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Understanding the Cancer
Process
The Lungs
Understanding Lung Cancer
Lung Cancer: Who's at Risk?
Recognizing Symptoms
Diagnosing Lung Cancer
Staging the Disease
Treatment for Lung Cancer
Treating Nonsmall Cell Lung Cancer
Treating Small Cell Lung Cancer
Side Effects
The Importance of Followup Care
Providing Emotional Support
Questions for Your Doctor
Dictionary
The diagnosis of lung cancer brings with it many questions and a need for clear, understandable answers. We hope this National Cancer Institute (NCI) booklet will help. It provides information about some causes and ways to prevent lung cancer, and it describes the symptoms, detection, diagnosis, and treatment of this disease. Having this important information can make it easier for patients and their families to handle the challenges they face.
Cancer research has led to progress against lung cancer--and our knowledge is increasing. Researchers continue to look for better ways to prevent, detect, diagnose, and treat lung cancer. The Cancer Information Service and the other NCI resources listed under "Links" can provide the latest, most accurate information on lung cancer.
Words that may be new to readers appear in italics. Definitions of these and other terms related to lung cancer can be found in the Dictionary. For some words, a "sounds-like" spelling is also given.
Understanding the Cancer Process
All types of cancer develop in our cells, the body's basic unit of life. To understand cancer, it is helpful to know how normal cells become cancerous. The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes astray--cells keep dividing when new cells are not needed. The mass of extra cells forms a growth or tumor. Tumors can be benign or malignant.
Benign tumors are not cancer. They often can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.
Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system (the tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases). This process, called metastasis, is how cancer spreads from the original (primary) tumor to form new (secondary) tumors in other parts of the body.
The lungs, a pair of sponge-like, cone-shaped organs, are part of the respiratory system. The right lung has three sections, called lobes; it is a little larger than the left lung, which has two lobes. When we breathe in, the lungs take in oxygen, which our cells need to live and carry out their normal functions. When we breathe out, the lungs get rid of carbon dioxide, which is a waste product of the body's cells.
Cancers that begin in the lungs are divided into two major types, non-small cell lung cancer and small cell lung cancer, depending on how the cells look under a microscope. Each type of lung cancer grows and spreads in different ways and is treated differently.
Nonsmall cell lung cancer, is more common than small cell lung cancer, and it generally grows and spreads more slowly. There are three main types of non-small cell lung cancer. They are named for the type of cells in which the cancer develops: squamous cell carcinoma (also called epidermoid carcinoma), adenocarcinoma, and large cell carcinoma.
Small cell lung cancer, sometimes called oat cell cancer, is less common than non-small cell lung cancer. This type of lung cancer grows more quickly and is more likely to spread to other organs in the body.

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Cancers that begin in the lungs are divided into two major types,
non-small cell lung cancer and small cell lung cancer, depending on
how the cells look under a microscope. Each type of lung cancer grows
and spreads in |
Researchers have discovered several causes of lung cancer--most are related to the use of tobacco.
Researchers continue to study the causes of lung cancer and to search for
ways to prevent it. We already know that the best way to prevent lung cancer
is to quit (or never start) smoking. The sooner a person quits smoking the
better. Even if you have been smoking for many years, it's never too late
to benefit from quitting.
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The best way to prevent
lung cancer is to quit, or never start, smoking.
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Common signs and symptoms of lung cancer include:
These symptoms may be caused by lung cancer or by other conditions. It is important to check with a doctor.
To help find the cause of symptoms, the doctor evaluates a person's medical history, smoking history, exposure to environmental and occupational substances, and family history of cancer. The doctor also performs a physical exam and may order a chest x-ray and other tests. If lung cancer is suspected, sputum cytology (the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs) is a simple test that may be useful in detecting lung cancer. To confirm the presence of lung cancer, the doctor must examine tissue from the lung. A biopsy--the removal of a small sample of tissue for examination under a microscope by a pathologist--can show whether a person has cancer. A number of procedures may be used to obtain this tissue:
If the diagnosis is cancer, the doctor will want to learn the stage (or extent) of the disease. Staging is done to find out whether the cancer has spread and, if so, to what parts of the body. Lung cancer often spreads to the brain or bones. Knowing the stage of the disease helps the doctor plan treatment. Some tests used to determine whether the cancer has spread include:
Treatment depends on a number of factors, including the type of lung cancer (non-small or small cell lung cancer), the size, location, and extent of the tumor, and the general health of the patient. Many different treatments and combinations of treatments may be used to control lung cancer, and/or to improve quality of life by reducing symptoms.
Clinical trials (research studies) to evaluate new ways to treat cancer are an option for many lung cancer patients. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the usual (standard) therapy to another group. Through research, doctors are exploring new and possibly more effective ways to treat lung cancer. More information about treatment studies can be found in the NCI publication Taking Part in Clinical Trials: What Cancer Patients Need To Know. PDQ®, NCI's cancer information database, contains detailed information about ongoing studies for lung cancer. NCI also has a Web site at http://cancertrials.nci.nih.gov/ that provides detailed information about ongoing studies for lung cancer for patients, health professionals, and the public.
Treating Nonsmall Cell Lung Cancer
Patients with non-small cell lung cancer may be treated in several ways. The choice of treatment depends mainly on the size, location, and extent of the tumor. Surgery is the most common way to treat this type of lung cancer. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of non-small cell lung cancer. Radiation therapy and chemotherapy may also be used to slow the progress of the disease and to manage symptoms.
Treating Small Cell Lung Cancer
Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy. Treatment may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body (such as in the brain). Some patients have radiation therapy to the brain even though no cancer is found there. This treatment, called prophylactic cranial irradiation (PCI), is given to prevent tumors from forming in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.
The side effects of cancer treatment depend on the type of treatment and may be different for each person. Side effects are often only temporary. Doctors and nurses can explain the possible side effects of treatment, and they can suggest ways to help relieve symptoms that may occur during and after treatment.
Today, because of what has been learned in clinical trials, doctors are able to control, lessen, or avoid many of the side effects of treatment. Several useful NCI booklets, including Chemotherapy and You, Radiation Therapy and You, and Eating Hints for Cancer Patients, suggest ways to cope with the side effects of cancer treatment.
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Doctors and nurses can explain the possible side effects
of treatment, and they can suggest ways to help relieve symptoms that
may occur during and after treatment.
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The Importance of Followup Care
Followup care after treatment for lung cancer is very important. Regular checkups ensure that changes in health are noticed, and if the cancer returns or a new cancer develops, it can be treated as soon as possible. Checkups may include physical exams, chest x-rays, or lab tests. Between scheduled appointments, people who have had lung cancer should report any health problems to their doctor as soon as they appear.
Living with a serious disease, such as cancer, is challenging. Apart from having to cope with the physical and medical challenges, people with cancer face many worries, feelings, and concerns that can make life difficult. They may find they need help coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional and psychological burden of having cancer is often part of a patient's treatment plan. The support of the health care team (doctors, nurses, social workers, and others), support groups, and patient-to-patient networks can help people feel less alone and upset, and improve the quality of their lives. Cancer support groups provide a safe environment where cancer patients can talk about living with cancer with others who may be having similar experiences. Patients may want to speak to a member of their health care team about finding a support group. Many also find useful information in NCI fact sheets and booklets, including Taking Time and Facing Forward.
This booklet is designed to help you get information you need from your doctor, so that you can make informed decisions about your health care. In addition, asking your doctor the following questions will help you further understand your condition. To help you remember what the doctor says, you may take notes or ask whether you may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor--to take part in the discussion, to take notes, or just to listen.
Diagnosis
Treatment
Side Effects
Followup
The Health Care Team
Resources
adenocarcinoma (AD-in-o-kar-sin-O-ma): Cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties.
anesthetics (an-es-THET-iks): Substances that cause loss of feeling or awareness. Local anesthetics cause loss of feeling in a part of the body. General anesthetics put the person to sleep.
anterior mediastinotomy (MEE-dee-a-stin-AH-toe-mee): A procedure in which a tube is inserted into the chest to view the tissues and organs in the area between the lungs and between the breastbone and spine. The tube is inserted through an incision next to the breastbone. This procedure is usually used to get a tissue sample from the lymph nodes on the left side of the chest. Also called the Chamberlain procedure.
asbestos (as-BES-tus): A natural material that is made up of tiny fibers. The fibers can cause cancer.
aspiration (as-per-AY-shun): Removal of fluid from a lump, often a cyst, with a needle and a syringe.
benign (beh-NINE): Not cancerous; does not invade nearby tissue or spread to other parts of the body.
biopsy (BY-ahp-see): The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.
bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.
bronchitis (bron-KYE-tis): Inflammation (swelling and reddening) of the bronchi.
bronchoscope (BRON-ko-skope): A thin, lighted tube used to examine the inside of the trachea and bronchi, the air passages that lead into the lungs.
bronchoscopy (bron-KOS-ko-pee): A procedure in which a thin, lighted tube is inserted through the nose or mouth. This allows examination of the inside of the trachea and bronchi (air passages that lead to the lung), as well as the lung. Bronchoscopy may be used to detect cancer or to perform some treatment procedures.
cancer: A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body.
carcinogen (kar-SIN-o-jin): Any substance that causes cancer.
catheter (KATH-i-ter): A flexible tube used to deliver fluids into or withdraw fluids from the body.
chemotherapy (kee-mo-THER-a-pee): Treatment with anticancer drugs.
clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease.
cryosurgery (KRYE-o-SIR-jer-ee): Treatment performed with an instrument that freezes and destroys abnormal tissues. This procedure is a form of cryotherapy.
CT scan: Computed tomography scan. A series of detailed pictures of areas inside the body; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan.
epidermoid carcinoma (ep-i-DER-moyd kar-sin-O-ma): A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma.
external radiation (ray-dee-AY-shun): Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external-beam radiation.
internal radiation (ray-dee-AY-shun): A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy.
IV: Intravenous (in-tra-VEE-nus). Injected into a blood vessel.
large cell carcinomas (kar-sin-O-mas): A group of lung cancers in which the cells are large and look abnormal when viewed under a microscope.
laser (LAY-zer): A device that concentrates light into an intense, narrow beam used to cut or destroy tissue. It is used in microsurgery, photodynamic therapy, and for a variety of diagnostic purposes.
lobe: A portion of an organ such as the liver, lung, breast, or brain.
lobectomy (lo-BEK-toe-mee): The removal of a lobe.
lymphatic system (lim-FAT-ik): The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, and lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body.
malignant (ma-LIG-nant): Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body.
mediastinoscopy (MEE-dee-a-stin-AHS-ko-pee): A procedure in which a tube is inserted into the chest to view the organs in the area between the lungs and nearby lymph nodes. The tube is inserted through an incision above the breastbone. This procedure is usually performed to get a tissue sample from the lymph nodes on the right side of the chest.
mediastinum (mee-dee-a-STYE-num): The area between the lungs. The organs in this area include the heart and its large blood vessels, the trachea, the esophagus, the bronchi, and lymph nodes.
metastasis (meh-TAS-ta-sis): The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases.
MRI: Magnetic resonance imaging (mag-NET-ik REZ-o- nans IM-a-jing). A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body.
non-small cell lung cancer: A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
oat cell cancer: A type of lung cancer in which the cells look like oats when viewed under a microscope. Also called small cell lung cancer.
pathologist: (pa-THOL-o-jist): A doctor who identifies diseases by studying cells and tissues under a microscope.
photodynamic therapy: (fo-toe-dye-NAM-ik): Treatment with drugs that become active when exposed to light and kill cancer cells.
pneumonectomy: (noo-mo-NEK-toe-mee): An operation to remove an entire lung.
pneumonia: (noo-MONE-ya): An inflammatory infection that occurs in the lung.
prophylactic cranial irradiation: (pro-fih-LAK-tik KRAY-nee-ul ir-ray-dee-AY-shun): Radiation therapy to the head to reduce the risk that cancer will spread to the brain.
radiation therapy: (ray-dee-AY-shun): The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy.
radioactive: (RAY-dee-o-AK-tiv): Giving off radiation.
radionuclide scanning: A test that produces pictures (scans) of internal parts of the body. The person is given an injection or swallows a small amount of radioactive material; a machine called a scanner then measures the radioactivity in certain organs.
radon: (RAY-don): A radioactive gas that is released by uranium, a substance found in soil and rock. When too much radon is breathed in, it can damage lung cells and lead to lung cancer.
resection: (ree-SEK-shun): Removal of tissue or part or all of an organ by surgery.
respiratory system: (RES-pih-ra-tor-ee): The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs.
side effects: Problems that occur when treatment affects healthy cells. Common side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.
small cell lung cancer: A type of lung cancer in which the cells appear small and round when viewed under the microscope. Also called oat cell lung cancer.
sputum: Mucus coughed up from the lungs.
squamous cell carcinoma: (SKWAY-mus. . .kar-sin-O-ma): Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.
surgery: A procedure to remove or repair a part of the body or to find out whether disease is present.
thoracentesis: (thor-a-sen-TEE-sis): Removal of fluid from the pleural cavity through a needle inserted between the ribs.
thoracotomy: (thor-a-KAH-toe-mee): An operation to open the chest.
tissue: (TISH-oo): A group or layer of cells that are alike in type and work together to perform a specific function.
tumor (TOO-mer): An abnormal mass of tissue that results from excessive cell division. Tumors perform no useful body function. They may be benign (not cancerous) or malignant (cancerous).
x-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer.