Conditions

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, ovarian and breast cancers combined.

People who smoke have the greatest risk of lung cancer, but there are a large group of lung cancer patients who have never smoked. The risk of lung cancer does increase with the length of time and number of cigarettes smoked. Those who smoke can significantly reduce their chances of developing lung cancer – even after smoking for many years – by quitting. Smoking causes lung cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances, changes in the lung tissue begin almost immediately. At first, the body may be able to repair this damage, but normal cells in the lung’s lining will become increasingly damaged with repeated exposure. Over time, the damage causes cells to act abnormally and may lead to cancer.

Types of lung cancer
Doctors divide lung cancer into two major types based on the appearance of lung cancer cells under the microscope. Your doctor makes treatment decisions based on which major type of lung cancer you have. The two general types of lung cancer include:

• Small cell lung cancer occurs almost exclusively in heavy smokers and 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.
• Non-small cell lung cancer is a term used for several types of lung cancers that behave in a similar way. Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma..

Symptoms
Lung cancer typically doesn’t cause signs and symptoms in its earliest stages. Signs and symptoms of lung cancer typically occur only when the disease is advanced.

Signs and symptoms may include:

• Persistent cough
• Chest pain
• Coughing up blood, even a small amount
• Coughing up phlegm
• Hoarseness
• Shortness of breath
• Wheezing
• Weight loss

Diagnosis
Lung cancer is difficult to diagnose. Because lungs can accommodate large tumors without compromising breathing, many people don’t experience symptoms as the tumor is growing.

If a nodule, or mass, is found on a scan, a tissue biopsy is performed to confirm the diagnosis.

Methods of biopsy include the following:

Conventional bronchoscopy

is a thin fiberoptic endoscope is inserted into the airways to examine the inside of the lungs

Electromagnetic navigational bronchoscopy (superDimension®)

is a special bronchoscope with a device that works like the GPS for your car allows the surgeon to reach areas that aren’t possible with conventional bronchoscopy.

Endobronchial ultrasound (EBUS)

is a special bronchoscope with an ultrasound probe built into it that allows the surgeon to see enlarged lymph nodes or masses through the airway walls. This advanced tool is used for the staging of lung cancer and enhances the accuracy of diagnosis.

CT-guided FNA biopsy

is a procedure performed by an interventional radiologist who places a needle into the tumor under direct radiographic guidance.

Surgical biopsy

is a minimally invasive procedure used when more tissue is required or if other diagnostics fail and in which the portion of the lung containing the tumor is removed.

After diagnosis has been made, the next step is to stage the disease using CT scans or an integrated PET/CT scan. This determines how severe the disease is and whether it has spread to the lymph nodes or other organs.

Treatments

Each patient’s lung cancer treatment plan will be based on a number of factors, such as overall health, cancer type and stage and patient preferences. Options include one or more treatments, including surgery, chemotherapy, radiation therapy, targeted drug therapy or immunotherapy.

Chemotherapy
Chemotherapy uses medication to kill cancer cells. Chemotherapy drugs may be taken orally or given intravenously. A combination of drugs usually is given in a series of treatments over a period of weeks or months depending on how it is tolerated and importantly, if a remission in the cancer is seen. Chemotherapy is often used after surgery to kill any cancer cells that may remain. It may also be used before surgery to shrink cancers and make them easier to remove. In some cases, chemotherapy can be used to relieve pain and other symptoms of advanced cancer.

Targeted drug therapy
Targeted therapies are newer cancer treatments that work by targeting specific abnormalities that are driving the cancer cells to grow and divide. In this way, treatment is personalized to the patient’s specific cancer target. Specialized molecular testing is performed on an individual’s cancer cells to find these driver mutations. Many of the drugs that target these mutations are pills and have a high chance of shrinking cancer and causing lasting remissions.

Immunotherapy
Once thought of as a type of cancer that was poorly immunogenic, lung cancer has recently emerged as an exciting new target of immune-based therapies. These treatments work by exposing the cancer to the immune system allowing it to attack the disease.

Radiation therapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy can be directed at lung cancer from outside the body (external beam radiation) or it can be put inside needles, seeds or catheters and placed inside the body near the cancer (brachytherapy). Radiation therapy can be used after surgery to kill any cancer cells that may remain. It may also be used as the first treatment for lung cancers that can’t be removed during surgery. For people with advanced lung cancer, radiation therapy may be used to relieve pain and other symptoms.

Stereotactic radiosurgery, using the Varian® TrueBeam™ STx, can treat lung tumors previously considered inoperable, as an alternative to surgical resection for high-risk patients. This form of radiation aims many beams of radiation from different angles at the lung cancer. In certain cases, it may be used in place of surgery for small tumors.

Radiation therapy treatments include:

• Varian® TrueBeam™ STx
• Intensity modulated radiation therapy (IMRT)
• 3-D conformal radiation therapy (3-D CRT)
• CT-guided percutaneous thermal ablation or cryoablation

Surgery
During surgery, the surgeon works to remove the lung cancer and a portion of healthy tissue. Procedures to remove lung cancer include:

• Lobectomy – removal the entire lobe of one lung
• Pneumonectomy – removal of an entire lung
• Segmental resection – removal of a larger portion of lung, but not an entire lobe
• Wedge resection – removal of a small section of lung that contains the tumor along with a margin of healthy tissue

The surgeon may also remove lymph nodes from a patient’s chest during surgery in order to check them for signs of cancer.

Lung cancer surgery carries risks, including bleeding and infection. Patients can expect to experience shortness of breath after lung surgery. If a portion of the lung is removed, your remaining lung tissue will expand over time and make it easier to breathe. The medical team often recommends a respiratory therapist who can guide patients through breathing exercises to aid in recovery.

Advanced surgical procedures include:

• Robotic lung resection using the da Vinci Xi robot
• Video-assisted thoracoscopic surgery (VATS) lung resection allows for a faster recovery and a greater chance for the wound to heal.
• Surgical treatment of stage IIIA disease
• Novel therapy for refractory malignant effusions
• Tracheal resection and bronchoplastic surgery

Robotic Surgery
Our dedicated thoracic surgeons use the da Vinci Xi robotic system to perform complex surgery. The Xi robot is optimized for thoracic procedures. The robotic system gives surgeons greater dexterity, precision and ability to remove cancerous tissue in all quadrants of the abdomen and chest because of its smaller arms. In addition, surgeons have a larger operating field in which to work, leading to better maneuverability without having to reposition the robot as frequently throughout the procedure.
For our patients, robotic surgery, when appropriate, provides a minimally invasive treatment choice that often leads to smaller incisions (less than one inch), less pain and less need for medication, minimal scarring and reduced bleeding. However, the biggest advantages for robotic surgery are the shorter hospital stay and faster recovery time for patients to return to normal daily routines – often cutting these times in half.

Keck Medical Center was the first in Los Angeles to provide robotic lobectomies and is now the only worldwide training center for Da Vinci Xi robotic-assisted thoracic surgery.

Patient Information

Cancer screening
Our comprehensive services include low-dose chest CT scan for screening and monitoring. The National Lung Screening Trial conducted by the National Cancer Institute has shown that lung cancer screening with low-radiation dose CT scans significantly lowers the risk of dying from lung cancer by 20 percent.

Keck Medical Center is one of the original centers approved by the National Framework for Lung Screening Excellence, offering screening and its interpretation since 2013. Screening is recommended in high-risk individuals. The Lung Cancer Program at USC Norris offers the test and its interpretation at a cost of $200.

For more information, click here to learn more about lung cancer screening program.

Resources

Clinical trials
Clinical trials are experiments that are used to determine if new treatments or diagnostic tools are effective in lung cancer patients. All new medications to treat cancer must be validated in clinical trials before they are approved for routine use. Sometimes clinical trials will provide patients with treatments before their general approval, and other times, approved drugs are used in clinical trials to determine if they work against the cancer at a different stage or in a different patient type. The treatments studied in a clinical trial may be the latest innovations, but they don’t guarantee a cure. Patients should carefully weigh treatment options with their doctor. Participation in a clinical trial may help doctors better understand how to treat lung cancer in the future.

clinicaltrials.keckmedicine.org

Support

Bonnie J. Addario Lung Cancer Foundation
lungcancerfoundation.org

Lung Cancer Alliance
lungcanceralliance.org

Lungevity Foundation
lungevity.org