Lung cancer forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
Lung cancer is the second most common cancer and the most common cause of cancer-related death in both men and women in the United States. The overall mortality rate for lung and bronchus cancer rose steadily through the 1980s and peaked around 1990. While incidence and mortality rates for men have dropped in the last decade, a similar trend has not occurred in women. Mortality rates are highest among African American males, followed by White males.
Common signs and symptoms of lung cancer include:
- A cough that doesn't go away and gets worse over time
- Constant chest pain
- Coughing up blood
- Shortness of breath, wheezing, or hoarseness
- Repeated problems with pneumonia or bronchitis
- Swelling of the neck and face
- Loss of appetite or weight loss
These symptoms may be caused by lung cancer or by other conditions. It is important to check with a doctor.
To help find the cause of symptoms, the doctor evaluates a person's medical history, smoking history, exposure to environmental and occupational substances, and family history of cancer. The doctor also performs a physical exam and may order a chest x-ray and other tests. If lung cancer is suspected, sputum cytology (the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs) is a simple test that may be useful in detecting lung cancer. To confirm the presence of lung cancer, the doctor must examine tissue from the lung. A biopsy -- the removal of a small sample of tissue for examination under a microscope by a pathologist -- can show whether a person has cancer. A number of procedures may be used to obtain this tissue:
- Bronchoscopy. The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue.
- Needle aspiration. A needle is inserted through the chest into the tumor to remove a sample of tissue.
- Thoracentesis. Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells.
- Thoracotomy. Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital.
Treatment depends on a number of factors, including the type of lung cancer (non-small or small cell lung cancer), the size, location, and extent of the tumor, and the general health of the patient. Many different treatments and combinations of treatments may be used to control lung cancer, and/or to improve quality of life by reducing symptoms.
- Surgery is an operation to remove the cancer. The type of surgery a doctor performs depends on the location of the tumor in the lung. An operation to remove only a small part of the lung is called a segmental or wedge resection. When the surgeon removes an entire lobe of the lung, the procedure is called a lobectomy. Pneumonectomy is the removal of an entire lung. Some tumors are inoperable (cannot be removed by surgery) because of the size or location, and some patients cannot have surgery for other medical reasons.
- Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Even after cancer has been removed from the lung, cancer cells may still be present in nearby tissue or elsewhere in the body. Chemotherapy may be used to control cancer growth or to relieve symptoms. Most anticancer drugs are given by injection directly into a vein (IV) or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are given in the form of a pill.
- Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells. Radiation therapy is directed to a limited area and affects the cancer cells only in that area. Radiation therapy may be used before surgery to shrink a tumor, or after surgery to destroy any cancer cells that remain in the treated area. Doctors also use radiation therapy, often combined with chemotherapy, as primary treatment instead of surgery. Radiation therapy may also be used to relieve symptoms such as shortness of breath. Radiation for the treatment of lung cancer most often comes from a machine (external radiation). The radiation can also come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation).
- Photodynamic therapy (PDT), a type of laser therapy, involves the use of a special chemical that is injected into the bloodstream and absorbed by cells all over the body. The chemical rapidly leaves normal cells but remains in cancer cells for a longer time. A laser light aimed at the cancer activates the chemical, which then kills the cancer cells that have absorbed it. Photodynamic therapy may be used to reduce symptoms of lung cancer -- for example, to control bleeding or to relieve breathing problems due to blocked airways when the cancer cannot be removed through surgery. Photodynamic therapy may also be used to treat very small tumors in patients for whom the usual treatments for lung cancer are not appropriate.
Clinical trials (research studies) to evaluate new ways to treat cancer are an option for many lung cancer patients. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the usual (standard) therapy to another group. Through research, doctors are exploring new and possibly more effective ways to treat lung cancer.
Prevention / Risk Factors
Researchers have discovered several causes of lung cancer -- most are related to the use of tobacco.
- Cigarettes. Smoking cigarettes causes lung cancer. Harmful substances, called carcinogens, in tobacco damage the cells in the lungs. Over time, the damaged cells may become cancerous. The likelihood that a smoker will develop lung cancer is affected by the age at which smoking began, how long the person has smoked, the number of cigarettes smoked per day, and how deeply the smoker inhales. Stopping smoking greatly reduces a person's risk for developing lung cancer.
- Cigars and Pipes. Cigar and pipe smokers have a higher risk of lung cancer than nonsmokers. The number of years a person smokes, the number of pipes or cigars smoked per day, and how deeply the person inhales all affect the risk of developing lung cancer. Even cigar and pipe smokers who do not inhale are at increased risk for lung, mouth, and other types of cancer.
- Environmental Tobacco Smoke. The chance of developing lung cancer is increased by exposure to environmental tobacco smoke (ETS) -- the smoke in the air when someone else smokes. Exposure to ETS, or secondhand smoke, is called involuntary or passive smoking.
- Radon. Radon is an invisible, odorless, and tasteless radioactive gas that occurs naturally in soil and rocks. It can cause damage to the lungs that may lead to lung cancer. People who work in mines may be exposed to radon and, in some parts of the country, radon is found in houses. Smoking increases the risk of lung cancer even more for those already at risk because of exposure to radon. A kit available at most hardware stores allows homeowners to measure radon levels in their homes. The home radon test is relatively easy to use and inexpensive. Once a radon problem is corrected, the hazard is gone for good.
- Asbestos. Asbestos is the name of a group of minerals that occur naturally as fibers and are used in certain industries. Asbestos fibers tend to break easily into particles that can float in the air and stick to clothes. When the particles are inhaled, they can lodge in the lungs, damaging cells and increasing the risk for lung cancer. Studies have shown that workers who have been exposed to large amounts of asbestos have a risk of developing lung cancer that is 3 to 4 times greater than that for workers who have not been exposed to asbestos. This exposure has been observed in such industries as shipbuilding, asbestos mining and manufacturing, insulation work, and brake repair. The risk of lung cancer is even higher among asbestos workers who also smoke. Asbestos workers should use the protective equipment provided by their employers and follow recommended work practices and safety procedures.
- Pollution. Researchers have found a link between lung cancer and exposure to certain air pollutants, such as by-products of the combustion of diesel and other fossil fuels. However, this relationship has not been clearly defined, and more research is being done.
- Lung Diseases. Certain lung diseases, such as tuberculosis (TB), increase a person's chance of developing lung cancer. Lung cancer tends to develop in areas of the lung that are scarred from TB.
- Personal History. A person who has had lung cancer once is more likely to develop a second lung cancer compared with a person who has never had lung cancer. Quitting smoking after lung cancer is diagnosed may prevent the development of a second lung cancer.
Researchers continue to study the causes of lung cancer and to search for ways to prevent it. We already know that the best way to prevent lung cancer is to quit (or never start) smoking. The sooner a person quits smoking the better. Even if you have been smoking for many years, it's never too late to benefit from quitting.