Source: Cancer Resource Room

What is Lung Cancer?
The lungs are two large sponge-like organs in the chest. They bring in oxygen and get rid of carbon dioxide. Lung cancer can occur in many age groups, but is rare under 20 years old. The group of cancers that occur in the lungs are the most common cancers in both men and women, with approximately 164,000 new cases each year in the United States alone. Of these, about 80% are called non-small cell lung cancers, and the other 20% are small cell lung cancers; the differences are important in choosing the right cancer treatment for a patient.

All cancers are the result of a group of abnormal cells growing and multiplying without stopping. These abnormal cells can spread to other parts of the body and grow there as well. So lung cancer is the uncontrolled growth of abnormal cells in the lung. To understand why this is a problem, it is important to know what the lungs do and how they do it.

The lungs are specifically for getting oxygen into the blood and getting carbon dioxide out. To do this the tissues of the lung must be very thin and have lots of spaces so air can pass through to the blood. When tumor cells grow they fill up the spaces and block the thin tissues so the air cannot go in or out in that area. As lung cancer develops the abnormal tumor cells cause enough trouble with air exchange so symptoms of illness begin. Because there are many air spaces in the lungs, a tumor can grow for a long time and even spread to other parts of the body before symptoms begin. Therefore, anyone with even the mildest symptoms should be checked for lung cancer, especially if they have a history of exposure to smoke, radon, asbestos, or other known risk factors.

The most common symptoms of lung cancer are:

• Cough or hoarseness from trying to clear air passages blocked by tumor cells
• Pain in the chest, shoulder, or upper back because a tumor can press against the inside of the chest and irritate the chest lining or pleura
• Fatigue and weight loss because the tumor uses up the body's energy
• Repeated lung infections from tumor cells trapping bacteria in the lung spaces
• Coughing up blood which comes from tumor cells breaking down normal lung cells
• Swelling of the neck and face because tumors can press on blood and lymph vessels causing a back-up of fluids

Symptoms from the spread of lung cancer may be the first sign that the disease is present. The most common sites of spread are the bones, brain, and liver. So lung cancer symptoms that come from the bones may include pain or fracture from tumor cells replacing normal bone. Disease that spreads to the brain can cause headaches, confusion, and weakness. The liver is another site for disease spread causing some abnormal blood tests but not often any symptoms.

How are lung cancers diagnosed?
Screening people for early detection of lung cancer has not yet effected the outcome of treating this disease. The reason is that a standard chest Xray can only show a lung tumor once it is about 1 cm in diameter; that size tumor has been present and growing for 8 to 15 years by most estimations. So unless a person has a particular risk for lung cancer or has symptoms of lung problems, screening probably makes no difference. Some rare medical conditions pose increased risks for developing lung cancer (for example, patients with pulmonary fibrosis have 14 times the rate of lung cancer compared to the general population of adults). Those patients with increased risks can be screened with a special CT scan that may show tumors earlier than a regular Xray. If a person's symptoms are suggestive of lung cancer and additional tests have shown a suspicious area in the lungs further testing is needed. A lung cancer diagnosis can only be made from cells or tissue taken from the lungs and looked at under a microscope. The following methods are used to get samples of cells or tissue from a tumor, and are listed in order of least to most invasive.

• Sputum cytology -best for diagnosing disease in the major airways of the lungs; about 20% of patients can be diagnosed this way. This is an analysis of the sputum (or phlegm) coughed up by the patient.
• A needle can be used to pull out some of the fluid for a cytologist or pathologist to look at on slides.
• Bronchoscopy -flexible tube (bronchoscope) with a small camera in it is passed down a patient's major air passages to a spot where tumor can be seen, and a piece is removed for diagnosis. This method has a 75 to 95% diagnostic rate but is only useful for tumors in the upper air passages that are big enough to see.
• Transthoracic needle aspiration -this involves putting a needle into the lung where a suspected tumor is imaged by CT scan, and pulling out cells from that area. The high rate of false negative results with this technique (meaning no cancer cells were obtained even though there really was a tumor there) makes it a poor diagnostic tool.
• Mediastinoscopy -rigid tube (bronchoscope) with a camera in it is placed into the middle of the chest through an incision made at the top of the sternum (breastbone). It requires general anesthesia, allows the surgeon to take samples of tissue from the lymph nodes of the chest, and provides accurate, specific information about lung cancer.
• Thoracoscopy -uses a rigid tube (bronchoscope) placed between the ribs, and by deflating the lung, allows a look at the lung surfaces and chest lining (pleura), and collection of many tissue samples for diagnosis. This is a surgical procedure done under general anesthesia and involves 2 or 3 days in the hospital.
• Surgical biopsy -if less invasive tests fail to provide cells or tissue to inspect under a microscope, and a tumor is suspected by some imaging test (CT or MRI), then an operation to open the chest cavity and remove a piece of the lung in the area of the mass may be necessary.

What information comes from the biopsy, and what does it mean for the patient?
First and most important is the decision regarding cancer. Once the cells or tissue are collected and prepared for inspection with a microscope, a pathologist will decide whether or not the cells are malignant (cancerous) and if so, what type of cancer cells they are. The biopsy results may take several days to complete and sometimes require special tests for an accurate analysis of the cells. Many details about a person's lung cancer treatment are based on this diagnosis so it must be done carefully and completely.

The diagnosis from the tumor cells may fall into several major groups:

The most common are called the Non-small Cell lung cancers They include the adenocarcinomas, squamous cell carcinomas, and large cell carcinomas. Together these represent 85% of all lung cancers, and when localized to one lung and only nearby lymph nodes, are the most successfully treated.

Second are the Small Cell lung cancers, a descriptive term that identifies the cells as relatively small in size, quite abnormal in cancerous ways, and known to have a high rate of spread to other sites in the body. While most of the varieties of small cell lung cancers are very aggressive and difficult to treat, two subgroups of small cell cancers have good prognoses (outcomes); they are the well-differentiated neuroendocrine carcinoma and the bronchial carcinoids.

A third group of tumors is called Malignant Mesothelioma, a cancer of the lining of the chest cavity (pleura). These tumors have a 70 to 80% association with asbestos exposure. Mesothelioma is similar to Small Cell lung cancer in its aggressive behavior and in its difficulty of treatment.

Another possible diagnosis of tumor cells in the lung is not lung cancer at all, but cancer of another type that has spread through the blood to the lungs. This is called metastatic disease to the lung. The cancers that spread to the lungs most commonly are breast cancer, tumors of the digestive tract, kidney cancer, melanoma, sarcomas, lymphomas, leukemias, some testicular cancers and rarely ovarian cancer. These are not lung cancers so they will not be included in any other discussions in this section.

What does the "stage" of a cancer mean?

There are two parts to a diagnosis: 1. what type of lung cancer the cells represent, and 2. what the stage of the disease is. The stage of a cancer describes the size of a tumor and whether or not it has spread to lymph nodes or other organs. The different types of lung cancers have unique staging systems, so each will be described separately.

Non-small Cell Lung Cancer:
This group of lung cancers is staged by the TNM system. T is for tumor size, N for lymph node spread or involvement, and M for metastasis to other parts of the body.

• Stage I -no lymph nodes involved
• Stage II -lymph nodes in the hilum of the lung are affected (the hilum is the part of the lung in the middle of the chest where the biggest air passages are).
• Stage III A -lymph nodes in the mediastinum are involved (the mediastinum is the space between the two lungs in the middle of the chest).
• Stage III B -disease in the mediastinum that cannot be removed surgically
• Stage IV -disease has spread to other organs in the body
• Recurrent -disease has come back after treatment was completed

Small Cell Lung Cancer:
These tumors spread so readily and treatment includes the whole body in nearly all cases anyway that the TNM system does not help to plan therapy. Instead three stages are based on how locally or distantly spread the disease is.

• Limited -disease in one lung and nearby lymph nodes
• Extensive -spread to other organs in the chest or other parts of the body
• Recurrent -disease came back after treatment

Mesothelioma:
The issues of local disease involvement and lymph node spread are similar to the other lung cancers, however the disease affects lining tissues within the chest so the spread of the disease is described differently.

• Stage I (localized) -disease is only in the lining tissue of the chest wall, lung, pericardium (sac around the heart), and diaphragm (breathing muscle that separates the chest and abdomen).
• Stage II (advanced) -disease involving the tissues in
• Stage I and lymph nodes within the chest.
• Stage III (advanced) -cancer invades the chest wall, mediastinum (space between the lungs), heart, diaphragm, abdominal tissues, and has spread to lymph nodes outside the chest.
• Stage IV (advanced) -disease spread to parts of the body distant from the chest
• Recurrent -disease came back in any site after treatment

Treatment for a particular type of lung cancer is based on the diagnosis of the tissue and the stage as described above, and in most cases includes chemotherapy, radiation, and for lower stages of disease it may include surgery as well.

Support & Education Programs

We know that being diagnosed with cancer can be stressful for you and your family. We offer a variety of cancer support services to help patients and families gain the support and information they will need to meet the challenges ahead.

To find cancer support and education workshops, and wellness services offered this month, please view the HOPES calendar.

Read the most recent SUPPORT publication, a resource written by patients and families for patients and families >>>