Lung Cancer Description, Prevention, Diagnosis and Treatment More than 90,000 men and 79,000 women are diagnosed each year with cancer of the lungs and bronchi (the air tubes leading to the lungs). Among men, the incidence of lung cancer has been declining, but it continues to increase among women. The number of lung cancer deaths among women surpasses those from breast cancer. Recent studies indicate that female smokers may be more likely to develop lung cancer than male smokers. Types of Lung Cancer There are two major types of primary lung cancer: non-small cell and small cell. Each affects different types of cells in the lung and grow and spread in different ways, so doctors treat them differently. A diagnosis will include not only the type of lung cancer but the stage, which describes the extent and spread of the disease at diagnosis. - Non-Small Cell Lung Cancer
Non-small cell lung cancer, the most common type of lung cancer, is usually associated with a history of smoking. The three main types of non-small cell lung cancer are named for the type of cell found in the tumor: squamous cell carcinoma (also called epidermoid carcinoma); adenocarcinoma; and large cell carcinoma. Non-small cell lung cancer is described using four stages: in stage I, the cancer is confined to the lung; in stages II and III, the cancer is confined to the chest; and in stage IV, the cancer has spread from the chest. - Small Cell Lung Cancer
Small cell lung cancer (sometimes called oat cell lung cancer) accounts for approximately 20 percent of all lung cancer cases and is also associated with a history of smoking. The extent of the disease is described using a two-stage system. A case can either be limited, meaning the cancer is confined to a portion of the chest where it originated, or extensive, meaning the cancer has spread throughout or from the chest.
Mesothelioma, a rare cancer of the chest and abdominal lining, primarily affects persons who have had occupational exposure to asbestos particles. Tumors found in the lungs sometimes originate from cancers elsewhere in the body. These tumors are called lung metastases. This overview focuses on non-small cell and small cell lung cancer. | Smoking tobacco in any form is the major risk factor for lung cancer. Nonsmokers who breathe the smoke of others, often called secondhand smoke, are also at increased risk for lung cancer. Stopping exposure to tobacco smoke at any age lowers the risk of lung cancer. Risk factors for lung cancer besides smoking include the following: - Radon
An oderless radioactive gas produced naturally in rocks and soil, radon is found in homes and mines in some areas. Exposure to high indoor radon levels can cause damage to the lungs that may lead to cancer. - Asbestos
If inhaled, asbestos particles can cause lung damage that may lead to lung cancer and mesothelioma (a rare cancer of the chest and abdominal lining).
Smoking Cessation Not everyone who gets lung cancer has a history of smoking. If you do smoke, however, you can reduce your risk for lung cancer -- and the risk of those around you -- by stopping now. Memorial Sloan-Kettering has smoking cessation programs for those who have cancer, as well as for those who want to quit for cancer prevention and to improve their overall health. | Lung cancer is difficult to detect early because symptoms usually do not appear until the disease is advanced. Symptoms depend on the location of the tumor and can include persistent cough, hoarseness or wheezing, shortness of breath, sputum streaked with blood, recurring bronchitis or pneumonia, weight loss and loss of appetite, and chest pain. Physicians use several techniques to diagnose lung cancer, including the following: Imaging Tests Chest x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) help locate abnormal areas in the lung. Low-Dose Helical CT  A technique called low-dose helical (or spiral) CT may offer a novel approach for diagnosing lung cancer by exposing the patient to less radiation than a conventional chest CT scan while allowing the doctor to see areas of the chest normally obscured in a standard x-ray. Memorial Sloan-Kettering is now studying the effectiveness of low-dose helical CT in a clinical trial. Outside of New York, the National Cancer Institute has begun a multi-center study of the technology. Combined PET/CT Scans Memorial Sloan-Kettering's radiology department includes the best combined PET/CT imaging technology available in the United States. This is particularly important in imaging lung cancer, which can be difficult to identify on a regular CT. To address this situation, a PET (positron emission tomography) scan, which picks up the metabolic signal of actively growing cancer cells in the body, is run simultaneously with the CT scan. This improved imaging capability provides for superior treatment planning because the details of the tumor are better defined. Bronchoscopy & Biopsies A sputum sample can be analyzed for the presence of cancerous cells. Doctors may perform a bronchoscopy, which allows them to examine the bronchial passages using an instrument called a bronchoscope. This is a small tube that is inserted through the nose or mouth, down the throat and into the bronchi. During the procedure physicians may remove some tissue for analysis. A modified form of bronchoscopy called autofluorescence bronchoscopy, which can detect early invasive cancers not seen with standard x-rays or white-light bronchoscopy, is being used to detect very early lung cancer. To examine areas of the lungs that are not accessible during a bronchoscopy, physicians may perform a needle biopsy ("fine needle aspiration" or FNA) to remove a small sample of tissue for analysis. | Depending on the type and stage of the disease, lung cancer can be treated with surgery, chemotherapy, radiation therapy, or a combination of these treatments. Surgery For non-small cell lung cancers that have not spread beyond the lung, surgery is most often used. Over the past several years, surgical techniques for treating lung cancer have improved greatly. There are three surgical procedures commonly used to treat lung cancer: - wedge resection, or segmentectomy (in which a small section of the lung is removed)
- lobectomy (in which an entire section is removed)
- pneumonectomy (which involves the removal of an entire lung)
Minimally Invasive Surgery Where appropriate, Memorial Sloan-Kettering offers minimally invasive surgical procedures, including video-assisted thoracic surgery (VATS), or thoracoscopy. VATS allows the surgeon to operate with roboting assistance by inserting an illuminated tube through a small incision into the lung through the ribs. Because the incisions are much smaller than with an open operation, post-operative healing time and pain are reduced. Chemotherapy For patients whose tumors are somewhat more advanced, a program of chemotherapy before surgery that was pioneered at Memorial Sloan-Kettering has doubled the cure rate. In some cases, the cancer is completely eliminated with chemotherapy before the patient has even had surgery. Because of these good results, we now treat larger tumors that have not spread from the lung in a similar fashion. Even if the surgeon removes the entire tumor that can be seen, adjuvant chemotherapy may be offered to kill cancer cells that may still be present in nearby tissues or elsewhere in the body. For small cell lung cancer in particular, chemotherapy, often combined with radiation therapy, is now the most common treatment. Our Thoracic Oncology Service has led the nation in research in anti-nausea drugs and techniques, which make chemotherapy more tolerable, allowing more patients to complete their course of treatment with less disruption of their normal lives. Radiation Therapy When surgery is not the best option, our 3-D conformal radiation therapy system permits the delivery of the highest possible radiation dose targeted precisely to the tumor. This method spares normal tissues and lessens damage to other organs in the chest. Radiation therapy is also sometimes used to relieve pain and bleeding and alleviate problems with swallowing. Both 3-D conformal radiation therapy and intensity modulated radiation therapy (IMRT) allow doctors to change the shape and intensity of radiation beams so they are focused more effectively on cancer cells and away from the surrounding tissue and organs. Memorial Sloan-Kettering has developed a procedure known as respiratory gating, integrating it into what's called a real-time patient management system. In this procedure, the rise and fall of a patient's chest is measured using infrared lights. This information is fed into a computer, which then creates a radiation treatment plan, so the radiation can be synchronized with the patient's normal breathing movements. Thanks to respiratory gating, radiation oncologists can immobilize the tumor, then, using IMRT, they can make the field smaller, thus treating less of the normal lung tissue. New Chemotherapeutic & Biological Approaches New agents to treat lung cancer and prevent its recurrence are under investigation at Memorial Sloan-Kettering. Our researchers are evaluating new drugs for lung cancer, including gefitinib (Iressa). First tested here, gefitinib is one of a new class of drugs known as signal transduction inhibitors, which work by blocking the signals that make cancer cells grow and spread. Such research protocols are sometimes offered to eligible patients through the clinical trial process. For up-to-date details about current lung cancer clinical trials at Memorial Sloan-Kettering, please visit our clinical trial database. |
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