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Lung Cancer

Lung cancer occurs when cells in the lung grow and multiply uncontrollably, damaging surrounding tissue and interfering with the normal function of the lung. The cells can spread to other parts of the body. When the disease spreads, it is still called lung cancer.

Types

Non-small cell lung cancer (NSCLC) accounts for 80 percent of all lung cancers. Non-small cell lung cancers include adenocarcinoma, squamous cell carcinoma and large cell carcinoma. They generally spread very slowly to other organs in the body, and can be hard to detect in the early stages. Small cell lung cancer is responsible for about 20 percent of all lung cancers. Also known as “oat cell” cancer, it spreads very quickly through the lungs to other parts of the body.

Symptoms

Lung cancer symptoms vary from person to person and may include:

  • A cough that will not go away and gets worse over time
  • Constant chest pain, or arm and shoulder pain
  • Coughing up blood
  • Shortness of breath, wheezing or hoarseness
  • Repeated episodes of pneumonia or bronchitis
  • Swelling of the neck and face
  • Loss of appetite and/or weight loss
  • Fatigue
  • Clubbing of fingers

Many of these symptoms are not cancer, but if you notice one or more of them for more than two weeks, see your doctor.

Diagnosis

Although there are currently no screening tests for lung cancer, there are many procedures that can be used to diagnose lung cancer. Some of these tests may be used in combination to obtain the most accurate diagnosis possible.

Chest X-rays

A common method that photographs the lungs. Specialists can spot abnormal areas that may indicate the presence of cancer.

CAT scans

A specialized X-ray machine which uses radiographic beams to create precise computerized pictures of the lung

Bronchoscope

A thin flexible tube with a tiny camera, which is inserted through the nose or mouth and down into the lungs. A bronchoscope can also take a small tissue sample for biopsy.

Fine Needle Aspiration (FNA): A thin needle attached to a syringe is inserted through the chest into the lung tissue and cells are drawn out for examination under a microscope.

Cells taken from mucus expelled by coughing are analyzed for the presence of cancer.

Thoracentesis

Fluid from around the lungs is drawn out with a needle for examination.

Video Assisted Thoracoscopic Surgery (VATS): VATS can be used to aid in the diagnosis of thoracic cancers. Using a limited number of tiny incisions, small diameter video-thoracoscopes can allow examination of the entire thoracic cavity. Biopsies of the lining of the chest cavity (pleura), lung nodules, mediastinal masses and pleural fluid can easily be obtained for diagnosis.

Doctors describe non-small cell lung cancer based on the size of the lung tumor and whether cancer has spread to the lymph nodes or other tissues. A staging system, below, is used to characterize the tumors. Staging is very important when deciding the best form of treatment for each patient. Early stage lung cancer is considered to be any tumor classified as stage 0 through stage IB, in which the cancer is still localized and hasn't spread to nearby lymph nodes.

Occult stage

Lung cancer cells are found in sputum or in a sample of water collected during bronchoscopy, but a tumor cannot be seen in the lung.

Stage 0: Cancer cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A stage 0 tumor is also called carcinoma in situ. The tumor is not an invasive cancer.

Stage IA: The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no more than three centimeters across (less than 1 ¼ inches). It is surrounded by normal tissue and the tumor does not invade the bronchus. Cancer cells are not found in nearby lymph nodes.

Stage IB: The tumor is larger or has grown deeper, but cancer cells are not found in nearby lymph nodes. The lung tumor is one of the following:

  • Cancer cells are not found in nearby lymph nodes, but the tumor has invaded the chest wall, diaphragm, pleura, main bronchus or tissue that surrounds the heart
  • Cancer cells are found in nearby lymph nodes, and one of the following:
    • The tumor is more than three centimeters across
    • It has grown into the main bronchus
    • It has grown through the lung into the pleura

Stage IIIA: The tumor may be any size. Cancer cells are found in the lymph nodes near the lungs and bronchi, and in the lymph nodes between the lungs but on the same side of the chest as the lung tumor.

Stage IIIB: The tumor may be any size. Cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumor may have invaded nearby organs, such as the heart, esophagus or trachea. More than one malignant growth may be found within the same lobe of the lung. The doctor may find cancer cells in the pleural fluid.

Stage IV: Malignant growths may be found in more than one lobe of the same lung or in the other lung. Cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver or bone.

Treatment

Surgery

The standard operation for lung cancer includes removal of the lobe of the lung in which the tumor resides (lobectomy) and dissection and removal of the mediastinal lymph nodes (MLND).

Radiation Therapy

External beam radiation treatment is most often used in conjunction with surgery, but it can also be combined with chemotherapy as an alternative to surgery.

Chemotherapy

Chemotherapy, the use of drugs to destroy tumors, is usually used along with surgery in lung cancer patients. Chemotherapy can make the tumor more manageable before surgery, or to destroy lingering cancer cells at the tumor site after surgery.

Photodynamic Therapy (PDT)

Photodynamic therapy involves a light-sensitive chemical injected into the body, where it remains longer in cancer cells than it does in normal cells. The chemical is activated with a laser that initiates the destruction of cancer cells. PDT is best used on very small tumors, or to reduce some symptoms of lung cancer.

Clinical Trials

New treatments are always being tested in clinical trials and some patients with cancer may want to consider participating in one of these research studies. These studies are meant to help improve current cancer treatments or obtain information on new treatments. Talk to your doctor about the clinical trials that may be right for you.