Lung Cancer
You can live for a while without food, water or shelter. But you always need to breathe.
If you’ve recently been told you might have lung cancer, you may be among the almost a quarter million Americans who’ll be diagnosed this
year. You need medical professionals who will help you control your condition and guide you on the path to recovery.
You need the personalized, leading edge care you’ll get from the medical specialists at Abrazo Central Campus’
lung cancer diagnostic and treatment program. You will never be alone; our doctors, nurses and other health care personnel will partner with you to fight your disease.
Our care includes conventional treatments and supportive therapies
that can give you a chance to breathe freely, beat your cancer and be as healthy as possible.
What is Lung Cancer?
There are two major types of lung cancer. It’s important to know which one you have, because they behave differently and different treatment options are available.
- Non-Small Cell Lung Cancer – By far the most common type of lung cancer, this accounts for more than 80 percent of all lung cancer cases. It usually grows slowly and often has few symptoms until it’s far advanced. It includes three subtypes with different rates of development and treatments.
- Small Cell Lung Cancer – About 10 to 15 percent of lung cancers are this type that grows quickly and spreads rapidly to lymph nodes and other areas. It is also called “oat cell” cancer due to the appearance of its cells under a microscope.
Almost any cancer, including the three types of lung cancer above, can become metastatic and spread throughout the body when cancer cells break away from a tumor and travel through the blood or the lymph system. Because early stages of lung cancer do not have symptoms, it is common for lung cancer to metastasize before it is diagnosed.
Medical Specialists for You
When you come to us, our attentive and experienced cancer healthcare professionals will meet with you and, if you want, close family members or friends to:
- Learn about your medical history and risk factors
- Understand your symptoms
- Plan your screening, tests and treatments
Cancer care is their job – and they’re committed to your progress.
Specialists Who Understand Your Condition, Your Needs
Cancer is complicated. Did you know that just as no two people are the same, no two cancers are exactly alike?
Our physicians, nurses and clinicians know your treatment has to be as unique as you are.
Working Together
You’ll have ongoing access to your team so you get your test results, understand your diagnosis and are part of developing your treatment plan that will be designed to best meet your individual needs.
Our healthcare professionals will
be there to facilitate your treatment every step of the way.
Making It As Easy as Possible
You can get your screening, diagnostic procedures, surgical and other care on our Abrazo Central Campus. If you need additional procedures, our medical professionals will facilitate every step with you so that appointments and services are smooth and seamless.
Support for You and Your Family
You are never alone. Cancer is a very big deal that not only affects you, but your whole family and other loved ones. Our compassionate cancer care physicians, nurses and technicians will be there for all of you.
Lung Cancer Resources
There is a spectrum of tests, ranging from simple to sophisticated, that medical professionals use to detect lung cancer. Your primary care provider or medical specialist can discuss the tests he or she thinks will best identify your condition.
If you meet certain criteria as high risk and you have no symptoms of lung cancer, federal guidelines recommend you be screened for lung cancer with a low-dose CT scan. This screening is covered by most insurance plans and Medicare. High risk is defined as people who are:
- Aged 55 through 80
- 30 “Pack Year” Smokers or Ex-Smokers – People who smoked the equivalent of a pack of cigarettes daily for 30 years.
- Current Smokers or those who quit smoking within the past 15 years.
Are you Eligible for a Screening?
You are eligible for a screening if you are at “high risk”. Federal guidelines recommend you be screened with low-dose CT scan if you are:
- Age 55 through 80 (age 55 through 77 for Medicare)
- Have no signs or symptoms of lung cancer
- Smoked at least a pack of cigarettes daily for 30 years
- Are a current smoker or quit within the past 15 years
Below are quick descriptions of common diagnostic tests that are frequently used determine whether lung cancer exists and to identify what kind of cancer it may be.
Sputum cytology
Samples of mucus (sputum) you cough up from your lungs, preferably early in the morning, three days in a row, is examined under a microscope to see if it contains cancer cells.
Chest x-ray
This is often the first, easiest and least expensive test for lung cancer and may be done at imaging centers, hospitals or even in some doctors’ offices.
CT or Low-Dose CT Scans
CT scans of the chest provide cross-sectional and more detailed images than chest x-rays. They are better at finding small abnormal areas in the lungs. Low-dose CT uses less radiation than standard chest CTs and does not require use of intravenous contrast dye.
EBUS
The latest ultrasound procedure to create clearer and more accurate imaging is in use at the Abrazo Central Campus and Abrazo West Campus. Our endobronchial ultrasound (EBUS) allows your pulmonologist to take samples for biopsy, and diagnose lung cancer, infections and other diseases causing enlarged lymph nodes in the chest.
Thoracentesis
Especially if you are having trouble breathing, your medical specialist may do a procedure to remove excess fluid from the pleural space between your lungs and your chest wall. This can help you breathe more easily, and samples of the fluid can be tested for cancerous cells.
Bronchoscopy
A medical specialist called a pulmonologist can visually examine the inner surfaces of the airways in your lungs by passing a tiny camera on a long thin tube called a bronchoscope down your throat and into the airways of your lungs. A small hollow needle on the end of the bronchoscope can get a sample of suspicious tissue to be biopsied in the pathology lab.
PET Scan
Cancer cells inside your lungs may be identified with a sophisticated medical imaging system called positron emission tomography, or a PET scan.
Small Cell Lung Cancer accounts for less than 20 percent of lung cancers, but it grows quickly and spreads rapidly to lymph nodes and other areas of the body. Small Cell Lung Cancer is often called “oat cell” cancer, due to the appearance of its cells under a microscope.
Risk Factors for Small Cell Lung Cancer
Genetics
People with immediate family members (parents, brothers, sisters) who have had cancer may be more likely to get the disease.
Tobacco
Smoking (cigarettes, cigars and pipes) is recognized as the leading cause of Small Cell Lung Cancer. Second-hand smoke (being exposed regularly to someone else who smokes) increases the risk of developing lung cancer.
Exposure to asbestos or other pollutants in the air
Exposure to asbestos in the workplace can increase Small Cell Lung Cancer risks, especially for miners and workers in mills, shipyards and construction.
Industrial exposure
Breathing chemicals or minerals such as arsenic, chromium, nickel, soot or tar and/or other workplace chemicals over time may increase lung cancer risk.
Radon
A colorless, odorless radioactive gas prevalent in certain areas of the country where uranium exists in the soil or rocks, radon poses a serious risk and is the leading cause of lung cancer among non-smokers.
Prior cancer treatment
People who have had radiation therapy to the chest are at higher risk for Small Cell Lung Cancer, particularly if they smoke.
Symptoms of Small Cell Lung Cancer
Small Cell Lung Cancers often grow slowly for a long time before symptoms develop, but tumors may grow large enough to interfere with air passageways. Common symptoms that eventually develop include:
- A persistent cough.
- Coughing up blood or rust-colored spit or phlegm.
- Chest pain, especially pain that is often worse with deep breathing, coughing, or laughing.
- Shortness of breath, painful breathing, or noisy breathing (called stridor).
- Feeling fatigued, tired or weak; needing to nap frequently or for extended periods.
- Unexplained loss of appetite and unintended loss of weight.
- Frequent upper respiratory infections such as bronchitis and pneumonia that don’t go away or keep coming back.
- Hoarseness, a chronic raspy or ragged quality to speech, or new onset of wheezing.
- Symptoms of Advanced-Stage Small Cell Lung Cancer include:
- Headaches or dizziness
- Jaundice
- Weakness or numbness in your limbs.
- Lumps in the neck or collar bone area.
Stages of Small Cell Lung Cancer
Small Cell Lung Cancer often starts in the bronchi and quickly grows and spreads to other parts of the body, including the lymph nodes. It is classified in two ways:
Limited Stage
The cancer is found in one lung, sometimes including nearby lymph nodes.
Extensive Stage
The cancer has spread to the other lung, to the fluid around the lung (pleura) and/or to other organs.
By far the most common type of lung cancer, this accounts for more than 80 percent of all lung cancer cases. It usually grows slowly and often has few symptoms until it’s far advanced.
Subtypes of Non-Small Cell Lung Cancer
Squamous Cell
Almost a third of non-small cell lung cancers are this subtype that often begin in the flat cells that line the inside of the airways in the lungs. They tend to be found in the central part of the lungs where the trachea (windpipe) joins the primary bronchi (the main airway branches).
Adenocarcinoma
This type, accounting for about 40 percent of lung cancers, is usually found in the outer parts of the lung. It tends to grow more slowly than other types of lung cancer, is more common in women than in men and is more likely to occur in younger people. While it occurs most commonly in smokers or ex-smokers, it is the most common lung cancer seen in non-smokers.
Large cell (undifferentiated) carcinoma
Only a little over 10 percent of lung cancers are this type that can appear in any part of the lungs. Unlike the other types of Non-Small Cell Lung Cancer, undifferentiated carcinomas tend to grow and spread quickly.
Risk Factors for Non-Small Cell Lung Cancer
Genetics
People with immediate family members (parents, brothers, sisters) who have had cancer may be more likely to get the disease.
Tobacco
Smoking (cigarettes, cigars and pipes) is recognized as the leading cause of Non-Small Cell Lung Cancer. Both second-hand smoke (being exposed regularly to someone else who smokes) and the use of smoke-free tobacco products increase the risk of developing lung cancer.
Exposure to asbestos or other pollutants in the air
Exposure to asbestos in the workplace can increase Non-Small Cell Lung Cancer risks, especially for miners and workers in mills, shipyards and construction.
Industrial exposure
Breathing chemicals or minerals such as arsenic, chromium, nickel, soot or tar and/or other workplace chemicals over time may increase lung cancer risk.
Radon
A colorless, odorless radioactive gas prevalent in certain areas of the country where uranium exists in the soil or rocks, radon poses a serious risk and is the leading cause of lung cancer among non-smokers.
Prior cancer treatment
People who have had radiation therapy to the chest are at higher risk for lung cancer, particularly if they smoke.
Symptoms of Non-Small Cell Lung Cancer
Non-Small Cell Lung Cancers often grow slowly for a long time before symptoms develop, but tumors may grow large enough to interfere with air passageways.
Common symptoms that eventually develop include:
- A persistent cough, especially without a known cause, that does not go away, becomes chronic, or gets worse and causes pain.
- Coughing up blood or rust-colored spit or phlegm.
- Shortness of breath, painful breathing, or noisy breathing (called stridor).
- Chest pain, especially pain that is often worse with deep breathing, coughing, or laughing.
- Feeling fatigued, tired or weak; needing to nap frequently or for extended periods.
- Frequent upper respiratory infections such as bronchitis and pneumonia that don’t go away or keep coming back.
- Hoarseness, a chronic raspy or ragged quality to speech, or new onset of wheezing.
- Bone pain
Stages of Non-Small Cell Lung Cancer
Stages are the levels of cancer development. Non-Small Cell Lung Cancer staging uses the TNM system of factors:
- Tumor (T) describes the size of the original tumor.
- Lymph Node (N) indicates whether the cancer has spread to the lymph nodes.
- Metastasis (M) refers to whether cancer has spread to other parts of the body.
A number or the letter X is assigned to each factor with higher numbers indicating increasing severity. The letter X means information could not be assessed.
Stages are assigned once the TNM scores have been set:
Occult stage
Cancer cells are found in sputum, but not in the lung with imaging or bronchoscopy.
Stage 0
The cancer is tiny, has not spread and is known as carcinoma in situ.
Stage I
Cancer may be present in underlying lung tissue, but lymph nodes are unaffected.
Stage II
Cancer has spread to nearby lymph nodes or into the chest wall.
Stage III
The cancer has spread from the lungs and the lymph nodes to nearby structures and organs, such as the heart, trachea and esophagus.
Stage IV
Cancer has metastasized throughout the body and may now affect the liver, bones or brain.
Cancer can become metastatic and spread throughout the body when cancer cells break away from a tumor and travel through the blood or the lymph system. Because early stages of lung cancer do not have symptoms, it is common for lung cancer to metastasize before it is diagnosed.
Both Small Cell Lung Cancer and Large Cell Carcinoma, a type of Non-Small Cell Lung Cancer, are aggressive and spread more rapidly than the other types of Non-Small Cell Lung Cancer.
Risk Factors for Metastatic Lung Cancer
Tobacco – The amount and rate at which you smoke increases your chances of developing lung cancer. That makes tobacco use the most significant risk factor for metastatic lung cancer.
Symptoms of Metastatic Lung Cancer
Metastatic Lung Cancer symptoms depend on the part of the body to which the cancer has spread, as well as upon its size and location.
If the cancer has spread to the bones, it may cause bone pain, often in the vertebrae (spinal bones) or ribs. It may also cause fractures, constipation or decreased alertness due to high calcium levels in the bloodstream.
If the cancer spreads to the liver, symptoms may include nausea, extreme fatigue, increased abdominal girth, fluid buildup and swelling in the face, arms, neck, feet and/or hands, and yellowing or itchy skin.
If the cancer spreads to the spinal cord or brain, symptoms may include headache, blurred or double vision, difficulty with speech or seizures.
There are a wide variety of treatments for lung cancer that may be conventional, experimental or supportive. The combination of these treatments is what we call integrative care.
The treatments or combination of treatments recommended for you will depend on the specific type and/or subtype of your cancer, the location of your tumor(s), the stage of your cancer’s development and your overall health or other medical conditions.
You may work with our doctors, nurses and other cancer healthcare professionals to develop your personalized treatment plan.
They will facilitate your care and answer your questions as you progress through your cancer-fighting therapies, so you can focus on the one thing that is most important – healing.
Surgery
Surgery can be involved in diagnosing, staging and treating your cancer, and it can relieve pain or other problems related to your cancer. Advances in surgical techniques provide a better chance for optimal outcomes.
Diagnosis
Surgery can help diagnose cancer when a surgeon removes a tiny piece of suspicious tissue (called a sample) and sends it to a pathology laboratory. There the sample can be examined under a microscope and other tests can be performed on it. This is called a biopsy.
Staging
During cancer surgery, the area around the cancer, including lymph nodes and nearby organs, is examined to find out how much cancer has developed and how far it has spread. This information is important because it guides decisions about further treatment.
Curative
When cancer is found in a limited area and it’s likely all of it can be removed, surgery may be the main treatment, although it may still be used with chemotherapy or radiation.
Debulking
When removing an entire tumor would cause too much damage to nearby organs or tissue, a surgeon may remove as much of the cancer as possible and then rely on radiation, chemotherapy or other treatments to treat the remainder of the tumor.
Palliative Procedures
This type of surgery can fix problems that are causing pain or disability. It helps you feel better, but is not designed to cure your cancer.
Radiation Therapy
Radiation therapy is targeted to kill your cancer cells. It can be given from a machine outside the body or from objects put inside the body.
External beam radiation
A machine sends painless high-energy beams aimed directly at the tumor and some of the area around the tumor. Sometimes the radiation passes through your body; with newer technology the radiation can be set to stop at the tumor, which protects tissue behind the tumor.
Internal radiation therapy
A radioactive implant that looks like a wire, a pellet or seeds is surgically implanted adjacent to or even inside the cancer tumor, and the radiation travels only a very short distance.
Chemotherapy
Chemotherapy, often referred to simply as chemo, is the name of the process that uses drugs to work throughout your body to kill cancer cells that may have spread far away from the original site where your cancer started. You may get it at home, in your doctor’s office, in a clinic or in the hospital.
You may get chemo treatments daily, weekly or monthly, but they’re usually given in on-and-off cycles that allow healthy new cells to grow and you to regain your strength.
Chemo usually is given intravenously through a tiny, soft plastic tube called a catheter. Sometimes chemo can be given as a pill or through other drug delivery systems.
Because chemo may weaken your immune system, it’s important to practice good hygiene such as hand washing, make sure your vaccinations including flu shots are up to date, and avoid people or pets who are sick.
Your caregivers should be very careful to avoid contact with your body fluids.
Chemotherapy has three goals:
Cure
This is always a goal, not a guarantee. It takes years to know if cancer is really destroyed, gone and unable to come back.
Control
Chemo is used to shrink tumors or stop cancer from growing and spreading. This can help you feel better and live longer. Even if the cancer doesn’t totally go away, it may be controlled and managed as a chronic disease.
Palliation
When cancer is advanced, chemo may be used to shrink a tumor that’s causing pain or pressure and ease your symptoms that interfere with living.
Targeted chemotherapy aims its cell-killing power at the parts of cancer cells that make them different from healthy body cells. It may be used as part of the main treatment or it may be used after traditional treatment ends to keep your cancer under control or to stop it from coming back.
Immunotherapy
Immunotherapy, sometimes called biologic therapy or biotherapy, uses your body’s own immune system to fight cancer.
Your immune system is a collection of organs, special cells and substances that naturally work to protect you from infection and disease. It can also protect you from cancer.
The main types of immunotherapy include:
Monoclonal antibodies
These are man-made versions of immune system proteins that can be designed to attack a very specific part of a cancer cell.
Immune checkpoint inhibitors
These drugs help the immune system recognize and attack cancer cells.
Cancer vaccines
Vaccines start an immune response against disease and some can help prevent or treat cancer.
Other, non-specific immunotherapies
These generally boost the immune system help it attack cancer cells.
Stem Cell Transplants
If your blood-forming stem cells have been damaged or destroyed by chemo or radiation, stem cell transplants can restore your ability to produce your own new stem cells that can grow into red or white blood cells or platelets.
Stem cells may come from you, harvested and stored prior to your radiation or chemo. They may also come from a twin, a blood relative or someone who is not related but whose tissue is compatible with yours.
Hyperthermia
Research has shown that exposure to high temperatures – up to 113 degrees Fahrenheit – can damage or kill cancer cells and thus shrink tumors with minimal injury to normal tissue.
Hyperthermia is only available through clinical trials.
Laser Therapy
Laser, the abbreviation for light amplification by stimulated emission of radiation, is unlike ordinary light that has many wavelengths and spreads in all directions.
A laser is focused in a narrow beam that creates a very high-intensity light that can cut through steel or shape diamonds.
Because lasers can focus accurately on tiny areas, they can be used for precise surgical work, cutting through tissue without a scalpel. They can be used to shrink or destroy tumors.
Photodynamic Therapy
Photodynamic Therapy (PDT) uses a drug called a photosensitizing agent that, when exposed to a specific wavelength of light, forms a type of oxygen that kills nearby cells.
Although the photosensitizing agent is carried throughout the body through the bloodstream, it stays in cancer cells longer than in normal cells. With proper timing, PDT kills nearby cancer cells, prevents the tumor from receiving necessary nutrients for it to continue to grow and stimulates your own immune system to fight the cancer cells.
