Lung Cancer

Smoking is responsible for nearly 1 in 5 deaths in the United States making it the most preventable cause of premature death in our society and that’s just part of the story. Lung cancer will kill more people than breast, colon and prostate cancers combined. What can you do to avoid lung cancer? Quit smoking, or never start in the first place. Try to avoid being around people who are smoking, and avoid pipes, cigars, and marijuana. E-Cigarettes, also known as ENDS (electronic nicotine delivery systems) or vaping, are now subject to the U.S. Food and Drug Administration. Ingredients must now be listed so consumers know if they are consuming known cancer-causing ingredients.

If you live in an area with radon, a naturally occurring element in soil, consider testing your home. Radon is responsible for 15,000 to 22,000 lung cancer deaths each year. A far smaller risk than cigarette smoke, radon is the #2 cause of lung cancer in the U.S. Radon levels can vary day to day so it’s important to have adequate ventilation in your basement where gases can collect. If you work in an industry where you are exposed to substances known to cause lung cancer including rubber manufacturing, paving, roofing, painting, iron or steel foundry working and others, make sure to use all the proper protective equipment and attire made available by your employer.

Adapted from cancer.org, cancer.gov, Oncolink.org

This information is provided for a better understanding of the disease and does not replace the dialogue you should have with your physician regarding screening and treatment for lung cancer.

Lung Cancer - About

What is the lung?

The lungs are two spongy organs found in the chest. They deliver oxygen to the bloodstream. Take a breath and air moves into the lungs, expanding them, and exposing it to blood that is traveling in small vessels called capillaries. Breathe out and you exhale stuff that you don't need like carbon dioxide. The lungs are specially designed to place blood in close contact with as much air as possible, so their tissues are very delicate. The right lung has three sections called lobes. The left lung has only two lobes. Air comes in through your mouth and nose and then travels down a tube to the lungs called the trachea. The trachea divides into smaller branches called bronchi, and the bronchi keep dividing and dividing like branches on a tree. As the branches get smaller, they are called bronchioles. At the end of the branches, there are little sacs of air called alveoli. The air comes into contact with blood in the alveoli. The lungs are exposed to whatever you breathe in, so any toxic chemicals or pollutants in the air you breathe can get into your body through your lungs.

What is lung cancer?

Lung cancer happens when cells in the lung begin to grow out of control and can then invade nearby tissues or spread throughout the body. Large collections of this out of control tissue are called tumors. Any of the tissues in the lung can become cancer; but most commonly, lung cancer comes from the lining of the bronchi. Lung cancer is not really thought of as a single disease, but rather a collection of several diseases that are characterized by the cell type that makes them up, how they behave, and how they are treated.

Lung cancer is the most common cause of cancer death in the world for both men and women. In the United States alone, about 224,390 people will be diagnosed and 158,080 people will die from lung cancer in 2016. In comparison, fewer people will die this year from colon, breast and prostate cancer combined (the 2nd, 3rd, and 4th most common cancers in the U.S. aside from skin cancer) The five-year survival rate for patients with localized stage small cell lung cancer is 54%. The five-year survival rate for patients with all stages combined is 21%.

 

Lung Cancer, what screening tests are available?

Screening for lung cancer in high-risk populations is now available in the US. A long awaited study has been completed and recommendations put in place. The US Preventive Services Task Force now supports screening with Low-Dose Computed Tomography (LDCT) scanners for people who have a history of heavy smoking or exposure during their lifetime. Screening programs are being put into place in south central Wisconsin. Because Low-Dose CT scans expose the patient to a low level of ionizing radiation, it is recommended only for those 55-80 years of age who have smoked a pack a day for 30 years, or the equivalent in 15 years, and currently smoke or have quit within the last 15 years. LDCT screening for high-risk populations was shown to reduce lung cancer deaths by 20%. Research has shown 2 other clinically available tests, chest x-ray and sputum cytology, to have no benefit.  Talk with your doctor regarding your medical history and to see if screening is right for you.

Lung Cancer, what are the symptoms?

Unfortunately, the early stages of lung cancer may not have any symptoms. As the tumor grows in size, it can produce a variety of symptoms including:

  • cough (especially one that doesn't go away or gets worse in character)
  • chest pain
  • shortness of breath
  • coughing up blood or bloody phlegm
  • new onset hoarseness or wheezing
  • recurrent problems with pneumonia or bronchitis
  • weight loss
  • loss of appetite
  • fatigue
  • bone pain
  • dizziness or double vision
  • numbness or tingling in your arms or legs
  • turning yellow (jaundice)

Many of these symptoms are non-specific, and could represent a variety of different conditions; however, your doctor needs to see you if you have any of these problems. Most patients (85%-90%) who are diagnosed with lung cancer have symptoms that prompt a doctor to order tests to look for a problem. A cough is the most common presenting symptom of lung cancer; however, many long term smokers have a chronic cough, so it is especially important for someone with a chronic cough to see their doctor if their cough changes in character or severity.

How is lung cancer diagnosed?

When a patient at risk for lung cancer has symptoms suggestive of a lung tumor, they will be referred for a chest x-ray or a CT scan (a 3-D x-ray) to better characterize the lesion. If imaging reveals a suspected cancer, your doctors will recommend a biopsy. A CT guided needle biopsy may be employed. A biopsy is the only way to know for sure if you have cancer, because it allows your doctors to get cells that can be examined under a microscope.

Lung Cancer, what are the treatments for lung cancer?

Surgery

Cancers differ. Options typically include one or more treatments, including surgery, chemotherapy, radiation therapy or targeted drug therapy. The purpose of surgery is to remove all of the cancer and a margin of healthy tissue.

Procedures include:
Wedge resection If the tumor is small the surgeon may remove the tumor with a small section of lung along with a margin of healthy tissue.
Segmental Resection is a procedure to remove a larger part of a lung but not an entire lobe.
Lobectomy is the removal of an entire lobe of one lung.
Pneumonectomy the surgical removal of the entire lung.
Patients with diminished lung function due to other diseases may not be candidates for such a surgery. Preoperative pulmonary function tests (PFT's) are used to help predict who is a good candidate for surgery. Other lung cancers are treated with chemotherapy and radiation therapy.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs taken intravenously or orally to kill cancer cells. Chemotherapy is recommended after surgery for some patients. In some it may be used to shrink tumors prior to surgery. And, it is recommended for those patients that are not candidates for surgery or choose not to have surgery. In some cases, it may be used to relieve pain and other symptoms of advanced cancer.

There are many different chemotherapy drugs, and they are often given in combinations. Patients usually go to a clinic for chemotherapy because many of the drugs have to be given through a vein. Different chemotherapy regimens are used with advantages and disadvantages to each. Your medical oncologist will discuss them with you to select the regimen for your cancer and your lifestyle.

Targeted Therapies/Biologic Therapies

Targeted (also called "biologic") therapies are a new class of medications that have been specifically designed to combat precise pathways in cancers whose cells have certain genetic mutations. They can also be given in combination with standard chemotherapy. For more information on targeted therapies talk to your doctor.

Radiation Therapy

Lung cancer patients commonly are treated with radiation therapy. Radiation therapy uses high-energy rays, similar to x-rays, to kill cancer cells. It comes from an external source, and it requires patients to come in 5 days a week for up to 6-8 weeks to a radiation therapy treatment center. The treatment takes just a few minutes, and it is painless.

The use of Radiation Therapy

is often combined with surgery and is important in the treatment of all types of lung cancer.
may be recommended before surgery to shrink a tumor making it easier for the surgeon to remove.
may be used after surgery if there are risk factors that make it likely for a tumor to come back in the chest.
is a treatment for those with a very small early stage tumor and are candidates for stereotactic body radiation therapy or SBRT. Typically completed in one or a few treatments, it may be used in place of surgery.
is used instead of surgery in patients who are not surgical candidates.
is used in palliative care to ease the pain of metastases, stop tumors from bleeding, and prevent airway obstruction.

Radiation is important in reducing the risk of local recurrence of tumors and is often offered in more advanced cases to kill tumor cells that may be living in lymph nodes. Generally, doctors try to limit the amount of radiation that your vital organs get. Your radiation oncologist can answer questions about the utility, process, and side effects of radiation therapy in your particular case.

Follow-up testing

Once a patient has been treated for lung cancer, they need to be closely followed for a recurrence. At first, you will have follow-up visits fairly often. The longer you are free of disease, the less often you will have to go for checkups. Your doctor will tell you when he or she wants follow-up imaging or blood tests. Lung cancer is generally considered an aggressive tumor that often comes back after treatment; thus it is very important that you let your doctor know about any symptoms you are experiencing and that you keep all of your follow-up appointments. Finally, if you haven't yet done it, you need to quit smoking. Remember, it is never too late to get the health benefits of smoking cessation.

Lung Cancer, how do I prevent it?

Many researchers believe that prevention offers the greatest promise at this time for fighting lung cancer. Protect your lungs. Smoking still accounts for an estimated 87% of lung cancer deaths.

Don’t smoke. If you don’t smoke, don’t start. Avoid smoke from others cigarettes, pipes, cigars and vapors.

Quit smoking. If you do smoke you’ll begin to benefit from quitting immediately.

Test your home for Radon, a naturally occurring element in soil, can collect in basements and is dangerous when inhaled over time.

Use the protective gear supplied by your employer if you work in industries known to be cancer causing.

Use protective gear when doing indoor and outdoor home projects where air quality is reduced.

More about prevention

Every smoker is at risk for lung cancer. It is estimated that cigarette smoking causes 87% of all cases of lung cancer, says the American Lung association. The longer you smoke, the more you smoke, and the deeper you inhale the greater the risk. Smoking low tar cigarettes does not prevent you from getting lung cancer. Importantly, if you quit smoking, your risk of getting lung cancer declines. The longer you go without smoking, the greater your risk declines; it is never too late to quit because your risk declines somewhat no matter how long you have been smoking. Smoking also has an affect on people around you. Second-hand smoke, or smoke inhaled when you are near someone smoking, is another risk factor for lung cancer. Second-hand smoke exposure in childhood, adolescence, and adulthood causes cancer. Non-smoking spouses of smokers are 20-30% more likely than spouses of non-smokers to get lung cancer. Even though many people don't inhale them, smoking pipes and cigars is a risk factor for lung cancer as well. The more pipes or cigars you smoke, the more likely you are to get lung cancer. Although it is not as well established as cigarette smoking, smoking marijuana may be a risk factor for getting lung cancer. Both the magnitude and duration of marijuana use seem to be related to your overall risk.

Although smoking cigarettes is by far the most common and important risk factor for getting lung cancer, there are some environmental exposures that increase your risk for lung cancer as well. People who work with asbestos are more likely to get lung cancer; and if they smoke cigarettes too, their risk rises even higher. Asbestos is found in industries like shipbuilding, brake manufacture, insulation/fireproofing, and asbestos mining and production. Other substances that have been associated with lung cancer in workers who are exposed to them on a regular basis include arsenic, chromium, nickel, vinyl chloride, hard metal dusts, talc, uranium, and gasoline and diesel exhaust fumes.

Radon is an invisible, odorless gas that exists naturally in soil. Radon can collect in basements of homes. Exposure to radon has been associated with an increased risk of lung cancer. You can check for radon with detectors available at your hardware store, and getting rid of it involves proper ventilation of basement spaces.

People who have already had lung cancer are at risk for getting it again. A history of interstitial lung disease or tuberculosis (TB) also increases your risk of getting lung cancer. However, it should be stressed that cigarette smoking is far and away the most important and dangerous risk factor for developing lung cancer.

Lung Cancer, why quit smoking?

What in cigarette smoke is harmful?

Cigarette smoke is a complex mixture of chemicals produced by the burning of tobacco and the additives. The smoke contains tar, which is made up of more than 4,000 chemicals, including over 60 known to cause cancer. Some of these substances cause heart and lung diseases, and all of them can be deadly. You might be surprised to know some of the chemicals found in cigarette smoke. They include:

  • cyanide
  • benzene
  • formaldehyde
  • methanol (wood alcohol)
  • acetylene (the fuel used in welding torches)
  • ammonia
  • Cigarette smoke also contains the poisonous gases nitrogen oxide and carbon monoxide. Its main active ingredient is nicotine, an addictive drug.

Can quitting really help a lifelong smoker?

Yes. It is never too late to quit. The sooner smokers quit, the more they can reduce their chances of getting cancer and other diseases. Within minutes of smoking the last cigarette, the body begins to restore itself.

  • 20 minutes After Quitting: Your heart rate and blood pressure drop.
  • 12 hours After Quitting: The carbon monoxide level in your blood drops to normal.
  • 2 weeks to 3 Months After Quitting: Your circulation improves and your lung function increases.
  • 1 to 9 Months After Quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
  • 1 Year After Quitting: The excess risk of coronary heart disease is half that of a smoker's.
  • 5 Years After Quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
  • 10 Years After Quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases.
  • 15 Years After Quitting: The risk of coronary heart disease is that of a nonsmoker's.

Visible and Immediate Rewards of Quitting

Quitting helps stop the damaging effects of tobacco on your appearance, including:
premature wrinkling of the skin

  • premature wrinkling of the skin
  • bad breath
  • stained teeth
  • gum disease
  • bad smelling clothes and hair
  • yellow fingernails

Kicking the tobacco habit offers benefits that you'll notice immediately and some that will develop gradually over time. These rewards can improve your day-to-day life immensely.

  • Food tastes better.
  • Your sense of smell returns to normal.
  • Ordinary activities no longer leave you out of breath (for example, climbing stairs or light housework).

Suppose I smoke for a while and then quit?

Smoking begins to cause damage right away and is highly addictive. Several studies have found nicotine to be as addictive as heroin, cocaine, or alcohol; it’s the most common form of drug addiction in the United States. Therefore, it’s obviously better never to start smoking cigarettes -- and become addicted to nicotine -- than it is to smoke with the thought of quitting later. Like alcohol, heroin, and cocaine, nicotine creates a tolerance in the body, making it hard to quit, but with the right support it can be done.

When an ex-smoker smokes a cigarette, even years after quitting, the body reacts in the same way as when the person was smoking, which can cause the person to want to smoke again. Don't think you can smoke for a short while and quit when you want to; it's seldom that easy.

How do people quit smoking?

Quitting smoking is not easy, and some people try several times before succeeding. There are many ways to quit smoking. For example, some have been successful by stopping "cold turkey," while others might create a plan and use resources such as smart phone apps. There's no single best way to quit. Quitting for good may mean using many methods, including step-by-step manuals, self-help classes or counseling, toll-free telephone-based counseling programs, and/or using medicine (see next question). Smokers may also need to make changes in their daily routine to help them break their smoking habits. For more information, see this Quit Guide and these Quit Smoking Apps.

What is nicotine replacement therapy?

Nicotine replacement therapies (NRTs) are medicines that help decrease or stop a smoker's withdrawal symptoms by providing controlled doses of nicotine without the other harmful chemicals of cigarette smoke. NRTs are available as patches, gums, inhalers, nasal sprays, or lozenges. The US Food and Drug Administration (FDA) has approved all of these products as smoking cessation aids. Patches, gums, and lozenges are available "over-the-counter," while inhalers and nasal sprays require a doctor’s prescription.

These products work by helping smokers control their physical responses as they quit; for best results, smokers should use NRTs in combination with behavioral change programs that are designed to help smokers break their psychological (mental) dependence on cigarettes. For more information on such programs, call the American Cancer Society at 1-800-ACS-2345.

Not everyone can use nicotine replacement therapy. People with certain medical conditions and pregnant women should use it only with a doctor's supervision. It is always a good idea to get your doctor's input and support when you make the decision to quit smoking. Learn more here.

Are there other medicines or vaccines to help smokers quit?

Yes. Some medicines that don't contain nicotine are already approved to help with quitting smoking.

Bupropion (Zyban) is an antidepressant that is FDA approved for helping people quit smoking. This medicine, which does not contain nicotine, is available only with a doctor's prescription. It affects chemicals in the brain that are related to nicotine craving. It can be used alone or together with nicotine replacement.

Newer medicines may help smokers (or former smokers) by stopping them from getting physical pleasure from smoking. The medicines seem to work by stopping nicotine from stimulating the brain, either by blocking the brain receptors that nicotine normally attaches to, or (in the case of the vaccines) preventing it from reaching the brain altogether.

One such medicine, varenicline (Chantix), attaches to nicotine receptors in the brain, reducing the pleasurable effects of smoking and helping to reduce nicotine withdrawal symptoms. Because varenicline is a new drug, there is no research supporting its safety in using it with nicotine replacement products at the same time.

It is unlikely that any of these drugs will work for every person, however, and using different quitting aids at the same time may increase your chances of quitting successfully.

Are You at Risk? 10 Lung Cancer Risk Factors You Should Know

Tobacco. 87% of all lung cancers in the United States are tobacco-related. Quitting smoking helps to reduce that risk.

Secondhand smoke. Exposure to secondhand smoke increases the risk of lung cancer by 20 percent to 30 percent.

Asbestos. When asbestos is inhaled, the fibers can irritate the lung and may eventually cause lung disease. People who smoke and are exposed to asbestos have a higher risk of developing lung cancer. Fortunately, professional protective breathing equipment can reduce the risk of breathing in asbestos fibers for those who work with or around asbestos.

Radon. It’s an odorless gas released by some soil and rocks that contain uranium. Some homes may have high levels of radon, especially on the lower levels, because they are built on soil that naturally contains radon. You can purchase Environmental Protection Agency-approved kits in hardware stores to measure the amount of radon in your home.

Industrial substances.  Arsenic, uranium, beryllium, vinyl chloride, nickel chromates, coal products, mustard gas, chloromethyl ethers, gasoline, and diesel exhaust are known cancer causing substances.

Radiation exposure.  X-rays to the chest area can increase the risk of lung cancer, especially in people who smoke.

Air pollution. Polluted air can contain trace amounts of diesel exhaust, coal products, and other industrial substances known to cause cancer.

Tuberculosis. TB can cause scarring of lung tissue, which can be a risk factor for developing lung cancer.

Genetics. Family history can also play a role in the development of lung cancer.

Military service.  Both veterans and active-duty personnel may have exposures to industrial substances, asbestos bearing materials, and air pollution, as well as tactical chemicals such as Agent Orange.

*FromLungCancer.org, a Program of CancerCare

Lung Cancer - quit smoking links

Want to quit? Need help? Contact one of the following organizations:

American Cancer Society
Telephone: 1-800-ACS-2345 (1-800-227-2345)
www.cancer.org

American Heart Association
Telephone: 1-800-AHA-USA-1 (1-800-242-8721)
www.amhrt.org

American Lung Association
Telephone: 1-800-586-4872 (1-800-LUNG-USA)
www.lungusa.org

National Cancer Institute Cancer Information Service
Telephone: 1-800-4-CANCER (1-800-422-6237)
www.cancer.gov

Centers for Disease Control and Prevention
Office on Smoking & Health
www.cdc.gov/tobacco

Smokefree.gov
(Info on state telephone-based counseling programs)
Telephone: 1-800-QUITNOW (1-800-784-8669)
www.smokefree.gov