• Lung Cancer

    (NSCLC; Non-small Cell Lung Cancer; Non-small Cell Bronchogenic Carcinoma; Small Cell Lung Cancer)

    Definition

    Lung cancer is a disease in which cancer cells grow in the lungs. The most common type of lung cancer include:
    • Non-small cell lung cancer—generally grows and spreads more slowly (most common)
    • Small cell lung cancer—generally grows more quickly and is more likely to spread to other parts of the body
    Lung cancer is the leading cause of cancer deaths in the US for both men and women.
    Lung Cancer
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    Causes

    Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.
    The following can cause damage to the cells in the lungs, leading to lung cancer:
    • First- or second-hand smoke from cigarettes, cigars, or pipes
    • Exposure to asbestos (a type of mineral) or radon (radioactive gas)

    Risk Factors

    Factors that may increase your chances of lung cancer:
    • Smoking
    • Using chewing tobacco
    • Exposure to second-hand smoke
    • Exposure to to asbestos or radon
    • Having a lung disease, such as tuberculosis
    • Family or personal history of lung cancer
    • Exposure to to certain air pollutants
    • Exposure to to coal dust
    • Radiation therapy that was used to treat other cancers
    • HIV infection

    Symptoms

    Symptoms may include:
    • A cough that does not go away and worsens 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

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will also ask about:
    • Smoking history
    • Substances that you have been exposed to
    • Family history of cancer
    Tests may include:
    • Sputum cytology—a test that examines of a sample of mucus from the lungs
    • Biopsy—removal of a sample of lung tissue to be examined under a microscope
    Imaging tests evaluate the lungs and other structures. These may include:
    The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, lung cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

    Treatment

    The goal of treatment is to eliminate the cancer and/or control the symptoms.

    Surgery

    Surgery involves removing the tumor and nearby tissue. Lymph nodes may also need to be removed. The type of surgery depends on the location of the tumor such as:
    • Segmental or wedge resection—removal of only a small part of the lung
    • Lobectomy —removal of an entire lobe of the lung
    • Pneumonectomy—removal of an entire lung

    Radiation Therapy

    Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. This may also be used to relieve symptoms such as shortness of breath. External radiation is usually used to treat lung cancer. With this treatment, radiation is directed at the tumor from a source outside of the body.

    Chemotherapy

    Chemotherapy is the use of drugs to kill cancer cells. This may be given in many forms, including pill, injection, and via a catheter. Chemotherapy is often used to kill lung cancer cells that have spread to other parts of the body.

    Newer Treatments

    Researchers continue to study ways to treat lung cancer. The National Cancer Institute considers these potential therapies:
    • Photodynamic therapy (PDT)—A type of laser therapy. A chemical is injected into the bloodstream. It is then absorbed by the cells of the body. The chemical rapidly leaves normal cells. It will remain in cancer cells for a longer time. A laser aimed at the cancer activates the chemical. This chemical then kills the cancer cells that have absorbed it. This treatment may also be used to reduce symptoms.
    • Cryosurgery—A treatment that freezes and destroys cancer tissue.
    Other treatments that are being researched include:
    • Targeted therapy—involves using medications or substances to target certain molecules in the cancer cells
    • Immunotherapy—involves using medications or substances made by the body to increase or restore the body's natural defenses against cancer

    Prevention

    To help reduce your chances of lung cancer:
    • Do not start smoking. If you smoke, talk to your doctor about how to successfully quit.
    • Avoid places where people are smoking.
    • Test your home for radon gases and asbestos. Have these substances removed if they are in the home.
    • Try to avoid or limit occupational exposures.
    The American Lung Association and American Cancer Society both suggest that screening for lung cancer with a low-dose CT scan may be considered if you are a smoker (or former smoker), aged 55-74 years, and have a history of heavy smoking (such as one pack a day for 30 years).

    RESOURCES

    American Cancer Society https://www.cancer.org

    American Lung Association http://www.lung.org

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca

    The Lung Association https://www.lung.ca

    References

    Cancer immunotherapy. American Cancer Society website. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy.html. Accessed October 9, 2017.

    General information about non-small cell lung cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq. Updated April 13, 2017. Accessed October 9, 2017.

    General information about small cell lung cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/lung/patient/small-cell-lung-treatment-pdq. Updated December 16, 2016. Accessed October 9, 2017.

    Lung cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/lung-cancer.html. Updated October 9, 2017.

    Munden RF, Swisher SS, Stevens CW, Stewart DJ. Imaging of the patient with non-small cell lung cancer. Radiology. 2005;237(3):803.

    Non-small cell lung cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114774/Non-small-cell-lung-cancer. Updated June 23, 2017. Accessed October 9, 2017.

    Small cell lung cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115654/Small-cell-lung-cancer. Updated June 23, 2017. Accessed October 9, 2017.

    Targeted cancer therapies. National Cancer Institute website. Available at: https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet. Updated October 5, 2017. Accessed October 9, 2017.

    What do I need to know about lung cancer screening? American Lung Association website. Available at: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/learn-about-lung-cancer/lung-cancer-screening. Updated November 3, 2016. Accessed October 9, 2017.

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