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Lung Cancer

Wake Forest Baptist Approach The Multidisciplinary Treatment Advantage Thoracic Oncology Program The Thoracic Oncology Program, the region’s only multidisciplinary thoracic oncology clinic, consolidates the services of a team of physicians and other health care professionals involved in care of patients with malignancies of the chest, including lung cancer, mesothelioma, carcinoid tumor and thymoma.  The Program’s primary goal is to facilitate communication between physicians to provide the highest level of care for patients with these common and uncommon chest malignancies.  Evaluating treatment options and determining a course of action as quickly as possible is of great importance.  In most cases, patients need to come to the clinic only once to see appropriate specialists and receive a treatment plan for their care. The team includes cancer specialists in pulmonary medicine, medical oncology, cardiothoracic surgery, radiation oncology, radiology and pathology.  The members of the team meet weekly to discuss new cases and develop the most effective treatment plan for each patient.  The patient sees the specialists in the morning, his/her case is discussed at a noon conference, and in the afternoon the patient leaves with an initial treatment plan in place. As a comprehensive cancer center, we offer our patients access to the best diagnostic tools and the latest advances in treatment, including interventional pulmonary procedures, surgical techniques, radiation techniques and chemotherapy. The team is involved in clinical trials testing novel therapies including combinations of surgery, radiation and chemotherapy.  Research protocols are available to study new approaches in each of these areas.  Wake Forest Baptist is the lead site for a clinical trial evaluating the use of dose-dense chemotherapy as front-line treatment for patients with advanced non-small cell lung cancer. This clinical trial involves intensive chemotherapy with the support of growth factors to stimulate the production of red blood cells and white blood cells which should minimize symptoms such as fatigue, weakness, fever, and infections. Half of the patients will also be assigned to receive an investigational medicine that may reduce side-effects on the peripheral nervous system such as numbness and tingling in the hands and feet.  This research study is sponsored by the Cancer and Leukemia Group B (CALGB), a national cooperative cancer research group. Making cutting-edge research and treatments available to lung cancer patients is the only way real progress will be made in improving both quantity and quality of life.     Lung cancer Definition: Lung cancer is cancer that begins in the lungs, the two organs found in the chest that help you breathe. The lungs are made up of areas called lobes. The right lung has three lobes; the left lung has two, so there's room for the heart. 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. Alternative Names: Cancer - 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 non-smoking 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: Weakness Swallowing difficulty Nail problems Joint pain Hoarseness or changing voice Swelling of the face 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. 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 Blood work CT scan of the chest MRI of the chest Positron emission tomography (PET) scan In some cases, the health care provider may need 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 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. You should also avoid breathing in the smoke from other people's cigarettes, cigars, or pipes. Eating a diet rich in fruits and vegetables may help prevent some cases of lung cancer. References: 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. 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. National Cancer Institute. Lung Cancer Home Page. Bethesda, MD: U.S. National Institutes of Health. Accessed August 3, 2008 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. 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:11/14/2008 Reviewed By:James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.