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Lung Cancer

Lung cancer is the number one cancer killer among both men and women. One third of all cancer-related deaths in the United States are due to lung cancer. While the number of men who get lung cancer has dropped slightly in recent years, the number of women who get lung cancer has steadily grown. For about 40 years, breast cancer was the leading cause of cancer-related death in women until lung cancer replaced it in 1987.

Lung cancer can be either small cell cancer or non-small cell lung cancer. These two types of lung cancer behave differently and are evaluated and treated differently.

Small cell lung cancer, which includes oat cell carcinoma, is a more aggressive lung disease and often more advanced by the time it is diagnosed. Treatment usually involves chemotherapy and radiation.

Non-small cell lung cancer involves adenocarcinoma, squamous cell and large cell cancer. Surgery is the primary option for early stages of this type. Overall, between 20 to 80% of non-small cell lung cancer can be cured by surgery, depending on the size of the tumor and whether the cancer has spread to other parts of the body.

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Lung cancer may be found as a mass or tumor on the chest X-ray in a patient with no symptoms, but most patients have symptoms when diagnosed, including:

• A new cough, a change in an existing cough or a bloody cough
• Pneumonia
• Rib or shoulder pain; bone pain
• Hoarseness
• Loss of appetite and weight loss
• Facial swelling
• Headaches

A total of 90% of lung cancer cases are related to smoking. The risk of lung cancer is 30 times greater in smokers than in nonsmokers. This correlates with the total exposure to cigarettes (packs smoked per day times the number of years of smoking, referred to as pack-years). One in seven people who smoke at least two packs per day will die of lung cancer. Cigar and pipe smoke doubles the risk of developing lung cancer. Between 5,000 to 10,000 Americans develop lung cancer each year from secondhand smoke.

Exposure to air pollution, radiation and industrial chemicals, arsenic, nickel, chromium and asbestos increase the risk of lung cancer. Asbestos alone increases the risk of getting lung cancer four times. The combination of asbestos and smoking increase the risk 90 times. Asbestos exposure is also associated with mesothelioma, a type of cancer that starts in the lining of the chest.

Diagnosis of this condition involves:

• Chest X-ray
• Computer tomography scan
• Magnetic resonance imaging (MRI)
• PET scan
• Sputum sample
• Needle biopsy
• Flexible bronchoscopy
• Cervical mediastinoscopy
• Surgical biopsy

About 25% of all lung cancer is small cell cancer. The stages of this type of lung cancer range from limited disease (confined to the chest) to extensive disease (spread outside the chest). The outlook is better for limited-stage small cell cancer. Generally, patients are treated with chemotherapy and radiation. Surgery is rarely done, because by the time this cancer has been diagnosed it usually spread to other parts of the body, even if tests do not prove it.

There are four stages of non-small cell lung cancer:

• Stage I lung cancer, in which the cancer is only in the lung
• Stage II lung cancer, in which the cancer has spread to lymph nodes near the tumor and within the lung
• Stage III lung cancer, in which the cancer is confined to the chest, but has spread beyond the lungs
• Stage IV lung cancer, in which the cancer has spread from the lungs to other parts of the body, such as the brain, liver or bones

Knowing the stage of lung cancer helps the doctor set the treatment plan. The patient's medical history and condition are evaluated as part of the staging process. Tests are given to see if the patient has enough lung capacity to safely undergo surgery. Other tests, such as a bone or brain scans, may be needed to see if the tumor has spread to other parts of the body.

As with all cancers, lung cancer may be treated with surgery, chemotherapy or radiation treatments. The treatment depends on the type and extent of the cancer.