Lung cancer is the growth of malignant cells in one or both of your lungs.
Types of Lung Cancer
- Small cell is the more aggressive form of lung cancer. It is usually not surgical. In rare cases the surgeons will remove the tumor if the disease is limited.
- Non-small cell lung cancer- squamous cell carcinoma, adenocarcinoma, large cell carcinoma
- Carcinoid (neuroendocrine)- slower growing
Lung cancer often takes many years to develop, which is why you may not experience any symptoms until the disease is in an advanced stage. Common symptoms of lung cancer include:
- Weight loss
- Hemoptysis – coughing blood
- Chest pain
- Worsening shortness of breath
- Non-resolving cough headache
- Voice hoarseness
A risk factor is anything that increases your chances pf developing lung cancer. It is possible to develop lung cancer with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing lung cancer. Risk factors for lung cancer include:
Almost all lung cancer is found in people over the age of 40 years, but it is most common in men after the age of 65 years.
African Americans, both men and women, carry a substantially higher risk of lung cancer than Caucasians.
Nearly 85% of all lung cancers are associated with smoking. Smoking is considered a direct and main cause, especially of small cell cancer. The risk of lung cancer increases with the number of years a person has been smoking and the number of cigarettes they have smoked in their life. Smoking includes other forms of tobacco, such as that which is found in pipes and cigars. Long-term exposure to secondhand smoke also contributes to an increased risk of lung cancer.
Occupational and Environmental Exposure
Exposure to lung irritants such as asbestos, wood smoke, burning coal, mine dust, metals, and paint increase the risk of lung cancer. Long-term or heavy exposure to radon, a naturally occurring radioactive gas that seeps into buildings, is also associated with the development of lung cancer. Even air pollutants from the combustion of diesel fuel and other fossil fuels have been linked to lung cancer.
Those with close family members who have had lung cancer carry a higher risk of developing in themselves. This risk is higher if the relative was 60 years old or younger when they developed it.
Medical Conditions and Treatments
Inflammation, irritation, and scarring that result from the certain medical conditions and treatments can increase your risk of lung cancer. Some examples include:
- Lung diseases, such as Chronic Obstructive Pulmonary Disease (COPD) and Tuberculosis (TB)
- HIV Infections suppress the body’s immune system, causing lung diseases like pneumonia
- Radiation therapy for a previous lung or breast can affect the cells in your lungs
- Multiple endocrine neoplasia is associated with carcinoid tumors
To determine whether you have lung cancer or not, your doctor will perform one or more of the following tests:
- Advanced Imaging scans such as CT Chest, PET/CT, MRI Brain, VQ Scan
- CT Guided-Biopsy- done by IR if the lesion is peripheral and can be reached
- Bronchoscopy/Navigational Bronchoscopy- uses bronchoscope to drive down the airways to biopsy lesion
- Surgical Biopsy (VATS)- if unable to obtain diagnosis, can go straight to surgery including wedge resection, pleural biopsy, lymph node biopsies
- PET/CT- abnormal uptake (SUV, FDG accumulation, uptake) above the mediastinal blood pool (written on the exam)
- EBUS- bronchoscopy with endobronchial ultrasound to biopsy mediastinal lymph nodes
- Mediastinoscopy- surgical biopsy of the mediastinal lymph nodes, a small incision at the base of the neck above the sternum with removal of mediastinal lymph nodes for testing. It is always booked with a bronchoscopy. It is an outpatient procedure if completed by itself.
- The surgeon may choose to include this as the FIRST portion of the procedure
Lung cancer can be diagnosed in different stages:
Stage I- cancer is localized to one area, surgery is the best option for cure if the patient can tolerate resection. Other option is SBRT
Stage II- cancer is in the lesion and may have spread to nearby lymph nodes (within the lobe) or into the chest wall. Surgical resection is recommended
Stage III- lymph node involvement in center of the chest. Defer to surgeon recommendation. Sometimes neoadjuvant chemo/rad first, sometimes definitive treatment
Stage IV- spread to distant lymph nodes, pleura (including pleural effusion), other lung or other organs (not surgical-definitive treatment)
*There are rare cases that advanced stage will have surgery, this is up to the discretion of the surgeon and treating oncologist.
Lung Cancer is typically treated using a combination of surgery, radiation, and chemotherapy. In its early stages, surgery is often a viable option for treating lung cancer. In its advanced stages, lung cancer is usually treated with radiation and chemotherapy, because surgery is no longer an option.
- Stereotactic Body Radiotherapy (SBRT)- treatment for localized cancer for patients that cannot tolerate resection or do not want surgery. We try to obtain tissue diagnosis before referral. Sometimes the Radiation Oncologists request mediastinal staging with EBUS or mediastinoscopy.
- Definitive chemotherapy and radiation
Types of Surgery:
- Wedge resection - the nodule with a small amount of tissue margin is removed. These are done for metastasectomies (removal of a metastasis from another primary cancer), if patient cannot tolerate lobectomy or wider resection, or if the lesion is found to be benign (ex: granuloma). Type and Screen needed + basic labs if the patient is not going to PAT. Average hospital stay 1-2 days.
- Segmental resection - removes an anatomic segment of a lobe, but not the entire lobe. Type and screen + basic labs. Average hospital stays 1-2 days.
- Lobectomy - removes entire lobe *best oncological outcomes for early stage lung cancer. Type and crossmatch (2 Units of blood for OR) + basic labs. Average hospital stays 2-4 days.
- Sleeve Resection (sleeve lobectomy) - removal of a tumor in the lung and a part of the main bronchus. The ends of the bronchus are rejoined, and remaining lobes are reattached to the bronchus. Type and crossmatch (2 Units of blood for OR) + basic labs
- Bilobectomy - removal of two lobes of the RIGHT lung (left lung only has two lobes). Type and crossmatch (2 Units of blood for OR) + basic labs. Average hospital stays 2-4 days.
- Pneumonectomy - removal of entire lung. These two tests must be completed in addition to the standard workup of PET, PFT, MRI Brain, and biopsy-
- VQ- looking at how much each lobe of the lung is contributing to overall function. Order is under Radiology-> NM VQ Quantitative
- ECHO- pay particular attention to RVSP that can indicate pulmonary hypertension and ejection fraction
- VATS lymph node dissection - mediastinal lymph nodes that are NOT accessible via EBUS or mediastinoscopy may need to be approached from the side (ex: AP window lymph nodes). Average hospital stays 1-2 days.
American Lung Association
The American Lung Association is the oldest voluntary health organization in the United States fighting lung disease in all its forms, with special emphasis on asthma, tobacco control and environmental health. The American Lung Association has many programs and strategies for fighting lung disease.