Then electric current is passed through a probe to destroy your cancer cells. This is an option if you have small tumors that are near the outer edge of your lungs.
Chemotherapy: These drugs can be taken by IV or pills to help kill the cancer. You may get them before or after surgery, with radiation, or as the main treatment.
Targeted therapy: This focuses on the changes your cells go through when you get NSCLC. You’ll usually get this when your cancer has spread. Sometimes you’ll take these drugs along with chemotherapy.
Immunotherapy: This helps your own immune system fight your cancer. It does this by making it easier for your body to recognize and destroy cancer cells. You’ll usually get this if your NSCLC is advanced, or after other treatments haven’t worked.
American Cancer Society: “What is Non-Small Cell Lung Cancer?” “Chemotherapy for Non-Small Cell Lung Cancer,” “Radiation Therapy for Non-Small Cell Lung Cancer,” “Immunotherapy for Non-Small Cell Lung Cancer,” “Targeted Therapy Drugs for Non-Small Cell Lung Cancer.”
University of Iowa Hospitals & Clinics: “Non-small cell lung cancer,” “Small cell lung cancer.”
National Cancer Institute: ” Non-Small Cell Lung Cancer Treatment (PDQ®) — Patient Version.”
Medscape: “Non-Small Cell Lung Cancer.”
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