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Wake Forest Baptist Approach View Lung Cancer Video 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. 3D Conformal and Intensity Modulated Radiation Therapy Among the newer treatment options for cancer of the prostate, brain, lung, and head and neck are two methods of focusing radiation on the tumor and surrounding at-risk tissues while optimally sparing nearby normal tissues, 3-dimensional (3D) conformal radiation therapy, and intensity modulated radiation therapy (IMRT).  This approach uses anatomic computed tomogrphic and/or magnetic resonance images of the patient, computer-generated radiation dose calculations, and a computer-controlled linear accelerator to conform or “paint” the radiation dose very precisely to match the shape of the tumor to be treated, avoiding critical structures that may be only millimeters away. The linear accelerator radiation beam intensity is varied, or modulated, over space and time during the patient’s treatment, hence the term “Intensity Modulated” radiation therapy. In combination with advanced imaging techniques like magnetic resonance spectroscopy and positron emission tomography that image both tumor anatomy and biology, IMRT holds great promise for improving local tumor control and survival, even in the most resistant and aggressive human cancers.   Lung cancer - non-small cell Lungs Vitamin B3 source Vitamin B6 benefit Vitamin C benefit   Secondhand smoke and lung cancer Alternative Names: Cancer - lung - non-small cell; Non-small cell lung cancer; NSCLC Definition: Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. It usually grows and spreads more slowly than small cell lung cancer. There are three forms of NSCLC: Adenocarcinomas are often found in an outer area of the lung. Squamous cell carcinomas are usually found in the center of the lung by an air tube (bronchus). Large cell carcinomas can occur in any part of the lung. They tend to grow and spread faster than the other two types. Causes, incidence, and risk factors: Smoking causes most cases of lung cancer. Being around the smoke from others (secondhand smoke) also raises your risk for lung cancer. However, people who do not smoke and have never smoked have become sick with lung cancer. A review of decades of research has recently shown that smoking marijuana may help cancer cells grow, but there is no direct link between the drug and lung cancer. High levels of air pollution, working with or near cancer-causing chemicals or materials (such as asbestos), and drinking water containing high levels of arsenic can increase your risk for lung cancer. Radiation therapy to the lungs can also increase the risk. Symptoms: Early lung cancer may not cause any symptoms. Symptoms you should watch for include: Cough that doesn't go away Coughing up blood Shortness of breath Wheezing Chest pain Loss of appetite Losing weight without trying Fatigue Other symptoms that may be due to NSCLC: Weakness Swallowing difficulty Nail problems Joint pain Hoarseness or changing voice Swelling of the face Facial paralysis Eyelid drooping Bone pain or tenderness Note: These symptoms can be due to other, less serious conditions. 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 CBC Sputum test Bone scan CT scan MRI Positron emission tomography (PET) scan Thoracentesis 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 Endoscopic esophageal ultrasound (EUS) with biopsy If the biopsy reveals you do have lung cancer, more imaging tests will be done to determine the stage of the cancer. Stage means how big the tumor is and how far it's spread. Non-small cell lung cancer is divided into five stages: Stage 0 - the cancer has not spread beyond the inner lining of the lung Stage I - the cancer is small and hasn't spread to the lymph nodes Stage II - the cancer has spread to some lymph nodes near the original tumor Stage III - the cancer has spread to nearby tissue or spread to far away lymph nodes Stage IV - the cancer has spread to other organs of the body such as the other lung, brain, or liver Treatment: There are many different types of treatment for non-small cell lung cancer: Surgery - part or all of the lung is removed Radiation therapy - uses powerful x-rays or other radiation to kill cancer cells Chemotherapy - uses drugs to kill cancer cells and stop new ones from growing Laser therapy - a small beam of light burns and kills cancer cells Photodynamic therapy - uses a light to activate a drug in the body, which kills cancer cells Watchful waiting - in rare cases, the person may only be monitored until symptoms change Treatment depends upon the stage of the cancer. A combination of treatments may be needed. Research has suggested that chemotherapy or a combination of chemotherapy and radiation therapy prior to surgery might be the best treatment for some patients. Surgery is the often the first line of treatment for most patients with stage I and II non-small cell lung cancer, and some patients with stage III tumors. Surgery can cure the disease. Chemotherapy alone is often used when the cancer has spread (stage IV). Chemotherapy has been shown to prolong the life and improve the quality of life in some stage IV patients. Support Groups: For additional information and resources, see cancer support group. Expectations (prognosis): Cure rates are related to the stage of disease and whether you are able to have surgery. Stage I and II cancer can be cured with surgery, sometimes in more than 50% of cases. Stage III tumors can be cured in some cases, but cure rates are much lower than earlier stage NSCLC Patients with stage IV disease are almost never cured, and the goals of therapy are to extend and improve the quality of their life. Complications: Spread of disease beyond the lung Side effects of surgery, chemotherapy, or radiation therapy Prevention: If you smoke, stop smoking. It's never too early to quit. Try to avoid secondhand smoke. Eat a diet rich in fruits and vegetables. Routine screening for lung cancer is not recommended. Many studies have been done to look at the idea, but scientists have concluded that, at this time, screening would not find help improve a person’s chance for a cure. 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. American Cancer Society. Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society; 2008. 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.