LUNG CANCER
 

Lung cancer is cancer that starts in the lungs and usually begins in cells that line the airways.

There are two main types of lung cancer:

  • Non-small cell lung cancer (NSCLC) is the most common type of lung cancer.

  • Small cell lung cancer (SCLC) makes up about 20% of all lung cancer cases.

If the lung cancer is made up of both types, it is called mixed small cell/large cell cancer.

If the cancer started somewhere else in the body and spreads to the lungs, it is called metastatic cancer to the lung.

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CAUSES

  • Smoking (Accounts for 90%)

  • 2nd hand smoke

  • Age>45

  • Exposure to asbestos

  • Exposure to carcinogens

  • Exposure to radon gas

  • Family history of lung cancer

  • High levels of air pollution

  • High levels of arsenic in drinking water

  • Radiation therapy to the lungs

 

SYMPTOMS

Early stages:

  • Chest pain

  • Cough that does not go away

  • Coughing up blood

  • Fatigue

  • Losing weight without trying

  • Loss of appetite

  • Shortness of breath

  • Wheezing

 

In later stages:

  • Bone pain or tenderness

  • Eyelid drooping

  • Facial paralysis

  • Hoarseness or changing voice

  • Joint pain

  • Nail problems

  • Shoulder pain

  • Swallowing difficulty

  • Swelling of the face or arms

  • Weakness

 

It is important to be properly evaluated by your physician to rule out other possible conditions.

 

DIAGNOSIS

A thorough history and physical exam will begin the process.

Tests that may be done to diagnose lung cancer or see if it has spread include:

  • Bone scan:  Imaging used to evaluate any bone involvement with cancer.

  • Chest x-ray:   This test takes a picture of the lungs.  This is one of the earlier tests that may suggest the need for further investigation.

  • CT scan of the chest:  This imaging test is more detailed than the x-ray.

  • MRI of the chest:  This imaging test provides more detail than a CT scan, but generally takes longer to schedule and and to perform.

  • Positron emission tomography (PET) scan:  This imaging test can help to see if cancer has spread.

  • Complete blood count (CBC):  Used to show immune response or other abnormalities.

  • Thoracentesis:  Testing the fluid taken during this test can provide a clue as to whether cancer could be the cause of the fluid build-up.

 

Often a piece of tissue will be extracted for testing, this is called a biopsy.  There are several ways to do this:

  • Bronchoscopy combined with biopsy

  • CT-scan-directed needle biopsy

  • Endoscopic esophageal ultrasound (EUS) with biopsy

  • Mediastinoscopy with biopsy

  • Open lung biopsy

  • Pleural biopsy

 

If the biopsy shows cancer, more imaging tests are done to find out the stage of the cancer. Stage means how big the tumor is and how far it has spread. Staging helps guide treatment and follow-up and gives you an idea of what to expect.

 

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TREATMENT

Treatment depends on several factors including the type and stage of the cancer:

  • Surgery to remove the tumor may be done if it has not spread (metastasized) to other areas of the body.

  • Chemotherapy uses drugs to kill cancerous cells and hinder them from reproducing.

  • Radiation therapy uses radiation and kills cancerous cells.

  • Palliative Care may be warranted if cancer is discovered too late or is very advanced.  This aims to keep the patient comfortable even if still being treated by the above therapies.

These treatments may be used in combination with one another.  Your physician will tailor a treatment plan to your specific needs.