WELLNESS INITIATIVE NOW To promote personal well-being, fitness and nutrition for all TDCJ employees. November 2008 Lung cancer is cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. Theses types are diagnosed based on how the cell looks under a microscope. Lung cancer is the leading cause of cancer deaths in the United States, among both men and women. It claims more lives each year than colon, prostate, lymph and breast cancers combined. Yet most lung cancer deaths could be prevented. That is because smoking accounts for nearly ninety percent of lung cancer cases. Your risk of lung cancer increases with the length of time and number of cigarettes you smoke. If you quit smoking, even after smoking for many years, you can significantly reduce your chances of developing lung cancer. Lung cancer typically does not cause signs and symptoms in its earliest stages. Signs and symptoms usually occur only when the disease is advanced. Signs and symptoms may include: A new cough Changes in a chronic cough or smokers cough Shortness of breath Chest pain Wheezing Hoarseness Lung cancer most commonly begins in the cells that line your lungs. Smoking causes the majority of lung cancers, both in smokers and in people exposed to secondhand smoke. Lung cancer also occurs in people who never smoked. In these cases, there may be no clear cause of lung cancer. Doctors have identified factors that may increase the risk. Doctors believe smoking causes lung cancer by damaging cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately. At first your body may be able to repair this damage, but with each repeated exposure, normal cells that line your lungs are increasingly damaged. Over time, the damage causes cells to act abnormally and eventually cancer may develop. Your lungs are full of blood vessels and lymph vessels, giving lung cancer cells easy access to travel to other parts of your body. For this reason, lung cancer may spread to other parts of your body before you experience any signs or symptoms. In many cases lung cancer may spread before it can even be detected in the lungs. Doctors divide lung cancer into two major types based on the appearance of lung cancer cells under a microscope. Decisions regarding treatment are based on which major type you have. The two types of lung cancer include: Small cell lung cancer, also called oat cell carcinoma, occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for several types of lung cancers that behave in a similar way. Non-small cell lung cancer includes squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
A number of factors may increase your risk of lung cancer. Some risk factors can be controlled, while others can not. Risk factors for lung cancer include: Smoking Smoking remains the greatest risk factor for lung cancer. Your risk of lung cancer increases with the number of cigarettes you smoke each day and the number of years you have smoked. Quitting at any age can significantly lower your risk of developing lung cancer. Your sex Current or former women smokers have a greater risk of lung cancer than do men who have smoked an equal amount. Though it is not known why, some experts speculate that women have a greater susceptibility to the cancer-causing substances found in tobacco. Others believe that estrogen may play a role. Women are also known to inhale more than men do, and they are less likely to quit. Exposure to secondhand smoke Even if you do not smoke, your risk of lung cancer increases if you are exposed to secondhand smoke. Exposure to radon gas Radon is produced by the natural breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Although unsafe levels of radon can accumulate in any building, the greatest exposure risk most people face is at home. Radon testing can determine whether levels are safe. Exposure to asbestos and other chemicals Work place exposure to asbestos and other substances known to cause cancer, such as arsenic, chromium, nickel and tar soot, can also increase your risk of developing lung cancer, especially if you are a smoker. Family history of lung cancer Individuals with a parent, sibling or other first-degree relative with lung cancer have an increased risk of developing the disease. Excessive alcohol use - Drinking more than a moderate amount of alcohol, no more than one drink a day for women or two drinks a day for men, may increase your risk of lung cancer. Doctors are not sure whether you should undergo screening for lung cancer. Even if you have an increased risk of lung cancer, for instance, if you are a smoker, it is not clear that a chest x-ray or computerized tomography (CT) scan can be beneficial. Some studies show that these tests can find cancer earlier, when it may be treated more successfully. However other studies find that these tests often reveal more benign conditions that require invasive testing and expose people to unnecessary risks. If there is reason to think that you may have lung cancer, your doctor can order a number of tests to look for cancerous cells and to rule out other conditions. In order to diagnose lung cancer, your doctor may recommend: Imaging tests An X-ray image of your lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in your lungs. Sputum cytology - If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells. Before the test, you may be asked to breathe a mildly irritating mist to help you produce more sputum. Tissue samples (biopsy) A sample of abnormal cells may be removed in a procedure called a biopsy in order to diagnose lung cancer. Your doctor can perform a biopsy in a number of ways, including: Bronchoscopy Your doctor examines abnormal areas of your lungs using a lighted tube that is passed down your throat and into your lungs. Mediastinoscopy - An incision is made at the base of your neck and surgical tools are
inserted behind your breastbone to take tissue samples. Needle biopsy - Your doctor uses x-ray or CT images to guide a needle through your chest and into a suspicious lump or nodule to collect cells. A biopsy may also be taken from lymph nodes or other areas where cancer has spread, such as your liver. Once your lung cancer has been diagnosed, your doctor will work to determine the extent, or stage, of your cancer. Your cancers stage helps your doctor determine what treatment is most appropriate. Staging test may include imaging, procedures that allow your doctor to look for signs that cancer has spread beyond your lungs, such as magnetic resonance imaging (MRI), positron emission testing (PET)( and bone scans. Not every test is appropriate for every person, so talk with your doctor about which procedures are appropriate for you. Each type of lung cancer has different stages, these are as follows: Stages of non-small cell lung cancer: Stage I Cancer at this stage has invaded the underlying lung tissue but has not spread to the lymph nodes. Stage II Cancer has spread to neighboring lymph nodes or invaded the chest wall. Stage IIIA At this stage, cancer has spread from the lung to lymph nodes in the center of the chest. Stage IIIB The cancer has spread locally to areas such as the heart, blood vessels, trachea and esophagus, or to lymph nodes in the area of the collarbone or to the tissue that surrounds the lungs within the rib cage. Stage IV The cancer has spread to other parts of the body, such as the liver, bones or brain. Stages of small cell lung cancer: Limited Cancer is confined to one lung and to its neighboring lymph nodes. Extensive Cancer has spread beyond one lung and nearby lymph nodes, and may have invaded both lungs, more remote lymph nodes and other organs. You and your doctor will choose a cancer treatment regimen based on a number of factors. These factors include your overall health, the type and stage of your cancer, and your own preferences. Treatment options typically include one or more treatments, including surgery, chemotherapy, radiation therapy or targeted drug therapy. In some cases you may choose not to undergo treatment. For instance, you may feel that the side effects of treatment will outweigh the potential benefits. When that is the case, your doctor may suggest supportive, also known as palliative, care to treat only the symptoms the cancer is causing, such as pain. Treatment options for non-small cell lung cancers Stage Common Options I Surgery II Surgery, chemotherapy, radiation IIIA Combined chemotherapy and radiation, sometimes surgery based on results of treatment IIIB Chemotherapy, sometimes radiation IV Chemotherapy, targeted drug therapy, clinical trials, supportive care Treatment options for small cell lung cancers Stage Common options Limited Combined chemotherapy and radiation, sometimes surgery Extensive Chemotherapy, clinical trials, supportive care Surgery During surgery your surgeon works to remove the lung cancer and a margin of healthy tissue.
Procedures to remove lung cancer include: Edge resection to remove a small section of lung that contains the tumor along with a margin of healthy tissue Lobectomy to remove the entire lobe of one lung Pneumonectomy to remove an entire lung If you undergo surgery, your surgeon may also remove lymph nodes from your chest in order to check them for signs of cancer. If your lymph nodes contain cancer cells, this usually indicates that cancer has spread, even if cancer has not been detected outside of your chest. Lung cancer surgery carries risks, including bleeding and infection. Expect to feel short of breath after lung surgery. Your lung tissue will expand over time and make it easier to breathe. You may also feel pain in the muscles of your chest and in your arm on the side where you had the operation. Your doctor may recommend physical therapy or a rehabilitation program to help you restore your strength and range of motion. Chemotherapy Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be administered through a vein in your arm (intravenously) or taken orally. A combination of drugs is usually given in a series of treatments over a period of weeks or months, with breaks in between so that your body can recover. Chemotherapy can be used as a first line treatment for lung cancer or as additional treatment after surgery. In some cases, chemotherapy can be used to lessen side effects of your cancer. Radiation therapy Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy can be directed at your lung cancer from outside your body (external beam radiation) or it can be put inside needles, seeds or catheters and placed inside your body near the cancer (brachytherapy). Radiation therapy can be used alone or along with other lung cancer treatments. Sometimes it is administered at the same time as chemotherapy. Radiation therapy can also be used to lessen side effects of lung cancer. Targeted drug therapy Targeted therapies are new cancer treatments that work by targeting specific abnormalities in cancer cells. Targeted therapy options for treating lung cancer include: Bevacizumab (Avastin). Bevacizumab stops a tumor from creating a new blood supply. Blood vessels that connect to tumors can supply oxygen and nutrients to the tumor, allowing it to grow. Bevacizumab is usually used in combination with chemotherapy and is approved for advanced and recurrent non-small cell lung cancer. Bevacizumab carries a risk of severe bleeding. Erlotinib (tarceva). Erlotinib blocks chemicals that signal the cancer cells to grow and divide. Erlotinib is approved for people with advanced and recurrent non-small cell lung cancer that have not been helped by chemotherapy. Eroltinib side effects include a skin rash and diarrhea. Clinical trials Clinical trials are studies of new lung cancer treatment methods. You may be interested in enrolling in a clinical trial if lung cancer treatments are not working or if your treatment options are limited. The treatments studied in a clinical trial may be the latest innovations, but they do not guarantee a cure. Carefully weigh your treatment options with your doctor. Your participation in a clinical trial may help doctors better understand how to treat lung cancer in the future. Supportive (palliative) care When treatments offer little chance for a cure, your doctor may recommend you avoid harsh treatments and opt for supportive care instead. If you are receiving supportive care, your doctor may treat any signs and symptoms you
experience to make you feel more comfortable, but you will not receive treatment aimed at stopping your cancer. Supportive care allows you to make the most of your final weeks or months without enduring treatment side effects that can negatively impact your quality of life. There is no sure way to prevent lung cancer, but you can reduce your risk if you: Do not smoke - If you have never smoked, do not start. Talk to your children about not smoking, so they understand how to avoid this major risk factor for lung cancer. Stop smoking Quitting reduces your risk of lung cancer, even if you have smoked for years. Talk to your doctor about strategies and smoking aids that can help you quit. Avoid secondhand smoke If you live or work with a smoker, urge him or her to quit. At the very least, ask him or her to smoke outside. Avoid areas where people smoke, such as bars and restaurants, and seek smoke-free options. Test your home for radon Have the radon levels in your home checked, especially if you live in an area where radon is known to be a problem. High radon levels can be remedied to make your home safer. Avoid carcinogens at work Take precautions to protect yourself from exposure to toxic chemicals at work. In the United States, your employer must tell you if you are exposed to dangerous chemicals in your workplace. Follow your employer s precautions. For instance, if you are given a face mask for protection, always wear it. Ask your doctor what more you can do to protect yourself at work. You risk of lung damage from these carcinogens increases if you smoke. Eat a diet full of fruits and vegetables Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Avoid taking large doses of vitamins in pill forms, there may be unknown harms. For instance, researchers hoping to reduce the risk of lung cancer in heavy smokers gave them beta carotene supplements. Results showed the supplements actually increased the risk of cancer in smokers. Drink alcohol in moderation, if at all Limit yourself to one drink a day if you are a woman or two drinks a day if you are a man. Anyone age 65 or older should drink no more than one drink a day. Exercise Aim to achieve at least thirty minutes of exercise on most days of the week. Check with your doctor first if you are not already exercising regularly. Start out slowly and continue adding more activity. Biking, swimming, and walking are good choices. Add exercise throughout your day - park farther away from work and walk the rest of the way or take the stairs rather than the elevator. For more information regarding lung cancer, please visit www.cancer.org