Lung cancer is one of the most common cancers among men and women. More than 200,000 new cases are diagnosed yearly in the United States.
Almost 90% of lung cancers start in the lining of air passages or air sacs. Air passages are tubes called bronchi (main tubes) and bronchioles (smaller tubes). Air sacs (alveoli) are at the ends of the tubes.
For treatment purposes, lung cancer is usually divided into two types: non–small-cell and small-cell. Non-small cell lung cancer can be further subdivided by specific cell type and in stages I, II, III, or IV. Therapy differs for each.
Use of cigarettes, cigars, and pipes is the main cause. Others include exposure to asbestos radon, radiation, and second-hand smoke.
Some people may have no symptoms until cancer is advanced. Others have long-lasting cough, coughing up bloody phlegm, shortness of breath, wheezing, recurrent pneumonia, loss of appetite, and weight loss. Swelling of the face and neck (superior vena cava syndrome) and pain in shoulders, arms, and hands (Pancoast tumor) can occur in some cases.
Early diagnosis can be hard because some people may have no symptoms until cancer is advanced. Low-dose CT scan of the chest can be used to look for lung cancer in people over age 50 who are smokers or have a significant history of smoking. If an abnormality is noted additional tests can be done. The only sure way to diagnose lung cancer is to take and study samples of lung fluid or tissue (biopsy). The doctor gets these by bronchoscopy (inserting a lighted, thin, flexible tube into the lungs), needle aspiration (passing a needle through the chest), or surgery.
After diagnosis, staging is done to find out whether the cancer spread. Early detection is important because only early lung cancers, before spread (metastasis) occurs, can be cured.
For non-small-cell cancer, computed tomography (CT) of the chest and abdomen helps find spread of cancer to other body parts, such as lymph nodes (glands) and liver. A radiology test called positron emission tomography (PET) can also do this. Breathing tests (pulmonary function tests) are done before surgery to help find out whether removal of part of the lung will be tolerated. Surgery for localized cancer offers the best hope for cure. For more advanced disease or people who cannot have surgery, radiation therapy alone or radiation and chemotherapy (drugs) are tried.
For small–cell cancer, CT of the chest, abdomen, and head; PET; and bone marrow biopsy are usually done to look for spread into the brain or bone marrow. Surgery usually cannot cure small-cell lung cancer, so chemotherapy and chemotherapy with radiation therapy are options.
All treatments have complications, including pain and shortness of breath (surgery), tiredness and shortness of breath (radiation); and easy bruising and bleeding, nausea, vomiting, and hair loss (chemotherapy).
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