Lung cancer

Lung cancer is a type of cancer that begins in the lungs. Your lungs are two spongy organs in your chest that take in oxygen when you inhale and release carbon dioxide when you exhale.
Lung cancer is the leading cause of cancer deaths in the United States, among both men and women
. Lung cancer claims more lives each year than do colon, prostate, ovarian and breast cancers combined.
People who smoke have the greatest risk of lung cancer. The risk of lung cancer increases with the length of time and number of cigarettes you've smoked. If you quit smoking, even after smoking for many years, you can significantly reduce your chances of developing lung cancer
Symptoms
Lung cancer typically doesn't cause signs and symptoms in its earliest stages. Signs and symptoms of lung cancer typically occur only when the disease is advanced.
Signs and symptoms of lung cancer may include:
• A new cough that doesn't go away
• Changes in a chronic cough or "smoker's cough"
• Coughing up blood, even a small amount
• Shortness of breath
• Chest pain
• Wheezing
• Hoarseness
• Losing weight without trying
• Bone pain
• Headache
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
If you smoke and have been unable to quit, make an appointment with your doctor. Your doctor can recommend strategies for quitting smoking, such as counseling, medications and nicotine replacement products.
Causes
Smoking causes the majority of lung cancers — both in smokers and in people exposed to secondhand smoke. But lung cancer also occurs in people who never smoked and in those who never had prolonged exposure to secondhand smoke. In these cases, there may be no clear cause of lung cancer.
How smoking causes lung cancer
Doctors believe smoking causes lung cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately.
At first your body may be able to repair this damage. But with each repeated exposure, normal cells that line your lungs are increasingly damaged. Over time, the damage causes cells to act abnormally and eventually cancer may develop.
Types of lung cancer
Doctors divide lung cancer into two major types based on the appearance of lung cancer cells under the microscope. Your doctor makes treatment decisions based on which major type of lung cancer you have. The two general types of lung cancer include:
• Small cell lung cancer. Small cell lung cancer occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer.
• Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for several types of lung cancers that behave in a similar way. Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
Risk factors
A number of factors may increase your risk of lung cancer. Some risk factors can be controlled, for instance, by quitting smoking. And other factors can't be controlled, such as your family history. Risk factors for lung cancer include:
• Smoking. Your risk of lung cancer increases with the number of cigarettes you smoke each day and the number of years you have smoked. Quitting at any age can significantly lower your risk of developing lung cancer.
• Exposure to secondhand smoke. Even if you don't smoke, your risk of lung cancer increases if you're exposed to secondhand smoke.
• Exposure to radon gas. Radon is produced by the natural breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Unsafe levels of radon can accumulate in any building, including homes.
Radon testing kits, which can be purchased at home improvement stores, can determine whether levels are safe. If unsafe levels are discovered, remedies are available.
• Exposure to asbestos and other chemicals. Workplace exposure to asbestos and other substances known to cause cancer — such as arsenic, chromium and nickel — also can increase your risk of developing lung cancer, especially if you're a smoker.
• Family history of lung cancer. People with a parent, sibling or child with lung cancer have an increased risk of the disease.

Complications
Lung cancer can cause complications, such as:
• Shortness of breath. People with lung cancer can experience shortness of breath if cancer grows to block the major airways. Lung cancer can also cause fluid to accumulate around the lungs, making it harder for the affected lung to expand fully when you inhale.
• Coughing up blood. Lung cancer can cause bleeding in the airway, which can cause you to cough up blood (hemoptysis). Sometimes bleeding can become severe. Treatments are available to control bleeding.
• Pain. Advanced lung cancer that spreads to the lining of a lung or to another area of the body, such as a bone, can cause pain.
Tell your doctor if you experience pain. Pain may initially be mild and intermittent, but can become constant. Medications, radiation therapy and other treatments may help make you more comfortable.

• Fluid in the chest (pleural effusion). Lung cancer can cause fluid to accumulate in the space that surrounds the affected lung in the chest cavity (pleural space).
Fluid accumulating in the chest can cause shortness of breath. Treatments are available to drain the fluid from your chest and reduce the risk that pleural effusion will occur again.
• Cancer that spreads to other parts of the body (metastasis). Lung cancer often spreads (metastasizes) to other parts of the body, such as the brain and the bones.
Cancer that spreads can cause pain, nausea, headaches, or other signs and symptoms depending on what organ is affected. Once lung cancer has spread to other organs, it's generally not curable. Treatments are available to decrease signs and symptoms and to help you live longer.
Stages of lung cancer
• Stage I. Cancer is limited to the lung and hasn't spread to the lymph nodes. The tumor is generally smaller than 2 inches (5 centimeters) across.
• Stage II. The tumor at this stage may have grown larger than 2 inches, or it may be a smaller tumor that involves nearby structures, such as the chest wall, the diaphragm or the lining around the lungs (pleura). Cancer may also have spread to the nearby lymph nodes.
• Stage III. The tumor at this stage may have grown very large and invaded other organs near the lungs. Or this stage may indicate a smaller tumor accompanied by cancer cells in lymph nodes farther away from the lungs.
• Stage IV. Cancer has spread beyond the affected lung to the other lung or to distant areas of the body.
Small cell lung cancer is sometimes described as being limited or extensive. Limited indicates cancer is limited to one lung. Extensive indicates cancer has spread beyond the one lung.
Treatments and drugs
You and your doctor choose a cancer treatment plan based on a number of factors, such as your overall health, the type and stage of your cancer, and your preferences. Options typically include one or more treatments, including surgery, chemotherapy, radiation therapy or targeted drug therapy.
In some cases you may choose not to undergo treatment. For instance, you may feel that the side effects of treatment will outweigh the potential benefits. When that's the case, your doctor may suggest comfort care to treat only the symptoms the cancer is causing, such as pain or shortness of breath.
Surgery
During surgery your surgeon works to remove the lung cancer and a margin of healthy tissue. Procedures to remove lung cancer include:
• Wedge resection to remove a small section of lung that contains the tumor along with a margin of healthy tissue
• Segmental resection to remove a larger portion of lung, but not an entire lobe
• Lobectomy to remove the entire lobe of one lung
• Pneumonectomy to remove an entire lung
If you undergo surgery, your surgeon may also remove lymph nodes from your chest in order to check them for signs of cancer.
Lung cancer surgery carries risks, including bleeding and infection. Expect to feel short of breath after lung surgery. If a portion of your lung is removed, your remaining lung tissue will expand over time and make it easier to breathe. Your doctor may recommend a respiratory therapist who can guide you through breathing exercises to aid in your recovery.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that you can recover.
Chemotherapy is often used after surgery to kill any cancer cells that may remain. It may also be used before surgery to shrink cancers and make them easier to remove. In some cases, chemotherapy can be used to relieve pain and other symptoms of advanced cancer.
Radiation therapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy can be directed at your lung cancer from outside your body (external beam radiation) or it can be put inside needles, seeds or catheters and placed inside your body near the cancer (brachytherapy).
Radiation therapy can be used after surgery to kill any cancer cells that may remain. It may also be used as the first treatment for lung cancers that can't be removed during surgery. For people with advanced lung cancer, radiation therapy may be used to relieve pain and other symptoms.
For people with lung cancers that are very small, one option may be stereotactic body radiotherapy. This form of radiation aims many beams of radiation from different angles at the lung cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments. In certain cases, it may be used in place of surgery for small tumors.
Targeted drug therapy
Targeted therapies are newer cancer treatments that work by targeting specific abnormalities in cancer cells. Targeted therapy options for treating lung cancer include:

• Bevacizumab (Avastin). Bevacizumab stops a tumor from creating a new blood supply. Blood vessels that connect to tumors can supply oxygen and nutrients to the tumor, allowing it to grow.
Bevacizumab is usually used in combination with chemotherapy and is approved for advanced and recurrent non-small cell lung cancer. Bevacizumab carries a risk of bleeding, blood clots and high blood pressure.

• Erlotinib (Tarceva). Erlotinib blocks chemicals that signal the cancer cells to grow and divide.
Erlotinib is approved for people with advanced and recurrent non-small cell lung cancer that has a specific genetic mutation. Cells taken from your lung cancer will be tested to see whether this medication is likely to help you.
Erlotinib side effects include a skin rash and diarrhea. Smokers are less likely to benefit from erlotinib than are nonsmokers.
Crizotinib (Xalkori). Crizotinib blocks chemicals that allow cancer cells to grow out of control and live longer than normal cells.
Crizotinib is approved for use in people with advanced non-small cell lung cancer whose cancer cells have a particular genetic mutation. A special laboratory test using your cancer cells determines whether your cells have this certain genetic mutation.
Crizotinib side effects include nausea and vision problems, such as double vision or blurred vision.
Clinical trials
Clinical trials are studies of experimental lung cancer treatments. You may be interested in enrolling in a clinical trial if lung cancer treatments aren't working or if your treatment options are limited.
The treatments studied in a clinical trial may be the latest innovations, but they don't guarantee a cure. Carefully weigh your treatment options with your doctor.
Your participation in a clinical trial may help doctors better understand how to treat lung cancer in the future.
Palliative care
People with lung cancer often experience signs and symptoms of the cancer, as well as side effects of treatment. Supportive care, also known as palliative care, is a specialty area of medicine that involves working with a doctor to minimize your signs and symptoms.
Your doctor may recommend that you meet with a palliative care team soon after your diagnosis to ensure that you're comfortable during and after your cancer treatment.
In one study, people with advanced non-small cell lung cancer who began receiving supportive care soon after their diagnosis lived longer than those who continued with treatments, such as chemotherapy and radiation. Those receiving supportive care reported improved mood and quality of life. They survived, on average, almost three months longer than did those receiving standard care.
You may be concerned that receiving palliative care means you can't undergo aggressive treatment for your cancer. But rather than replace curative treatments, palliative care complements your cancer treatment and may make it more likely that you can complete your treatments.
Prevention
There's no sure way to prevent lung cancer, but you can reduce your risk if you:
• Don't smoke. If you've never smoked, don't start. Talk to your children about not smoking so that they can understand how to avoid this major risk factor for lung cancer. Begin conversations about the dangers of smoking with your children early so that they know how to react to peer pressure.
• Stop smoking. Stop smoking now. Quitting reduces your risk of lung cancer, even if you've smoked for years. Talk to your doctor about strategies and stop-smoking aids that can help you quit. Options include nicotine replacement products, medications and support groups.
• Avoid secondhand smoke. If you live or work with a smoker, urge him or her to quit. At the very least, ask him or her to smoke outside. Avoid areas where people smoke, such as bars and restaurants, and seek out smoke-free options.
• Test your home for radon. Have the radon levels in your home checked, especially if you live in an area where radon is known to be a problem. High radon levels can be remedied to make your home safer. For information on radon testing, contact your local department of public health or a local chapter of the American Lung Association.
• Avoid carcinogens at work. Take precautions to protect yourself from exposure to toxic chemicals at work. Follow your employer's precautions. For instance, if you're given a face mask for protection, always wear it. Ask your doctor what more you can do to protect yourself at work. Your risk of lung damage from workplace carcinogens increases if you smoke.
• Eat a diet full of fruits and vegetables. Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Avoid taking large doses of vitamins in pill form, as they may be harmful. For instance, researchers hoping to reduce the risk of lung cancer in heavy smokers gave them beta carotene supplements. Results showed the supplements actually increased the risk of cancer in smokers.
• Exercise most days of the week. If you don't exercise regularly, start out slowly. Try to exercise most days of the week.