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LUNG CANCER

What is lung cancer?

Lung Cancer occurs when cells in the lungs start to grow rapidly in an uncontrolled manner. Lung Cancer can start anywhere in the lungs and affect any part of the respiratory system. It is the leading cause of cancer deaths in both men and women. Some well-established risk factors are associated with lung cancer. Changing your lifestyle can, over time, gradually reduce some of your risk factors for developing lung cancer.

What causes lung cancer?

Researchers have identified several causes of lung cancer. Most lung cancers are related to the use of tobacco. Harmful substances, called carcinogens, in tobacco smoke damage the cells in the lungs. Experts estimate that 85% to 90% of lung cancers are caused by tobacco smoke.^{1,

2} About 1 in every 4 adults smoke cigarettes, significantly increasing the risk of lung cancer in these people. Even secondhand tobacco smoke is a risk factor for lung cancer.

Besides tobacco use, exposure to harmful substances such as arsenic, asbestos, radioactive dust, or radon can increase the risk for lung cancer. Having a combination of risk factors—for example, being a smoker who is also exposed to asbestos—greatly increases your risk of getting lung cancer. Radiation exposure from occupational, medical, or environmental sources may also increase your risk for lung cancer.

The most important prevention measure is to not use any tobacco. If you do use tobacco, you can reduce your risk for lung cancer by quitting. Your risk will gradually decrease over 10 to 15 years as your lungs recover.³ Quitting smoking reduces your risk for developing cancer and your risk continues to decrease as long as you don't smoke. The benefit of quitting smoking is greater if it occurs at a young age.

What types of lung cancer are there?

There are two main types of lung cancer: non–small cell lung cancer and small cell lung cancer. The cancer cells of these two types of lung cancer look different under a microscope, grow and spread in different ways, and are treated differently.

Non–small cell lung cancer is more common than small cell lung cancer. Over 80% of all lung cancers are non–small cell cancer.⁴ It generally grows and spreads more slowly than small cell lung cancer. The types of non–small cell lung cancer are:

Adenocarcinoma. About 35% to 40% of non–small cell lung cancers are adenocarcinoma.⁵ This type often begins near the outside surface of the lung and may vary both in size and how fast it grows. Adenocarcinoma is likely to spread to lymph nodes and other organs. This type is more common than other types of lung cancer in women, nonsmokers, or former smokers.

Squamous cell carcinoma, also called epidermoid carcinoma. About 25% to 35% of all lung cancers are squamous cell.⁵ This type usually begins in one of the larger airway tubes (bronchi), generally grows more slowly than the other types of non–small cell cancer, and may vary in size from very small to very large. Squamous cell may spread to nearby lymph nodes or to other organs.

Large cell carcinoma. About 5% to 10% of all lung cancers are large cell.⁵ This type often begins near the surface of the lung and usually is large when diagnosed. Large cell is likely to spread to lymph nodes and other organs.

Adenocarcinoma with other, less common subtypes, such as clear cell or mucinous adenocarcinoma. This occurs less often.⁴

Small cell lung cancer, which used to be called oat cell cancer, is less common than non–small cell lung cancer, accounting for about 20% of lung cancers.⁴ This type of cancer grows very rapidly and in over 80% of cases has already spread to other organs in the body by the time it is diagnosed.⁴ Small cell lung cancer is more strongly linked to smoking than non–small cell cancer.⁴

How will I know I have lung cancer?

You may not know. Early lung cancer rarely causes symptoms. In its advanced stage, the cancer may interfere with normal lung function. Respiratory problems, such as a cough, wheezing, or shortness of breath, may be the first symptoms of lung cancer.

Lung cancer eventually spreads (metastasizes) to nearby lymph nodes or other tissues in the chest, such as the lining of the lungs (pleura) or around the heart (pericardium) or the other lung. In many cases, lung cancer may also spread to other organs—such as the brain, liver, adrenal glands, or bones—and cause other symptoms that prompt you to seek medical evaluation.

How is lung cancer diagnosed?

A health professional evaluates your symptoms, medical history, smoking history, and exposure to environmental and occupational substances and your family history of cancer to help determine whether lung cancer may be the cause of your respiratory symptoms.

Lung cancer is usually first detected with a chest X-ray. Tests to diagnose non–small cell or small cell lung cancer can also help determine the stage of the cancer—whether it is confined to your lung or has spread to other parts of your body.

What are Conventional Treatment Options?

Treatment for lung cancer depends on the stage of your cancer and may include surgery (removing the cancer), radiation therapy (using high-dose X-rays or other high-energy rays to kill cancer cells), or chemotherapy (using medications to kill cancer cells). A combination of treatments may also be used.

Your treatment choice and long-term outcome (prognosis) depend on:

The type of your lung cancer. Treatment of non–small cell lung cancer may be more successful than that of small cell lung cancer because non–small cell lung cancer usually grows and spreads more slowly and may be detected in its early stages when treatment is most effective.

The stage of your cancer.⁴ Treatment in the early stages of disease may be more successful than after the disease is more advanced.

Your age and general health. Research has shown that long-term survival is better if you:

Are able to walk and move around as compared with people who are not able to walk.

Have not lost more than 10% of your body weight in the 3 to 6 months prior to diagnosis. The greater the weight loss before diagnosis, the worse the long-term prognosis.⁴

Lung cancer treatment may be moderately successful in early-stage disease, but only about 15% of lung cancers are discovered in the early stages.⁶Treatment is not very successful if the lung cancer is advanced at the time of diagnosis. The overall 1-year survival rate is about 42%. At 5 years, the survival rate is about 15%.⁶

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References

Citations

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Miller YE (2004). Lung cancer and other pulmonary neoplasms. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 22nd ed., pp. 1201–1208. Philadelphia: Saunders.

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Humphrey LL, et al. (2004). Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: An update for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 140(9): 740–753.

National Cancer Institute (2004). Lung Cancer PDQ: Screening Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/screening/lung/HealthProfessional/page1.

National Cancer Institute (2005). Lung Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional.

International Adjuvant Lung Cancer Trial Collaborative Group (2004). Cisplatin-based adjuvant chemotherapy in patients with completely resected non–small-cell lung cancer. New England Journal of Medicine, 350(4): 351–360.

Centers for Disease Control and Prevention (2005). Lung cancer statistics. Available online: http://www.cdc.gov/cancer/lung/statistics.htm.

Goodman GE, et al. (2004). The beta-carotene and retinol efficacy trial: Incidence of lung cancer and cardiovascular disease mortality during 6-year follow-up after stopping beta-carotene and retinol supplements. Journal of the National Cancer Institute, 96(23): 1743–1750.

Food and Drug Administration (2004). FDA statement on Iressa. FDA Public Health Web Notification. Available online: http://www.fda.gov/bbs/topics/news/2004/new01145.html.

Chesnutt MS, Prendergast TJ (2005). Pulmonary neoplasms. In LM Tierney Jr et al., eds., Current Medical Diagnosis and Treatment, 44th ed., pp. 262–271. New York: McGraw-Hill.

Other Works Consulted

Centers for Disease Control and Prevention (2005). Lung cancer statistics. Available online: http://www.cdc.gov/cancer/lung/statistics.htm.

National Comprehensive Cancer Network and American Cancer Society (2004). Non–Small Cell Lung Cancer: Clinical Practice Guidelines in Oncology, version V.1.2005. Jenkintown, PA: National Comprehensive Cancer Network.

National Comprehensive Cancer Network and American Cancer Society (2004). Small Cell Lung Cancer: Clinical Practice Guidelines in Oncology, version V.1.2005. Jenkintown, PA: National Comprehensive Cancer Network.

Neville A (2004). Lung cancer. Clinical Evidence (11): 2031–2053.