The most widely used therapies for lung cancer are surgery, chemotherapy, and radiation therapy.

Medical Treatment

Chemotherapy and radiation therapy

• Chemotherapy and radiation may lead to a cure in a small number of patients. These therapies result in shrinking of the tumor and are known to prolong life for extended periods in most patients.
• Chemotherapy and radiation are very effective at relieving symptoms.
• Inoperable NSCLCs are treated with chemotherapy or a combination of chemotherapy and radiation.
• If SCLC is in an early stage (confined to the thorax), the standard of care is chemotherapy and radiation therapy given at the same time.
• In later stages (spread outside of the thorax), SCLC is treated with chemotherapy and palliative radiation therapy to areas where metastases may be present.
• The brain is sometimes treated with radiation even if no tumor is present there. Called prophylactic cranial irradiation (PCI), this therapy may prevent a tumor from forming. PCI is not suitable for all patients, however, and side effects may occur.
• Limited SCLC (has not spread outside the chest cavity) has an 80%-90% rate of response to combination chemotherapy and radiation therapy. Remission (no cancer detected by physical examination or x-ray studies) occurs in 50%-60% of cases.
• Of all cases of advanced-stage lung cancer (spread outside the chest cavity), approximately 50%-60% of SCLC and 15%-40% of NSCLC will go in to remission with chemotherapy.
• If relapse occurs, a different type of chemotherapy regimen may offer symptom relief and modest survival benefit.
• Even with an initially favorable response to treatment, SCLC tends to relapse within one to two years in most patients, particularly in those with extensive disease.
• Recent research has shown benefits of adjuvant chemotherapy in early stage NSCLC in preventing or delaying recurrence of the tumor, even after surgery that is felt to be successful at removing cancer.
• Chemotherapy uses chemicals that travel through the bloodstream. It affects both cancerous and healthy cells. This accounts for the many well-known side effects of chemotherapy, including nausea and vomiting, hair loss, skin problems, mouth sores, and fatigue.
• Radiation therapy does not affect cells throughout the body the way chemotherapy does. However, it does affect healthy tissues overlying or directly adjacent to the tumor. To a certain extent, the side effects of radiation depend on which part of the body is targeted with radiation.
• Based on recent clinical trial data, chemotherapy has been found to be beneficial for all stages of non-small cell lung cancer, including stage I or II. People with lung cancer should be referred to an oncologist for discussion of options.

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Upon hearing about the symptoms, a health-care provider will formulate a list of possible diagnoses. He or she will ask questions about the symptoms, medical and surgical history, smoking and work history, and other questions about lifestyle, overall health, and medications.

Unless severe hemoptysis is occurring, a chest x-ray will most likely be performed first to look for a cause of the respiratory symptoms.

• The x-ray film may or may not show an abnormality.
• Types of abnormalities seen in lung cancer include a small nodule or nodules or a large mass.
• Not all abnormalities observed on a chest x-ray are cancers. For example, some people develop scarring and calcium deposits in their lungs that may look like tumors on a chest x-ray film.

In most cases, a CT scan or MRI of the chest will further define the problem.

• If symptoms are severe, the x-ray may be skipped and a CT scan or MRI may be performed right away.
• The advantages of CT scan and MRI are that they show much greater detail than x-rays and are able to show the lungs in three dimensions.
• These tests help determine the stage of the cancer by showing the size of the tumor or tumors.
• They can also help identify spread of the cancer into nearby lymph nodes or certain other organs.

If a person’s chest x-ray film or scan suggests that a tumor is present, he or she will undergo a procedure for diagnosis.

• This procedure involves collection of sputum, removal of a small piece of the tumor tissue (biopsy) or a small volume of fluid from the sac around the lung.
• The retrieved cells are reviewed under a microscope by a doctor who specializes in diagnosing diseases by looking at cell and tissue types (a pathologist).
• Several different ways exist to obtain these cells.

Sputum testing: This is a simple test that is sometimes performed to detect cancer in the lungs.

• Sputum is thick mucus that may be produced during a cough.
• Cells in the sputum can be examined to see if they are cancerous. This is called cytologic review.
• This is not a completely reliable test. If negative, the findings usually need to be confirmed by further testing.

Bronchoscopy: This is an endoscopic test, meaning that a thin, flexible, lighted tube with a tiny camera on the end is used to view organs inside the body.

• Bronchoscopy is endoscopy of the lungs. The bronchoscope is inserted through the mouth or nose and down the windpipe. From there, the tube can be inserted into the airways (bronchi) of the lungs.
• A tiny camera transmits images back to a video monitor.
• The physician operating the bronchoscope can look for tumors and collect samples of any suspected tumors.
• Bronchoscopy can usually be used to determine the extent of the tumor.
• The procedure is uncomfortable. A local anesthetic is administered to the mouth and throat as well as sedation to make bronchoscopy tolerable.
• Bronchoscopy has some risks and requires a specialist proficient in performing the procedure.

Needle biopsy: If a tumor is on the periphery of the lung, it usually cannot be seen with bronchoscopy. Instead, a biopsy is taken through a needle inserted through the chest wall and into the tumor.

• Typically, a chest x-ray or CT scanning is used to guide the needle.
• This procedure is safe and effective in obtaining sufficient tissue for diagnosis. After the chest surface is cleaned and prepared, the skin and the chest wall are numbed.
• The most serious risk with this procedure is that the needle puncture may cause an air leak from the lung (pneumothorax). This air leak occurs in as many as 3%-5% of cases. Although this condition can be dangerous, it is almost always recognized and treated without serious consequences.

Thoracentesis: Lung cancers, both primary and metastatic, can cause fluid to collect in the sac surrounding the lung. This fluid is called a pleural effusion.

• The fluid usually contains cells from the cancer.
• Sampling this fluid can confirm the presence of cancer in the lungs.
• The fluid sample is removed by a needle in a procedure similar to needle biopsy.
• Thoracentesis can be important for both staging and diagnosis of the condition.

Thoracotomy: Sometimes a lung cancer tumor cannot be reached by bronchoscopy or needle procedures.

• In these cases, the only way to obtain a biopsy is by performing an operation.
• The chest is opened (thoracotomy), and as much of the tumor as possible is removed surgically. The removed tumor is then examined microscopically.
• Unfortunately, this operation may not be successful in removing all tumor cells if the tumor is large or has spread to the lymph nodes outside of the lungs.
• Thoracotomy is a major operation that is performed in a hospital.

Mediastinoscopy: This is another endoscopic procedure. It is performed to determine the extent that the cancer has spread into the area of the chest between the lungs (the mediastinum).

• A small incision is made into the lower part of the neck, above the breastbone (sternum). A variation is to make the incision in the chest.
• A mediastinoscope is inserted behind the breastbone.
• Samples of the lymph nodes are taken to evaluate for cancer cells.
• Mediastinoscopy is a very important step to determine whether the tumor can be surgically removed or not.

Other tests: Other tests are performed to stage the tumor and to assess a person’s ability to withstand surgery and other treatment.

• Pulmonary function tests assess breathing capacity.
• Blood tests are performed to identify any chemical imbalances, blood disorders, or other problems that might complicate treatment.
• CT scans or MRIs may be performed on the most common areas of spread to check for metastatic disease. These tests are generally performed only if symptoms occur that suggest metastatic disease. Certain treatment protocols require that these tests be performed.
• A bone scan can determine whether the cancer has spread to the bones.

Staging: Staging is a method of classifying the tumor for purposes of treatment planning.

• Staging is based on size of the tumor, location of the tumor, and degree of metastasis of the tumor (if any).
• The treatment will be individually tailored to the tumor stage.
• Tumor stage is related to the outlook for cure and survival (prognosis). The higher the tumor stage, the less likely the disease will be cured.

By : http://www.emedicinehealth.com

See a health-care provider as soon as possible if any of the following develop:

• any symptom of lung cancer,
• new cough or change in an existing cough,
• hemoptysis (flecks of blood in the sputum when coughing),
• unexplained weight loss,
• unexplained persistent fatigue, or
• unexplained deep aches or pains.

Go immediately to the nearest hospital emergency department if any of the following occur:

• coughing up a large amount of blood,
• sudden shortness of breath,
• sudden weakness,
• sudden vision problems, or
• persistent chest pain.

• Cigarette smoke contains more than 4,000 chemicals, many of which have been identified as causing cancer.
• A person who smokes more than one pack of cigarettes per day has a risk of developing lung cancer 20-25 times greater than someone who has never smoked.
• Once a person quits smoking, his or her risk for lung cancer gradually decreases. About 15 years after quitting, the risk for lung cancer decreases to the level of someone who never smoked.
• Cigar and pipe smoking increases the risk of lung cancer but not as much as smoking cigarettes.

About 90% of lung cancers arise due to tobacco use. The risk of developing lung cancer is related to the following factors:

• the number of cigarettes smoked,
• the age at which a person started smoking, and
• how long a person has smoked (or had smoked before quitting).

Other causes of lung cancer include the following:

• Passive smoking, or secondhand smoke, presents another risk for lung cancer. An estimated 3,000 lung cancer deaths occur each year in the U.S. that are attributable to passive smoking.
• Air pollution from motor vehicles, factories, and other sources probably increase the risk for lung cancer, and many experts believe that prolonged exposure to polluted air is similar to prolonged exposure to passive smoking in terms of risk for developing lung cancer.
• Asbestos exposure increases the risk of lung cancer by nine times. A combination of asbestos exposure and cigarette smoking raises the risk to as much as 50 times. Another cancer known as mesothelioma (a type of cancer of the pleura or of the lining of the abdominal cavity called the peritoneum) is also strongly associated with exposure to asbestos.
• Lung diseases, such as tuberculosis (TB) and chronic obstructive pulmonary disease (COPD), also create a risk for lung cancer. A person with COPD has a four to six times greater risk of lung cancer even when the effect of cigarette smoking is excluded.
• Radon exposure poses another risk.
  • Radon is a by-product of naturally occurring radium, which is a product of uranium.
  • Radon is present in indoor and outdoor air.
  • The risk for lung cancer increases with significant long-term exposure to radon, although no one knows the exact risk. An estimated 12% of lung cancer deaths are attributable to radon gas, or 15,000 to 22,000 lung cancer-related deaths annually in the U.S. Radon gas is the second leading cause of lung cancer in the U.S. As with asbestos exposure, smoking greatly increases the risk of lung cancer with radon exposure.
• Certain occupations where exposure to arsenic, chromium, nickel, aromatic hydrocarbons, and ethers occurs may increase the risk of lung cancer.
• A person who has had lung cancer is more likely to develop a second lung cancer than the average person is to develop a first lung cancer.

SOURCE : http://www.emedicinehealth.com/lung_cancer/page2_em.htm

Lung cancer is the leading cause of cancer deaths in both women and men in the United States and throughout the world. Lung cancer has surpassed breast cancer as the leading cause of cancer deaths in women. In the United States in 2007, 160,390 people were projected to die from lung cancer, which is more than the number of deaths from colorectal, breast, and prostate cancer combined. Only about 2% of those diagnosed with lung cancer that has spread to other areas of the body are alive five years after the diagnosis, although the survival rates for lung cancers diagnosed at a very early stage are higher, with approximately 49% surviving for five years or longer.

Cancer occurs when normal cells undergo a transformation that causes them to grow and multiply without the normal controls. The cells form a mass or tumor that differs from the surrounding tissues from which it arises. Tumors are dangerous because they take oxygen, nutrients, and space from healthy cells.

Most lung tumors are malignant. This means that they invade and destroy the healthy tissues around them and can spread throughout the body.

• The tumors can also spread to nearby lymph nodes or through the bloodstream to other organs. This process is called metastasis.
• When lung cancer metastasizes, the tumor in the lung is called the primary tumor, and the tumors in other parts of the body are called secondary tumors or metastatic tumors.

Some lung tumors are metastatic from cancers elsewhere in the body. The lungs are a common site for metastasis. If this is the case, the cancer is not considered to be lung cancer. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer (a secondary cancer) in the lung and is not called lung cancer.

Lung cancers are usually divided into two main groups that account for about 95% of all cases.

• The division into groups is based on the type of cells that make up the cancer.
• The two main types of lung cancer are characterized by the cell size of the tumor when viewed under the microscope. They are called small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC includes several subtypes of tumors.
• SCLCs are less common, but they grow more quickly and are more likely to metastasize than NSCLCs. Often, SCLCs have already spread to other parts of the body when the cancer is diagnosed.
• About 5% of lung cancers are of rare cell types, including carcinoid tumor, lymphoma, and others.

The specific types of primary lung cancers are as follows:

• Adenocarcinoma (an NSCLC) is the most common type of lung cancer, making up 30%-40% of all cases. A subtype of adenocarcinoma is called bronchoalveolar cell carcinoma, which creates a pneumonia-like appearance on chest x-rays.
• Squamous cell carcinoma (an NSCLC) is the second most common type of lung cancer, making up about 30% of all lung cancers.
• Large cell cancer (another NSCLC) makes up 10% of all cases.
• SCLC makes up 20% of all cases.
• Carcinoid tumors account for 1% of all cases.

SOURCE : http://www.emedicinehealth.com/lung_cancer/article_em.htm

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 want to stop in order to reduce your risk of lung cancer, make an appointment with your doctor. Your doctor can recommend strategies for quitting, such as counseling, medications and nicotine replacement products.

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