Lung Cancer: Five Things You Need to Know

This post originally appeared on the Dana-Farber Insight blog.

More than 228,000 new cases of lung cancer will be diagnosed in the United States in 2013, according to the National Cancer Institute (NCI).

With November marking Lung Cancer Awareness Month, Pasi A. Jänne, MD, PhD, director of Dana-Farber’s Lowe Center for Thoracic Oncology, answers some key questions about the disease:

1.    What are the different types of lung cancer?

Lung cancer develops in the tissue of the lung, usually in the cells that line the air passages. There are several types of lung cancer:

• Non-small cell lung cancer — Non-small cell lung cancer is named for the size of the cells when viewed under a microscope. It begins whenepithelial cells inside the lining of the lungs grow rapidly or uncontrollably, often forming a tumor. This is the most common form of lung cancer.
• Small cell lung cancer — Small cell lung cancer is also named for the size of the cells when viewed under a microscope. Affecting approximately 15 percent of lung cancer patients, it typically starts in the bronchial.
• Mesothelioma — Although it is not technically a lung cancer, mesothelioma shares many of the same symptoms as lung cancer. Malignant mesothelioma is a disease in which cancer cells form in the linings of the organs, most often the pleura and sometimes the peritoneum.

2.    What are the risk factors for lung cancer?

The Centers for Disease Control and Prevention (CDC) estimates 90 percent of lung cancers are caused by cigarette smoke. However, there are also other risk factors:

• Smoking pipes or cigars
• Exposure to second-hand smoke
• Being treated with radiation therapy
• Being exposed to asbestos, radon, chromium, nickel, arsenic, soot, or tar. Specifically, exposure to asbestos can increase risk of developing malignant mesothelioma.
• Living where there is air pollution
• Family history of lung cancer

3.    What are the symptoms of lung cancer?

Some of the more common symptoms include a cough that does not go away, trouble breathing, chest discomfort, wheezing, hoarseness and streaks of blood in mucus. Other symptoms can include loss of appetite, weight loss for no reason, and unusual tiredness.

Patients with mesothelioma may notice lumps, pain or swelling in their abdomen, or pain under the rib cage.

4.    How do doctors diagnose lung cancer?

When lung cancer is suspected, patients typically have a CT scan, MRI, orPET/CT scan to produce a detailed image of their lungs. If a mass is detected, either a fine needle biopsy, core needle biopsy, bronchoscopy, or endobronchial ultrasound (EBUS) will be done to remove a piece of tissue from a node or tumor. If necessary, surgeons may remove a tissue sample. If so, a pathologist will examine the tissue to determine whether cancer is present and, if so, the type and stage of the cancer.

5.    What are the treatment options for lung cancer?

In the case of non-small cell lung cancer, patients in early stages first undergo surgery to remove tumors. After surgery, patients may go on to chemotherapy and/or radiation treatments, depending on the stage and type of cancer. In some cases, radiation therapy may be used to eliminate early-stage tumors, instead of surgery.

Patients with small cell lung cancer typically have chemotherapy and/or radiation therapy. This is because the disease often does not have symptoms and is diagnosed at a more advanced stage where surgery would not have an impact on the progress of the cancer. Chemotherapy and/or radiation are also often the first steps for more advanced stages of non-small lung cancer.

A combined approach of surgery, radiation therapy, and chemotherapy are used to treat mesothelioma, as there is not one universally accepted standard for treatment of the disease.

Researchers are also developing several new treatment approaches for lung cancer, including immunotherapy and targeted therapy options.  All lung cancer patients at DFCI have their cancer analyzed for several genetic alterations; the results of which can help identify whether a targeted therapy is most the appropriate treatment. Through clinical trials, some of these new treatments are now available for lung cancer patients. Dana-Farber is currently offering 33 clinical trials for lung cancer and the NCI maintains a list of clinical trials atclinicaltrials.gov.