Lung Cancer

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Lung cancer is the second most common cancer among both men and women in the United States.  It is the most common cause of cancer death.

In general, oncologist break lung cancer down into 2 broad groups: small cell lung cancer (SCLC) versus non-small cell lung cancer (NSCLC). Non-small cell lung cancer includes adenocarcinoma, squamous cell carcinoma, and large cell neuroendocrine tumors.

Mesothelioma is a separate class of lung cancer and is predominantly caused by inhalation of asbestos particles.

 Most lung cancer is caused by damage done to the lung cells by toxins in the air that we breathe. Cigarette smoking is the most common cause, but environmental exposures to other inhaled toxins (like dust and vapors, if you work in a factory) can also damage lung cells and lead to abnormal cell growth and eventually cancer.  

Individuals who are non-smokers who developed lung cancer are more likely to have a "driver" mutation in the tumor which may be targetable with special medications.

Common presentations for patients with lung cancer are worsening shortness of breath, new or worsening cough, or coughing up blood.  When patients come to the hospital for respiratory symptoms and a CT scan of the chest is ordered, a mass in one of the lungs may be identified.  This finding often leads to biopsy to determine the type of lung cancer a patient has.

Recent clinical trials have shown the effectiveness of low-dose CT (LDCT) screening for lung cancer.  Individuals who have smoked for many years may be eligible for this screening test, will which can find early, small lung cancers which can be treated much more easily than larger cancers that have spread to lymph nodes.  If you or loved one is a smoker, ask a physician if you meet the criteria for low-dose CT screening for lung cancer.

After diagnosis of lung cancer, your oncologist may order additional tests including a PET scan or an MRI of your brain to rule out spread of cancer.

Early stage, small lung cancers may be treated with either surgery or stereotactic body radiation therapy (SBRT).  SBRT is typically given over the course of 5 treatments and is highly focused, high dose radiation therapy which leads to good chance of local control of the cancer.

For more advanced tumors including cancers that have spread to the lymph nodes around the vessels and breathing tubes, chemotherapy and radiation are often given together to improve your chances of curing this cancer type.  Immunotherapy will likely also be added at the end of treatment to help your bodies natural immune system attack any remaining tumor cells.

Each patient has a unique cancer type and stage with different underlying risk factors. During a oncology consultation visit, your oncologist will discuss what to expect from treatment. Ask your doctor about the expected outcomes. 

Some of the most important factors in determining a patient's prognosis include the stage of the tumor which depends on its initial size, lymph node involvement, or distant metastatic disease.  A patient's baseline health also plays a role in their likely outcomes.

Radiation treatment side effects tend to affect the tissues that are close to the tumor where the radiation is directed. Some side effects can be more pronounced during and shortly after radiation treatment (acute side effects). While other side effects may occur many months or years after treatment (chronic or late side effects).

Side effects for lung cancer treatment with radiation can include esophagitis, pain with swallowing, or difficulty swallowing.  Patients may also experience fatigue.  These symptoms tend to resolve 2 to 4 weeks after completion of radiation therapy.  

Patients are at increased risk of pneumonitis, and inflammation of the lung tissue.  This may be caused by either their radiation treatments or the immunotherapy treatments that they often receive afterwards, or a combination of both.  Pneumonitis typically presents with cough, shortness of breath, and low-grade fever.  It can be treated by your oncology specialist typically with moderate duration steroid medication to decrease inflammation in the lung.

Longer-term side effects of radiation including increased risk of cardiovascular disease.  Patient is to develop lung cancer also typically have high risk factors for heart disease including long-term smoking.  Radiation to the heart muscle is often unavoidable if the lung tumor is near the heart.  This will increase risk of cardiovascular events like arrhythmias and myocardial infarction (heart attack).

• Non-small cell lung cancer
  • https://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq
• Small cell lung cancer
  • https://www.cancer.gov/types/lung/patient/small-cell-lung-treatment-pdq
• https://www.mayoclinic.org/diseases-conditions/lung-cancer/symptoms-causes/syc-20374620
• https://my.clevelandclinic.org/health/diseases/4375-lung-cancer