Risk Factors

Several factors influence the risk of developing lung cancer:

• Tobacco smoke: Tobacco smoke causes most cases of lung cancer. It's by far the most important risk factor for lung cancer. Harmful substances in smoke damage lung cells. That's why smoking cigarettes, pipes, or cigars can cause lung cancer and why secondhand smoke can cause lung cancer in nonsmokers. The more a person is exposed to smoke, the greater the risk of lung cancer. Read more about quitting smoking and tobacco use.
• Radon: Radon is a radioactive gas that you cannot see, smell, or taste. It forms in soil and rocks. People who work in mines may be exposed to radon. In some parts of the country (including Utah), radon is found in houses. Radon damages lung cells, and people exposed to radon over long periods of time are at increased risk of lung cancer. The risk of lung cancer from radon is even higher for smokers. Radon test kits are available for a low cost at www.radon.utah.gov. It includes supplies to do a 48-hour test for the gas as well as the cost of having it processed at a lab and receiving test results. Those without web access can call 1-800-324-5928.
• Asbestos and other substances: People who have certain jobs (such as those who work in the construction and chemical industries) have an increased risk of lung cancer. Exposure to asbestos, arsenic, chromium, nickel, soot, tar, and other substances can cause lung cancer. The risk is highest for those with years of exposure. The risk of lung cancer from these substances is even higher for smokers.
• Air pollution: Air pollution may slightly increase the risk of lung cancer. The risk from air pollution is higher for smokers.
• Family history of lung cancer: People with a father, mother, brother, or sister who had lung cancer may be at an increased risk of the disease, even if they don't smoke.
• Personal history of lung cancer: People who have had lung cancer are at increased risk of developing a second lung tumor.
• Age: Most people diagnosed with lung cancer are older than age 65.

Symptoms

Early lung cancer often does not cause symptoms. But as the cancer grows, common symptoms may include the following:

• A cough that gets worse or does not go away
• Breathing trouble, such as shortness of breath
• Constant chest pain
• Coughing up blood
• Hoarse voice
• Feeling very tired all the time
• Frequent lung infections, such as pneumonia
• Weight loss with no known cause

Most often these symptoms are not due to cancer. Other health problems can cause some of these symptoms. Anyone with such symptoms should see a doctor to be diagnosed and treated as early as possible.

Screening and Diagnosis

Three screening tests are available for detecting lung cancer:

• Chest x-ray: This is an x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Sputum cytology: This test looks for cancer cells in a sample of sputum (mucus that is coughed up from the lungs).
• Low-dose spiral computed tomography (LDCT) scan: This test uses low-dose radiation to make a series of very detailed pictures of areas inside the body. It uses an x-ray machine that scans the body in a spiral path. The pictures are made by a computer linked to the x-ray machine. This test is also called a low-dose helical CT scan.

These screening tests have been studied to see if they decrease the risk of dying from lung cancer. The following results have been found:

• Screening with LDCT scans has been shown to decrease the risk of dying from lung cancer in heavy smokers.

A lung cancer screening trial studied over 50,000 people aged 55 years to 74 years who had smoked at least one pack of cigarettes per day for 30 years or more and quit within the past 15 years. The trial used chest x-rays or LDCT scans to check for signs of lung cancer.

LDCT scans were better than chest x-rays at finding early-stage lung cancer. Screening with LDCT also significantly decreased the risk of dying from lung cancer.

The National Comprehensive Cancer Network (NCCN) updated its lung cancer screening guidelines in 2011 based on the findings of this trial. However, a low-dose spiral CT scan isn't meant to screen for lung cancer in everyone. A patient and his or her doctor should discuss the risks and benefits of lung cancer screening.

• Screening with chest x-rays or sputum cytology does not decrease the risk of dying from lung cancer.

Chest x-ray and sputum cytology screening tests can help detect lung cancer, but they do not decrease the risk of dying from the disease.

If symptoms or a screening test suggest lung cancer, the doctor may order one or more of the following tests to help make a diagnosis:

• Physical exam: Doctors check general signs of health, listen to your breathing, check for fluid in the lungs, and may feel for swollen lymph nodes and a swollen liver.
• Chest x-ray: This is an x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the chest. An x-ray machine linked to a computer takes several pictures. For a spiral CT scan, the CT scanner rotates around you as you lie on a table. The table passes through the center of the scanner. The pictures may show a tumor, abnormal fluid, or swollen lymph nodes.
• Biopsy: The only sure way to know if lung cancer is present is to take a tissue sample from the lungs. A doctor called a pathologist studies the sample under a microscope to look for cancer cells. There are many ways to collect samples. The doctor may order one or more of the following tests to collect samples:
  • Sputum cytology: Thick fluid (sputum) is coughed up from the lungs. The lab checks samples of sputum for cancer cells.
  • Thoracentesis: The doctor uses a long needle to remove fluid (pleural fluid) from the chest. The lab checks the fluid for cancer cells.
  • Bronchoscopy: The doctor inserts a thin, lighted tube (a bronchoscope) through the nose or mouth into the lung. This allows an exam of the lungs and the air passages that lead to them. The doctor may take a sample of cells with a needle, brush, or other tool.
  • Fine-needle aspiration: The doctor uses a thin needle to remove tissue or fluid from the lung or lymph node. Sometimes the doctor uses a CT scan or other imaging method to guide the needle to a lung tumor or lymph node.
  • Thoracoscopy: The surgeon makes several small incisions in your chest and back. The surgeon looks at the lungs and nearby tissues with a thin, lighted tube. If an abnormal area is seen, a biopsy to check for cancer cells may be needed.
  • Thoracotomy: The surgeon opens the chest with a long incision. Lymph nodes and other tissue may be removed.
  • Mediastinoscopy: The surgeon makes an incision at the top of the breastbone. A thin, lighted tube is used to see inside the chest. The surgeon may take tissue and lymph node samples.

Staging

To plan the best treatment, the doctor needs to know the type of lung cancer and the stage (extent) of the disease. Staging is the process of finding out whether the cancer has spread, and if so, to what parts of the body.

Staging can involve several tests:

• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show a tumor, abnormal fluid, swollen lymph nodes, or if the cancer has spread to other parts of the body.
• Bone scan: Doctors inject a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner finds and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
• Magnetic resonance imaging (MRI): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
• PET scan: Doctors use a PET scan to find cancer that has spread. The patient receives a small amount of radioactive sugar by injection. A machine makes computerized pictures of the sugar being used by cells in the body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.

Stages of Lung Cancer

Small cell lung cancer has two stages:

• Limited stage: Cancer is found only in one lung and its nearby tissues.
• Extensive stage: Cancer is found in tissues of the chest outside of the lung in which it began, or cancer is found in distant organs.

Non-small cell lung cancer stages are based on the size of the lung tumor and whether cancer has spread to the lymph nodes or other tissues.

• Occult stage: Lung cancer cells are found in sputum or in a watery fluid from the lungs collected during bronchoscopy, but a tumor cannot be seen in the lung.
• Stage 0: Cancer cells are found only in the lining of the lung.
• Stage IA: The lung tumor has grown through the lining of the lung into nearby tissue. The tumor is no more than 3 centimeters across. Cancer cells are not found in nearby lymph nodes.
• Stage IB: The tumor is larger or has grown deeper, but cancer cells are not found in nearby lymph nodes.
• Stage IIA: The tumor is no more than 3 centimeters across, but cancer cells are found in nearby lymph nodes.
• Stage IIB: The tumor has invaded deeper into nearby tissues, or cancer cells are found in nearby lymph nodes.
• Stage IIIA: The tumor may be any size, and cancer cells are found in the lymph nodes near the lungs.
• Stage IIIB: The tumor may be any size, and cancer cells have spread to other areas of the chest and neck.
• Stage IV: Malignant growths may be found in more than one lobe of the same lung or in the other lung. Or cancer cells may be found in other parts of the body such as the brain, adrenal gland, liver, or bone.

Treatment

At Huntsman Cancer Institute, lung cancer is treated by a team of specialists, including surgeons, medical oncologists, radiation oncologists, nurses, social workers, dietitians, and other professionals.

Lung cancer treatment options include the following:

• Surgery
• Radiation therapy
• Targeted therapy
• Laser therapy
• Photodynamic therapy
• Cryosurgery
• Electrocautery
• Chemotherapy
• Clinical trials

A patient may receive more than one type of treatment. The treatment that's right for each patient depends on the type and stage of the cancer.

Small cell lung cancer

People with limited stage small cell lung cancer usually have radiation therapy and chemotherapy. For a very small lung tumor, a person may have surgery and chemotherapy. Most people with extensive stage small cell lung cancer are treated with chemotherapy only.

Non-small cell lung cancer

People with non-small cell lung cancer may have surgery, chemotherapy, radiation therapy, or a combination of treatments. The treatment choices are different for each stage. Some people with advanced cancer receive targeted therapy.

Surgery

This treatment removes the tissue that contains the tumor. Sometimes the surgeon also removes nearby lymph nodes. Types of surgery include the following:

• Wedge resection or segmentectomy: The surgeon removes the tumor and a small part of the lung.
• Lobectomy or sleeve lobectomy: The surgeon removes a lobe of the lung. This is the most common surgery for lung cancer.
• Pneumonectomy: The surgeon removes the entire lung.

Radiation therapy

This treatment uses high-energy rays to kill cancer cells. It affects cells only in the treated area. You may receive external radiation, which is the most common type of radiation therapy for lung cancer. The radiation comes from a large machine outside your body.

Targeted therapy

This treatment uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapy being used in the treatment of non-small cell lung cancer.

Laser therapy

This treatment uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Photodynamic therapy

This treatment uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiber optic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs.

Cryosurgery

This is a treatment that uses an instrument to freeze and destroy cancer cells.

Electrocautery

This treatment uses a probe or needle heated by an electric current to destroy abnormal tissue.

Chemotherapy

This treatment uses drugs that enter the bloodstream and destroy or control cancer throughout the body. Learn more about this treatment in our introduction to chemotherapy video.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.