Lung Cancer

Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. The two major types of lung cancer are:

  • Non-small cell lung cancer (the most common)
  • Small cell lung cancer

There are also less common types of lung cancer. One example is mesothelioma, which affects the lining of several organs in the body, but most commonly the lungs. Another less common cancer is a carcinoid tumor, which grows slowly and is generally cured by surgery.

Our patients with lung cancer are treated at the Moores Lung Cancer Unit. See the Lung Cancer Unit for more information.

You can also review the tabs at top of this page for information on Lung cancer symptoms and risks, causes, diagnosis, and treatment.

Symptoms

Most lung cancers do not cause any symptoms until they have spread too far to be cured, but symptoms do occur in some people with early disease. The most common symptoms of lung cancer are:

  • A cough that gets worse or does not go away
  • Chest pain that is often worse with deep breathing, coughing, or laughing
  • Hoarseness
  • Weight loss and loss of appetite
  • Bloody or rust-colored sputum (spit or phlegm)
  • Shortness of breath
  • Recurring infections such as bronchitis and pneumonia
  • New onset of wheezing

When lung cancer spreads to distant organs, it may cause:

  • Bone pain
  • Neurologic changes (such as headache, weakness or numbness of a limb, dizziness, or recent onset of a seizure)
  • Jaundice (yellowing of the skin and eyes)
  • Lumps near the surface of the body, due to cancer spreading to the skin or to lymph nodes (collections of immune system cells) in the neck or above the collarbone

You may not have any symptoms of lung cancer, or you may have symptoms such as a cough or shortness of breath that you think are related to a respiratory illness. As a result, only about 16% of lung cancers are diagnosed early when treatment is most effective

Risk factors

  • Cigarette smoking
  • Exposure to certain industrial substances, such as arsenic
  • Some organic chemicals
  • Radon and asbestos, particularly for persons who smoke
  • Radiation exposure from occupational, medical
  • Environmental sources, such as air pollution and tuberculosis
  • Environmental tobacco smoke in nonsmokers

There is currently no approved screening test for lung cancer; however, see the following known causes:

Smoking

Smoking causes most cases of lung cancer, and secondhand smoke can be a contributor, as well. However, people who have never smoked can be diagnosed with lung cancer, as well. The American Cancer Society notes that if you stop smoking before a cancer develops, your damaged lung tissue gradually starts to repair itself. No matter what your age or how long you've smoked, quitting may help you live longer. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who continue to smoke.

Exposure

Air pollution may increase the risk of lung cancer, but it is much less a risk factor than smoking. Additional causes of lung cancer may include exposure to radon, a naturally occurring radioactive gas that results from the breakdown of uranium in soil and rocks, and exposure to asbestos fibers in the workplace or home. Treatment with radiation therapy to the breast or chest may be a risk factor. Cancer-causing agents found in the workplace include radioactive ores such as uranium; inhaled chemicals or minerals such as arsenic (or arsenic in the water), beryllium, cadmium, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas, and chloromethyl ethers; and diesel exhaust.

History of cancer

Individuals who have had lung cancer in the past have a higher risk of developing another lung cancer. Genetics is another factor, as brothers, sisters, and children of those who have had lung cancer may have a slightly higher risk.

Combined risk factors

When smoking is combined with other risk factors, the risk of developing lung cancer is increased. The American Cancer Society notes that people who are current smokers should realize that the best way to avoid dying from lung cancer is to stop smoking.

During your initial diagnostic exam, your doctor will ask about your personal and family health history, conduct a physical exam, and order several tests.

The UC San Diego Moores Cancer Center is the only facility in San Diego and one of only a handful on the West Coast to provide lung cancer diagnosis via endobronchial ultrasound (EBUS). This procedure allows your physician to perform a biopsy of chest masses and lymph nodes without conventional surgery (mediastinoscopy). Another alternative to mediastinoscopy offered at UCSD is trans-esophageal endoscopic ultrasound (EUS). The samples obtained through either proedure can be used for diagnosing and staging lung cancer.

Whether EBUS or EUS is utilized depends upon the location of the tumor. When neither procedure is possible, a mediastinoscopy is performed, in which a small incision is made in the upper part of the chest and a camera is used to find and retrieve lymph nodes.

Additional diagnostic tests may include:

  • Blood test
  • Chest x-ray
  • Computed Tomography (CT) scan or Positron Emission Tomography (PET) scan
  • Sputum cytology: The lab examines your sputum (mucus coughed up from the lungs) for cancer cells
  • Thoracentesis: A needle is used to remove fluid from your chest
  • Bronchoscopy: A thin, lighted tube (bronchoscope) is inserted into the lungs through the nose or mouth, so that the doctor may look inside the airways for abnormal areas. A tissue sample may be taken.
  • Fine-needle aspiration: A thin needle is used to remove the specimen from the lungs or lymph nodes.
  • Thorascoscopy: The surgeon makes several small incisions in the chest and back, looks at the lungs and nearby tissues with a thin, lighted tube, and takes tissue samples as needed.
  • Thoractomy: The chest is opened with a long incision so that lymph nodes and other tissue can be removed.
  • Mediastinoscopy: A small incision is made in the upper part of the chest and a camera is used to find and retrieve lymph nodes

Staging

A process called staging is used to determine how much your cancer has spread and what treatment options will be considered.

Generally, physicians consider the cancer to be:

  • Early stage
  • Locally advanced
  • Advanced

The mainstay of early stage lung cancer treatment is surgical removal, sometimes augmented by chemotherapy and radiation. Locally advanced cancer may involve a combination of chemotherapy, radiation and surgery, in different treatment sequences. In advanced cases, chemotherapy is the main treatment, with radiation or ablation sometimes used to control symptoms. Clinical trials could be offered for patients in all stages of the disease.

Surgery

UC San Diego’s lung surgery team has more than 20 years of experience with thousands of lung cancer patients. Many studies have shown that the best surgical outcomes occur in medical centers with a high volume of cases.

If your lung tumor has not spread beyond the lung, surgery is frequently the first choice of treatment to remove all the cancer. A variety of techniques may be used, with the choice dependent upon the size of the tumor, its location and your overall health. The surgical team also works closely with your medical oncologist and radiation oncologist, as needed, to ensure that your therapy is ideal for your specific case. For example, in some cases, radiation or chemotherapy will shrink the tumor to assist in its removal by the surgeon.

Just one example of UC San Diego’s surgical expertise in lung cancer is video-assisted thoracic surgery (VATS) which is performed at only a handful of centers in the U.S. The surgeon uses a video camera to help visualize and operate upon the lung, with surgical incisions much smaller than those required for other forms of surgery. Read more about Lung Surgery at UC San Diego Health System.

Chemotherapy

Chemotherapy is an outpatient treatment using drugs to kill cancer cells. The decision about chemotherapy is made with your input and heavily relies on your acceptance of aggressive vs non-aggressive management of your disease.

Chemotherapy can be used to increase the chance of cure after the surgery, to increase survival in advanced lung cancer, and to help reduce pain and other problems caused by lung cancer. Side effects depend mainly on the type of drug, how much of it is used, how often it is given and for how long.

Radiation therapy

Radiation therapy, also known as radiation oncology, provides the most advanced techniques available to treat lung cancer. A multi-step process, radiation therapy begins with your consultation, followed by a “simulation,” visit, where your radiation oncologist precisely outlines the area in your body that needs to be treated, and, together with the medical physicist and dosimetrist, generates your treatment plan. Once your treatment plan is finalized, you will begin therapy.

Radiofrequency ablation

Radiofrequency ablation uses a small needle inserted through the skin and into the tumor. Energy passes through the needle into the tumor, heating and killing the cancer cells. It also closes up the little blood vessels in the area so there is less bleeding.

This procedure may be available for:

Non-operative, early stage lung cancer patients (such as those who have lung disease or severe heart disease) or individuals who refuse to have surgery.
Patients with more advanced cancer, who may benefit from a reduction in symptoms by undergoing the procedure.
Those with metastatic disease where the tumor size is relatively small and not adjacent to any critical structure like a central airway or blood vessels.