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Lung Cancer - Symptoms, Detection
& Treatment of this Disease
Introduction
The diagnosis of lung cancer brings with it many questions and
a need for clear, understandable answers. This page provides information
about some causes and ways to prevent lung cancer, and it describes
the symptoms, detection, diagnosis, and treatment of this disease.
Having this important information can make it easier for patients
and their families to handle the challenges they face.
Cancer research has led to progress against lung cancer -- and
our knowledge is increasing. Researchers continue to look for better
ways to prevent, detect, diagnose, and treat lung cancer.
The Lungs
The lungs, a pair of sponge-like, cone-shaped organs, are part
of the respiratory system. The right lung has three sections, called
lobes; it is a little larger than the left lung, which has two lobes.
When we breathe in, the lungs take in oxygen, which our cells need
to live and carry out their normal functions. When we breathe out,
the lungs get rid of carbon dioxide, which is a waste product of
the body's cells.
Understanding Lung Cancer
Cancers that begin in the lungs are divided into two major types,
non-small cell lung cancer and small cell lung cancer, depending
on how the cells look under a microscope. Each type of lung cancer
grows and spreads in different ways and is treated differently.
Nonsmall cell lung cancer is more common than small cell lung cancer,
and it generally grows and spreads more slowly. There are three
main types of non-small cell lung cancer. They are named for the
type of cells in which the cancer develops: squamous cell carcinoma
(also called epidermoid carcinoma), adenocarcinoma, and large cell
carcinoma.
Small cell lung cancer, sometimes called oat cell cancer, is less
common than non-small cell lung cancer. This type of lung cancer
grows more quickly and is more likely to spread to other organs
in the body.
Cancers that begin in the lungs are divided into two major types,
non-small cell lung cancer and small cell lung cancer, depending
on how the cells look under a microscope. Each type of lung cancer
grows and spreads in different ways and is treated differently.
Lung Cancer: Who's at Risk?
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.
Recognizing Symptoms
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
- Fatigue
These symptoms may be caused by lung cancer or by other conditions.
It is important to check with a doctor.
Diagnosing Lung Cancer
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.
Staging the Disease
If the diagnosis is cancer, the doctor will want to learn the
stage (or extent) of the disease. Staging is done to find out whether
the cancer has spread and, if so, to what parts of the body. Lung
cancer often spreads to the brain or bones. Knowing the stage of
the disease helps the doctor plan treatment. Some tests used to
determine whether the cancer has spread include:
- CAT (or CT) scan (computed tomography). A computer linked
to an x-ray machine creates a series of detailed pictures of areas
inside the body.
- MRI (magnetic resonance imaging). A powerful magnet linked
to a computer makes detailed pictures of areas inside the body.
- Radionuclide scanning. Scanning can show whether cancer
has spread to other organs, such as the liver. The patient swallows
or receives an injection of a mildly radioactive substance. A
machine (scanner) measures and records the level of radioactivity
in certain organs to reveal abnormal areas.
- Bone scan. A bone scan, one type of radionuclide scanning,
can show whether cancer has spread to the bones. A small amount
of radioactive substance is injected into a vein. It travels through
the bloodstream and collects in areas of abnormal bone growth.
An instrument called a scanner measures the radioactivity levels
in these areas and records them on x-ray film.
- Mediastinoscopy/Mediastinotomy. A mediastinoscopy can
help show whether the cancer has spread to the lymph nodes in
the chest. Using a lighted viewing instrument, called a scope,
the doctor examines the center of the chest (mediastinum) and
nearby lymph nodes. In mediastinoscopy, the scope is inserted
through a small incision in the neck; in mediastinotomy, the incision
is made in the chest. In either procedure, the scope is also used
to remove a tissue sample. The patient receives a general anesthetic.
Treatment for Lung Cancer
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.
Treating Nonsmall Cell Lung Cancer
Patients with non-small cell lung cancer may be treated in several
ways. The choice of treatment depends mainly on the size, location,
and extent of the tumor. Surgery is the most common way to treat
this type of lung cancer. Cryosurgery, a treatment that freezes
and destroys cancer tissue, may be used to control symptoms in the
later stages of non-small cell lung cancer. Radiation therapy and
chemotherapy may also be used to slow the progress of the disease
and to manage symptoms.
Treating Small Cell Lung Cancer
Small cell lung cancer spreads quickly. In many cases, cancer
cells have already spread to other parts of the body when the disease
is diagnosed. In order to reach cancer cells throughout the body,
doctors almost always use chemotherapy. Treatment may also include
radiation therapy aimed at the tumor in the lung or tumors in other
parts of the body (such as in the brain). Some patients have radiation
therapy to the brain even though no cancer is found there. This
treatment, called prophylactic cranial irradiation (PCI), is given
to prevent tumors from forming in the brain. Surgery is part of
the treatment plan for a small number of patients with small cell
lung cancer.
Side Effects
The side effects of cancer treatment depend on the type of treatment
and may be different for each person. Side effects are often only
temporary. Doctors and nurses can explain the possible side effects
of treatment, and they can suggest ways to help relieve symptoms
that may occur during and after treatment.
Surgery for lung cancer is a major operation. After lung surgery,
air and fluid tend to collect in the chest. Patients often need
help turning over, coughing, and breathing deeply. These activities
are important for recovery because they help expand the remaining
lung tissue and get rid of excess air and fluid. Pain or weakness
in the chest and the arm and shortness of breath are common side
effects of lung cancer surgery. Patients may need several weeks
or months to regain their energy and strength.
Chemotherapy affects normal as well as cancerous cells. Side effects
depend largely on the specific drugs and the dose (amount of drug
given). Common side effects of chemotherapy include nausea and vomiting,
hair loss, mouth sores, and fatigue.
Radiation therapy, like chemotherapy, affects normal as well as
cancerous cells. Side effects of radiation therapy depend mainly
on the part of the body that is treated and the treatment dose.
Common side effects of radiation therapy are a dry, sore throat;
difficulty swallowing; fatigue; skin changes at the site of treatment;
and loss of appetite. Patients receiving radiation to the brain
may have headaches, skin changes, fatigue, nausea and vomiting,
hair loss, or problems with memory and thought processes.
Photodynamic therapy makes the skin and eyes sensitive to light
for 6 weeks or more after treatment. Patients are advised to avoid
direct sunlight and bright indoor light for at least 6 weeks. If
patients must go outdoors, they need to wear protective clothing,
including sunglasses. Other temporary side effects of PDT may include
coughing, trouble swallowing, and painful breathing or shortness
of breath. Patients should talk with their doctor about what to
do if the skin becomes blistered, red, or swollen.
The Importance of Followup
Care
Followup care after treatment for lung cancer is very important.
Regular checkups ensure that changes in health are noticed, and
if the cancer returns or a new cancer develops, it can be treated
as soon as possible. Checkups may include physical exams, chest
x-rays, or lab tests. Between scheduled appointments, people who
have had lung cancer should report any health problems to their
doctor as soon as they appear.
Providing Emotional Support
Living with a serious disease, such as cancer, is challenging.
Apart from having to cope with the physical and medical challenges,
people with cancer face many worries, feelings, and concerns that
can make life difficult. They may find they need help coping with
the emotional as well as the practical aspects of their disease.
In fact, attention to the emotional and psychological burden of
having cancer is often part of a patient's treatment plan. The support
of the health care team (doctors, nurses, social workers, and others),
support groups, and patient-to-patient networks can help people
feel less alone and upset, and improve the quality of their lives.
Cancer support groups provide a safe environment where cancer patients
can talk about living with cancer with others who may be having
similar experiences. Patients may want to speak to a member of their
health care team about finding a support group.
Questions for Your Doctor
This booklet is designed to help you get information you need
from your doctor, so that you can make informed decisions about
your health care. In addition, asking your doctor the following
questions will help you further understand your condition. To help
you remember what the doctor says, you may take notes or ask whether
you may use a tape recorder. Some people also want to have a family
member or friend with them when they talk to the doctor -- to take
part in the discussion, to take notes, or just to listen.
Diagnosis
- What tests can diagnose lung cancer? Are they painful?
- How soon after the tests will I learn the results?
- What type of lung cancer do I have?
Treatment
- What treatments are recommended for me?
- What clinical trials are appropriate for my type of cancer?
- Will I need to be in the hospital to receive my treatment? For
how long?
- How might my normal activities change during my treatment?
Side Effects
- What side effects should I expect? How long will they last?
- What side effects should I report? Whom should I call?
Followup
- After treatment, how often do I need to be checked? What type
of followup care should I have?
- Will I eventually be able to resume my normal activities?
The Health Care Team
- Who will be involved with my treatment and rehabilitation? What
is the role of each member of the health care team in my care?
- What has been your experience in caring for patients with lung
cancer?
Resources
- Are there support groups in the area with people I can talk
to? Are there organizations where I can get more information about
cancer, specifically lung cancer?
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