Lung Cancer
Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs, typically originating in the cells lining the air passages. The two main types are non-small cell lung cancer (about 85% of cases) and small cell lung cancer (about 15%), which differ in how they grow and spread, and how they are treated. Lung cancer is the leading cause of cancer deaths worldwide, largely because it is often diagnosed at an advanced stage. While smoking is the primary risk factor, responsible for about 80-90% of cases, lung cancer can also occur in non-smokers due to exposure to radon, asbestos, air pollution, or genetic factors. Early detection through screening in high-risk individuals and advances in treatment have improved outcomes for many patients.
Causes
- Tobacco smoking - The primary risk factor, responsible for 80-90% of lung cancer cases. Risk increases with the number of cigarettes smoked per day and the number of years of smoking.
- Secondhand smoke exposure - Living or working with smokers increases lung cancer risk by 20-30% in non-smokers.
- Radon gas - A naturally occurring radioactive gas that can accumulate in homes and buildings, radon is the second leading cause of lung cancer and the primary cause in non-smokers.
- Occupational exposures - Carcinogens in the workplace, including asbestos, arsenic, chromium, nickel, and diesel exhaust, can increase risk, particularly in combination with smoking.
- Air pollution - Outdoor air pollution, particularly fine particulates, is classified as carcinogenic and linked to increased lung cancer risk.
- Previous radiation therapy - Radiation therapy to the chest for other cancers increases lung cancer risk, especially in combination with smoking.
- Family history - Having a parent or sibling with lung cancer increases risk, suggesting genetic factors or shared exposures.
- Personal history of lung disease - Chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and tuberculosis are associated with increased lung cancer risk.
- Genetic factors - Certain inherited genetic mutations may increase susceptibility, particularly in non-smokers who develop lung cancer.
- Age - Lung cancer risk increases with age, with most cases diagnosed in people over 65.
Signs and Symptoms
- Persistent cough - A cough that doesn't go away or worsens over time
- Coughing up blood (hemoptysis) - Even small amounts of blood in sputum
- Shortness of breath - Difficulty breathing, especially with activity
- Chest pain - That worsens with deep breathing, coughing, or laughing
- Hoarseness - Persistent changes in voice
- Unexplained weight loss - Losing weight without trying
- Bone pain - Particularly in the back, hips, or ribs if cancer has spread to bones
- Headache - Persistent headaches may indicate spread to the brain
- Chronic fatigue - Feeling unusually tired or weak
- Recurrent respiratory infections - Such as bronchitis or pneumonia
- Wheezing - A whistling sound when breathing
- Many people with early lung cancer have no symptoms, which is why screening is important for high-risk individuals
Diagnosis
Imaging Studies
Initial detection often begins with a chest X-ray showing an abnormality, followed by more detailed imaging. CT (computed tomography) scans provide detailed cross-sectional images of the lungs and can detect smaller lesions than X-rays. PET (positron emission tomography) scans use radioactive glucose to identify actively growing cancer cells and help determine if cancer has spread. MRI may be used to evaluate specific areas, particularly the brain or spine if spread is suspected.
Sputum Cytology
Analysis of mucus coughed up from the lungs (sputum) under a microscope to check for cancer cells. This is most useful for cancers that begin in the major airways, though it has lower sensitivity than other tests.
Biopsy Procedures
Definitive diagnosis requires examination of tissue samples. Methods include bronchoscopy (inserting a thin tube through the nose or mouth to view airways and obtain samples), needle biopsy (guided by CT imaging to sample lung nodules), thoracentesis (removing fluid from around the lungs for analysis), or surgical procedures like mediastinoscopy or thoracoscopy for more extensive sampling.
Molecular Testing
Analysis of cancer cells for specific gene mutations or proteins that can guide treatment decisions. This includes testing for mutations in genes like EGFR, ALK, ROS1, BRAF, and NTRK, as well as PD-L1 expression levels. Results help determine eligibility for targeted therapies or immunotherapy.
Staging Procedures
Once cancer is diagnosed, additional tests determine the extent of spread (staging). These may include mediastinal lymph node evaluation through mediastinoscopy or endobronchial ultrasound (EBUS), brain MRI, bone scans, or additional PET-CT imaging. Complete staging is crucial for treatment planning.
Pulmonary Function Tests
These evaluate lung capacity and function to determine if a patient can safely undergo lung surgery if that is being considered as a treatment option.
Treatment Options
Surgery
For early-stage non-small cell lung cancer, surgical removal of the tumor and surrounding tissue offers the best chance for cure. Procedures range from removal of a small segment of lung (segmentectomy), a lobe (lobectomy), or an entire lung (pneumonectomy), depending on tumor size and location. Minimally invasive approaches like video-assisted thoracoscopic surgery (VATS) or robotic-assisted surgery allow for smaller incisions and faster recovery. Surgery is rarely used for small cell lung cancer, which tends to spread early.
Radiation Therapy
Uses high-energy rays to kill cancer cells. External beam radiation delivers radiation from outside the body, while brachytherapy places radioactive seeds near the tumor. Stereotactic body radiation therapy (SBRT) delivers highly focused radiation in fewer, higher doses and may be an option for early-stage patients who cannot undergo surgery. Radiation may be used as primary treatment, before or after surgery, or to relieve symptoms in advanced disease.
Systemic Therapies
Treatments that travel through the bloodstream to reach cancer cells throughout the body. Chemotherapy uses drugs to kill rapidly dividing cells and is the primary treatment for small cell lung cancer and many stages of non-small cell lung cancer. Targeted therapies attack specific abnormalities in cancer cells and are used for tumors with certain genetic mutations (EGFR, ALK, ROS1, etc.). Immunotherapy helps the immune system recognize and attack cancer cells and has revolutionized treatment of many lung cancers.
Multimodality Approach
Many patients receive combinations of treatments. Neoadjuvant therapy (given before surgery) may reduce tumor size and eliminate micrometastases. Adjuvant therapy (given after surgery) aims to kill any remaining cancer cells. Chemoradiation combines chemotherapy and radiation simultaneously for enhanced effect. Treatment plans are individualized based on cancer type, stage, molecular features, and patient factors like overall health and preferences.
Home Remedies
Smoking Cessation
If you smoke, quitting is the most important step you can take, even after diagnosis. Continued smoking can interfere with treatment effectiveness, increase side effects, and raise the risk of recurrence or second cancers. Ask your healthcare team about smoking cessation programs, medications, and counseling support.
Nutrition During Treatment
Maintain adequate calorie and protein intake to support healing and maintain strength during treatment. Small, frequent meals may be easier to tolerate if appetite is poor. Stay hydrated and consider working with a dietitian who specializes in oncology nutrition for personalized advice to manage treatment-related side effects.
Energy Conservation
Prioritize activities, pace yourself, and plan rest periods to manage fatigue. Use assistive devices if needed, and consider activity planning strategies like keeping frequently used items within easy reach. Energy conservation techniques can help maintain independence and quality of life during treatment.
Breathing Exercises
Simple techniques like diaphragmatic breathing, pursed-lip breathing, or guided breathing exercises can help improve lung function, reduce anxiety, and manage shortness of breath. A respiratory therapist can provide personalized guidance on effective breathing techniques.
Stress Management
Relaxation techniques such as meditation, guided imagery, or progressive muscle relaxation can help manage anxiety and improve sleep quality. Support groups, either in-person or online, provide connection with others facing similar challenges. Professional counseling may also be beneficial for coping with the emotional impact of diagnosis and treatment.
Preventive Care
- Avoid tobacco in all forms, as smoking is responsible for the majority of lung cancer cases. If you smoke, quit as soon as possible.
- Avoid secondhand smoke exposure by making your home and vehicle smoke-free and avoiding places where people smoke.
- Test your home for radon, an odorless, colorless gas that is the second leading cause of lung cancer. Radon testing kits are inexpensive and widely available.
- Follow safety guidelines if you work with known carcinogens like asbestos, arsenic, chromium, or nickel to minimize exposure.
- Reduce exposure to air pollution by checking air quality forecasts and limiting outdoor activities during high pollution days.
- Eat a diet rich in fruits and vegetables, which contain antioxidants and other compounds that may help protect lung cells.
- Exercise regularly to improve overall health and lung function.
- If you're at high risk (55-80 years old with a significant smoking history), discuss lung cancer screening with low-dose CT scans with your doctor.
- Get vaccinated against infectious diseases that can damage the lungs, such as influenza and pneumonia.
- Be aware of symptoms that could indicate lung cancer and seek prompt medical attention if they occur, especially if you have risk factors.
Surgical Options
Wedge Resection
A limited procedure that removes a small, wedge-shaped portion of lung containing the tumor and a margin of healthy tissue. This lung-sparing approach may be appropriate for very small, peripheral tumors, particularly in patients with limited lung function who cannot tolerate larger resections. However, it carries a higher risk of local recurrence compared to more extensive surgeries.
Learn More About This ProcedureSegmentectomy
Removes a larger portion of lung than a wedge resection but less than a lobe. The lung is divided into segments based on the branching patterns of airways and blood vessels, and this procedure removes one or more anatomically defined segments containing the tumor. It balances the need to remove the cancer with preserving lung function.
Learn More About This ProcedureLobectomy
The standard surgical procedure for most lung cancers, involving removal of an entire lobe of the lung (the right lung has three lobes, the left has two). This provides the best balance between complete cancer removal and preserving lung function. Nearby lymph nodes are also removed and examined to determine if cancer has spread beyond the lung.
Learn More About This ProcedurePneumonectomy
Removal of an entire lung, performed when the tumor is centrally located or involves the main bronchus or pulmonary artery. This extensive procedure is used only when necessary, as it significantly reduces breathing capacity. Careful preoperative assessment of lung function is essential to ensure the patient can tolerate living with a single lung.
Learn More About This ProcedureMinimally Invasive Approaches
Traditional open thoracotomy involves a large incision and spreading of ribs, but many lung cancer surgeries now use less invasive techniques. Video-assisted thoracoscopic surgery (VATS) uses small incisions and a camera, while robotic-assisted surgery provides enhanced visualization and precision. These approaches typically result in less pain, shorter hospital stays, and faster recovery without compromising cancer outcomes.
Learn More About This ProcedureSchedule a Consultation
If you're experiencing symptoms of lung cancer, our expert team is here to help you find the right treatment approach for your specific needs.