Each year, about 116,400 men and 111,700 women are diagnosed with lung cancer in the United States. If you or someone you care about has received a lung cancer diagnosis, you may have questions about what it is, who’s at risk and how it’s treated.
Lung cancer frequently asked questions (FAQs)
Lung cancer forms when the cells in the lungs begin growing abnormally. These cells divide more quickly than healthy cells do and continue to accumulate, forming a mass. The cells may spread (metastasize) to both lungs, nearby lymph nodes or other parts of your body. Lung cancer often begins in certain parts of the lung, like the bronchi, bronchioles or alveoli.
Lung cancer is the second most common form of cancer among both men and women in the U.S. It is also the leading cause of cancer deaths in the country, claiming more lives each year than colon, breast and prostate cancers combined. Outcomes for patients with lung cancer continue to improve, however, due to increased awareness about the benefits of early detection through screening, as well as advancements in treatment therapies. In fact, from 1990 to 2016, lung cancer mortality rates among men declined by 48%. Among women, mortality rates dropped 23% from 2002 to 2016, according to the latest data from the American Cancer Society.
Doctors divide lung cancer into two major types — non-small cell lung cancer and small cell lung cancer — 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, and the growth and progression of the cancer to other parts of the body (staging).
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 account for 80% to 85% of lung cancer cases and are generally categorized into three main subtypes:
- Adenocarcinoma forms in the outer areas of the lung. It is the most common lung cancer found in nonsmokers; is more prevalent in women than in men; and is more likely to develop in younger people.
- Large cell carcinoma can form in any part of the lung and tends to grow and spread quickly.
- Squamous cell carcinoma forms inside of the lung’s airways. It is commonly found in smokers.
In addition to determining what type of non-small cell lung cancer you have, your doctors must establish the stage of your cancer. Generally, staging of non-small cell lung cancer is measured from 0 to 4 (IV), and a higher number indicates further spread of the cancer.
Small cell lung cancer occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer, accounting for 10% to 15% of lung cancer cases. This type of lung cancer grows more quickly and is more likely to spread to other organs in the body. Staging for small cell lung cancer is commonly divided into two categories: limited stage and advanced stage.
The risk of lung cancer increases with the length of time and number of cigarettes smoked. 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. People who smoke can significantly reduce their chance of developing lung cancer — even after smoking for many years — by quitting.
People who have never smoked can also develop lung cancer. Other risk factors for lung cancer besides smoking include exposure to secondhand smoke, radon gas, asbestos, radiation, air pollution and diesel exhaust. Exposure to certain metals and organic compounds can also increase a person’s risk of developing lung cancer.
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:
- Chest pain
- Coughing up blood, even a small amount
- Coughing up phlegm
- Persistent cough
- Recurrent pneumonia or bronchitis
- Shortness of breath
- Voice change
- Weight loss
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 bronchoscopy, CT-guided biopsy and surgical biopsy.
If you have smoked for many years, you should consider lung cancer screening with a low-dose chest CT scan. Research has shown that this type of screening lowers the risk of dying from lung cancer by 20%.
To receive lung cancer screening at the USC Lung Cancer Program, you must meet the following criteria:
- You must be at least 55 years old; have smoked the equivalent of one pack of cigarettes a day for 30 years; and be either a current smoker or have quit within the past 15 years
- You must be older than 50; have smoked the equivalent of one pack of cigarettes a day for 20 years; and have at least one of the following risk factors:
- Significant chronic lung disease (chronic obstructive pulmonary disease [COPD], pulmonary fibrosis)
- Exposure to toxins such as radon, asbestos, coal and diesel fumes
- A first-degree relative with lung cancer
- A personal history of lung cancer, lymphoma, or head and neck cancer
The test and its interpretation cost $200. Click here for more information on our lung cancer screening program.
How you feel while undergoing chemotherapy will depend on the medicines you receive. Common side effects include hair loss, nausea, vomiting, fatigue and an increased risk of developing infection.
Your medical oncologist should have a thorough discussion with you about the short-term and long-term effects of chemotherapy. Sometimes side effects are unavoidable, but other times they can be reduced or prevented with everything from exercise to changes in nutrition. Your lung cancer health care team can help guide you through the process.
Radiation therapy uses X-rays or other high-powered beams of energy to kill cancer cells. Radiation therapy is usually done using a large machine that aims the energy beams at your body (external beam radiation). It can also be done by placing radioactive material inside your body (brachytherapy).
Possible side effects of radiation therapy include fatigue, nausea and inflammation of the tissue being radiated, such as the lung, esophagus and skin. How you feel with radiation depends on the details of your personalized treatment plan. Your radiation oncologist should thoroughly discuss the short- and long-term side effects before starting treatment.
During surgery, your surgeon works to remove the lung cancer and a portion of healthy tissue. Procedures to remove lung cancer include:
- Lobectomy — the removal of an entire lobe of one lung
- Pneumonectomy — the removal of an entire lung
- Segmental resection — the removal of a larger portion of lung but not an entire lobe
- Wedge resection — the removal of a small section of lung that contains the tumor, along with a margin of healthy tissue
Your surgeon may also remove lymph nodes from your chest during surgery in order to check them for signs of cancer.
Robotic surgery may be recommended for certain patients undergoing lung cancer treatment. This type of procedure is a minimally invasive option that often leads to smaller incisions (less than one inch), less pain and less need for medication, minimal scarring and reduced bleeding. People who undergo robotic surgery are also more likely to have a shorter hospital stay and a faster recovery time.
You 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. Your medical team will often recommend a respiratory therapist who can guide you through breathing exercises to aid in recovery.
The majority of people who undergo lung cancer surgery will require short-term oxygen after surgery. Before your surgery, your care team will assess your particular needs and discuss whether you will need short-term or long-term oxygen, so that you can prepare accordingly.
Dr. Ye is a radiation oncologist at USC Norris Comprehensive Cancer Center at Keck Medicine of USC. He specializes in a wide array of advanced radiation treatment techniques for people with lung, breast, brain and spine tumors. Here’s what you won’t find on his resume. He can’t wait to swim with manta rays in Kona.
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