Lung Cancer

 

 

OVERVIEW

The number of Americans who develop lung cancer is decreasing, due primarily to the decrease in adult smoking over the past 30 years. However, smoking among teens and pre-teens has increased in recent years - raising the potential for increased lung cancer rates in the future.

In 2007, the American Cancer Society estimates that about 215,000 new cases of lung cancer will be diagnosed in the United States. Lung cancer is the deadliest cancer for both men and women, accounting for about 31 percent of all cancer deaths in men and 26 percent of all cancer deaths in women. The five-year survival rate for localized lung cancer is only 50 percent, while the five-year survival rate for all stages combined is a dismal 15 percent.

A major reason for the high percentage of deaths from lung cancer is that the cancer is often detected late, when it has advanced and spread. Efforts are being made by many organizations and physician groups to develop screening strategies that will detect lung cancers early, when they are most treatable. Many advocate the use of screening helical (spiral) CT scans to detect cancer before it can be seen on a standard chest X-ray.

Lung cancer takes many years to develop, but changes in the lungs can begin almost as soon as a person is exposed to cancer-causing substances. Soon after exposure begins, a few abnormal cells may appear in the lining of the bronchi (the main breathing tubes). If a person continues to be exposed to the substance, more abnormal cells appear. These cells may become cancerous and form a tumor.

There are several types of lung cancer. The disease is usually classified as either small cell or non-small cell based upon the appearance of the cells under the microscope. Small cell carcinoma usually starts in one of the larger breathing tubes, grows rapidly, and has commonly spread by the time of diagnosis. Non-small cell lung cancer has three subtypes: epidermoid carcinoma, adenocarcinoma, and large cell carcinoma. Carcinoid, cylindrome, mucoepidermoid, and malignant mesothelioma are uncommon types of lung cancer.

If you're looking for top lung cancer treatment centers, discover all of the options at the John Theurer Cancer Center. Our lung cancer specialists - including board-certified thoracic surgeons, medical oncologists, radiation oncologists, and radiologists - are highly skilled in diagnosing, treating, and managing all types of lung cancer.

Other innovations at The Cancer Center include:

  • The Breath and Lung Institute
  • interventional pulmonology
  • twice-monthly lung cancer conferences
  • the weekly multidisciplinary Lung Cancer Program
  • state-of-the-art diagnostic technology and imaging studies
  • clinical trials to investigate new medications and treatment methods
  • a full range of support services

 

PREVENTION

The Breath and Lung Institute at Hackensack University Medical Center aims to prevent lung cancer through routine screenings for those at risk. The Breath and Lung Institute provides smoking cessation programs, early detection screenings including high-resolution helical CT scanning, educational services, and pulmonary rehabilitation to help patients achieve their best lung health.

 

RISK FACTORS

By far, the greatest risk factor for lung cancer is the use of tobacco. Smoking tobacco accounts for 87 percent of all lung cancer deaths in the United States. Radon - a gas that can come up through the soil under a home or building and enter through gaps in the foundation, insulation, pipes, drains, or walls - is the second leading cause, accounting for about 12 percent of all lung cancer deaths. The third is on-the-job exposure to cancer-causing substances, including asbestos, uranium, arsenic, and certain petroleum products.

 

SYMPTOMS

Lung cancer can be difficult to diagnose and treat because it often does not produce symptoms until it has advanced and spread. Symptoms of lung cancer include:

  • a nagging cough
  • chest, shoulder, or back pain, which feels like a constant ache
  • shortness of breath
  • fatigue
  • weight loss
  • repeated pneumonia or bronchitis
  • coughing up blood
  • hoarseness
  • unexplained weakness in the legs
  • swelling of the neck and face

 

TREATMENT SERVICES

Your doctor will decide what is the best treatment based on the type of lung cancer you have, whether it has spread, your overall health, your age, and other factors. Treatment may include interventional pulmonology, surgery, radiation therapy, chemotherapy, and/or other medications. Your doctor may advise a combination of treatment methods. As one of the top lung cancer treatment centers, the John Theurer Cancer Center offers all of these treatments with exceptional, personalized care from our experienced staff.

Interventional Pulmonology

There are several innovative interventional pulmonary procedures that are performed jointly by a thoracic surgeon and a radiologist at The Cancer Center. These include laser bronchoscopy and photodynamic therapy, which is used to treat some cases of non-small cell lung cancer. Photodynamic therapy utilizes a photosensitizing drug that is activated by light to destroy lung cancer cells.

Treatment for Non-Small Cell Lung Cancer

Surgery to remove the cancer and tissue surrounding it is the main treatment for non-small cell lung cancer. The surgery may be:

  • a wedge resection (section of the lobe is removed)
  • a lobectomy (whole lobe of lung is removed)
  • a pneumonectomy (entire lung is removed)

Lymph nodes are also removed during these procedures.

Although these surgeries may be performed in a traditional "open&quot: procedure that requires separating the sternum (breastbone) and operating through a large chest incision, your thoracic surgeon may instead perform the procedure using video-assisted thoracic surgery (VATS) if the tumor is small and at an early stage. VATS is performed through small incisions, does not require separating the sternum, and reduces scarring, hospitalization, pain, and bleeding. VATS is a specialized technique and should only be performed by thoracic surgeons with experience and expertise in the procedure.

Radiation therapy may be used as the primary therapy for non-small cell lung cancer if the patient is too sick to undergo surgery; to relieve symptoms of pain, bleeding, or trouble swallowing; or if the cancer has spread to the brain. The radiation may be administered outside the body (external beam radiation therapy) or directly into the tumor via seeds that are implanted into the tumor (brachytherapy) through a bronchoscope.

Chemotherapy may be the primary therapy or may be used in combination with other treatment methods. A targeted therapy called Avastin, which "starves" tumors by keeping their "food supply" of new blood vessels from forming, can help patients with advanced lung cancer live longer when combined with chemotherapy.

Treatment for Small Cell Lung Cancer

The main treatment for small cell lung cancer is chemotherapy, either given alone or in combination with radiation therapy. Your doctor will probably order a combination of chemotherapy drugs.

Surgery is rarely used to treat small cell lung cancer, but if it is, it is usually followed by radiation therapy and chemotherapy. The surgery may be:

  • a wedge resection (section of the lobe is removed)
  • a lobectomy (whole lobe of lung is removed)
  • a pneumonectomy (entire lung is removed)

Lymph nodes are also removed during these procedures.

Although these surgeries may be performed in a traditional "open" procedure that requires separating the sternum (breastbone) and operating through a large chest incision, your thoracic surgeon may instead perform the procedure using video-assisted thoracic surgery (VATS) if the tumor is small and at an early stage. VATS is performed through small incisions, does not require separating the sternum, and reduces scarring, hospitalization, pain, and bleeding. VATS is a specialized technique and should only be performed by thoracic surgeons with experience and expertise in the procedure.

External beam radiation therapy (given outside the body) is frequently used in addition to chemotherapy or as an adjuvant (addition) to treat the tumor and lymph nodes in the chest.

Treatment for Lung Carcinoid Tumor

Surgery is the main treatment for lung carcinoid tumor. Most cases can be cured by surgery alone. The surgery may be:

  • a sleeve resection to treat carcinoids of a large airway
  • a wedge resection (section of the lobe is removed)
  • a lobectomy (whole lobe of lung is removed)
  • a pneumonectomy (entire lung is removed)

Lymph nodes are also removed during these procedures to reduce the risk of the tumor spreading.

Although these surgeries may be performed in a traditional "open" procedure that requires separating the sternum (breastbone) and operating through a large chest incision, your thoracic surgeon may instead perform the procedure using video-assisted thoracic surgery (VATS) if the tumor is small and at an early stage. VATS is performed through small incisions, does not require separating the sternum, and reduces scarring, hospitalization, pain, and bleeding. VATS is a specialized technique and should only be performed by thoracic surgeons with experience and expertise in the procedure.

Chemotherapy is only used for tumors that have spread to other organs. Other medications may be used to treat carcinoid symptoms. These include octreotide, lanreotide, and interferons to boost the ability of the patient's own immune system to fight the cancer and suppress tumor growth.

Radiation therapy may be used if surgery is not an option because of the patient's overall health and the stage of the tumor.

The Lung Cancer Program

This specialized program brings together the Division of Thoracic Oncology's specialists on Mondays from 1 to 4 p.m. to discuss and treat new and established patients. A multidisciplinary group of medical oncologists, radiation oncologists, thoracic surgeons, pulmonolgists, pathologists, radiologists, and other physicians are available at the same time so that you may schedule one appointment and see a number of specialists depending on your needs. Or, if it is more convenient, you may choose to see the physicians separately on other days or times that are more convenient to you.