Lung cancer refers to the growth of abnormal (malignant or cancerous) cells in one or both lungs. These cells are often referred to as a malignant or cancerous tumor.
- The lungs are the main part of the respiratory system, which helps us breathe.
- The respiratory system is made up of several parts. These parts work together to allow the body to take in oxygen (inhale) and eliminate carbon dioxide (exhale).
- When you inhale, air goes through your mouth or nose, down your trachea (also called the windpipe) and into your lungs. Once in your lungs, the air goes into smaller tubes called bronchi.
- Bronchi are a common place for lung cancer to start.
Lung cancer can be non-small cell lung cancer (NSCLC) or small cell lung cancer. Non-small cell lung cancer (NSCLC) is the most common form of lung cancer. The three types of NSCLC are:
- Adenocarcinomas, which are typically in the outer parts of the lung
- Squamous cell carcinomas, which are typically found in the middle parts of the lung
- Large cell carcinomas, which can be found anywhere in the lung
Small cell lung cancer is a fast growing cancer that spreads quickly to other parts of the body.
Healthcare providers will look for spread of the lung cancer to other areas of the body. This process is called “staging.”
- In advanced cases, lung cancer can involve the bones, lung, liver, brain and other organs and tissues.
- Metastatic lung cancer is cancer that started in the lung and has spread to other organs and tissues.
Your healthcare provider will need the following clinical information to decide what type of treatment is right for you.
- What does the cancer look like under the microscope?
- How large is the primary cancer in the lung?
- Has the cancer spread to the nearby lymph glands or anywhere else in the body?
- What are the specific genetics of the tumor?
Radiation therapy involves the use of various forms of radiation, or high-energy x-ray beams, to kill cancer cells in a specific area of the body. Radiation therapy can be used:
- Before surgery to make a tumor smaller
- After surgery to prevent a cancer from returning
- As an alternative to surgery to eliminate the cancer
- To cure a cancer that cannot be removed by surgery
- To decrease symptoms that are related to the cancer
- With chemotherapy to treat the cancer and delay or prevent the cancer from returning
Radiation therapy can be given in various ways, depending on what type of cancer you have and where it is located in your body.
- Radiation therapy to treat lung cancers can be given externally by a machine that is located outside the body. The machine sends high-energy x-ray beams to the tumor.
- The x-ray beams can kill the cancer cells and shrink a tumor or even make it disappear.
- The x-ray beams must pass through normal tissue on their way to the cancer and out of the body. The radiation that passes through normal organs can cause damage.
- Radiation oncologists plan treatments to minimize exposure to normal organs.
- The treatments must be given daily over several weeks because normal tissues do not tolerate a large dosage given at one time.
Some types of radiation therapy include:
- Three-dimensional (3D) conformal radiation, which uses a beam that goes straight through the body. The patient's position is changed so this beam comes through from two or three different angles. The approach is planned to allow the maximum exposure of radiation to the tumor.
- Intensity-modulated radiation therapy (IMRT) uses hundreds of angles to accomplish the same task. It is far more expensive and is used when many angles are necessary. This approach helps to spare an important organ that is not affected by the cancer. In IMRT, the intensity of the beam is varied to conform to the shape of the tumor. The aim is to limit damage to surrounding healthy tissues, while effectively treating the cancer. IMRT is a valuable technique for treating a small percentage of cancerous tumors, but adds little value in the treatment of others. IMRT may not be covered by your health plan unless certain criteria are met.
- Stereotactic body radiation therapy (SBRT) treats a smaller area, but uses a higher dose of radiation. SBRT is typically used to treat small, isolated cancers that can change position with normal movement of the body.
The decision to administer radiation therapy will depend on the individual circumstances.
Many risk factors increase your chance of lung cancer. These risks factors can be divided into those that you cannot control and those that you can control or eliminate. Some of the controllable risks factors for lung cancer include:
- Smoking - The longer you smoke, and the more you smoke, the greater the risk.
- Exposure to secondhand smoke on a regular basis.
Although cigarette smoking is the main cause of lung cancer, people who have never smoked or been exposed to secondhand smoke can develop lung cancer. However, small cell lung cancer is very uncommon in people who have never smoked.
Some of the uncontrollable risks factors for lung cancer include:
- Increased age – Lung cancer is uncommon if you are younger than 45 years of age.
- Family history – A close family member has had lung cancer.
- Radiation - You underwent radiation treatment, especially if you received the radiation as a child or young adult.
- Radon exposure – You have been exposed to radon gas.
- Other Exposures – You were exposed to asbestos, certain chemicals (paints, formaldehyde, uranium, beryllium etc.), excess air pollution or high levels of arsenic in drinking water.
There may be no symptoms in the early stages of lung cancer. Some of the symptoms that can develop as the cancer grows include:
- Chest pain and difficulty breathing
- Persistent cough and blood in your sputum
- Being unusually tired and weak
- Unexplained weight loss and loss of appetite
- Seizures, if the cancer involves the brain
As the cancer advances, other symptoms can develop. These include:
- Bone and joint pain
- Changes in voice
- Difficulty swallowing
- Swelling of the face or other facial symptoms
Contact your healthcare provider if you have any of the above symptoms. Remember, these symptoms can be caused by other medical conditions that are not as serious as lung cancer. Your healthcare provider will perform a physical exam and may order some tests, such as a:
- Chest x-ray
- Lung CT scan
- Lung biopsy
- Bone scan
- PET scan
- Sputum analysis
- Thoracentesis (using a needle to remove fluid from around the lungs)
The treatment for lung cancer is based on many factors. These factors include:
- Your age
- Your general health
- The type of cancer (NSCLC or small cell lung cancer)
- The size of the tumor
- How fast the tumor is growing
- Whether the cancer has spread to other parts of the body
Treatments for lung cancer are either local (only affects the area of the cancer) or systemic (affects all areas of the body). Local treatments include:
- Surgery to remove the cancer
- Radiation to kill the cancer cells
Systemic treatments include:
- Chemotherapy to kill the cancer cells
- Targeted or biologic therapy to interfere with the changes in cells that help the cancer grow
Treatment for lung cancer usually involves a combination of local and systemic treatments. You may also have more than one type of cancer treatment at a time. Depending on your situation, you may alternate between chemotherapy and radiation before or after surgery.
- Targeted therapy has been approved for advanced non-small cell lung cancer.
- Radiation and chemotherapy are usually given in a physician clinic or hospital by specially trained medical personnel.
- In some cases, you may be able to receive chemo at home with the help of specially trained nurses.
To get a full range of opinions and perspectives, you may want to consider input from a variety of doctors. This group may include:
- Your primary care physician
- A medical oncologist (a doctor who specializes in the treatment of cancer)
- A surgeon with experience in lung cancer
- A pulmonologist (a doctor who specializes in the treatment of lung disorders)
- A radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)
It is important to remember that the total cost of this care path does not include all possible medications, labwork or imaging studies. Those charges can add up. If your healthcare provider recommends any labwork or imaging studies you may need to search for their costs separately.
Also known as:
You should contact your healthcare provider if you have symptoms of lung cancer or want to discuss programs that can help you quit smoking. Be prepared to discuss your symptoms and how long you've had them.
- Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
- Make a list of your medications (including over-the-counter).
- Write down any questions, symptoms or concerns you want to talk about.
- If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).
What should I ask my healthcare provider before having radiation therapy?
- How will radiation improve my prognosis?
- What specific precautions do I need to take after receiving radiation therapy?
- What are the possible complications?
- How will I feel after radiation therapy? Will I have to modify my activity?
- What type of radiation will I receive? What symptoms should I report to my healthcare provider before my next appointment?
- Is there a reason you are recommending one form of radiation therapy over another?
- Will I be receiving other treatments along with the radiation therapy?
It is important you understand all home care instructions (including medications and side effects) and follow-up plans. Don't forget to make arrangements for help at home.