Respiratory Disease

Lung Cancer

What is lung cancer?

For More Information

Greenebaum Cancer Center: Treatment Programs
Our Thoracic Oncology Program treat patients with all types of thoracic malignancies and perform the largest number of thoracic procedures in the Mid-Atlantic region.

Lung cancer usually starts in the lining of the bronchi, but can also begin in other areas of the respiratory system, including the trachea, bronchioles, or alveoli.

Lung cancers are believed to develop over a period of many years.

Nearly all lung cancers are carcinomas, a cancer that begins in the lining or covering tissues of an organ.

The tumor cells of each type of lung cancer grow and spread differently, and each type requires different treatment. More than 95 percent of lung cancers belong to the group called bronchogenic carcinoma.

Lung cancers are generally divided into two types:

Non-small cell lung cancer is more common than small cell lung cancer. The three main kinds of non-small cell lung cancer are named for the type of cells in the tumor:

Squamous cell carcinoma, also called epidermoid carcinoma, is the most common type of lung cancer in men. It often begins in the bronchi, and usually does not spread as quickly as other types of lung cancer.

Adenocarcinoma usually begins along the outer edges of the lungs and under the lining of the bronchi. It is the most common type of lung cancer in women and in people who have never smoked.

Large cell carcinomas are a group of cancers with large, abnormal-looking cells. These tumors usually begin along the outer edges of the lungs.

Small cell lung cancer, sometimes called oat cell cancer because the cancer cells may look like oats when viewed under a microscope, grows rapidly and quickly spreads to other organs.

General Information Regarding Cancer

It is the nature of cells to divide and increase their number in a process called mitosis. Normal cells divide to replace those lost or to repair injuries only, then stop dividing.

Cancer is an abnormal, continuing multiplying of cells. The cells divide uncontrollably and may grow into adjacent tissue or spread to distant parts of the body. The mass of cancer cells will eventually become large enough to produce lumps, masses or tumors that can be detected. These lumps, masses or tumors can be benign or malignant:

benign tumors:

are not cancerous
can usually be removed
do not come back in most cases
do not spread to other parts of the body and the cells do not invade other tissues

malignant tumors:

are cancerous

can invade and damage nearby tissues and organs

metastasize (cancer cells break away from a malignant tumor and enter the bloodstream or lymphatic system to form secondary tumors in other parts of the body)

The smallest cancer that can be detected by examination, x-ray, or scan is slightly less than one-fourth of an inch in diameter and contains between a million to a billion cancer cells.

General Categories of Cancers
There are several general categories of cancer, with carcinomas and adenocarcinomas being the most common:

Carcinomas are cancers that occur in epithelial surfaces -- the cells that form the outer surface of the body to line or cover the body cavities, tubes and passageways
Adenocarcinomas are cancers that form on a glandular surface, such as the lung, breast, prostate, ovary or kidney
Sarcomas are cancers that occur in supporting structures, such as bone, muscle, cartilage, fat or fibrous tissue.
Leukemias and lymphomas are the cancers occur in blood cell elements.

Brain cancers, nerve cancers, melanomas and certain testicular and ovarian cancers do not fall into a general category.

Metastatic cancer can spread from its original location to other parts of the body.

It is important to find out what kind of lung cancer a person has. The different types of carcinomas, involving different regions of the lung, may cause different symptoms and are treated differently.

What are the symptoms of lung cancer?

Lung cancer usually does not cause symptoms when it first develops, but symptoms often become present after the tumor begins growing. A cough is the most common symptom of lung cancer. The following are the other most common symptoms for lung cancer; however, each person may experience symptoms differently:

constant chest pain
shortness of breath
wheezing
recurring lung infections, such as pneumonia or bronchitis
bloody or rust colored sputum
hoarseness
swelling of the neck and face caused by a tumor that presses on large blood vessels near the lung
pain and weakness in the shoulder, arm, or hand caused by a tumor that presses on certain nerves near the lung
fever for unknown reason

Like all cancers, lung cancer can cause:

fatigue
loss of appetite
loss of weight
headache
pain in other parts of the body not affected by the cancer
bone fractures

Other symptoms can be caused by substances made by lung cancer cells -- referred to as a paraneoplastic syndrome. Certain lung cancer cells produce a substance that causes a sharp drop in the level of sodium in the blood, which can cause many symptoms, including confusion and sometimes even coma.

None of these symptoms is a sure sign of lung cancer. Only a doctor can tell whether a patient's symptoms are caused by cancer or by another problem. Consult your doctor for a diagnosis.

What are the risk factors for lung cancer?

A risk factor is anything that increases a person's chance of getting a disease such as cancer. Different cancers have different risk factors. Several risk factors make a person more likely to develop lung cancer:

Smoking is the leading cause of lung cancer, with more than 90 percent of lung cancers thought to be a result of smoking.

Additional risk factors include:

second-hand smoke - breathing in the smoke of others.
smoking marijuana cigarettes, which:

contain more tar than tobacco cigarettes.
are inhaled very deeply.

are smoked all the way to the end where tar content is the highest.

Because marijuana is an illegal substance, it is not possible to control whether it contains fungi, pesticides and other additives.

recurring inflammation, such as from tuberculosis and some types of pneumonia.

asbestos exposure.

talcum powder.
While no increased risk of lung cancer has been found from the use of cosmetic talcum powder, some studies of talc miners and millers suggest a higher risk of lung cancer and other respiratory diseases from their exposure to industrial grade talc. Talcum powder is made from talc, a mineral which in its natural form may contain asbestos, although by law, all home-use talcum products (baby, body, and facial powders) have been asbestos-free.

cancer-causing agents in the workplace, including:

radioactive ores such as uranium

arsenic

vinyl chloride

nickel chromates

coal products

mustard gas

chloromethyl ethers

radon - a radioactive gas that cannot been seen, tasted or smelled. It is produced by the natural breakdown of uranium.

family history

personal history of lung cancer

vitamin A deficiency
People who do not get enough vitamin A are at increased risk of lung cancer. Taking too much vitamin A may also increase lung cancer risk.

air pollution
In some cities, air pollution may slightly increase the risk of lung cancer.

How is lung cancer diagnosed?

What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.

Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

In addition to a complete medical history to check for risk factors and symptoms, and a physical examination to provide other information about signs of lung cancer and other health problems, procedures used to diagnose lung cancer include:

chest x-ray - to look for any mass or spot on the lungs.

other special x-rays and scans (such as the CT (computed tomography) scan) - can provide more precise information about the size, shape, and position of a tumor.

sputum cytology - a study of phlegm (spit) cells under a microscope.

needle biopsy - a needle is guided into the mass while the lungs are being viewed on a CT scan and a sample of the mass is removed and evaluated in the pathology laboratory under a microscope.

bronchoscopy - a fiberoptic flexible, lighted tube is passed through the mouth into the bronchi to help find centrally located tumors or blockages, and gather samples of tissue or fluids to be examined under a microscope.

mediastinoscopy - a process in which a small cut is made in the neck so that a tissue sample can be taken from the lymph nodes (mediastinal nodes) along the windpipe and the major bronchial tube areas to evaluate under a microscope.

x-rays and scans of the brain, liver, bone, and adrenal glands - to determine if the cancer has spread from where it started into other areas of the body.

Other tests and procedures may be used as well.

Treatment for lung cancer:

Specific treatment will be determined by your doctor(s) based on:

your age, overall health and medical history
extent of the disease
your tolerance for specific medications, procedures or therapies
expectations for the course of the disease
your opinion or preference

Surgery, radiation therapy and chemotherapy may be used in the treatment of lung cancer.

surgery

Three main types of surgery are most often used in lung cancer treatment. The choice depends on the size and location of the tumor, the extent of the cancer, the general health of the patient, and other factors.

segmental or wedge resection - to remove only a small part of the lung

lobectomy - removal of an entire lobe of the lung

pneumonectomy - removal of an entire lung

radiation therapy (also called radiotherapy) - the use of high-energy rays to damage cancer cells and stop them from growing and dividing.

chemotherapy - the use of drugs to kill cancer cells.

This page was last updated on: May 14, 2009.

For patient inquiries, call 1-800-492-5538 or click here to make an appointment.