What are the lungs?
The lungs are two organs in the chest that are responsible for breathing. They move oxygen from the air into the blood and carbon dioxide from the blood out of the body into the air. The lungs are divided into sections called lobes. There are three lobes in the right lung and two lobes in the left lung. A thin lining called the pleura surrounds the lobes. Air flows through your windpipe to the lung’s many tubes to help you breathe.
What is Non-Small Cell Lung Cancer?
Non-small cell lung cancer is the most common form of lung cancer. In the United States, 85 percent of lung cancers are non-small cell lung cancers (NSCLC).
There are three major types of NSCLC:
- Accounts for about 40 percent of all lung cancers in the United States.
- Is the most common lung cancer diagnosed in women
- Usually starts in cells that make mucus near the outer edges of the lungs
- May occur in those with a history of smoking, but is the type most often found in those who never smoked
Squamous cell carcinoma
- Represents about 30 percent of NSCLC cases in the United States
- Usually starts in the thin, flat cells in the lung's airways
- Is strongly associated with smoking
Large cell carcinoma
- Accounts for about 5 to 10 percent of all lung cancers in the United States
- May start in any part of the lung
- Is often the diagnosis when other types of lung cancer have been ruled out
Risk Factors, Symptoms and Screening
A risk factor is something that increases your chances of developing a disease. Research has found these risk factors for lung cancer:
- History of Smoking – Smoking harms the lungs and may lead to cancer. People who smoke more cigarettes or smoke for more years have a higher risk. Smokers and former smokers with high lifetime exposure may eligible for lung cancer screening in the form of low-dose CT scan. Talk with your doctor about current guidelines for screening and the process.
- Exposure to secondhand Smoke – People who have had regular exposure to secondhand smoke are at high risk. Exposure can come from living or working in a place where people smoke.
- Age - The risk of developing cancer increases as you get older. Most people are over 65 when diagnosed with lung cancer.
- Environment - Exposure to high levels of certain natural gases and chemicals such as radon, uranium, arsenic, bischloromethyl ether, asbestos, chromium, nickel, soot, tar and other substances can cause lung cancer.
- Personal or Family History – If you had lung cancer before, you have a greater risk of having it again. Radiation treatment to the chest also can increase your risk. Your risk may be higher if your parents, siblings, or children have had lung cancer. Talk with your doctor about your family's history of cancer and how it might affect your risk.
Lung cancer screening (in the form of a CT scan) is recommended for high-risk groups and significantly reduces the risk of dying from lung cancer. The U.S. Services Task Force recommends screening for people ages 55-80 who:
- Currently smoke
- Previously smoked and have quit within the last 15 years
- Have a history of more than 30 pack years (e.g. 1 pack-per day for 30 years or 2 packs per day for 15 years)
If you are considering screening for lung cancer, talk to your doctor so you have a clear understanding of the process.
Your doctor may use several different tests to determine if you have lung cancer, what type, and where it has spread. They include:
Physical exam – The exam will include questions about your medical history and any symptoms, such as cough, pain, or shortness of breath. Your doctor will listen to your breathing, check for swollen lymph nodes in or near the neck or collarbones, and feel your liver and stomach area for swelling or masses.
Imaging (scans) - Scans provide a picture of the lungs and other areas. They are used to look for tumors or abnormal cells. They help determine the extent or spread of the cancer. Common ones include:
- Chest x-ray – This is likely to be used first but does not provide as clear a picture as other scans.
- CT scan and MRI - CT (computed tomography) and MRI (magnetic resonance imaging) use computers to produce detailed, 3-D images. These images help diagnose lung cancer by determining the size, shape, and location of a tumor.
- PET scan - PET (positron emission tomography) uses a sugar substance and special camera to see if and where cancer has spread.
Samples of tissue, blood, or mucus – A sample of tissue or fluid will be needed to confirm cancer and identify its type and stage. There are many ways to obtain a sample. Common ones include:
- Needle biopsy - A small piece of tissue is removed and looked at under a microscope. This may be taken from the lung or a part of the body where the cancer has spread.
- Sputum cytology - A sample of sputum (mucus produced by a cough) is collected and looked at under a microscope.
- Thoracentesis - If there is fluid build-up around the lungs (called pleural effusion), a doctor can use a needle to remove some of the fluid. This can help you breathe better by expanding your lungs. A sample of the fluid can be sent to a lab to be tested for cancer cells.
- Bronchoscopy - A bronchoscope (a thin, lighted tube) is used to view the airways into the lungs and to collect tissue samples. Local anesthesia and mild sedation are generally used.
- Navigational bronchoscopy - This new technology uses a bronchoscope to provide a 3-D virtual “roadmap.” It is used to biopsy hard-to-reach parts of the lungs.
- Liquid biopsy - This new technology helps detect tumor DNA in your blood. It is still being studied and is best not used alone (without other types of biopsy) because it is not as sensitive as other types of biopsies.
Biomarker Testing - A complete lung cancer diagnosis also may include tests of the blood, tumor tissue, or cough mucous for biomarkers. Biomarkers are features of your tumor cells that can be measured. The results of these tests will guide treatment planning. A positive biomarker test may mean more treatment options. If you have advanced or recurrent NSCLC, ask to have your tumor tested for biomarkers. If your hospital is unable to do this, ask if your doctor can send your sample out for testing.
Staging is used to find out whether the cancer has spread, and if so, to which parts of the body. It is a vital part of treatment planning. The American Joint Committee on Cancer’s TNM staging system is used to collect information on the tumor (T), the lymph nodes involved (N) and metastasis or how the cancer has spread (M). Doctors match what they learn into one of several distinct groups, also known as stages, to help guide treatment.
Your doctor will recommend the treatment type and approach based on your cancer’s stage. Non-small cell lung cancer has the following stages:
STAGE 0 (Carcinoma in situ)
- This very early stage is marked by abnormal cells only in the air passages.
STAGES IA & IB (1A & 1B)
- The tumor is small and cancer has not spread to the lymph nodes.
- In Stage IA, the tumor is 3 cm or less. In Stage IB, the tumor is between 3 and 4 cm.
STAGES IIA & IIB (2A & 2B)
- In Stage IIA, the tumor is between 4 and 5 cm. It has not spread to the lymph nodes.
- In IIB, the tumor is smaller than 5 cm and cancer has spread to the lymph nodes on the same side of the chest as the tumor.
- The tumor may be larger than 5 cm but has not spread to the lymph nodes.
STAGES IIIA, IIIB, & IIIC (3A, 3B, & 3C)
- Cancer has spread to the lymph nodes. It has not spread to other parts of the body.
- The tumor may be bigger or the cancer may be in an area that is harder to reach than cancers in earlier stages. Stages IIIB and IIIC are often treated more like Stage IV cancers.
STAGE IV (4)
- Cancer has spread beyond one lung. It is in the other lung, the fluid near the lungs (the pleura) or heart (pericardium), or another part of the body. When it spreads, lung cancer often moves to the brain, bones, liver, kidneys, or adrenal glands.
If your cancer spreads to the bone, visit our bone metastases page.
There are many possible treatments for non-small cell lung cancer. They work in different ways and have different side effects. Be sure to ask about the side effects before you start treatment. Your treatment options will depend upon the stage of your lung cancer. They may include:
If your cancer has not spread to other tissues, your doctor may recommend surgery to remove the tumor. The following surgical procedures may be used:
- Wedge or segmental resection – Surgery to remove a small part of the lung
- Segmentectomy – Surgery to remove one or more segments of the lung
- Lobectomy – Surgery to remove an entire section (lobe) of the lung
- Bilobectomy – Surgery to remove two lobes in the same lung
- Pneumonectomy – Surgery to remove an entire lung
- Thoracotomy – Surgical approach in which a cut is made across the chest and the ribs are spread apart so that the surgeon can reach the lung
- Video-assisted thoracic surgery (VATS) – Surgical approach that uses a tiny video camera to guide the surgeon, making a smaller cut to reduce recovery time
- Robotic Surgery – Surgical approach that uses a machine with remote-controlled robotic arms and miniature instruments, making a smaller cut to reduce recovery time.
Chemotherapy (chemo) uses drugs to destroy cancer cells anywhere in your body. These drugs can also harm healthy cells, causing side effects such as hair loss. Chemo can be used to shrink tumors, slow cancer’s growth, relieve symptoms, or help people live longer. Many different chemo drugs are approved to treat NSCLC. Talk to your doctor about your options.
Immunotherapy works by making the immune system stronger so it can fight cancer better. These drugs are effective in treating some lung cancers. Ask your doctor if immunotherapy could be right for you.
Radiation uses high-energy rays to kill cancer cells. It works by damaging the genetic material in cells. After radiation treatment ends, cancer cells can keep dying for days or even months. Ask about different kinds of radiation, such as photons, protons, CyberKnife, GammaKnife, and others.
Targeted therapies work by blocking the action of certain genes, proteins, or molecules that cause cancer to grow and spread. These drugs destroy cancer cells with less harm to healthy cells. They are only used on tumors that test positive for their targets. Your doctor will need to test your tumor for biomarkers to find out if targeted therapy is right for you. Several lung cancer biomarkers have matching FDA-approved treatments. If you have advanced or recurrent lung cancer, ask to have your tumor tested.
Other targeted drugs stop angiogenesis. This is the process by which the tumor makes new blood vessels. These drugs are also known as VEGF inhibitors. They may be used to treat advanced NSCLC. No biomarker test is needed. They are most often given along with another treatment.
Radiofrequency ablation (RFA) uses heat made by radio waves to kill cancer cells. Cryotherapy uses freezing to do the same thing. Either approach may be used in people with early-stage NSCLC who can’t have surgery. These treatments involve a small probe (like a needle) that goes through the chest and directly into the tumor.
As you consider your options, be sure to ask about clinical trials. Clinical trials are research studies. They are used to test new treatments or learn how to use current treatments better. Today’s treatments were developed in yesterday’s clinical trials. Today’s clinical trials may become tomorrow’s standard treatments.
Lung cancer treatment is a very active area of research. Trials are generally available for each stage and type of lung cancer. Every individual may not be eligible for a given trial. Ask if a clinical trial might be right for you.
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