What You Need To Know About Lung Cancer —A booklet by National Institutes of Health


Contents

Introduction
    The Lungs
    What Is Cancer?
    What Causes Lung Cancer?
    Types of Lung Cancer
    Symptoms
    Diagnosis
    Staging
    Treatment
    Side Effects of Treatment
    Nutrition for Cancer Patients
    Support for Cancer Patients
    The Promise of Cancer Research
    Medical Terms
    Resources
    Other Booklets

Introduction

Each year, more than 170,000 people in the United States learn that they have lung cancer*.   This National Cancer Institute (NCI) booklet will give you some important information   about this disease. It explains how lung cancer is diagnosed and treated, and it has   information to help you deal with lung cancer if it affects you or someone you know.

Other NCI booklets are listed below. Our materials cannot answer every question you may   have about lung cancer. They cannot take the place of talks with doctors, nurses, and   other members of the health care team. We hope our information will help with those talks.

Researchers continue to look for better ways to diagnose and treat lung cancer, and our   knowledge is growing. For up-to-date information, call the NCI-supported Cancer   Information Service (CIS) toll free at 1-800-4-CANCER (1-800-422-6237). The CIS is described in the Resources   section of this guide.

*Words that may be new to readers are printed in italics. Definitions   of these and other terms related to lung cancer begin on page 25. For some words, a   "sounds-like" spelling is also given.

The Lungs

The lungs, a pair of cone-shaped organs made up of spongy, pinkish-gray tissue,   are part of the respiratory system. They take up most of the space in the chest   and are separated from each other by the mediastinum, an area that contains the   heart, trachea (windpipe), esophagus, and many lymph nodes. The   right lung has three sections, called lobes; it is a little larger than the left   lung, which has two lobes.

lung cancer

When we breathe, air enters the body through the nose or the mouth. The air travels   down the throat, through the larynx (voice box) and trachea, and into the lungs   through tubes called main-stem bronchi. One main-stem bronchus leads to the right   lung and one to the left lung. In the lungs, the main-stem bronchi divide into smaller   bronchi and then into even smaller tubes called bronchioles. The bronchioles end   in tiny air sacs called alveoli. The lungs take in oxygen, which cells need to   live and carry out their normal functions. The lungs also get rid of carbon dioxide, a   waste product of the body’s cells.

What Is Cancer?

Cancer is a group of more than 100 different diseases. Cancer occurs when cells become   abnormal and keep dividing and forming more cells without control or order.

Like all the other organs of the body, the lungs are made up of many types of cells.   Normally, cells divide to produce more cells only when the body needs them. This orderly   process helps keep us healthy.

If cells divide when new cells are not needed, a mass of tissue forms. This mass of   excess tissue, called a growth or tumor, can be benign or malignant.

       
  • Benign tumors are not cancer. They can usually be removed and, in most cases, they do       not come back. Most important, the cells in benign tumors do not invade other tissues and       do not spread to other parts of the body. Benign tumors are rarely a threat to life.
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  • Malignant tumors are cancer. They can invade and damage nearby tissues and organs. Also,       cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic       system. This is how cancer spreads from the original tumor and forms new tumors in       other parts of the body. The spread of cancer is called metastasis.
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Lung cancer often spreads to lymph nodes or other tissues in the chest (including the   other lung). In many cases, lung cancer also spreads to other organs of the body, such as   the bones, brain, or liver. Cancer that spreads is the same disease and has the same name   as the original (primary) cancer. In other words, lung cancer that spreads to the brain   (or another organ) is called metastatic lung cancer, even though the new tumor is in the   brain (or another organ).

What Causes Lung Cancer?

Most lung cancer is caused by cigarette smoking. Tobacco smoke contains many carcinogens–harmful     substances that damage cells. Over time, these cells can become cancerous. The more a     person smokes, the higher the risk of getting cancer-not just lung cancer, but also     cancers of the mouth, throat, esophagus, larynx, bladder, kidney, cervix, and pancreas.

It is clear that thousands of lives could be saved each year if people did not smoke.   For this reason, NCI strongly encourages smokers to quit. The risk of lung cancer begins   decreasing slowly as soon as a person quits smoking. The earlier the age at which a person   quits, the closer a former smoker’s risk of lung cancer will approach the risk for a   person who never smoked.

Although quitting early is best, smokers should know that it is never too late to   benefit from quitting-even if they have lung cancer. Lung cancer patients who stop smoking   are less likely to get a second lung cancer than are patients who continue to smoke.

Many programs are available to help people stop smoking. The Cancer Information   Service, the American Cancer Society, and the American Lung Association can offer advice   about quitting and can give you information about programs in your area. Information about   these organization is found in the Resources section of this   guide.

Although smoking is by far the major cause of lung cancer, it is not the only cause.   Exposure to other people’s tobacco smoke (environmental tobacco smoke) increases   the risk of lung cancer among nonsmokers. Scientists have found that nonsmokers who live   or work with smokers have a higher lung cancer risk than nonsmokers who do not face this   type of exposure to environmental tobacco smoke.

Exposure to certain carcinogens in the workplace, such as asbestos, also   increases the risk of lung cancer. (The risk is especially high for workers who smoke.)   People should carefully follow work and safety rules to reduce their exposure to workplace   carcinogens.

Workers (especially smokers) who are exposed to high levels of radon, a   radioactive gas, have an increased risk of developing lung cancer. High levels of radon   are found in some types of underground mines (for example, underground uranium mines).   Radon also can build up in some homes, but the levels in homes are generally much lower   than in mines. Researchers are studying whether exposure to radon in the home can increase   lung cancer risk. The U.S. Environmental Protection Agency can provide information about   radon exposure and testing for radon in the home. See the Resources   section of this guide.

Types of Lung Cancer

Nearly all lung cancers are carcinomas. A carcinoma is a cancer that begins in   the lining or covering tissues of an organ. Lung cancers are generally divided into two   types: nonsmall cell lung cancer and small cell lung cancer. The tumor cells   of each type of lung cancer grow and spread differently, and each type needs different   treatment.

Nonsmall cell lung cancer is more common than small cell lung cancer. The three main   kinds of nonsmall 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. This disease often begins in the bronchi. It       usually does not spread as quickly as other types of lung cancer.
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  • Adenocarcinoma usually begins along the outer edges of the lungs and under the       lining of the bronchi. This is the most common type of lung cancer in women and in people       who have never smoked.
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  • Large cell carcinomas are a group of cancers with large, abnormal-looking cells.       These tumors usually begin along the outer edges of the lungs.
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Small cell lung cancer is sometimes called oat cell cancer because the cancer   cells may look like oats when viewed under a microscope. This type of lung cancer grows   rapidly and quickly spreads to other organs.

Symptoms

Lung cancer usually does not cause Symptoms when it first develops. Doctors sometimes   discover lung cancer in a person with no symptoms after the individual has a chest x-ray   for another medical reason. Usually, however, lung cancer is found after the growing tumor   causes symptoms to appear.

A cough is the most common symptom of lung cancer. It is likely to occur when a tumor   irritates the lining of the airways or blocks the passage of air. The person may have a   "smoker’s cough" that becomes worse. Another symptom is constant chest pain.   Other symptoms may include shortness of breath, wheezing, repeated bouts of pneumonia or   bronchitis, coughing up blood, or hoarseness. A tumor that presses on large blood   vessels near the lung can cause swelling of the neck and face. If the tumor presses on   certain nerves near the lung, it can cause pain and weakness in the shoulder, arm, or   hand.

In addition, there may be symptoms that do not seem to be at all related to the lungs.   Like all cancers, lung cancer can cause fatigue, loss of appetite, and loss of weight. If   the cancer spreads to other parts of the body, it may cause headache, pain, or bone   fractures.

Other symptoms can be caused by substances made by lung cancer cells. Doctors often   refer to these symptoms as a paraneoplastic syndrome. For example, certain lung   cancer cells produce a substance that causes a sharp drop in the level of salt (sodium) in   the blood. A decrease in the sodium level 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.

Diagnosis

To find the cause of any of these symptoms, the doctor asks about the patient’s   personal and family medical background as well as smoking and work history. The doctor   also does a physical exam and usually orders x-rays and other tests.

In addition to chest x-rays, the doctor may order other pictures of areas inside the   body. For example, a CT scan (also called a CAT scan) is a series of x-ray images   put together by a computer. These detailed pictures can reveal that a tumor is in the   lung, but they cannot show whether the tumor is benign or malignant.

The only sure way to know whether cancer is present is to obtain cells from the lungs   so that a pathologist can examine them under a microscope. Sometimes, cancer cells   can be found in the sputum, a thick fluid that the patient coughs up from deep in   the airways. Also the doctor usually does a biopsy to remove a sample of cells from   the lung. To do a biopsy, the doctor uses one of the procedures described below:

       
  • An exam called bronchoscopy permits the doctor to look into the breathing       passages through a bronchoscope (a thin, lighted tube). A local anesthetic reduces       discomfort and gagging, and medicine helps the patient relax as the doctor inserts the       tube through the nose or mouth. (A general anesthetic may be used instead to put the       patient to sleep.) The doctor can brush or wash cells from the walls of bronchi or snip       off small pieces of tissue for study under a microscope.
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  • Needle aspiration is a procedure to remove cells that are hard to reach       with the bronchoscope. After the patient is given a local anesthetic, the doctor inserts a       needle through the chest into the tumor to withdraw a small sample of tissue. Most often,       the doctor uses fluoroscope or CT scans to locate the tumor.
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  • Sometimes, examination of fluid from the pleura (the fluid-filled sac that       surrounds the lungs) can reveal lung cancer. Using a needle, the doctor removes a sample       of the fluid in the pleura and checks it for cancer cells. For this procedure, called thoracentesis,       the patient receives a local anesthetic.
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  • For some patients, surgery is needed to diagnose lung cancer. Surgery to open the chest       (for diagnosis or treatment) is called thoracotomy. This is major surgery and is       done under a general anesthetic.
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If the doctor can feel swollen lymph nodes or an enlarged liver, these areas may be   biopsied to help with the diagnosis. The doctor also may biopsy other sites of the body   where cancer is suspected.

         
A patient who needs a biopsy may want to ask the doctor these questions:
         
  • What type of biopsy will I have? Why ?
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  • How long will it take? Will I be awake? Will it hurt?
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  • How soon will I know the results?
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  • If I do have cancer, who will talk with me about treatment? When?
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Staging

If lung cancer is diagnosed, the patient’s doctor needs to learn the stage, or extent,   of the disease so that proper treatment can be given. Staging is a careful attempt   to find out whether the cancer has spread and, if so, what parts of the body are affected.

To find out whether a patient’s lung cancer has spread to the lymph nodes in the chest,   the doctor removes a sample of tissue. In some patients, this can be done with a needle;   in others, the doctor will need to perform surgery. Surgery to biopsy lymph nodes in the   chest can often be done through a small incision near the breastbone. This procedure is   called mediastinoscopy when the incision is above the breastbone and mediastinotomy   when the incision is on one side of the breastbone. If a thoracotomy is planned, the   doctor removes lymph nodes during the operation. Patients receive a general anesthetic for   any of these operations.

Doctors may order CT scans to detect the spread of lung cancer to the lymph nodes and   other parts of the body. Radionuclide scans of the bones, brain, or liver also may   help doctors find out whether the cancer has spread. In these tests, a small amount of   radioactive material is injected into a vein. A machine then scans the body to measure the   radiation and reveal abnormal areas.

In another technique, called MRI (for magnetic resonance imaging), a strong   magnet linked to a computer is used to produce images. Doctors may order MRI to see   whether lung cancer has spread to the brain or spinal cord.

Treatment

The doctor develops a treatment plan to fit each patient’s needs. This plan depends on   many factors, including the type of lung cancer, the size and location of the tumor, and   the stage of the disease. The doctor also considers the patient’s age, medical history,   and general health.

Most people with cancer want to learn all they can about their disease and their   treatment choices so they can take an active part in decisions about their medical care.   The doctor is the best person to answer questions about the extent of the cancer, how it   can be treated, how successful the treatment is likely to be, and how much it is likely to   cost. The patient also may want to talk with the doctor about taking part in a research   study of new treatment methods. Such studies, called clinical trials, are designed   to find ways to improve cancer treatment. More information about clinical trials is found   in The Promise of Cancer Research section of   this guide.

Many patients find it helps to make a list of questions before seeing the doctor.   Taking notes during visits can make it easier to remember what the doctor says. Some   patients also find that it helps to have a family member or friend with them-to take part   in the discussion, to take notes, or just to listen.

         
A patient may want to ask the doctor these questions before treatment begins:
         
  • What is my diagnosis?
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  • What is the stage of the disease?
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  • What are my treatment choices? Which do you recommend for me? Why?
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  • Will I need to stay in the hospital, or will I be treated as an outpatient?
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  • Would a clinical trial be appropriate for me?
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  • What are the risks and possible side effects of each treatment?
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  • How long will treatment last?
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  • Will I need to change my normal activities?
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  • What is the treatment likely to cost?
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There is a lot to learn about cancer and its treatment. Patients should   not feel that they need to understand everything at once. They will have many chances to   ask the doctor to explain things that are not clear and to ask for more information.

Getting a Second Opinion

Treatment decisions for lung cancer are complex. Before starting treatment, the patient   might want another doctor to review the diagnosis and the treatment plan. There are a   number of ways to find another doctor for a second opinion:

       
  • The patient’s doctor may be able to suggest a specialist. Specialists who treat lung       cancer include thoracic surgeons, radiation oncologists, and medical       oncologists.
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  • The Cancer Information Service, at 1-800-4-CANCER, can tell callers about cancer centers       and other programs in their area supported by the National Cancer Institute.
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  • Patients can get the names of doctors from their local medical society, a nearby       hospital, or a medical school.
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Methods of Treatment

Surgery, radiation therapy, and chemotherapy are the usual treatments for   lung cancer. Surgery is done when it is likely that all of the tumor can be removed.   Radiation therapy (also called radiotherapy) is the use of high-energy rays to damage   cancer cells and stop them from growing and dividing. Chemotherapy is the use of drugs to   kill cancer cells. A patient may have just one form of treatment or a combination,   depending on his or her needs. Several specialists may work together as a team to provide   treatment.

Three main types of surgery are 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. An operation to remove only a small part of the lung is called   a segmental or wedge resection. When the surgeon removes an entire lobe of the   lung, the procedure is a lobectomy. Pneumonectomy is the removal of an entire lung.

A patient may want to ask the doctor these questions before surgery:

       
  • What kind of operation will it be?
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  • How will I feel after the operation? If I have pain, how will you help me?
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  • How long must I stay in the hospital?
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  • Will I have to do special exercises?
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Like surgery, radiation therapy is local treatment; it can affect cancer only in   the treated area. The radiation, which comes from a large machine, is usually given 5 days   a week for several weeks. The patient goes to the hospital or clinic each day to receive   the treatments.

         
A patient may want to ask the doctor these questions before radiation therapy:
         
  • What will this treatment do?
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  • When will the treatments begin? When will they end?
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  • How will I feel during therapy?
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  • What can I do to take care of myself during therapy?
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Chemotherapy is systemic treatment, meaning that the drugs flow   through the bloodstream to nearly every part of the body. Most anticancer drugs are   injected into a blood vessel or a muscle; some are given by mouth. Chemotherapy is most   often given in cycles-a treatment period followed by a recovery period, then another   treatment period, and so on.

Usually a patient has chemotherapy as an outpatient at the hospital, at the doctor’s   office, or at home. However, depending on which drugs the doctor orders and on the   patient’s health, the patient may need to stay in the hospital for a few days so that the   drugs’ side effects can be watched.

         
These are some questions a patient may want to ask the doctor before chemotherapy:
         
  • What will this treatment do?
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  • What drugs will I be taking?
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  • Will there be side effects? What can I do about them?
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  • How long will I need to take this treatment?
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Treating Nonsmall Cell Lung Cancer

Patients with nonsmall cell lung cancer may be treated in several ways. The choice of   treatment depends mainly on the extent of the disease.

Surgery is the usual treatment for patients whose cancer is in only one lung or in one   lung and the closest lymph nodes. Patients who cannot have surgery because of other   medical problems and patients with large tumors often receive radiation therapy. Radiation   therapy also is the usual treatment for patients whose cancer has spread within the   chest-to more distant lymph nodes or other tissues. Some patients have both surgery and   radiation therapy.

Doctors may use radiation therapy and chemotherapy to treat patients whose cancer has   spread from the lung to other parts of the body. Although it is very hard to control lung   cancer that has spread, treatment can often shrink the tumors. This can help relieve pain   and other symptoms.

Treating Small Cell Lung Cancer

Small cell lung cancer spreads quickly. In most cases, cancer cells have already spread   to distant parts of the body when the disease is diagnosed. To be sure that treatment   affects all cancer cells, doctors generally use chemotherapy, even when the disease   appears to be limited to the lung and nearby lymph nodes. Usually, chemotherapy for small   cell lung cancer includes a combination of two or more anticancer drugs.

In many cases, treatment also includes radiation therapy-to shrink or destroy the   primary tumor in the lung or tumors elsewhere in the body (such as in the brain). Some   patients have radiation therapy to the brain even though no cancer is found there. This   treatment, called prophylactic cranial irradiation or PCI, is given to prevent   tumors from forming in the brain. Usually, PCI is reserved for patients whose lung tumor   has responded well to treatment.

Surgery also can be part of the treatment plan for small cell lung cancer. This   treatment is appropriate only for a small number of patients.

Side Effects of Treatment

It is hard to limit the effects of cancer therapy so that only cancer cells are removed   or destroyed. Because treatment also damages healthy cells and tissues, it often causes   unpleasant side effects.

The side effects of cancer treatment vary. They depend mainly on the type and extent of   the treatment. Also, each person reacts differently to treatment.

Doctors try to plan the patient’s therapy to keep side effects to a minimum.

Doctors and nurses can explain the side effects of cancer treatment and can suggest   ways to deal with them. The National Cancer Institute booklets Radiation Therapy and   You and Chemotherapy and You also have helpful information about cancer   treatment and coping with side effects.

Surgery

Surgery for lung cancer is a major operation. It may take several weeks or months for   patients to regain their energy and strength. This recovery time differs from patient to   patient. The doctor and nurse will explain what will happen and what they and the patient   can do to make recovery easier.

Doctors can prescribe medicine to control pain after surgery. The doctor or nurse also   may suggest other ways to reduce discomfort. Patients should feel free to ask what can be   done to relieve their pain or discomfort.

After lung surgery, air and fluid tend to collect in the chest. The air and fluid are   drained out through flexible tubes put in place during surgery. Patients also are helped   to turn, cough, and breathe deeply. All of these procedures are important for recovery   because they help expand the remaining lung tissue and get rid of excess air and fluid.

Generally, patients who have had lung surgery receive respiratory therapy-treatments   and exercises to keep the lungs expanded and prevent fluid buildup. Patients may feel   short of breath because they have less lung tissue to supply the body with oxygen. For   this reason, they may have to limit their activities for some time. In most cases, the   remaining lung tissue gradually expands somewhat, making it easier to breathe.

After surgery, the muscles of the chest and the arm on the affected side may become   weak. Special exercises can help the patient regain strength in these muscles.

Radiation Therapy

Patients often become very tired during radiation therapy, especially in the later   weeks of treatment. Resting is important, but doctors usually advise their patients to try   to stay as active as they can.

It also is common for the skin in the treated area to become red, dry, tender, and   itchy. There may be permanent darkening or "bronzing" in the treated area. The   skin should be exposed to the air but protected from the sun, and patients should avoid   wearing clothes that rub or irritate the treated area. Good skin care is important at this   time, and patients will be shown how to keep the area clean. They should not use any   lotion or cream on the skin without the doctor’s advice.

During radiation therapy for lung cancer and for a short time afterward, patients may   have a dry, sore throat, and it may be difficult to swallow. Many find it helpful to eat   soft foods and drink extra liquids until these problems go away.

Radiation therapy to the lungs can cause certain permanent changes in lung tissues.   These changes, called radiation fibrosis, tend to occur several months after the   treatment is over. Fibrosis, which is similar to scarring, can interfere with the ability   of the lung to supply the body with oxygen. Patients who have this problem may have to   limit their activities.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs the patient is given. In   addition, as with other types of treatment, side effects vary from person to person.   Generally, anticancer drugs affect cells that divide rapidly. These include blood cells,   which fight infection, help the blood to clot, or carry oxygen to all parts of the body.   When blood cells are affected by anticancer drugs, patients are more likely to get   infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and   cells that line the digestive tract also divide rapidly. When chemotherapy affects   these cells, it can cause hair loss and other problems such as nausea and vomiting.   Usually these side effects go away gradually during the recovery period or after treatment   stops.

Nutrition for Cancer Patients

Some patients find it hard to eat well. They may lose their appetite. In addition, the   common side effects of treatment, such as nausea, vomiting, or mouth sores, can make it   hard to eat. For some patients, foods taste different. Also, people may not feel like   eating when they are uncomfortable or tired.

Eating well means getting enough calories and protein to help prevent weight loss and   regain strength. Patients who eat well during cancer treatment often feel better and have   more energy. In addition, they may be better able to handle the side effects of treatment.

Doctors, nurses, and dietitians can offer advice for healthy eating during cancer   treatment. Patients and their families also may want to read the National Cancer Institute   booklet Eating Hints: Recipes and Tips For Better Nutrition During Cancer Treatment, which   contains many useful suggestions.

Support for Cancer Patients

Living with a serious disease is not easy. Cancer patients and those who care about   them face many problems and challenges. Coping with these difficulties is easier when   people have helpful information and support services. Several useful booklets, including Taking   Time: Support for People With Cancer and the People Who Care About Them, are available   from the Cancer Information Service.

Cancer patients may worry about holding jobs, caring for their families, or keeping up   with daily activities. Worries about tests, treatments, hospital stays, and medical bills   also are common. Doctors, nurses, and other members of the health care team can answer   questions and help calm fears about treatment, working, or other activities. Also meeting   with a social worker, counselor, or member of the clergy can be helpful to patients who   want to talk about their feelings or discuss their concerns about the future or about   personal relationships.

Friends and relatives, especially those who have had personal experience with cancer,   can be very supportive. Also, many patients find it helps to discuss their concerns with   others who are facing similar problems. Cancer patients often get together in support   groups, where they can share what they have learned about coping with cancer and the   effects of treatment. It is important to keep in mind, however, that each patient is   different. Treatments and ways of dealing with cancer that work for one person may not be   right for another–even if they both have the same kind of cancer. It is always a good   idea to discuss the advice of friends and family members with the doctor.

Often, a social worker at the hospital or clinic can suggest local and national groups   that help with rehabilitation, emotional support, financial aid, transportation, or home   care. The American Cancer Society is one such group. This nonprofit organization has many   services for patients and their families. Local offices of the American Cancer Society are   listed in the white pages of the telephone directory. More information the Amercan Cancer   Society is available in the Resources section of this guide.

Information about other programs and services is available through the Cancer   Information Service. The toll-free number is 1-800-4-CANCER.

The public library is a good place to find books and articles on living with cancer.   Cancer patients and their families and friends also can find helpful suggestions in the booklets listed at the end of this guide.

The Promise of Cancer Research

Researchers at hospitals and medical Centers all across the country are studying lung   cancer. They are trying to learn more about what causes this disease and how to prevent   it. They also are looking for better ways to detect and treat it.

Cause and Prevention

Scientists are continuing to identify factors that may increase the risk for lung   cancer. Recent research has shown that genetic factors play an important role in   lung cancer risk. For example, certain genetic traits make some people very sensitive to   carcinogens. Smokers with these traits may be more likely than other smokers to develop   lung cancer.

Researchers also are studying ways to help people lower their risk of lung cancer. An   important area of study is chemoprevention-the use of natural and   laboratory-made substances to prevent or delay cancer. Vitamin A and substances like it   may offer some protection against lung cancer. Other substances also are being studied.   However, more research is needed, and some vitamins can be dangerous if taken in large   doses. It is best to get a doctor’s advice before taking vitamins or other nutrients.

Currently, we know that the best way to prevent lung cancer is not to smoke. The   National Cancer Institute, the American Cancer Society, and other organizations have   programs designed to reduce the number of smokers. If these efforts are successful, far   fewer people will develop and die of lung cancer each year.

Detection

The earlier cancer is detected, the more successful treatment is likely to be. However,   lung cancer is difficult to diagnose at an early stage. For this reason, scientists are   studying ways of checking for lung cancer in people who have no symptoms of the disease.   This is called screening. The goal of screening is to detect lung cancer before symptoms   appear so that it can be treated as early as possible. Whether successful screening   methods for this disease can be developed is not yet known.

Treatment

Because lung cancer is so hard to control, researchers are looking for more effective   treatments. They also are exploring ways to reduce the side effects of treatment and   improve the quality of patients’ lives. When laboratory research shows that a new method   has promise, cancer patients can receive the treatment in clinical trials. These trials   are designed to find out whether the new approach is both safe and effective and to answer   scientific questions. Some clinical trials compare a new treatment with a standard   approach. Patients who take part in clinical trials make an important contribution to   medical science and may have the first chance to benefit from improved treatment methods.

Trials are under way to study new treatments for patients with all stages of lung   cancer. Some trials involve treatments to shrink or destroy the primary tumor. In others,   scientists are testing ways to prevent lung cancer from coming back in the chest or   spreading to other parts of the body after the primary tumor has been treated. Still   others involve treatments to slow or stop the spread of lung cancer.

Researchers are studying the timing of treatments and new ways to combine various types   of treatment. They also are trying new anticancer drugs and drug combinations, new forms   of radiation therapy, and drugs that make cancer cells more sensitive to radiation.   Another method under study is photodynamic therapy. In this treatment, cancer cells   are destroyed with a combination of laser light and light-sensitive drugs. Other   types of laser therapy are being studied as a way to open the airways in patients whose   tumors block the bronchi. Some researchers also are working with biological therapy. This   type of treatment includes efforts to help the body’s immune system fight cancer more   effectively or to protect the body from some of the side effects of treatment.

Patients with lung cancer may want to read a National Cancer Institute booklet called What   Are Clinical Trials All About?, which explains some of the possible benefits and risks   of treatment studies. Those who are interested in taking part in a trial should talk with   their doctor.

One way to learn about clinical trials is through PDQ, a computerized resource   developed by the National Cancer Institute. PDQ contains information about cancer   treatment and about clinical trials in progress all over the country. The Cancer   Information Service can provide PDQ information to doctors, patients, and the public.

Medical Terms

Adenocarcinoma (AD-en-o-kar-si-NO-ma): A type of lung cancer in which the cells   grow in patterns resembling cubes or columns.

Alveoli (al-VEE-o-lye): Tiny air sacs at the end of the bronchioles.

Anesthetic (an-es-THET-ik): Drugs or gases given to cause a loss of feeling. A   local anesthetic makes an area of the body numb. A general anesthetic puts the patient to   sleep.

Asbestos (as-BES-tus): A natural material that is made up of tiny fibers. If the   fibers are inhaled, they can lodge in the lungs and lead to cancer.

Aspiration (as-per-AY-shun): Removal of a sample of fluid and cells through a   needle.

Benign (be-NINE): Not cancerous; does not invade nearby tissue or spread to   other parts of the body.

Biological therapy (by-o-LOJ-i-kul): Treatment that uses the body’s natural   defenses to fight cancer. Also called immunotherapy.

Biopsy (BY-op-see): The removal of a sample of tissue for examination under a   microscope to check for cancer cells.

Bronchi (BRON-kye): The large air tubes leading to the lungs. One tube is called   a bronchus.

Bronchioles (BRON-kee-ols): The tiny branches of air tubes in the lungs.

Bronchitis (bron-KYE-tis): Inflammation (swelling and reddening) of the bronchi.

Bronchoscope (BRON-ko-skope): A thin, flexible instrument used to view the air   passages of the lung.

Bronchoscopy (bron-KOS-ko-pee): A test that permits the doctor to see the   breathing passages through a lighted tube.

Cancer: A term for diseases in which abnormal cells grow and divide without   control. Cancer cells can invade nearby tissues and can spread through the bloodstream and   lymphatic system to other parts of the body.

Carcinogen (car-SIN-o-jin): Any agent that is known to cause cancer.

Carcinoma (kar-si-NO-ma): Cancer that begins in the tissues that line or cover   an organ.

Chemoprevention (KEE-mo-pre-VEN-shun): The use of natural or laboratory-made   substances to prevent cancer.

Chemotherapy (kee-mo-THER-a-pee): Treatment with anticancer drugs.

Clinical trials: Research studies that involve patients. Each study is designed   to answer scientific questions and to find better ways to prevent or treat cancer.

CT scan: A series of detailed pictures of areas inside the body created by a   computer linked to an x-ray machine. Also called CAT scan.

Digestive tract: The organs through which food passes. These are the mouth,   esophagus, stomach, intestines, and rectum.

Environmental tobacco smoke: Smoke that comes from the burning end of a   cigarette and smoke that is exhaled by smokers. Also called ETS or second-hand smoke.   Inhaling ETS is called involuntary or passive smoking.

Epidermoid carcinoma (ep-i-DER-moyd): A type of lung cancer in which the cells   are flat and look like fish scales. Also called squamous cell carcinoma.

Esophagus (e-SOF-a-gus): The muscular tube through which food passes from the   mouth to the stomach.

Fluoroscopy (floor-OS-ko-pee): An x-ray procedure that makes it possible to see   internal organs in motion.

Genetic (jen-ET-ik): Related to genes, structures found in every cell of the   body. Each gene contains information that directs cell processes and controls the way an   individual develops.

Large cell carcinomas: A group of lung cancers in which the cells are large and   look abnormal.

Larynx (LAIR-inks): The valvelike structure at the top of the windpipe. It is   used in breathing, swallowing, and talking. Also called the voice box.

Laser (LAY-zer): A powerful beam of light used in some types of surgery and in   photodynamic therapy.

Lobe: A portion of the lung.

Lobectomy (lo-BEK-to-mee): An operation to remove an entire lobe of the lung.

Local treatment: Treatment that affects a tumor and the cells in the area close   to it.

Lymph (limf): The almost colorless fluid that travels through the lymphatic   system and carries cells that help fight infection.

Lymph nodes: Small, bean-shaped structures in the lymphatic system. The lymph   nodes store special cells that can trap cancer cells or bacteria traveling through the   body. Also called lymph glands.

Lymphatic system (lim-FAT-ik): The tissues and organs that produce, store, and   carry cells that fight infection and disease. This system includes the bone marrow,   spleen, thymus, lymph nodes, and vessels that carry lymph.

Malignant (ma-LIG-nant): Cancerous (see Cancer).

Mediastinoscopy (MEE-dee-a-stin-OS-ko-pee): A procedure in which the doctor   inserts a tube into the chest to view the organs in the mediastinum. The tube is inserted   through an incision above the breastbone.

Mediastinotomy (MEE-dee-a-stin-OT-o-mee): A procedure in which the doctor   inserts a tube into the chest to view the organs in the mediastinum. The tube is inserted   through an incision next to the breastbone.

Mediastinum (mee-dee-a-STY-num): The area between the lungs. The organs in this   area include the heart and its large veins and arteries, the trachea, the esophagus, the   bronchi, and lymph nodes.

Metastasis (meh-TAS-ta-sis): The spread of cancer from one part of the body to   another. Cells in the metastatic (secondary) tumor are like those in the original   (primary) tumor.

MRI: A procedure in which a magnet linked to a computer is used to create   pictures of areas inside the body. Also called magnetic resonance imaging.

Mucus: A thick fluid produced by the lining of some organs of the body.

Nonsmall cell lung cancer: A general classification for squamous cell carcinoma,   adenocarcinoma, and large cell carcinoma.

Oat cell cancer: A type of lung cancer in which the cells look like oats. Also   called small cell lung cancer.

Oncologist (on-KOL-o-jist): A doctor who specializes in treating cancer.

Paraneoplastic syndrome (pair-a-nee-o-PLAS-tik): A group of symptoms caused by   substances produced by certain cancer cells.

Pathologist (path-OL-o-jist): A doctor who identifies diseases by studying cells   and tissues under a microscope.

Photodynamic therapy (FO-to-dye-NAM-ik): Treatment with laser light and   substances that are sensitive to light. The laser light causes a chemical reaction that   destroys cancer cells.

Pleura (PLOOR-a): The thin covering that protects and cushions the lungs. The   pleura is made up of two layers of tissue that are separated by a small amount of fluid.

Pneumonectomy (noo-mo-NEK-to-mee): An operation to remove an entire lung.

Pneumonia (noo-MONE-ya): An infection that occurs when fluid and cells collect   in the lung.

Prognosis (prog-NO-sis): The probable outcome or course of a disease; the chance   of recovery.

Prophylactic cranial irradiation (pro-fi-LAK-tik KRAY-nee-ul   ir-ray-dee-AY-shun): Radiation therapy to the head to prevent cancer from spreading to the   brain.

Radiation fibrosis (ray-dee-AY-shun fye-BRO-sis): The formation of scar tissue   as a result of radiation therapy to the lung.

Radiation therapy (ray-dee-AY-shun): Treatment with high-energy rays to kill   cancer cells.

Radionuclide scans: Images of internal parts of the body. To produce these   images, a small amount of radioactive material is swallowed or injected into the body. An   instrument called a scanner then measures the radiation given off by certain organs.

Radon (RAY-don): A radioactive gas that is released by uranium, a substance   found in soil and rock. When too much radon is breathed in, it can damage lung cells and   lead to lung cancer.

Resection (ree-SEK-shun): Surgical removal of part of an organ.

Respiratory system (RES-pi-ra-tor-ee): The organs that are involved in   breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs.

Respiratory therapy (RES-pi-ra-tor-ee): Exercises and treatments that help   patients recover lung function after surgery.

Side effects: Problems that occur when treatment affects healthy cells. Common   side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell   counts, hair loss, and mouth sores.

Small cell lung cancer: A type of lung cancer in which the cells are small and   round. Also called oat cell lung cancer.

Sputum (SPYOO-tum): Mucus from the lungs.

Squamous cell carcinoma (SKWAY-mus): A type of lung cancer in which the cells   are flat and are arranged like fish scales. Also called epidermoid carcinoma.

Staging: Doing exams and tests to learn the extent of a cancer, especially   whether it has spread from its original site to other parts of the body.

Surgery: An operation.

Systemic treatment (sis-TEM-ik): Treatment using substances that travel through   the bloodstream, reaching and affecting cells all over the body.

Thoracentesis (thor-a-sen-TEE-sis): Removal of fluid in the pleura through a   needle.

Thoracic (thor-ASS-ik): Pertaining to the chest.

Thoracotomy (thor-a-KOT-o-mee): An operation to open the chest.

Tissue (TISH-oo): A group or layer of cells that together perform a specific   function.

Trachea (TRAY-kee-a): Windpipe.

Tumor: An abnormal mass of tissue.

Resources

Information about cancer is available from many sources, including the ones listed   below. You also may wish to check for information at your local library or bookstore and   from support groups in your community.

Cancer Information Service (CIS)
 
1-800-4-CANCER

The Cancer Information Service, a program of the National Cancer Institute, is a   nationwide telephone service for cancer patients and their families and friends, the   public, and health care professionals. The staff can answer questions in English or   Spanish and can send free National Cancer Institute booklets about cancer. They also know   about local resources and services. One toll-free number, 1-800-4-CANCER (1-800-422-6237),   connects callers all over the country with the office that serves their area.

American Cancer Society
  1599 Clifton Road, N.E.
  Atlanta, GA 30329
  1-800-ACS-2345

The American Cancer Society is a voluntary organization with a national office (at the   above address) and local units all over the country. It supports research, conducts   educational programs, sponsors support groups for cancer patients and for people who want   to quit smoking, and offers many services to patients and their families. It provides free   booklets on lung cancer and on caring for cancer patients at home. To request booklets or   to obtain information about services and activities in local areas, call the Society’s   toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under American   Cancer Society in the white pages of the telephone book.

American Lung Association
 
1740 Broadway
  New York, NY 10019
  212-315-8700

The American Lung Association is a voluntary organization concerned with the prevention   and treatment of lung diseases, including lung cancer. It supports many activities to make   the public aware of the dangers of smoking. The Association offers free printed material   on smoking and on lung cancer. It also sponsors programs to help people stop smoking.   Local chapters are listed in the white pages of the telephone book.

U.S. Environmental Protection Agency
  Public Information Center
  401 M Street, S.W.
  Washington, DC 20460
  202-260-2080

The U.S. Environmental Protection Agency is the Federal agency responsible for keeping   the environment safe. It supports research and sets regulations on air and water   pollution, toxic substances, and radiation in the environment. It also provides free   printed material on many topics, including radon, asbestos, and environmental tobacco   smoke.

Other Booklets

The National Cancer Institute booklets listed below are available free of charge by   calling 1-800-4-CANCER (1-800-422-6237).

Booklets About Cancer and Its Treatment

       
  • Research Report: Cancer of the Lung
  •    
  • Chemotherapy and You: A Guide to Self-Help During Treatment
  •    
  • Radiation Therapy and You: A Guide to Self-Help During Treatment
  •    
  • Eating Hints: Recipes and Tips for Better Nutrition During Cancer Treatment
  •    
  • What Are Clinical Trials All About?
  •    
  • Questions and Answers About Pain Control (also available from the American Cancer       Society)
  •  

Booklets About Living With Cancer

       
  • Facing Forward: A Guide for Cancer Survivors
  •    
  • Taking Time. Support for People With Cancer and the People Who Care About Them
  •    
  • When Cancer Recurs: Meeting the Challenge Again
  •    
  • Advanced Cancer: Living Each Day
  •  

This booklet was written and published by the National Cancer Institute (NCI), 9000   Rockville Pike, Bethesda, MD 20892.  

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