The lungs are made up of areas called lobes. The right lung has three lobes; the left lung has two, so there's room for the heart. When you breathe, air goes through your nose, down your windpipe (trachea), and into the lungs where it spreads through tubes called bronchi. Most lung cancer begins in the cells that line these tubes.
There are two main types of lung cancer:
- Non-small cell lung cancer (NSCLC) is the most common type of lung cancer
- Small cell lung cancer makes up about 20% of all lung cancer cases
If the lung cancer is made up of both large and small cell lung cancer, it is called mixed small cell/large cell cancer. If the cancer started somewhere else in the body and spread to the lungs, it is called metastatic cancer to the lung.
Lung cancer, or the possibility of having it, can be scary. Whatever your condition, the specialists at Wake Forest Baptist Comprehensive Cancer Center will be with you every step of the way. From screening to diagnosis and treatment, our goal is provide you the best care and outcome possible. And with advances like low-dose lung cancer screening, it is possible to catch lung cancer at earlier stages, improving your chances for a better outcome.
Lung Cancer Risk Factors
Lung cancer is the deadliest type of cancer for both men and women. Each year, more people die of lung cancer than of breast, colon, and prostate cancers combined.
You may be at risk for lung cancer if you have:
- Smoked cigarettes, pipes or cigars. The earlier in life you start smoking, the more you smoke and the more years you smoke, the greater the risk of lung cancer.
- Been exposed to secondhand smoke
- A family history of lung cancer
- Been treated with radiation therapy to the breast or chest
- Been exposed to asbestos, chromium, nickel, arsenic, soot or tar at work
- Been exposed to radon at home or work
- Lived where there is air pollution
- Been infected with the human immunodeficiency virus (HIV)
Lung Cancer Symptoms
If you have early stage thoracic or lung cancer, you may not notice any concerning symptoms. In these cases, your doctor may find signs of lung cancer during a test or X-ray for a different condition.
As lung cancer progresses, you may experience the following signs or symptoms:
- Chest discomfort or pain
- A cough that doesn’t go away or gets worse over time
- Trouble breathing
- Blood in mucus coughed up from the lungs
- Trouble swallowing
- Loss of appetite
- Weight loss for no known reason
If you experience symptoms like these, it is important to see your doctor quickly. Your doctor will discuss your general health and family history, and perform a physical exam to check for signs of wheezing or fluid in your lungs.
Lung Cancer Diagnosis
Low-dose CT (computed tomography) is one of the newest tools available for diagnosing early stage lung cancer when it is most treatable.
Wake Forest Baptist has been designated a Lung Cancer Screening Center of Excellence. This tool consists of a low dose, non-contrasted CT that uses X-rays to scan the entire chest in about 5 to 10 seconds. It differs from a regular chest CT because the radiation dose is reduced, an IV is not required and no contrast is used.
What is the difference between a screening exam and a diagnostic exam?
A screening is a test to find a disease before it causes symptoms or problems. A lung cancer screening is done to find lung cancer before it has spread.
Diagnostic testing is done if you have signs or symptoms of lung cancer or when a screening test finds something that looks like cancer. It is different from screening because it can involve scans with higher amounts of radiation, other tests to look at the lungs, and taking lung tissue samples.
If you have signs and symptoms of lung cancer, the following tests could be used to diagnose this condition:
- Laboratory tests to check samples of tissue, blood and urine
- Chest X-ray
- CT (computed tomography) scan of the brain, chest and abdomen. This test makes a series of detailed pictures, taken at different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into your vein or you may swallow it to help your organs or tissues show up more clearly.
- Sputum cytology. A microscope is used to check for cancer cells in your spit (mucus coughed up from your lungs).
- Biopsy. Removing cells or tissues so they can be viewed under a laboratory microscope to check for signs of cancer. Types of biopsies include:
- Fine-needle aspiration (FNA). A CT scan, ultrasound or other exam is used to find abnormal tissue or fluid. A small incision may be made in your skin, where a fine needle is inserted into the abnormal tissue or fluid, and a sample is removed. A chest X-ray is done afterwards to make sure no air is leaking from your lung into your chest.
- Bronchoscopy. A procedure to look inside the trachea and large airways in your lung for abnormal areas. A bronchoscope is inserted through your nose or mouth into your trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples.
- Thoracoscopy. A surgical procedure to look at the organs inside your chest to check for abnormal areas. A cut is made between two ribs, and a thoracoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into your chest. The thoracoscope may also have a tool to remove tissue or lymph node samples. In some cases, this test is used to remove part of your esophagus or lung. If certain tissues, organs or lymph nodes can’t be reached, your doctor may perform a thoracotomy. In this procedure, a larger cut is made between your ribs and your chest is opened.
- Thoracentesis. Removing fluid from the space between the lining of your chest and lung, using a needle.
- Mediastinoscopy. A surgical procedure to look at the organs, tissues and lymph nodes between your lungs for abnormal areas. A cut is made at the top of your breastbone and a mediastinoscope is inserted into your chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples.
- Light microscopy. A test in which a sample of tissue is viewed under regular and high-powered microscopes to look for certain changes in your cells.
- Immunohistochemistry. A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between various types of cancer.
Once lung cancer is diagnosed, tests called staging are done to learn if cancer cells have spread within your chest or to other parts of your body.
Information gathered during staging determines how advanced your cancer is. It is important to know the stage of the cancer in order to plan treatment. Some tests used to diagnose lung cancer, such as CT scans, are also used to stage the disease.
Other tests that may be used during staging include:
- MRI (magnetic resonance imaging) of the brain. This test uses a magnet, radio waves and a computer to make a series of detailed pictures. It is also called nuclear magnetic resonance imaging (NMRI).
- PET scan (positron emission tomography scan). This test finds malignant tumor cells in your body. A small amount of radioactive glucose (sugar) is injected into a vein - The PET scanner rotates around your body and makes a picture of where glucose is used in your body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan (PET-CT) may be done at the same time.
- Bone scan. This test checks if there are cancer cells in your bone. A very small amount of radioactive material is injected into your vein and travels through your bloodstream. The radioactive material collects in your bones and is detected by a scanner.
Lung Cancer Treatment
At the Comprehensive Cancer Center, we understand that cancer is one of life’s most significant challenges. We've built a team of committed and experienced thoracic oncologists and cancer specialists to care especially for you, your disease, and your family.
The earlier we diagnose your lung cancer, the better your chances of survival and recovery. Our lung cancer specialists are experienced in using the most advanced tools to diagnose your condition, and then put an effective treatment plan in place for you. Our thoracic oncology clinic is multidisciplinary, which means you will see different types of cancer doctors, who specialize in surgery, radiation and chemotherapy. After you meet with each of them, the doctors will confer on the best treatment plan for you.
As a new patient, you will visit our clinic in the morning. Our team of cancer specialists will discuss your case. Before you leave our clinic in the afternoon, you will have an initial treatment plan in place. Most importantly, you will leave knowing that you have a whole team of cancer specialists dedicated to healing you.
Lung cancer treatment depends on the specific type of disease you have, and how advanced it is. Your team will work together to design a treatment plan that is most effective for your disease, and most appropriate for you and your family.
Most lung cancer treatment plans include some combination of:
Many patients who are not responding to lung cancer treatment may be candidates for our Precision Medicine program.