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Lung cancer
Cancer - lung Last reviewed: September 26, 2010. Lung cancer is cancer that starts in the lungs. The lungs are located in the chest. They help you breathe. When you breathe, air goes through your nose, down your windpipe (trachea), and into the lungs, where it spreads through tubes called bronchi. Most lung cancer begins in the cells that line these tubes. There are two main types of lung cancer:

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Small cell lung cancer makes up about 20% of all lung cancer cases.

If the lung cancer is made up of both types, it is called mixed small cell/large cell cancer. If the cancer started somewhere else in the body and spread to the lungs, it is called metastatic cancer to the lung.

Causes, incidence, and risk factors

Lung cancer is the deadliest type of cancer for both men and women. Each year, more people die of lung cancer than breast, colon, and prostate cancers combined. Lung cancer is more common in older adults. It is rare in people under age 45. Cigarette smoking is the leading cause of lung cancer. The more cigarettes you smoke per day and the earlier you started smoking, the greater your risk of lung cancer. There is no evidence that smoking low-tar cigarettes lowers the risk. However, lung cancer has occurred in people who have never smoked.

Secondhand smoke (breathing the smoke of others) increases your risk of lung cancer. According to the American Cancer Society, an estimated 3,000 nonsmoking adults will die each year from lung cancer related to breathing secondhand smoke. The following may also increase one's risk of lung cancer:

High levels of air pollution High levels of arsenic in drinking water Radon gas Asbestos Family history of lung cancer Radiation therapy to the lungs Exposure to cancer-causing chemicals such as uranium, beryllium, vinyl chloride, nickel chromates, coal products, mustard gas, chloromethyl ethers, gasoline, and diesel exhaust

Symptoms
Early lung cancer may not cause any symptoms. Many times, lung cancer is found when an x-ray is done for another reason. Symptoms depend on the specific type of cancer you have, but may include:

Cough that doesn't go away Coughing up blood Shortness of breath Wheezing Chest pain Loss of appetite Losing weight without trying Fatigue

Additional symptoms that may also occur with lung cancer, often in the late stages:

Weakness Swallowing difficulty Nail problems Joint pain Hoarseness or changing voice Shoulder pain Swelling of the face or arms Facial paralysis Eyelid drooping Bone pain or tenderness

These symptoms can also be due to other, less serious conditions, so it is important to talk to your health care provider.

For more information, see:

Small cell lung cancer Non-small cell lung cancer

Signs and tests

The health care provider will perform a physical exam and ask questions about your medical history. You will be asked if you smoke, and if so, how long you have smoked. When listening to the chest with a stethoscope, the health care provider can sometimes hear fluid around the lungs, which could (but doesn't always) suggest cancer. Tests that may be performed include:

Chest x-ray Sputum cytology test to look for cancer cells Blood work CT scan of the chest MRI of the chest Positron emission tomography (PET) scan

To confirm lung cancer, the health care provider needs to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:

Bronchoscopy combined with biopsy Pleural biopsy CT-scan-directed needle biopsy Mediastinoscopy with biopsy Open lung biopsy Endoscopic esophageal ultrasound (EUS) with biopsy

For more information, see:

Small cell lung cancer Non-small cell lung cancer

Treatment
Treatment depends on the specific type of lung cancer. Each type is treated differently. Chemotherapy, radiation, and surgery may be needed. See the individual articles on the different types of lung cancer:

Non-small cell lung cancer Small cell lung cancer

Expectations (prognosis)
How well a patient does depends on the following:

Type of lung cancer Whether or not the cancer has spread Your age Your overall health How well you respond to treatment

The earlier the cancer is found, the better the chances of survival. Lung cancer is a deadly disease. Nearly 60% of people with lung cancer die within a year. However, some people are cured and go on to live many years.

Complications
The cancer may spread to other parts of the body (metastasis). Cancer treatment can cause significant side effects.

Calling your health care provider

Call your health care provider if you develop symptoms of lung cancer (particularly if you smoke).

Prevention
If you smoke, quit. It is never too late to stop smoking. Your risk of lung cancer drops dramatically the first year after you quit. You should also avoid breathing in the smoke from other people's cigarettes, cigars, or pipes. Routine screening for lung cancer using chest x-ray or a lung CT scan is not recommended for people without symptoms. Many studies have been done to look at this idea. Most experts have concluded that, at this time, screening would not help improve a person's chance for a cure or for living longer.

References
1. Alberg AJ, Ford JG, Samet JM; American College of Chest Physicians. Epidemiology of

lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:29S-55S.

2. Bach PB, Silvestri GA, Hanger M, Jett JR. Screening for lung cancer: ACCP evidence-

based clinical practice guidelines (2nd edition). Chest. 2007;132:69S-77S.

3. Croswell JM, Baker SG, Marcus PM, Clapp JD, Kramer BS. Cumulative incidence of

false-positive test results in lung cancer screening: a randomized trial. Ann Intern Med. 2010;152:505-512. 4. Jett JR, Schild SE, Keith RL, Kesler KA. Treatment of non-small cell lung cancer, stage IIIB: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:266S-276S. 5. Johnson DH, Blot WJ, Carbone DP, et al. Cancer of the lung: non-small cell lung cancer and small cell lung cancer. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008:chap 76. Review Date: 9/26/2010. Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital.

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In this Page

Causes, incidence, and risk factors Symptoms Signs and tests Treatment Expectations (prognosis) Complications Calling your health care provider Prevention References

Evaluating your options

Multi-study review of the strengths and weaknesses of various treatment options. About Comparative Effectiveness Research

Chronic coughing and breathing difficulties: Chronic obstructive pulmonary disease (COPD)

When we breathe in, our lungs provide us with oxygen. COPD (chronic obstructive pulmonary disease) is a condition in which the lungs have become permanently damaged and the airways are constantly narrowed. This makes it difficult to breathe.

Fact sheet for family members of people with chronic obstructive pulmonary disease (COPD) COPD not only affects people who have it. Family members and friends also see how everyday life changes for people with COPD, and of course this affects their own lives as well.

Drugs of interest

Gefitinib Gefitinib is used to treat non-small cell lung cancer in people who have already been treated with certain other chemotherapy medications and have not improved or whose condition has worsened. Gefitinib has not been shown to help people who have non-small cell lung cancer live longer. There are other medications that may help people who have non-small cell lung cancer live longer. Therefore, only people who have already taken gefitinib and benefited from the medication should continue to take it. People who have never taken gefitinib should start their treatment with a medication that is known to help patients with lung cancer live longer. Gefitinib is in a class of anti-cancer medications called epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors. It works by blocking the action of a certain naturally occurring substance that may be needed to help cancer cells multiply.

Paclitaxel Injection Paclitaxel injection manufactured with human albumin is used to treat breast cancer that has not improved or that has come back after treatment with other medications. Paclitaxel injection manufactured with polyoxyethylated castor oil is used to treat ovarian cancer (cancer that begins in the female reproductive organs where eggs are formed), breast cancer, and lung cancer. Paclitaxel injection with polyoxyethylated castor oil is also used to treat Kaposi's sarcoma (a type of cancer that causes patches of abnormal tissue to grow under the skin) in people who have acquired immunodeficiency syndrome (AIDS). Paclitaxel is in a class of medications called antimicrotubule agents. It works by stopping the growth and spread of cancer cells.

Erlotinib Erlotinib is used to treat nonsmall cell lung cancer that has spread to nearby tissues or to other parts of the body in patients who have already been treated with at least one other chemotherapy medication and have not gotten better. Erlotinib is also used in combination with another medication (gemcitabine [Gemzar]) to treat pancreatic cancer that has spread to nearby tissues or to other parts of the body. Erlotinib is in a class of

medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps slow or stop the spread of cancer cells.

Bevacizumab Injection Bevacizumab is used with chemotherapy to treat cancer of the colon (large intestine) or rectum that has spread to other parts of the body. Bevacizumab is also used with chemotherapy to treat certain types of lung cancer. Bevacizumab is also used with chemotherapy to treat breast cancer that has spread to other parts of the body and that has not been treated with other chemotherapy medications in the past. Bevacizumab is in a class of medications called antiangiogenic agents. It works by stopping the formation of blood vessels that bring oxygen and nutrients to tumors. This may slow the growth and spread of tumors.

Pemetrexed Injection Pemetrexed is used with another chemotherapy (anti-cancer) medication to treat malignant pleural mesothelioma (a type of cancer that affects the inside lining of the chest cavity). Pemetrexed is also used to treat non-small cell lung cancer. Pemetrexed is in a class of medications called antifolate antineoplastic agents. It works by blocking the action of a certain substance in the body that may help cancer cells multiply.

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