Lung cancer starts when
abnormal cells grow out of control in the lung. They can invade nearby tissues
and form tumors. Lung cancer can start anywhere in the lungs and affect any
part of the
The cancer cells can
spread, or metastasize, to the
lymph nodes and other parts of the body.
Lung cancers are divided into small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). Small cell lung cancers usually grow more quickly and are more likely to spread than non-small cell lung cancer.
cancer is the leading cause of cancer deaths in the world.1
Most lung cancer is
caused by smoking.
But sometimes lung cancer develops in people who have never smoked.
Being exposed to
secondhand smoke, arsenic, asbestos, radioactive dust, or
radon can increase your chances of getting lung
cancer. People who are exposed to radiation at work or elsewhere have a higher
chance of getting lung cancer.
signs of lung cancer may include:
Because these symptoms are so general, many people don't suspect lung cancer. And by the time they see a doctor, often the cancer has already started to spread.
If the cancer spreads within and beyond the chest, other symptoms may occur.
Your symptoms and your medical history—especially if you have any history of cancer in your family—will help your doctor decide how likely it is
that you have lung cancer and whether you need tests to be sure.
Lung cancer is usually first found on a chest
X-ray or a
CT scan. More tests are done to find out what kind of
cancer cells you have and whether they have spread beyond your lung. These
tests help your doctor and you find out what
stage the cancer is in. The stage is a rating to
measure how big the cancer is and how far it has spread.
Treatment for lung cancer may
include surgery, chemotherapy,
radiation, or a combination of these therapies. Targeted therapy and laser therapy may also be used.
cancers are found in the early stages when treatment is most effective. When lung cancer is found before it has spread outside the lungs, about half of these people will live at least 5 more years.2 After lung cancer has spread outside the lungs, how long a person lives usually depends on how far the cancer has spread (the stage) by the time it is found.
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
Lung cancer that is caused by smoking can be prevented.
So it is important to stop smoking—or to stop being around someone else's
Even if you have smoked a long time, quitting can lower
your chances of getting cancer. If you already have lung cancer, quitting makes
your treatment work better and can help you live longer.
Learning about lung cancer:
Living with lung cancer:
Health Tools help you make wise health decisions or take action to improve your health.
More than 8 out of 10 lung
cancers are caused by smoking.3 Tobacco smoke contains carcinogens—substances that cause cancer. These substances damage lung cells, and over time the damaged cells can turn into lung cancer.
The more you smoke and the longer you have smoked, the higher your chances of getting lung cancer. You lower your chances when you quit or cut down on how much you smoke.
A few people get lung cancer after being exposed to other
harmful substances, including
asbestos, radioactive dust,
radon, or radiation such as X-rays.
Cancer also may be caused by gene changes (mutations) that occur as you get older.
Symptoms of lung cancer may include:
When lung cancer spreads, there may be other
symptoms. For example, if it spreads to the spine or
bones, it may cause pain in the back or other bones or cause weakness in the arms or
legs. If it spreads to the brain, it may cause seizures, headaches, or vision
Lung cancer can start anywhere in the lungs and may affect any
part of the
respiratory system. This can cause breathing or heart problems, such as:
As lung cancer grows, it may spread (metastasize) to other
parts of the body. Lung cancer is classified in
stages, which describe how far the cancer has grown and spread.
long-term outcome (prognosis) for lung cancer depends
on how much the cancer has grown and spread.
A risk factor for lung cancer is something that increases your chance of getting this cancer. Having one or more of these risk factors can make it more likely that you will get lung cancer. But it doesn't mean that you will definitely get it. And many people who get lung cancer don't have any of these risk factors.
About 85 out of 100 lung cancers are related to cigarette smoking.4 Smoking cigars or a pipe may also increase your risk for lung cancer.
Your risk of getting lung cancer increases:
Quitting smoking lowers your risk for getting cancer, and your risk keeps going down as
long as you don't smoke. Even cutting down how much you smoke may reduce your
risk (but not as much as quitting completely).
If you live with a smoker, you have a higher risk for
lung cancer compared with a person who lives in a nonsmoking
For more information, see the topic Quitting Smoking.
Exposure to some substances may increase your risk for lung cancer, including:
Some gene changes (mutations) can increase the risk of getting lung cancer. These gene changes mostly occur as a person gets older.
or other emergency services immediately if you:
Call your doctor immediately if you have:
Call your doctor to find out when an evaluation is needed
Health professionals who can evaluate your symptoms
and your risk for lung cancer include:
Health professionals who can evaluate and treat your lung
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will first do a physical exam and ask about your medical history to find out your risk for lung cancer and look for any lung problems. The exam may include a chest X-ray and blood test.
If your exam suggests that you may have lung cancer, your doctor may recommend other
tests, such as:
After lung cancer has been diagnosed, testing
is done to find out whether the cancer has spread (metastasized) to other
organs in your body and to determine the
stage of the cancer.
If you have non-small cell lung cancer, your doctor may check for tumor markers (biomarkers), such as EGFR, ALK, and KRAS, that are caused by gene changes (mutations) in cancer cells. This can help your doctor choose the treatment that will
work best for you.
A person whose lungs aren't working well may not be a good
candidate for surgery. If surgery to remove cancer in all or part of a lung is being
considered, the following tests may be done:
Screening tests help your doctor look for a certain disease or condition before any symptoms appear. This can increase your chance of finding the problem at a more treatable stage. Studies have not yet shown that routine screening for lung cancer saves lives or prevents lung cancer.
Screening may help people whose risk for lung cancer is higher than normal. Talk to your doctor about the pros and cons of screening tests if you:
Several studies have looked at the use of
chest X-rays, sputum cytologies, or
spiral CT to screen for lung cancer. Screening with chest X-rays or sputum didn't improve survival. But a large research study found that screening with low-dose spiral CT reduced lung cancer deaths among current and former smokers.6 Screening with low-dose CT scans may help if you are older than 55 and are a heavy smoker.7
While screening tests may aid in the early diagnosis of lung
cancer, they can also show abnormal findings, such as nodules, that
are not cancer. This is known as a false-positive, which can cause you to have more tests or even treatment that you don't need.
Treatment for both non-small cell lung
cancer (NSCLC) and small cell lung cancer (SCLC) may include the following:
Other treatments for NSCLC include:
Your doctor may check for tumor markers (biomarkers), such as EGFR, ALK, and KRAS, that are caused by gene changes (mutations) in cancer cells. This can help your doctor choose the treatment that will
work best for you.
Other treatments for SCLC include:
The kind of treatment and the
long-term outcome of
lung cancer depends on the
type and stage of the cancer and also on your age and your overall health.
Some treatments can cause side effects. Home treatment
measures may help.
Your quality of life is critical when you are considering your treatment choices.
Discuss your personal preferences with your
oncologist when he or she recommends treatment.
Additional information about lung cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/lung.
If you have been recently diagnosed with lung cancer, you may feel
denial, anger, and grief. Reactions vary from person to person. Talk to your doctor about steps you can take to help with your
If you are having a hard time moving forward with your life, talk
with your doctor. Your cancer treatment center may offer counseling services.
You may also contact your local chapter of the American Cancer Society to help
you find a support group.
Having cancer can change your life in many ways. For support in managing these changes, see the topic
Getting Support When You Have Cancer.
After initial treatment for
lung cancer, it is important to receive follow-up
You may be
interested in participating in research studies called
clinical trials. Clinical trials are based on the most
up-to-date information and are designed to find better ways to treat people who
People who do not want standard treatments or are not cured by
standard treatments may want to participate in clinical trials. These are
ongoing in most parts of the United States and in some other countries around
the world for all stages of lung cancer.
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It also can help you with other concerns that you may have when you're living with a serious illness.
One study of people with non-small cell lung cancer who started palliative care when they were diagnosed with lung cancer found that they not only felt better but also lived a little longer than the people who didn't have palliative care.8
For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.
It can be hard to decide when to stop treatment to prolong your life and shift the focus to end-of-life care.
To learn about supportive care, see:
Most lung cancers are caused by smoking. If
you use tobacco, you can help prevent lung cancer by quitting. For more information, see
You may be able to make other changes in your life that can help prevent lung cancer:
Studies show that taking supplements of beta carotene or vitamin E does not affect the risk of lung cancer for non-smokers. But for smokers, especially those who smoke one or more packs a day, taking beta carotene supplements can actually increase their risk for lung cancer.9
During treatment for any stage of
lung cancer, there are steps you can take at home to manage some symptoms and side effects. Be sure to follow any instructions your doctor has given you.
Other issues you may be able to handle at home include:
If you smoke and have lung cancer, quitting smoking
will make your treatment more effective and may help you live longer. Smoking
delays healing after surgery, so you may have a better recovery from lung
cancer surgery if you have quit smoking.
People with early-stage lung cancer
who continue to smoke during radiation therapy have been shown to have shorter
survival times than those who do not smoke.10
also make chemotherapy less effective. The nicotine in tobacco seems to help
the cancer cells and their blood supply multiply while also protecting the
cancer cells from destruction.11
For information and
help quitting smoking, see the topic
Medicines for lung cancer mainly involve chemotherapy. Other medicines may be used to help with pain.
Chemotherapy is the most effective treatment for
small cell lung cancer. It can help control the growth and spread of the
cancer, but it cures lung cancer in only a small number of people. It
also may be used to treat more advanced stages of
non-small cell lung cancer.
Chemotherapy is called a systemic
treatment because the medicines enter your bloodstream, travel through your
body, and kill cancer cells both inside and outside the lung area. Some
chemotherapy drugs are taken by mouth (orally), while others are injected into
a vein (intravenous, or IV).
Some of the more common chemotherapy medicines used for lung cancer include the
Most chemotherapy causes some
side effects. Your doctor may prescribe
medicines to control nausea or vomiting.
You may be concerned about losing your hair
from cancer treatment. Not all chemotherapy medicines cause hair loss, and some
people have only mild thinning that is noticeable only to them. Talk to your
doctor about whether hair loss is an expected side effect of the medicines you
Chemotherapy may be combined with surgery. It may be given before or after surgery to kill cancer cells.
Pain is one of the main concerns of people who have cancer. But cancer pain can almost always be controlled with medicines and other options. Medicines used for cancer pain include prescribed medicines, such as hydrocodone or morphine, or nonprescription medicines, such as aspirin and similar drugs.
Lung surgery to remove
the cancer may be an option when your cancer is in only one lung or present in
one lung and in nearby lymph nodes. It usually is done only if your doctor
thinks all the cancer can be removed and your general health is good enough for
you to handle the surgery.
Nearby lymph nodes may also be removed to find out whether the cancer has
The type of surgery performed depends on the location and
size of your lung cancer:
The side effects from surgery will depend on the type of surgery that you have. There is less pain with surgery that is minimally invasive (VATS) than the traditional surgery (thoracotomy). You may have numbness and tingling in the chest area. This usually goes away in a few weeks or months.
Radiation treatment is the use of
high-energy X-rays to kill cancer cells and shrink tumors. Most radiation for lung cancer is given externally, which means that the radiation comes from a machine outside the body.
Radiation is often used in combination with
surgery or chemotherapy or both. But it may be used alone if surgery is not possible.
People who can't have surgery may have a special type of radiation called stereotactic radiosurgery (SRS). This isn't surgery but a series of very high doses of radiation that are aimed at the cancer. SRS is usually given to treat tumors that have spread to the brain. SRS may also be called gamma knife radiosurgery, cyberknife, stereotactic ablative radiotherapy (SABR), or stereotactic body radiotherapy (SBRT).
Radiation may be used to prevent small
lung cancer from growing in your brain. This is called
prophylactic cranial irradiation (PCI).
Radiation also may be used as
palliative care to:
Radiation may cause
side effects, such as skin changes, fatigue, and trouble swallowing.
People sometimes use complementary treatments along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
The American Lung Association provides programs of
education, community service, and advocacy. Some of the topics available
include asthma, tobacco control, emphysema, infectious disease, asbestos, carbon monoxide, radon,
The American Thoracic Society provides information for
professionals and consumers about the prevention and treatment of lung
diseases. Its website provides educational materials for the consumer.
Cancer.Net is the information website of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
Silverstri GA, Jett JR (2010). Clinical aspects of lung cancer. In R Mason et al., eds., Murray and Nadel's Textbook of Respiratory Medicine, 5th ed., vol. 2, pp. 1116–1144. Philadelphia: Saunders.
American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online.
Ettinger DS (2012). Lung cancer and other pulmonary neoplasms. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1264–1272. Philadelphia: Saunders.
U.S. Department of Health and Human Services (2010). A Report of the Surgeon General: How Tobacco Smoke Causes Disease—The Biology and Behavioral Basis for Smoking-Attributable Disease Fact Sheet. Available online: http://www.surgeongeneral.gov/library/tobaccosmoke/factsheet.html.
Aldington S, et al. (2008). Cannabis use and risk of lung cancer: A case-control study. European Respiratory Journal, 31(2): 280–286.
Cornett PA, Dea TO (2012). Cancer. In SJ McPhee, MA Papadakis, eds., 2012 Current Medical Diagnosis and Treatment, 51st ed., pp. 1548–1614. New York: McGraw-Hill.
National Comprehensive Cancer Network (2012). Non-Small Cell Lung Cancer, version 2.2012. Available online.
Temel JS, et al. (2010). Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, 363(8): 733–742.
National Cancer Institute (2011). Small Cell Lung Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/Patient.
Fox JL, et al. (2004). The effect of smoking status on survival following radiation therapy for non–small cell lung cancer. Lung Cancer, 44(3): 287–293.
Dasgupta P, et al. (2006). Nicotine inhibits apoptosis induced by chemotherapeutic drugs by up-regulating XIAP and survivin. Proceedings of the National Academy of Sciences, 103(16): 6332–6337.
Other Works Consulted
Bedient JF, Schwartz DA (2011). Occupational and environmental lung diseases. In EG Nabel, ed., ACP Medicine, section 14, chap. 18. Hamilton, ON: BC Decker.
National Cancer Institute (2011). Small Cell Lung Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/Patient.
National Cancer Institute (2012). Non-Small Cell Lung Cancer PDQ: Treatment—Patient Version. Available online.
National Cancer Institute (2012). Small Cell Lung Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional.
Neville NJ, Kuruvilla MS (2010). Lung cancer, search date October 2009. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Strickler J, Crawford J (2011). Lung cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 8. Hamilton, ON: BC Decker.
September 12, 2012
E. Gregory Thompson, MD - Internal Medicine
& Michael Seth Rabin, MD - Medical Oncology
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