What Is Lung Cancer?

Lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs;
usually in the cells that line the air passages. The abnormal cells do not develop into healthy lung
tissue, they divide rapidly and form tumors. As tumors become larger and more numerous, they
undermine the lungs ability to provide the bloodstream with oxygen. Tumors that remain in one
place and do not appear to spread are known as benign tumors.

Malignant tumors, the more dangerous ones, spread to other parts of the body either through
the bloodstream or the lymphatic system. Metastasis refers to cancer spreading beyond its site of
origin to other parts of the body. When cancer spreads it is much harder to treat successfully.
Primary lung cancer originates in the lungs, while secondary lung cancer starts somewhere
else in the body, metastasizes, and reaches the lungs. They are considered different types of
cancers and are not treated in the same way.
According to the National Cancer Institute, by the end of 2012 there will have been 226,160 new
lung cancer diagnoses and 160,340 lung-cancer related deaths in the USA.
According to the World Health Organization (WHO), 7.6 million deaths globally each year are
caused by cancer; cancer represents 13% of all global deaths. As seen below, lung cancer is by
far the number one cancer killer.
Total deaths worldwide caused by cancer each year:
Lung cancer - 1,370,000 deaths
Stomach cancer - 736,000 deaths
Liver cancer - 695,000 deaths
Colorectal cancer - 608,000 deaths
Breast cancer - 458,000 deaths
Cervical cancer - 275,000 deaths
The American Cancer Society says that lung cancer makes up 14% of all newly diagnosed
cancers in the USA today. It adds that annually, more patients die from lung cancer alone than
prostate, breast and colon cancers combined (in the USA). An American mans lifetime risk of
developing lung cancer is 1 in 13; for a woman the risk is 1 in 16. These risk figures are for all
US adults, including smokers, ex-smokers and non-smokers. The risk for a regular smoker is
dramatically higher.
Most lung cancer patients are over the age of 60 years when they are diagnosed. Lung cancer
takes several years to reach a level where symptoms are felt and the sufferer decides to seek
medical help.
Female lung cancer rates set to rise rapidly
Over the next three decades, female lung cancers will increase thirty-five times faster than male
lung cancers, scientists from Kings College London reported in October 2012.
In the UK, female lung cancer deaths will reach 95,000 annually in 2040, from 26,000 in 2010
a rise of more than 350%. Male annual lung cancer deaths will increase by 8% over the same
period, to 42,000 in 2040 from 39,000 in 2010.
The authors of the report say that lung cancer will continue being the largest cancer killer over
the next thirty years. Twice as many people will be living with lung cancer in 2040 compared to
2010. The main reason for the increase will be longer lifespans - the older you are, the higher
your risk of cancer is, including lung cancer.
How is lung cancer classified?
Lung cancer can be broadly classified into two main types based on the cancer's appearance
under a microscope: non-small cell lung cancer and small cell lung cancer. Non-small cell lung
cancer (NSCLC) accounts for 80% of lung cancers, while small cell lung cancer accounts for the
remaining 20%.
NSCLC can be further divided into four different types, each with different treatment options:
Squamous cell carcinoma or epidermoid carcinoma. As the most common type of
NSCLC and the most common type of lung cancer in men, squamous cell carcinoma
forms in the lining of the bronchial tubes.
Adenocarcinoma. As the most common type of lung cancer in women and in
nonsmokers, adenocarcinoma forms in the mucus-producing glands of the lungs.
Bronchioalveolar carcinoma. This type of lung cancer is a rare type of adenocarcinoma
that forms near the lungs' air sacs.
Large-cell undifferentiated carcinoma. A rapidly growing cancer, large-cell
undifferentiated carcinomas form near the outer edges or surface of the lungs.
Small cell lung cancer (SCLC) is characterized by small cells that multiply quickly and form
large tumors that travel throughout the body. Almost all cases of SCLC are due to smoking.
What causes cancer?
Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in
the body follow an orderly path of growth, division, and death. Programmed cell death is called
apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells,
cancer cells do not experience programmatic death and instead continue to grow and divide. This
leads to a mass of abnormal cells that grows out of control.
Lung cancer occurs when a lung cell's gene mutation makes the cell unable to correct DNA
damage and unable to commit suicide. Mutations can occur for a variety of reasons. Most lung
cancers are the result of inhaling carcinogenic substances.
Carcinogens
Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting
or aiding cancer. Tobacco, asbestos, arsenic, radiation such as gamma and x-rays, the sun, and
compounds in car exhaust fumes are all examples of carcinogens. When our bodies are exposed
to carcinogens, free radicals are formed that try to steal electrons from other molecules in the
body. These free radicals damage cells and affect their ability to function and divide normally.
About 87% of lung cancers are related to smoking and inhaling the carcinogens in tobacco
smoke. Even exposure to second-hand smoke can damage cells so that cancer forms.
Genes
Cancer can be the result of a genetic predisposition that is inherited from family members. It is
possible to be born with certain genetic mutations or a fault in a gene that makes one statistically
more likely to develop cancer later in life. Genetic predispositions are thought to either directly
cause lung cancer or greatly increase one's chances of developing lung cancer from exposure to
certain environmental factors.
How does lung cancer develop? - video
A short video explaining how lung cancer develops. Video by eHow.
What are the symptoms of lung cancer?
Cancer symptoms are quite varied and depend on where the cancer is located, where it has
spread, and how big the tumor is. Lung cancer symptoms may take years before appearing,
usually after the disease is in an advanced stage.
Many symptoms of lung cancer affect the chest and air passages. These include:
Persistent or intense coughing
Pain in the chest shoulder, or back from coughing
Changes in color of the mucus that is coughed up from the lower airways (sputum)
Difficulty breathing and swallowing
Hoarseness of the voice
Harsh sounds while breathing (stridor)
Chronic bronchitis or pneumonia
Coughing up blood, or blood in the sputum
If the lung cancer spreads, or metastasizes, additional symptoms can present themselves in the
newly affected area. Swollen or enlarged lymph nodes are common and likely to be present
early. If cancer spreads to the brain, patients may experience vertigo, headaches, or seizures. In
addition, the liver may become enlarged and cause jaundice and bones can become painful,
brittle, and broken. It is also possible for the cancer to infect the adrenal glands resulting in
hormone level changes.
As lung cancer cells spread and use more of the body's energy, it is possible to present symptoms
that may also be associated with many other ailments. These include:
Fever
Fatigue
Unexplained weight loss
Pain in joints or bones
Problems with brain function and memory
Swelling in the neck or face
General weakness
Bleeding and blood clots
How is lung cancer diagnosed and staged?
Physicians use information revealed by symptoms as well as several other procedures in order to
diagnose lung cancer. Common imaging techniques include chest X-rays, bronchoscopy (a thin
tube with a camera on one end), CT scans, MRI scans, and PET scans.

Physicians will also conduct a physical examination, a chest examination, and an analysis of
blood in the sputum. All of these procedures are designed to detect where the tumor is located
and what additional organs may be affected by it.
Although the above diagnostic techniques provided important information, extracting cancer
cells and looking at them under a microscope is the only absolute way to diagnose lung cancer.
This procedure is called a biopsy. If the biopsy confirms lung cancer, a pathologist will
determine whether it is non-small cell lung cancer or small cell lung cancer.
After a diagnosis is made, an oncologist will determine the stage of the cancer by finding out
how far the cancer has spread. The stage determines which choices will be available for
treatment and informs prognosis. The most common cancer staging method is called the TNM
system. T (1-4) indicates the size and direct extent of the primary tumor, N (0-3) indicates the
degree to which the cancer has spread to nearby lymph nodes, and M (0-1) indicates whether the
cancer has metastasized to other organs in the body. A small tumor that has not spread to lymph
nodes or distant organs may be staged as (T1, N0, M0), for example.
For non-small cell lung cancer, TNM descriptions lead to a simpler categorization of stages.
These stages are labeled from I to IV, where lower numbers indicate earlier stages where the
cancer has spread less. More specifically:
Stage I is when the tumor is found only in one lung and in no lymph nodes.
Stage II is when the cancer has spread to the lymph nodes surrounding the infected lung.
Stage IIIa is when the cancer has spread to lymph nodes around the trachea, chest wall,
and diaphragm, on the same side as the infected lung.
Stage IIIb is when the cancer has spread to lymph nodes on the other lung or in the neck.
Stage IV is when the cancer has spread throughout the rest of the body and other parts of
the lungs.
Small cell lung cancer has two stages: limited or extensive. In the limited stage, the tumor exists
in one lung and in nearby lymph nodes. In the extensive stage, the tumor has infected the other
lung as well as other organs in the body.
Screening for lung cancer - video
A video tutorial discussing Lung Cancer and screening. Video by OncologyPodCasting.
How is lung cancer treated?
Lung cancer treatments depend on the type of cancer, the stage of the cancer (how much it has
spread), age, health status, and additional personal characteristics. As there is usually no single
treatment for cancer, patients often receive a combination of therapies and palliative care. The
main lung cancer treatments are surgery, chemotherapy, and/or radiation. However, there also
have been recent developments in the fields of immunotherapy, hormone therapy, and gene
therapy.
Surgery
Surgery is the oldest known treatment for cancer. If a cancer is in stage I or II and has not
metastasized, it is possible to completely cure a patient by surgically removing the tumor and the
nearby lymph nodes. After the disease has spread, however, it is nearly impossible to remove all
of the cancer cells.

Lung cancer surgery is performed by a specially trained thoracic surgeon. After removing the
tumor and the surrounding margin of tissue, the margin is further studied to see if cancer cells are
present. If no cancer is found in the tissue surrounding the tumor, it is considered a "negative
margin." A "positive margin" may require the surgeon to remove more of the lung tissue.
Lung cancer surgery can be curative or palliative. Curative surgery aims to cure a patient with
early stage lung cancer by removing all of the cancerous tissue. Palliative surgery aims to
remove an obstruction or open an airway, making the patient more comfortable but not
necessarily removing the cancer.
Surgery carries side effects - most notably pain and infection. Lung cancer surgery is an invasive
procedure that can cause harm to the surrounding body parts. Doctors will usually provide
several options for alleviating any pain from surgery. Antibiotics are commonly used to prevent
infections that may occur at the site of the wound or elsewhere inside the body.
Radiation
Radiation treatment, also known as radiotherapy, destroys or shrinks lung cancer tumors by
focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up
the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gamma-
rays that are emitted from metals such as radium or high-energy x-rays that are created in a
special machine. Radiation can be used as the main treatment for lung cancer, to kill remaining
cells after surgery, or to kill cancer cells that have metastasized.

Early radiation treatments caused severe side-effects because the energy beams would damage
normal, healthy tissue, but technologies have improved so that beams can be more accurately
targeted. Radiation oncologists can focus the radiation in precise locations in the body for certain
lengths of time, reducing the risk of damage to surrounding healthy tissue. Treatments occur
intermittently over weeks or months depending on the size and extent of the tumor, the dosage of
radiation, and how much damage is being done to noncancerous tissue.
Common side effects of radiation therapy include fatigue, nausea, loss of appetite, hair loss, and
skin affectations that cause skin to become dry, irritated, and sensitive.
Chemotherapy
Chemotherapy utilizes strong chemicals that interfere with the cell division process - damaging
proteins or DNA - so that cancer cells will commit suicide. These treatments target any rapidly
dividing cells (not just cancer cells), but normal cells usually can recover from any chemical-
induced damage while cancer cells cannot. Chemotherapy is considered systemic because its
medicines travel throughout the entire body, killing the original tumor cells as well as cancer
cells that have spread throughout the body.

A medical oncologist will usually prescribe chemotherapy drugs for lung cancer to be taken
intravenously, but there are also drugs available in tablet, capsule, and liquid form.
Chemotherapy treatment occurs in cycles so the body has time to heal between doses, and
dosages are determined by the type of lung cancer, the type of drug, and how the person
responds to treatment. Medicines may be administered daily, weekly, or monthly, and can
continue for months or even years.
Combination therapies often include multiple types of chemotherapy, and chemotherapy is also
given as adjuvant therapy as a complement to surgery and radiation. Adjuvant therapy is
designed to reduce the risk of cancer recurrence after surgery and killing any cancer cells that
exist after surgery. Chemotherapy can be given before surgery, called neo-adjuvant therapy, to
shrink tumors and to make surgery more successful.
Chemotherapy carries several common side effects, but they depend on the type of chemotherapy
and the health of the patient. These include nausea and vomiting, appetite loss, diarrhea, hair
loss, fatigue from anemia, infections, bleeding, and mouth sores. Many of these side effects are
only temporarily felt during treatment, and several drugs exist to help patients cope with the
symptoms.
Other lung cancer treatments
Researchers continue to search for ways to improve lung cancer treatments and find new
methods of treating the disease. Targeted therapies are designed to only treat cancer cells while
leaving alone normal and healthy lung cells. These include monoclonal antibodies that travel
directly to the cancer cells and release drugs or radiation, anti-angiogenesis agents that interfere
with the blood supply creation mechanism of cancer cells, and growth factor inhibitors that block
the effects of growth factors and disallow the cancerous cells to grow. There is also some
research in the area of lung cancer vaccines that first transform cancer cells so they are no longer
cancerous. However, the cells will exist such that the body's immune system can recognize the
cancerous cells as foreign and attack them. These targeted therapies are also called
immunotherapies because the treatment tweaks the body's natural immune responses.
How can lung cancer be prevented?
Cancers that are closely linked to certain behaviors are the easiest to prevent. For example,
choosing not to smoke tobacco or drink alcohol significantly lowers the risk of several types of
cancer - most notably lung, throat, mouth, and liver cancer. Even if you are a current tobacco
user, quitting can still greatly reduce your chances of getting cancer. The most important
preventive measure you can take to avoid lung cancer is to quit smoking.
Quitting smoking will also reduce your risk of several other types of cancer including esophagus,
pancreas, larynx, and bladder cancer. If you quit smoking, you will usually reap additional
benefits such as lower blood pressure, enhanced blood circulation, and increased lung capacity.
Exposure to tobacco smoke is not the only risk factor for lung cancer though. Those who have
come into contact with asbestos, radon, and secondhand smoke also have an increased risk of
developing lung cancer. In addition, having a family member who developed lung cancer
without being exposed to carcinogens could mean that you have a genetic predisposition for
developing the disease, increasing your overall risk.
Screening techniques are designed to find cancer at the earliest stage so that the most treatment
options are available, increasing survival rates and avoiding highly invasive procedures. Most
lung cancers are detected in the late stages of the disease after they have spread and are harder to
treat. Although there currently do not exist approved screening tests for lung cancer that improve
survival or detect localized disease, there is promising research underway. Advocates of
screening recommend that certain high risk groups be screened. This includes persons age 60 or
older with a history of smoking, previous lung tumors, or chronic obstructive pulmonary disease
(COPD). Possible lung cancer screening tests include analysis of sputum cells, fiberoptic
examination of bronchial passages (bronchoscopy), and low-dose spiral CT scans