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Risk factors increase your chances of developing lung cancer. Some of these can be changed, like smoking, while others, like family history, cannot. While some people with multiple risk factors never develop lung cancer, and others with no known risk factors do, knowing what may increase your chances of developing the disease can help you take charge of your own health as much as possible.
Smoking is the leading cause of lung cancer, and your risk increases with the number of cigarettes smoked per day and the number of years you have smoked. Smoking other tobacco products, such as cigars or pipes, also increases your risk. Exposure to secondhand smoke is also a risk and thought to cause more than 7,000 deaths from lung cancer every year. Quitting smoking at any age can lower your risk of lung cancer.
Smoking other products, such as marijuana and e-cigarettes, may increase your risk of lung cancer, but more research is needed to determine long-term effects on health.
Exposure to Radon
Radon is an invisible, tasteless, odorless radioactive gas that naturally occurs when uranium breaks down in soil and rocks. Radon is the second leading cause of lung cancer and the leading cause of lung cancer in nonsmokers. The risk of outdoor radon exposure is low, but exposure in homes and other buildings is more concentrated and poses a greater risk.
Workplace Exposure to Asbestos and Other Cancer-Causing Agents
People who work with asbestos in places like mines, mills, textile plants, and shipyards have a greater risk of developing lung cancer. Government regulations have greatly reduced the use of asbestos in commercial and industrial products. While it may be present in older homes and other buildings, it is usually not harmful unless it is released into the air through deterioration, demolition, or renovation.
Some workers may be exposed to cancer-causing agents called carcinogens, which may include radioactive ores, inhaled chemicals, or diesel exhaust. While government and industry regulations have taken steps to minimize the risk of these carcinogens in the workplace, the dangers are still there, and workers should take steps to limit exposure when possible.
Personal or Family History of Lung Cancer
People who have had lung cancer are at a higher risk of developing another lung cancer. If you have had radiation therapy to the chest to treat another cancer, you are at risk for developing lung cancer. Smokers who have had previous radiation therapy have an increased risk.
If a close family member, such as a parent or a sibling, has had lung cancer, shared environmental factors or genetics may increase your risk for lung cancer.
Air pollution, particularly in cities near roads with heavy traffic, can slightly raise your risk of developing lung cancer. This is a much smaller risk than smoking tobacco products, but about 5% of lung cancer deaths worldwide may be linked to outdoor air pollution.
Signs and Symptoms
Lung cancer symptoms can vary from person to person, and many people with lung cancer don’t experience symptoms until the disease has spread. Going to the doctor when you first notice symptoms increases the chance that your lung cancer will be diagnosed at an earlier stage, when treatment is more likely to be effective. While many common early symptoms can be caused by something other than lung cancer, it’s important to see your physician if you have concerns.
The most common lung cancer symptoms can include:
- A persistent cough
- Coughing up blood or rust-colored phlegm
- Chest pain that gets worse with deep breaths, coughing, or laughing
- Hoarse throat
- Loss of appetite
- Unexplained weight loss
- Shortness of breath
- Infections like bronchitis or pneumonia that don’t go away or keep coming back
Lung cancer that has spread may also cause:
- Bone pain
- Nervous symptom changes, including headaches, arm or leg numbness, dizziness, balance problems, or seizures
- Lymph node swelling
Syndromes Caused by Lung Cancer
Some lung cancers may also trigger syndromes—groups of symptoms that affect other organs in the body. These may include:
- Superior vena cava syndrome: The superior vena cava carries blood from the head and arms to the heart, passing between the lungs. Tumors pressing on this vein can cause swelling in the face, neck, arms, and upper chest. Headaches and dizziness may also occur.
- Horner syndrome: Tumors in the upper part of the lungs can affect nerves going to the eye and the face. This can cause drooping in the upper eyelid, a smaller pupil, and reduced sweating on one side of the face.
- Paraneoplastic syndromes: Cancers can produce substances similar to hormones, which enter the bloodstream and cause issues in distant tissues and organs where the cancer has not yet spread. These syndromes include:
- Hypercalcemia (high blood calcium levels)
- Blood clots
- SIADH (syndrome of inappropriate antidiuretic hormone)
- Cushing syndrome
- Excess growth or thickening of certain bones
- Gynecomastia (excess breast growth in men)
- Nervous system problems
After you have received a lung cancer diagnosis, your physician will look at the extent of the cancer and if it has spread in the body. This process is called staging, and it helps determine how serious the cancer is and how to best treat it. Your physician may use physical exams, biopsies, imaging tests, or any other testing that has been done to determine your lung cancer’s stage. Each person’s cancer is unique, but cancers within the same stage share similar outlooks and approaches to treatment.
How Lung Cancer is Stage is Determined
The American Joint Committee on Cancer (AJCC) has developed a formal system to describe the growth and spread of cancer cells, based on three pieces of information:
- The size and location of the main tumor
- The spread to lymph nodes, which are small immune system organs found throughout the body
- The spread to other parts of the body, called metastasis
Once these categories have been determined, the information is used to assign an overall stage. Small cell and Non-Small Cell Lung Cancer stages are described differently.
Small Cell Lung Cancer Stages
Most physician use two stages to describe small cell lung cancer:
- Limited stage lung cancer is located in one lung. It may have spread to the lymph nodes on the same side of the chest but not to other parts of the body.
- Extensive stage lung cancer has spread to the other lung, to lymph nodes on the other side of the chest, to fluid around the lung, or to other parts of the body.
Non-Small Cell Lung Cancer Stages
Non-small cell lung cancer is divided into multiple numbered and lettered stages indicating how much the cancer has spread:
- Occult (hidden) cancer: Cancer cells have been detected in samples, but cancer is not found in other tests. Cancer has not spread to lymph nodes or other parts of the body.
- Stage 0: The cancer is found in the top layer of the lung tissue on one side and has not spread to lymph nodes or other parts of the body.
- Stage I: The cancer is found beyond the top layer of lung tissue on one side of the lung. The main tumor is less than 4 cm across. It may have grown into the membrane surrounding lungs or be partially blocking the airway. Cancer cells have not spread to lymph nodes or other parts of the body.
- Stage II: The cancer is found on one side of lung. The main tumor is between 3-7 cm across, or there may be more than one tumor found in the same lobe of the lung. The tumor(s) may be partially blocking the airway, have grown into chest wall or other areas surrounding the lung. Cancer cells may have spread to nearby lymph nodes but not to other parts of the body.
- Stage III: The cancer is found in one side of the lung. The main tumor is at least 3 cm and may be larger than 7 cm, or there may be more than one tumor in the of the lung on one side. The tumor(s) may be affecting the airway, diaphragm, sac surrounding the heart, major blood vessels and other structures of the chest. Cancer cells may have spread to lymph nodes on either side of the chest but not to other parts of the body.
- Stage IV: Cancer is found in both lungs, the fluid around the heart or lung, lymph nodes outside of the chest or has spread to other parts of the body.
Lung cancer treatments are evolving rapidly. At Maryland Oncolgy Hematology, we offer the latest treatments including targeted therapy and immunotherapy with leading edge technologies. As part of The US Oncology Network, our patients also have access to clinical trials that offer lung cancer patients the opportunity to participate in groundbreaking research on new treatments.
Every individual is different, and so is their cancer. Your treatment plan will be determined by your provider based on your specific cancer and needs. Here are some of the treatments that may be used:
Lung Cancer Surgery
At Maryland Oncolgy Hematology, we offer the latest surgical treatment options for lung cancer. Our goal is to offer the least invasive treatment that will provide the best outcome. Lung cancer surgery can be performed in the following ways:
- Thoracotomy is traditional open surgery, in which a large incision is made in the chest and the ribs are spread to reach the lung tissue.
- VATS (video-assisted thoracoscopic surgery) is performed through small incisions. Surgeons insert long instruments and a tiny video camera through the incisions, allowing them to perform the same procedures that would be done in a thoracotomy without having to spread the ribs.
- Robotic-assisted surgery is also performed through several small incisions. This procedure uses a tiny video camera to view the inside of the chest, as well as robotically controlled instruments that surgeons operate with hand and foot controls.
Immunotherapy leverages your immune system to fight cancer. Immunotherapy drugs are used to either boost your immune system to help it target and attack cancer cells or to change the way your immune system works to fight the cancer cells.
Immunotherapy drugs called checkpoint inhibitors are used to treat some lung cancers. Your immune system keeps itself from attacking normal cells in the body with “checkpoint” proteins, which determine whether an immune response is started. Cancer cells can use these checkpoints and avoid being targeted by the immune system. Immunotherapy drugs target these checkpoints to start an immune response.
Targeted therapy uses drugs that identify and attack certain types of cancer cells. Targeted therapy can be used alone or in combination with other treatments. In lung cancer, drugs have been developed to target changes in cancer cells that help them grow.
Radiation therapy for lung cancer is an effective treatment that uses high energy rays to fight cancer cells and keep them from growing. Radiation can be used to shrink tumors and lower chances of the cancer spreading.
- Internal radiation therapy, also known as brachytherapy, places radiation inside the body either in or near the tumor. The radiation stays near the source, limiting the effects on nearby healthy tissue.
- Intensity Modulated Radiation Therapy (IMRT) is a form of 3D therapy using beams that can be shaped to precisely target the tumor from multiple angles, avoiding healthy tissue.
- Image Guided Radiation Therapy (IGRT) uses imaging during radiation treatment to improve the accuracy of treatment.
- Stereotactic body radiation uses a high dose of radiation to tumors in the lung while limiting the radiation exposure to surrounding organs. This can also be used for cancer that has spread to other parts of the body.
Chemotherapy is a cancer treatment that uses drugs to attack cancer cells by stopping or slowing the growth of cancer cells. It can be used to treat cancer, decrease the chance of cancer returning, or to ease cancer symptoms. Chemotherapy can be used with other treatments to make a tumor smaller before surgery or radiation, destroy cancer cells remaining after surgery or radiation, help other treatments work better, or destroy cancer cells in other parts of the body.
Oncology clinical trials play a vital role in fighting cancer. As a part of the US Oncology Network, lung cancer patients at Maryland Oncolgy Hematology have access to advanced clinical trials that provide the opportunity for a better outcome and quality of life. While clinical trials are usually only available in major academic medical centers or hospital systems in large cities, Maryland Oncolgy Hematology makes them accessible in [local community], where the patient can have the support of their family and friends close to home.
Removing the tumor with surgery may be an option for some lung cancers, especially cancer that is in an early stage or has not yet spread to other organs. Your physician may perform tests to check the function of your heart or other organs to determine whether you are healthy enough for surgery. They may also perform a pulmonary function test to be sure you will have enough healthy tissue left after surgery. Surgery may be used with additional treatment, like chemotherapy.
Types of Lung Surgery
The surgery used to treat your lung cancer will depend on a variety of factors, including the location of the tumor and your overall health. Different types of surgery include:
Thoracotomies are done through a large surgical incision between the ribs in the side of the chest or the back and require general anesthesia. You will most likely spend five to seven days in the hospital following surgery. These surgeries include:
- Pneumonectomy: This surgery removes an entire lung and is sometimes used for tumors close to the center of the chest.
- Lobectomy: This surgery, often performed on non-small cell lung cancer, removes the lobe of the lung where the cancer is located.
- Segmentectomy or wedge restriction: Part of the lobe containing the cancer is removed. If you do not have enough lung function to remove the entire lobe, this surgery may be used.
- Sleeve resection: This surgery removes a tumor in a lobe of the lung and part of the main airway, and then reattaches the ends of the airways and any remaining lobes. This may be done instead of a pneumonectomy to preserve lung function.
Video-assisted thoracic surgery (VATS) may be used to treat early-stage lung cancers. This surgery uses smaller incisions and usually requires a shorter hospital stay. Robotically-assisted thoracic surgery (RATS) is a similar procedure done using a robotic system; the surgeon will sit at a control panel and move robotic arms to operate through the small incisions.
Risks and Side Effects of Surgery for Lung Cancer
Surgery for lung cancer is a major procedure. All surgeries have potential risks and complications, so your physician will help you determine whether your overall health and the extent of the surgery needed makes surgery a good option for your treatment plan.
During or directly after surgery, you may experience a reaction to the anesthesia, excess bleeding, blood clots, infection, or pneumonia.
Recovery can take weeks to months. The area near your incision may hurt, and your activity may be limited for a month or two. If your lungs are otherwise healthy, you will most likely be able to return to normal activities after recovery. If you have another lung disease, you may experience shortness of breath with some levels of activity.