Lung Cancer
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| Lung cancer usually starts in the airways (bronchi or bronchioles) or small air sacs (alveoli) of your lungs. It can then spread to other organs. |
Lung cancer is one of the most common cancer
worldwide. It’s caused by harmful cells in your lungs growing unchecked.
Treatments include surgery, chemotherapy, immunotherapy, radiation and targeted
drugs. Screening is recommended if you’re at high risk. Advances in treatments
have caused a significant decline in lung cancer deaths in recent years.
There are usually no signs or symptoms in the early stages of lung cancer, but many people with the condition eventually develop symptoms including:
- a persistent cough
- coughing up blood
- persistent breathlessness
- unexplained tiredness and weight loss
- an ache or pain when breathing or coughing
What is lung cancer?
Lung cancer is a
disease caused by uncontrolled cell division in your lungs. Your cells
divide and make more copies of themselves as a part of their normal function.
But sometimes, they get changes (mutations) that cause them to keep making more
of themselves when they shouldn’t. Damaged cells dividing uncontrollably create
masses, or tumors, of tissue that eventually keep your organs from working
properly.
Lung cancer is the name for cancers
that start in your lungs — usually in the airways (bronchi or bronchioles) or small air
sacs (alveoli). Cancers that
start in other places and move to your lungs are usually named for where they
start (your healthcare provider may refer to this as cancer that’s metastatic to your lungs).
Types of lung cancer
Cancer that begins in the lungs is
called primary lung cancer. Cancer that spreads to the lungs from
another place in the body is known as secondary lung cancer. This page is
about primary lung cancer.
There are many cancers that affect
the lungs, but we usually use the term “lung cancer” for two main kinds:
non-small cell lung cancer and small cell lung cancer.
Non-small cell lung cancer (NSCLC)
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. It
accounts for over 80% of lung cancer cases. Common types include adenocarcinoma and
squamous cell carcinoma. Adenosquamous carcinoma and sarcomatoid carcinoma are
two less common types of NSCLC.
Small cell lung cancer (SCLC)
Small cell lung cancer (SCLC) grows more quickly and is harder to treat
than NSCLC. It’s often found as a relatively small lung tumor that’s already
spread to other parts of your body. Specific types of SCLC include small cell
carcinoma (also called oat cell carcinoma) and combined small cell carcinoma.
Other types of cancer in the lungs
Other types of cancer can start in or
around your lungs, including lymphomas (cancer in your lymph nodes), sarcomas (cancer
in your bones or soft tissue) and pleural
mesothelioma (cancer in the lining of your
lungs). These are treated differently and usually aren’t referred to as lung
cancer.
What are the stages of lung cancer?
Cancer is usually staged based on the
size of the initial tumor, how far or deep into the surrounding tissue it goes,
and whether it’s spread to lymph nodes or other organs. Each type of cancer has
its own guidelines for staging.
Lung cancer staging
Each stage has several combinations of size and spread that can fall into that category. For instance, the primary tumor in a Stage III cancer could be smaller than in a Stage II cancer, but other factors put it at a more advanced stage. The general staging for lung cancer is:
- Stage 0 (in-situ): Cancer is in the top lining of the lung or bronchus. It hasn’t spread to other parts of the lung or outside of the lung.
- Stage I: Cancer hasn’t spread outside the lung.
- Stage II: Cancer is larger than Stage I, has spread to lymph nodes inside the lung, or there’s more than one tumor in the same lobe of the lung.
- Stage III: Cancer is larger than Stage II, has spread to nearby lymph nodes or structures or there’s more than one tumor in a different lobe of the same lung.
- Stage IV: Cancer has spread to the other lung, the fluid around the lung, the fluid around the heart or distant organs.
Limited vs. extensive stage
While providers now use stages I
through IV for small cell lung cancer, you might also hear it described as
limited or extensive stage. This is based on whether the area can be treated
with a single radiation field.
- Limited stage SCLC is confined to one lung and can sometimes be in the lymph nodes in the middle of the chest or above the collar bone on the same side.
- Extensive stage SCLC is widespread throughout one lung or has spread to the other lung, lymph nodes on the opposite side of the lung, or to other parts of the body.
What is metastatic lung cancer?
Metastatic lung cancer is cancer that
starts in one lung but spreads to the other lung or to other organs. Metastatic
lung cancer is harder to treat than cancer that hasn’t spread outside of its
original location.
How common is lung cancer?
Lung cancer is the third most common
cancer in the U.S. Health systems report over 200,000 new cases of lung cancer
each year.
SYMPTOMS AND
CAUSES
What are the symptoms of lung cancer?
Most lung cancer symptoms look
similar to other, less serious illnesses. Many people don’t have symptoms until
the disease is advanced, but some people have symptoms in the early stages. For
those who do experience symptoms, it may only be one or a few of these:
- A cough that
doesn’t go away or gets worse over time.
- Trouble
breathing or shortness of breath (dyspnea).
- Chest
pain or discomfort.
- Wheezing.
- Coughing
up blood (hemoptysis).
- Hoarseness.
- Loss of
appetite.
- Unexplained
weight loss.
- Unexplained fatigue (tiredness).
- Shoulder
pain.
- Swelling
in the face, neck, arms or upper chest (superior vena cava syndrome).
- Small
pupil and drooping eyelid in one eye with little or no sweating on that
side of your face (Horner’s syndrome).
What are the first signs of lung
cancer?
A cough or pneumonia that keeps
coming back after treatment can sometimes be an early sign of lung cancer
(though it can also be a sign of less serious conditions). The most common
signs of lung cancer include a persistent or worsening cough, shortness of
breath, chest pain, hoarseness or unexplained weight loss.
Depending on where in your lungs
cancer starts, some of these symptoms can happen early (in stages I or II) but
often they don’t happen until cancer has progressed to later stages. That’s why
it’s important to get screened for lung cancer if you’re at higher risk.
How long can you have lung cancer
without knowing?
Cancer can grow in your body for a
long time — years — before you know it’s there. Lung cancer often doesn’t cause
symptoms in early stages.
What causes lung cancer?
Lung cancer is caused by cells that
keep dividing even though they shouldn’t. While cell division is a normal
process, all cells have a built-in off switch that keeps them from dividing
into more cells (senescence) or causes them to die off (apoptosis) when
necessary. The off switch is triggered when a cell has divided too many times
or has too many changes (mutations).
Cancer cells are normal cells in your
body that have gained mutations that remove the off switch. Cells keep
multiplying, unchecked, and interfere with your normal cells. Cancer cells can
get into your bloodstream or lymph
nodes and move to other places in
your body, spreading the damage.
We’re not sure what causes these
changes that lead to cancer in some people and not others, but certain factors,
including smoking tobacco products, can put you at higher risk for damage to
your cells that can cause lung cancer.
Risk factors for lung cancer
While there are many factors that can
increase your risk of lung cancer, smoking any kind of tobacco products,
including cigarettes, cigars or pipes is the biggest single risk factor.
Experts estimate that 80% of lung cancer deaths are smoking-related.
Other risk factors include:
- Being
exposed to secondhand tobacco smoke.
- Being
exposed to harmful substances, like air pollution, radon, asbestos,
uranium, diesel exhaust, silica, coal products and others.
- Having
previous radiation treatments to your chest (for instance, for breast
cancer or lymphoma).
- Having a
family history of lung cancer.
Does vaping cause lung cancer?
You can inhale a number of substances
when you vape (use a device to inhale a mist of nicotine and flavoring),
including some that are known to cause cancer. Vaping is too new to know all of
its long-term effects, but experts believe that it has the potential to cause
lung damage.
Can you get lung cancer if you don’t
smoke?
While smoking is the leading risk
factor for lung cancer, up to 20% of people diagnosed have never smoked. That’s
why it’s important to talk to your provider about any concerning symptoms.
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DIAGNOSIS
AND TESTS
How is lung cancer diagnosed?
Diagnosing lung cancer can be a
multi-step process. Your first visit to a healthcare provider will usually
involve them listening to your symptoms, asking you about your health history
and performing a physical exam (like listening to your heart and lungs). Since lung
cancer symptoms are similar to many other, more common illnesses, you provider
may start by getting blood tests and a chest
X-ray.
If your provider suspects you could
have lung cancer, your next steps in diagnosis would usually involve more imaging
tests, like a CT scan, and then a biopsy. Other tests include using a PET/CT scan to
see if cancer has spread, and tests of cancerous tissue from a biopsy to help
determine the best kind of treatment.
Does a chest X-ray show lung cancer?
X-rays aren’t as good as CT scans for
showing a tumor in your lungs, especially at earlier stages. Tumors might be
too small to see on an X-ray or can be blocked from view by other structures in
your body (like your ribs). X-rays can’t diagnose lung cancer — they can only
show your provider if there’s something suspicious that they should look into
further.
What tests will be done to diagnose
lung cancer?
Tests your healthcare provider might
order or perform include blood tests, imaging, and biopsies of fluid
or tissue.
Blood tests
Blood tests can’t diagnose cancer on
their own, but can help your provider check how your organs and other parts of
your body are working.
Imaging
Chest X-rays and CT scans give your
provider images that can show changes in your lungs. PET/CT scans are usually
done to evaluate a concerning finding on a CT scan or after a cancer diagnosis
to determine whether cancer has spread.
Biopsy
There are a number of procedures your
provider can use to look more closely at what’s going on inside your chest.
During the same procedures, your provider can take samples of tissue or fluid
(biopsy), which can be studied under a microscope to look for cancer cells and
determine what kind of cancer it is. Samples can also be tested for genetic
changes (mutations) that might affect your treatment.
Procedures used to initially diagnose
lung cancer or learn more about its spread include:
- Needle biopsy. During this procedure, your provider
will use a needle to collect samples of fluid or tissue for testing.
- Bronchoscopy, thoracoscopy or video-assisted
thoracic surgery (VATS). A provider uses these procedures to look at parts of your
lungs and take tissue samples.
- Thoracentesis. A provider uses this procedure
to take a sample of the fluid around your lungs for testing.
- Endobronchial ultrasound or endoscopic
esophageal ultrasound. A provider uses these procedures to look at and biopsy lymph
nodes.
- Mediastinoscopy or mediastinotomy. A provider uses these procedures
to look at and take samples from the area between your lungs
(mediastinum).
Molecular tests
As part of a biopsy, your provider
might have your tissue sample tested for gene changes (mutations) that special
drugs can target as part of your treatment plan. Genes that might have changes
that can be targeted in NSCLC include:
- KRAS.
- EGFR.
- ALK.
- ROS1.
- BRAF.
- RET.
- MET.
- HER2.
- NTRK.
MANAGEMENT
AND TREATMENT
How is lung cancer treated?
Treatments for lung cancer are
designed to get rid of cancer in your body or slow down its growth. Treatments
can remove cancerous cells, help to destroy them or keep them from multiplying
or teach your immune system to fight them. Some therapies are also used to
reduce symptoms and relieve pain. Your treatment will depend on the type of
lung cancer you have, where it is, how far it’s spread and many other factors.
What medications/treatments are used
in lung cancer?
Lung cancer treatments include
surgery, radiofrequency ablation, radiation therapy, chemotherapy, targeted
drug therapy and immunotherapy.
Surgery
NSCLC that hasn’t spread and SCLC
that’s limited to a single tumor can be eligible for surgery. Your surgeon
might remove the tumor and a small amount of healthy tissue around it to make
sure they don’t leave any cancer cells behind. Sometimes they have to remove
all or part of your lung (resection) for the best chance that the cancer won’t come back.
Radiofrequency ablation
NSCLC tumors near the outer edges of
your lungs are sometimes treated with radiofrequency ablation (RFA). RFA uses
high-energy radio waves to heat and destroy cancer cells.
Radiation therapy
Radiation uses high energy beams to kill cancer cells. It can
be used by itself or to help make surgery more effective. Radiation can also be
used as palliative care, to shrink tumors and relieve pain. It’s used in both
NSCLC and SCLC.
Chemotherapy
Chemotherapy is often a combination of multiple medications designed
to stop cancer cells from growing. It can be given before or after surgery or
in combination with other types of medication, like immunotherapy. Chemotherapy
for lung cancer is usually given through an IV.
Targeted drug therapy
In some people with NSCLC, lung
cancer cells have specific changes (mutations) that help the cancer grow.
Special drugs target these mutations to try to slow down or destroy cancer
cells. Other drugs, called angiogenesis
inhibitors, can keep the tumor from creating
new blood vessels, which the cancer cells need to grow.
Immunotherapy
Our bodies usually recognize cells
that are damaged or harmful and destroy them. Cancer has ways to hide from the
immune system to keep from being destroyed. Immunotherapy reveals cancer cells to your immune system so your
own body can fight cancer.
Treatments to ease symptoms
(palliative care)
Some lung cancer treatments are used
to relieve symptoms, like pain and difficulty breathing. These include
therapies to reduce or remove tumors that are blocking airways, and procedures
to remove fluid from around your lungs and keep it from coming back.
Side effects of the treatment
Side effects of lung cancer treatment
depend on the type of treatment. Your provider can tell you what side effects
to expect, and what complications to look out for, for your specific treatment.
|
Chemotherapy |
Immunotherapy |
Radiation |
Surgery |
|
Nausea, vomiting. Diarrhea. Hair loss. Fatigue. Mouth sores. Loss of feeling, weakness
or tingling (neuropathy). |
Fatigue. Itchy
rash. Diarrhea. Nausea,
vomiting. Joint
pain. Complications
(like pneumonitis, colitis, hepatitis and others) can have additional side
effects. |
Shortness
of breath. Cough. Pain. Fatigue. Difficulty
swallowing. Dry,
itchy or red skin. Nausea,
vomiting. |
Shortness
of breath. Chest
wall pain. Cough. Fatigue. |
How do I manage symptoms and side
effects?
Your provider can prescribe
medications to help manage your symptoms or side effects of treatment. A palliative care specialist
or a dietician can help you manage pain or other symptoms and improve your
quality of life while you’re in treatment.
PREVENTION
How can I prevent lung cancer?
Since we don’t know what causes most
cancers for sure, the only preventative measures are focused on reducing your
risk. Some ways to reduce your risk include:
- Don’t
smoke or quit smoking if you do. Your risk of lung cancer starts
coming down within five years of quitting.
- Avoid
second hand smoke and other substances that can harm your lungs.
- Eat a
healthy diet and maintain a weight that’s healthy for you. Some studies
suggest that eating fruits and vegetables (two to six-and-a-half cups per
day) can help reduce your risk of cancer.
- Get
screened for lung cancer if you’re at high risk.
Lung cancer screening
You can increase your chances of
catching cancer in its earliest stages with screening
tests. You’re eligible for lung cancer
screening if you meet all of these requirements:
- You’re
between the ages of 50 and 80.
- You
either currently smoke or have quit smoking within the last 15 years.
- You have
a 20 pack-year smoking history (number of packs of cigarettes per day
times the number of years you smoked).
Ask your provider about the benefits
and risks of yearly screening.
OUTLOOK /
PROGNOSIS
What can I expect if I have lung
cancer?
What to expect after a lung cancer
diagnosis depends on many factors. For some with early stage cancer, your
provider will remove the cancer and you’ll need follow up screenings for
several years. For many others, it’s a process that evolves over time. It may
mean doing one type of treatment until it stops being effective, then moving on
to another type.
Does lung cancer spread quickly?
How fast lung cancer spreads depends
on the type. Of the main types, small cell lung cancer tends to spread faster
than non-small cell lung cancer. By the time lung cancer is found, it may have
already started spreading to lymph nodes or other organs.
Can lung cancer be cured?
Some types of lung cancer can be
considered cured if diagnosed before they spread, though experts don’t often
use the word “cured” to describe cancer. More common terms are “remission” or
“no evidence of disease” (NED). If you’re in remission or NED for five years or
more, you might be considered cured. There’s always a small chance that cancer
cells could come back.
What is the survival rate of lung
cancer?
The survival rate of lung cancer
depends greatly on how far cancer has spread when it’s diagnosed, how it
responds to treatment, your overall health and other factors. For instance, for
small tumors that haven’t spread to the lymph nodes, the survival rates are 90%
for tumors that are smaller than 1 cm, 85% for tumors between 1 and 2 cm, and
80% for tumors between 2 and 3 cm.
The relative five-year survival rate
for lung cancer diagnosed at any stage is 22.9%. The five-year relative
survival rates by how much cancer has spread is:
- 61.2%
(64% for NSCLC, 29% for SCLC) for cancer that’s confined to one lung
(localized).
- 33.5%
(37% for NSCLC, 18% for SCLC) for cancer that’s spread to the lymph nodes
(regional).
- 7% (26%
for NSCLC, 3% for SCLC) for cancer that’s spread to other organs
(distant).
Remember that these numbers don’t
take into account the specific details of your diagnosis and treatment. Thanks
to improvements in detection and treatment, the rates of lung cancer deaths
have been rapidly coming down in recent years.
What do relative survival rates mean?
Your healthcare provider may share
five-year survival rates as a way of explaining how your lung cancer may affect
your health five years after diagnosis. These numbers compare the survival rate
of someone with lung cancer to someone of the same age in the general
population.
LIVING WITH
How do I take care of myself?
Self-care is an important part of
cancer care. Some ways you can take care of yourself while receiving or
recovering from treatment include:
- Bringing
a friend or family member with you to appointments if you can. They can
help you keep track of the information and options your provider gives you.
- Planning
in advance for how you’ll feel in the days following treatment. This might
include asking for extra help, having meals prepared ahead of time or
making sure you have a light schedule.
- Asking
your provider about getting proper nutrition even if you don’t feel well.
Drinking plenty of fluids to stay hydrated. Getting exercise if you can
and as recommended by your provider.
- Having
important phone numbers handy. You may see several providers and it’s
helpful to know who to contact if issues come up.
- Considering
joining a local or online support group. Being around others who’ve been
where you are can help you get perspective and know what to expect.
If you’ve completed treatments,
support and self-care can still play an important part in moving forward. Don’t
hesitate to reach out for help or guidance. Make sure you follow up with your
provider as recommended.
When should I see my healthcare
provider?
Check in with your provider if you
have any symptoms that concern you. If you smoke or used to smoke, ask your
provider about screening for lung cancer.
What
questions should I ask my doctor?
- What are
my treatment options?
- What’s
the best way to take care of myself at home?
- What
will treatment be like?
- What are
my next steps?
- What are
the important numbers for questions or emergencies?
- What
side effects should I call you about?
- When
should I go to the ER?
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