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Lung Cancer

Anatomical facts

The lungs are a pair of spongy, cone-shaped organs and are part of the respiratory system. The right lung is a bit larger and has three sections, called lobes; the left lung has two lobes. With each breath, the lungs take in oxygen, which cells need to live and carry out their normal functions. When we breathe out, the lungs get rid of carbon dioxide, which is a waste product of the body’s cells.

Approximately 213,000 Americans are diagnosed with lung cancer each year. It represents 13% of all cancer diagnoses in the United States.

This disease is very rare under age 40. The average age of diagnosis is 70. Cigarette smoking is the cause for the vast majority (87%) of lung cancers, although it is possible for a nonsmoker to develop this disease.

Diagram of lungsLung cancer facts

Lung cancer is the leading cause of cancer death for both men and women. More Americans die each year of lung cancer than of colon, breast, melanoma, and prostate cancers combined. It kills more women than breast cancer and more men than prostate cancer. The reason lung cancer is such a deadly disease is because its early signs such as coughing, shortness of breath, and chest pain tend to be disregarded in smokers or attributed to other conditions.

Consequently, most cases are diagnosed after the disease has already spread beyond the lung to other organs and cure is no longer possible.

Types of lung cancers

Lung cancers are divided into two major types: small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). These two cancer types originate from different lung cells and look and behave differently from each other. Accordingly, each type requires different treatment. Most information sources have separate sections describing treatment for NSCLC and SCLC, but the information on symptoms, diagnostic procedures, and supportive care is the same for both types. Other rare tumor types that appear in the lungs are carcinoid tumors and mesotheliomas. These diseases are decidedly different from NSCLC or SCLC, and information on them should be obtained from disease-specific resources and not from lung cancer information sources.

The three major treatment methods for lung cancer are surgery, chemotherapy, and radiation therapy. Surgery may include the removal of part of a lobe, known as a segmentectomy or wedge resection; removal of a lobe, called lobectomy; or removal of an entire lung, called a pneumonectomy. Surgery can potentially cure early-stage lung cancer that has not metastasized to distant organs or lymph nodes, but since most lung cancer cases are discovered after they have already spread, the majority of patients are treated
with radiation and/or chemotherapy without surgery.

Surgery

Surgery is used mostly for non-small cell cancers (stages I, II and III) that have not spread. Surgery is also done as a palliative treatment for advanced stage patients of non-small cell cancer. It helps to relieve symptoms. Surgery is not usually recommended for small cell lung cancer unless detected very early. Pulmonary function tests (breathing tests), which can assess the patient’s overall lung capacity, are performed before cancer surgery.

Surgery recommended for non–small cell lung cancer can be of various types:

  • Wedge resection: It involves the removal of a small portion of the affected lung.
  • Lobectomy: It involves the removal of a lobe of the lung bearing the tumor. This is the mostly recommended surgery for lung cancer. It is mostly used for stage II non-small lung cancer patients having good reserve capacity of the lungs.
  • Pneumonectomy: It involves the removal of the whole lung.  It is also used for stage II non-small lung cancer patients having good reserve capacity of the lungs.

Surgery is done under general anesthesia, and the patient needs to stay in the hospital for several days after the surgery. The patient may experience pain or discomfort even after surgery is completed successfully for some days.

Radiation therapy

Radiation therapy is mostly done when the cancer is diagnosed at an advanced stage. It refers to the use of high-powered energy beams, such as X-rays, to kill cancer cells.

Radiotherapy can be used before or after surgery. Radiation therapy alone is sometimes recommended for stage I and II non- small cell lung cancer when surgery is not possible due to too little lung capacity. Usually, small cell lung cancer is very sensitive to radiation therapy. Radiotherapy is the only form of treatment used in most cases of localized small cell lung cancer disease. It may not be used when the cancer cells have spread in the body. Radiation decreases the chances that the disease may recur. Radiation therapy can be of two types:

External radiation therapy: A beam of radiation from a machine outside the body is aimed at the affected site of the patient’s body.

Internal radiation therapy or brachytherapy: Radioactive substance sealed in small pellets is placed near the affected region. Cancer cells are killed by the radiations emitted from the radioactive substances.

Chemotherapy

Chemotherapy is the use of drugs for the treatment of cancer. When drugs are administered through a vein or by mouth, then this kind of chemotherapy is called systemic chemotherapy. Direct administration of drugs to the affected region is called regional chemotherapy.
The commonly used drugs are cisplatin, carboplatin, doxorubicin, docetaxel and etoposide.

Chemotherapy has shown better response in small cell lung cancer patients than in non-small cell lung cancer patients. Chemotherapy is really the only form of treatment for stage IV non-small cell lung cancer.

Chemotherapy can be used in combination with radiotherapy. This form of treatment is called chemoradiation therapy. It is more effective than either therapy alone.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), tyrosine kinases, mammalian target of rapamycin (mTOR) are some of the many targets for targeted therapy drugs. Non-small lung cancer can be treated with erlotinib and gefitinib. Cetuximab, a monoclonal antibody against EGFR, is a potential drug for lung cancer. Inhibition of VEGF by bevacizumab (Avastin) has also shown good response in advanced stage lung cancer patients. Many more target therapy drugs are under investigation.

Photodynamic therapy

Photodynamic therapy (PDT) is a new form of cancer treatment that uses a light sensitive drug and a certain type of laser light to kill cancer cells. After administration,  the drug accumulates more in the tumor cells than normal cells. It is then activated by a special type of laser light which is focused on the affected region. The active drug then kills the cancer cells. This treatment has minimum side effects. Photodynamic therapy may be useful for early-stage lung cancer and for relieving symptoms of a blocked airway.

Radiofrequency ablation

In this form of treatment radiofrequency is used to create heat which is transmitted through a needle inserted in the tumor. Heat kills the cancer cells of the lungs. This form of treatment is applied when the tumor cannot be operated. The procedure destroys non-resectable primary lung tumors and metastatic tumors that have spread to the lungs.

Prophylactic brain radiation

This radiation therapy is given to the brain to prevent the spread of SCLC cells and formation of a secondary tumor in the brain. This treatment has side effects that can cause memory loss.

Treatment of recurrence: Recurrent lung cancer can be removed by surgery. If it spreads to other organs, chemotherapy or radiotherapy can be used. Recurrent cancers do not respond to those drugs which have been already used. Therefore, a second line of chemotherapeutic drugs should be used.

Other forms of newer treatment for lungs cancer: Electrocautery, cryosurgery and laser surgery are some of the other newer forms of treatment which are being tried sometimes.

Breathing difficulties may occur in later stages of the illness and require special treatments. Pain is another concern and can be controlled by medications or radiation therapy to bone metastases. Smoking cessation is often a challenge for lung cancer patients and their doctors advise them that stopping smoking will increase their ability to tolerate treatment and greatly improve their quality of life. Emotionally, lung cancer patients often experience strong feelings of guilt and shame because lung cancer is perceived as a disease that they have brought on themselves.

Clinical trials
Clinical trials refer to those kinds of treatment which are not yet standardized. It is a part of research that aims to develop better strategies for the treatment of cancer. The patients may willingly participate in clinical trials, but cure is not guaranteed.

References

Gorenstein LA, Sonett JR. The surgical management of stage I and stage II lung cancer. Surg Oncol Clin N Am. 2011 Oct; 20(4):701-20.

West H. The evolving role of targeted therapy in early-stage and locally advanced non-small cell lung cancer. Curr Oncol Rep. 2011 Aug; 13(4):280-9.

Sheth S. Current and emerging therapies for patients with advanced non-small-cell lung cancer. Am J Health Syst Pharm. 2010 Jan 1; 67(1 Suppl 1):S9-14.

This article was originally published on 7/12/2014 and last revision and update of it was 9/14/2015.

 

Additional Resources:

CancerCare. Coping with Lung Cancer. A concise overview of lung cancer stages and treatment, with sections on communicating with the medical team, connecting with support systems, frequently asked questions, a glossary, and resources. Access at: www.cancercare.org/

CancerCare. Caring for Your Bones When You Have Lung Cancer. This publication is aimed at people who have bone metastases as a result of lung cancer. Includes sections on reatment, pain control, sources of support, frequently asked questions, a glossary, and resources. Access at: www.cancercare.org/

National Cancer Institute. What You Need to Know about Lung Cancer. A concise introduction to lung cancer covers staging and treatment options, emotional support, and a list of questions for the doctor. Access at: pubs.cancer.gov/ncipl/detail.aspx?prodid=T068

National Comprehensive Cancer Network (NCCN). Lung Cancer: Treatment  Guidelines for Patients.This publication includes an overview of lung cancer as well as treatment
decision “trees” explaining the treatment choices for different disease stages and conditions. Developed from the NCCN Clinical Practice Guidelines in Oncology-the standard for clinical policy in cancer care. Access at: www.nccn.org/patients/

Ruckdeschel, John C. 2002. Myths  Facts about Lung Cancer: What You Need to Know. MelviHe, NY: PRR.This 80-page handbook with a detailed overview of lung cancer includes
many color illustrations and photographs. The sidebar features facts that dispel common myths about lung cancer and repeat key points. Includes a list of resources and a glossary. The author is a lung cancer specialist from H. Lee Moffitt Cancer Center. To view online, download an Adobe Acrobat (.pdf) file or order access at: www.cancernetwork.com.

Lung Cancer Online Foundation (LCOF). Lung Cancer Online. Access at:  www.lcfamerica.org/welcome.html   A  comprehensive, annotated directory of Internet information and resources for patients and families, this site is edited by Karen Parles, a librarian and lung cancer survivor. The directory is divided into ten main topics, such as finding the best medical care, services and support, treatment information, medical tests, and news. The main topics further divide into subsections. This is an excellent starting point for any information search about lung cancer.