Lung Cancer | NSCLC

Understanding Lung Cancer Find the information you need to understand your disease — what it is, how to diagnose and treat it, and how to keep it from coming back. Being informed is the first step to empowering yourself!

What is lung cancer? Lung cancer is a type of cancer that starts in the lungs. Like all our cells, lung cells normally grow and multiply when the body needs to replace aging and damaged cells. When this process malfunctions, cell growth gets out of control, producing tumors and tissue masses that can be either malignant (cancerous) or benign (noncancerous).

Did you know?

When lung cancer cells spread to other parts of the body, the new tumors they form there are made of lung cells. So, even if this new tumor is in the liver, bones, or brain, it will still be called a lung cancer.

How common is lung cancer? One in 16 people in the U.S. will be diagnosed with lung cancer in their lifetime. More than 235,000 people in the U.S. will be diagnosed with lung cancer this year, with a new diagnosis every 2.2 minutes. Lung cancer is a major disease in many countries worldwide, especially in countries with high pollution and where smoking rates are higher. Nearly 65% of all new lung cancer diagnoses are among people who have never smoked or are former smokers. About 12% of new lung cancer cases are among never-smokers.

What are the types of lung cancer? The two main types of lung cancer are small cell lung cancer & non-small cell lung cancer. Non-small cell lung cancer is far more common, making up 80-85% of lung cancer cases, according to the American Cancer Society. Small cell lung cancer makes up the remaining 10-15% of cases. These two types of lung cancer require very different treatment approaches. The types of lung cancer are named for the kinds of cells found in the cancer and how they look under a microscope. Other kinds of lung tumors include : Metastatic lung cancer Metastatic tumors in the lungs Lung mass/nodules

What is non-small cell lung cancer? Most cases of lung cancer are classified as non-small cell lung cancers (NSCLC). There are three main subtypes : Adenocarcinoma: Occurs in the outer region of the lung, in glands that secrete mucus and help us breathe. Squamous Cell: Occurs on the central part of the lung, nearby or within the two main tubes that bring air into the lungs. Large Cell: Occurs anywhere in the lungs - grows and spreads quickly.

What is Small Cell Lung Cancer?

About 10-15% of all lung cancers are small cell lung cancer (SCLC), which is sometimes called oat cell cancer. This type of lung cancer tends to grow and spread faster than non-small cell lung cancer (NSCLC). About 70% of people with SCLC have cancer that has already spread at the time they are diagnosed. This cancer initially responds to chemotherapy and radiation therapy, but unfortunately, the cancer eventually returns in most people.

Not all tumorous growths in the lungs are necessarily cancerous. A lung mass, also called a nodule, is a small abnormal area that can be found during a 3D X-ray or Computed Tomography (CT) scan of the chest. These scans are often done as part of lung cancer screening. Most lung nodules seen on CT scans are not cancer. Sometimes, they’re the result of old infections or scar tissue. As a result, additional tests are often needed to be sure a nodule is not cancer.

Many people have small masses of tissue in their lungs. These small masses are called nodules. A nodule may have been found in your lung by chance.

Since there are very few nerves in your lungs, nodules often don’t cause symptoms. They are often found by chance on X-rays for an unrelated health problem. On X-rays, nodules may be called spots or shadows. Nodules can be caused by cancer, infections, scar tissue, or other health conditions. Most nodules are not cancer, but it takes a team of experts to determine if a nodule is cancer.

To decide if a nodule is cancer your doctors may:

Assess your risk for lung cancer Review images for signs of cancer Perform follow-up imaging Perform a procedure called a needle biopsy

Next: Symptoms, Risk Factors, & Prevention >>

Three things to lower your risk of lung cancer

1. Don’t smoke 2. Avoid secondhand smoke 3. Get your home tested for radon

Risk factors Smoking causes the majority of lung cancers in both smokers and people exposed to secondhand smoke, but it does not cause all cases of lung cancer. The exact cause is not always clear when a person who does not smoke is diagnosed with lung cancer.

Stopping your smoking habit is important. When you do, studies have shown it can: Increase your lifespan even if the cancer has spread. Lower the chances of getting another lung cancer. Lower the high risk of getting other cancers and other diseases. If you want more information about smoking cessation, talk to your doctor or call the
American Cancer Society at 800-227-2345. City of Hope’s C31 Cessation Program

Symptoms may not be present in the early stages of lung cancer, but can include:

Shortness of breath
Chest pain
Swollen lymph nodes
Repeated lung infections
Coughing up blood
Wheezing
Sudden weight loss
Tiredness
Others

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The American Cancer Society’s lung cancer screening guidelines recommend yearly low-dose computed tomography (LDCT) scans for people at higher risk of lung cancer who have the following characteristics: Those age 50 to 80 and in fairly good health Current smokers or people who quit smoking within the past 15 years Those with a smoking history equivalent to smoking a pack a day for 20 years, also known as 20 pack-years Current smokers who take part in smoking cessation counseling Those who have been involved in shared decision-making about the potential benefits, limitations and harms associated with LDCT scans People with access to a high-volume, high-quality lung cancer screening and treatment centers

Screenings are tests that look for cancer even when there are no symptoms or family history of the disease. Doctors recommend screenings to find cancer in its earliest stages when treatment may work better. Keep exploring this page to understand how lung cancer is detected through screenings.

While regular chest X-rays can be used to screen people at higher risk for lung cancer, they haven’t been shown to help most people live longer, and so are not recommended for lung cancer screening. Recently, a test known as a low-dose computed tomography (LDCT) scan has been studied in people at higher risk of getting lung cancer. LDCT scans, which produce 3D images, can help find abnormal areas in the lungs that may be cancerous. Unlike chest X-rays, yearly LDCT scans to screen people at higher risk of lung cancer can help save lives.

Currently, blood testing cannot detect lung cancer. However, the U.S. Food and Drug Administration has approved several types of liquid biopsies for non-small cell lung cancer. These tests use a blood sample to look for cancer cells and genetic changes in a tumor, which may help guide and personalize treatment.

In this procedure, a doctor removes a small piece of lung tissue to be checked by a pathologist for cancer or other diseases. The tissue may be removed in the following ways: By using a bronchoscope, a thin, lighted, tube-like instrument that is inserted through the throat and into the lung By using a fine needle inserted through the chest wall With video assisted surgery, where a tube called an endoscope is used to insert a tiny video camera and surgical instruments into the chest wall Through open biopsy, where a doctor makes an incision between the ribs, removes a sample of lung tissue and closes the incision with stitches

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What happens when I get diagnosed?

The process to diagnose lung cancer differs from person to person. A biopsy is required to get a diagnosis. Your medical team will choose tests based on the following: 1. Your medical history 2. Your symptoms 3. Physical exam 4. Test and imaging result findingsHere is a Worksheet to List Your Questions For Your Doctor

How is lung cancer staged? The stage of a cancer tells you how big it is and how much it has spread. Knowing the stage helps your doctor decide which treatment you need. Your scans and tests will give some information about the stage of your cancer. TNM stands for Tumor, Node, Metastasis. Doctors use the TNM system to create a number staging system. T How large is the main TUMOR and has it spread nearby? N Has the cancer spread to nearby lymph NODES? M Has the cancer METASTASIZED and spread to another part of the body?

What are the stages of non-small cell lung cancer?

For additional information regarding staging, please click here.

Your care team may include the following experts Meet City of Hope’s Lung Cancer Team

Click on any doctor below to learn more.

Make an appointment with City of Hope’s multidisciplinary lung cancer team

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What is survivorship?

Survivorship is defined as living with, through, and beyond cancer. The effects of the disease and its treatment change the lives of every survivor. It can be challenging to return to everyday life like it was before diagnosis. Some of the resources here can help you prepare for and navigate your way through life after cancer. Questions to ask about living with cancer

Here are a few tips to take control of your life with and beyond cancer: Follow-Up Visits In people with no signs of cancer remaining, many doctors recommend follow-up visits (which may include computed tomography scans and blood tests) about every three months for the first couple of years after treatment, about every six months for the next several years, then at least yearly after five years. Some doctors may advise different follow-up schedules. If you have completed treatment, your doctors will still want to watch you closely. It’s very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems and may do exams and lab tests or imaging tests to look for signs of cancer returning or treatment side effects. Long-term side effects Almost any cancer treatment can have side effects. Some might only last for a few days or weeks, but others might last a long time. Some side effects might not even show up until years after you have finished treatment. Your doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have. For all lung cancer survivors, it's important to let your doctor know about any new symptoms or problems because they could be caused by the cancer coming back, a second cancer, or a new disease. Maintain your medical records At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.

How do you make your survivorship care plan?

When you finish treatment, your health care team prepares a survivorship care plan. This personalized document contains diagnosis and treatment information to help you and your doctors manage your health. Many people need follow-up tests and scans to check for cancer. Others also need additional therapy to make sure cancer doesn’t return. Talk with your doctor about developing a survivorship care plan for you. This plan might include: A suggested schedule for follow-up exams and tests A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor A schedule for other tests you might need to look for long-term health effects from your cancer or its treatment Suggestions for things you can do that might improve your health and possibly lower your chances of the cancer coming back

What should you do if the cancer comes back?

If your lung cancer returns, your medical team will suggest a treatment plan based on the location of the tumor, treatments you’ve already received, and your overall health. Options to control the cancer include surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy or a combination of these treatments. What to do if the cancer is back

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