Lung Cancer

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One in 16 people will be diagnosed with lung cancer in their lifetime. The main causes of lung cancer are known to be smoking, but lung cancer can also affect non-smokers. In these cases, the growth of cancer cells is thought to be caused by passive (second-hand) smoke or regular exposure to pollution and carcinogens (radon or asbestos).

A significant step in your cancer treatment is to understand what type of cancer you have. That, along with other factors we’ll mention below, are what determines the treatment your cancer doctor recommends.

Different Types of Lung Cancer

Lung cancer is divided into two main types:

  • Non-small cell lung cancer (NSCLC)
  • Small cell lung cancer (SCLC)

Note: Besides NSCLC and SCLC, a person can also get cancer in the lungs if the primary cancer has spread from another area (for example, the lymph nodes). This is referred to as “secondary (metastatic) lung cancer.” Although the cancer cells are growing in the lung, they are not lung cancer cells.

NSCLC is diagnosed in about 80% of cancer cases. It’s divided into the following sub-types:

  • Adenocarcinoma — Cancer in the cells that secrete mucus. This is the most common type of NSCLC.
  • Bronchoalveolar carcinoma (BAC) — Now considered a subtype of adenocarcinoma, BAC grows in the areas adjacent to the small air sacs (alveoli) in lung tissue. This is a rare type of lung cancer, affecting just 1 – 4% of NSCLC cases.
  • Large cell carcinoma — Cancer cells that typically grow in the outer regions of the lungs. This type of cancer is found in about 10% of NSCLC cases.
  • Squamous cell — Cancer in the epithelial cells in the larger airways of the lungs. This is the second most common type of NSCLC.

SCLC is diagnosed for about 20% of lung cancer cases. This type of cancer begins in the neuroendocrine cells in the lung. It behaves very differently from NSCLC in that it is exceedingly sensitive to chemotherapy.

You likely know of someone who has been treated for cancer with radiation, chemotherapy, or surgery – or perhaps all three. You may feel apprehensive and worry about the cancer treatment you’ll receive, but it’s important to know that your cancer treatment may differ greatly from someone else who has cancer.

Your cancer doctor takes other factors into consideration before recommending a course of treatment. Besides the type of cancer you have and the presence (or lack of) certain biomarkers, other significant factors include:

  • Your age
  • Your general health
  • Stage of cancer

In general, the younger you are when cancer is diagnosed, the more aggressive the cancer, which requires an aggressive cancer treatment. When you are diagnosed with cancer later in life, the cancer is slower-growing and there is often time to examine various treatment options.

Your current state of health (for example, physical fitness or the presence of other medical conditions) is important in determining how aggressively your cancer can be treated and what treatments can be used. You should also discuss any past health issues with your oncologist so that he or she can determine if it’s a factor in your cancer treatment.

Staging your cancer is also a very important aspect of determining what treatment you’ll receive. In order to “stage” your lung cancer, the oncologist will determine the size of the tumor as well as if the cancer cells have spread to anywhere else in your body. Lung cancer can spread to lymph nodes, to the skin, or to distant sites like the liver, lungs, bones, or farther.

NSCLC is staged based on size of tumor, involvement of nodes in the chest, and Involvement of other organs like liver, brain and bones.

Stage I and Stage II NSCLC is confined to the lung.

Stage III NSCLC has spread to the mediastinal lymph nodes in the chest.

Stage IV NSCLC has spread to the liver, colon, or other organs (also known as metastatic).

When SCLC is localized (i.e., remains in the lungs), it is called limited stage. When it involves different areas and organs it is called extensive.

Immunotherapy is a newer type of treatment that has changed how we approach lung cancer treatment.

Certain types of lung cancer (those that have high expression of the molecule PD-L1 (programmed death ligand), respond well to newer drugs that can inhibit PD-L1. Although expensive, these drugs can be very effective in treating lung cancer and prolonging survival. However, they can cause serious side effects that must be closely monitored.

Targeted cancer therapy with newer types of monoclonal antibodies and other agents is another type of lung cancer treatment that looks promising.

Your Treatment Team

A medical oncologist, with the assistance of nurses and staff, will treat your cancer in addition to any cancer-related conditions. The medical oncologist has the role of treating your cancer using chemotherapy or other medications, if appropriate.

The oncologist also works with other types of healthcare professionals to treat your cancer:

Thoracic surgeons
Perform the medical procedures to check if the cancer has spread to nearby lymph nodes or remove tumors from the lungs.

Radiation oncologists
Treats cancer using radiation therapy.

Pulmonologists
Can help with breathing problems that can occur during cancer treatment.

Genetic counselor
Evaluates the results of genetic tests to provide further information about your cancer.

Your oncologist consults extensively with the other doctors to determine what type of treatment will result in the best outcome for you. Although you might receive treatment from any of the doctors on your cancer team, your oncologist is the “quarterback” who coordinates the treatment.

You can read more about your cancer doctor’s background and experience on the About page.

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