Cancer from A to Z

Many factors may influence the development of lung cancer, including:

Smoking - This is by far the most important risk factor. Smoking is responsible for 91% of death related to lung cancer in men and 77% in women. Also at higher risk are individuals who smoke cigars and pipes.

Family history - Research is beginning to show that a family history of lung cancer may be a risk factor.

Personal history - A person with a previous lung cancer diagnosis is more likely to develop a second lung cancer.

Occupational or environmental exposure – People who are routinely exposed to radon or asbestos are at increased risk for developing lung cancer — particularly if they are smokers.

Radiation exposure - People who are routinely exposed to radiation from occupational, medical and environmental sources are at increased risk.

Industrial exposure - People who are exposed to certain industrial substances like arsenic could be at high risk.

Air pollution - The byproducts from the combustion of fossil fuels can put people at risk.

Environmental tobacco smoke - People who live with or who are routinely around smokers are at higher risk.

Lung diseases - People with lung diseases such as tuberculosis (TB) are at higher risk.

Reducing Your Risk
You can take action to reduce your risk of developing lung cancer. MD Anderson suggests:

eliminating tobacco use
using protective equipment when exposed to dangerous substances and pollutants
avoiding secondhand smoke
Take time to discuss your own risks with your health care provider who can best advise you on the screening exams and risk-reduction strategies that are right for you.

Screening
Cancer screenings are medical tests that are performed when a person has no symptoms. There presently are no effective screening tests to find lung cancer early. X-rays and/or laboratory analysis of the cells in phlegm and fiber optic screening are limited in detecting lung cancer before it spreads. CT scans may be able to detect lung cancer earlier, but their ability to improve long-term survival has not been proven.

Although there are currently no screening tests for lung cancer, there are many procedures that can be used to diagnose lung cancer. Some of these tests may be used in combination to obtain the most accurate diagnosis possible.

• Chest X-rays: A common method that photographs the lungs. Specialists can spot abnormal areas that may indicate the presence of cancer.
• CAT scans: A specialized X-ray machine which uses radiographic beams to create precise computerized pictures of the lung
• Bronchoscope: A thin flexible tube with a tiny camera, which is inserted through the nose or mouth and down into the lungs. A bronchoscope can also take a small tissue sample for biopsy.
• Fine Needle Aspiration (FNA): A thin needle attached to a syringe is inserted through the chest into the lung tissue and cells are drawn out for examination under a microscope
• Positron Emission Tomography (PET) uses a special type of scanner and a form of sugar that contains a radioactive atom. This sugar is injected into a vein, and the scanner rotates around the patient's body and records the sugar as it moves through the body and collects in organs. Cancer cells show up brighter in the pictures because they absorb more sugar than normal cells.
• Sputum cytology: Cells taken from mucus expelled by coughing are analyzed for the presence of cancer.
• Thoracentesis: Fluid from around the lungs is drawn out with a needle for examination.
• Video Assisted Thoracoscopic Surgery (VATS): VATS can be used to aid in the diagnosis of thoracic cancers. Using a limited number of tiny incisions, small diameter video-thoracoscopes can allow examination of the entire thoracic cavity. Biopsies of the lining of the chest cavity (pleura), lung nodules, mediastinal masses and pleural fluid can easily be obtained for diagnosis.

Stages of Non-Small Cell Lung Cancer
- from the National Cancer Institute

Doctors describe non-small cell lung cancer based on the size of the lung tumor and whether cancer has spread to the lymph nodes or other tissues. A staging system, below, is used to characterize the tumors. Staging is very important when deciding the best form of treatment for each patient.

Early stage lung cancer is considered to be any tumor classified as stage 0 through stage IB, in which the cancer is still localized and hasn't spread to nearby lymph nodes.

Occult stage: Lung cancer cells are found in sputum or in a sample of water collected during bronchoscopy, but a tumor cannot be seen in the lung.

Stage 0: Cancer cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A stage 0 tumor is also called carcinoma in situ. The tumor is not an invasive cancer.

Stage IA: The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no more than three centimeters across (less than 1 ¼ inches). It is surrounded by normal tissue and the tumor does not invade the bronchus. Cancer cells are not found in nearby lymph nodes.

Stage IB: The tumor is larger or has grown deeper, but cancer cells are not found in nearby lymph nodes. The lung tumor is one of the following:

• The tumor is more than three centimeters across
• It has grown into the main bronchus
• It has grown through the lung into the pleura

Stage IIA: The lung tumor is no more than three centimeters across. Cancer cells are found in nearby lymph nodes.

Stage IIB: The tumor is one of the following:

Cancer cells are not found in nearby lymph nodes, but the tumor has invaded the chest wall, diaphragm, pleura, main bronchus or tissue that surrounds the heart
Cancer cells are found in nearby lymph nodes, and one of the following:The tumor is more than three centimeters across
It has grown into the main bronchus
It has grown through the lung into the pleura
Stage IIIA: The tumor may be any size. Cancer cells are found in the lymph nodes near the lungs and bronchi, and in the lymph nodes between the lungs but on the same side of the chest as the lung tumor.

Stage IIIB: The tumor may be any size. Cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumormay have invaded nearby organs, such as the heart, esophagus or trachea. More than one malignant growth may be found within the same lobe of the lung. The doctor may find cancer cells in the pleural fluid.

Stage IV: Malignant growths may be found in more than one lobe of the same lung or in the other lung. Cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver or bone.

Surgery
The standard operation for lung cancer includes removal of the lobe of the lung in which the tumor resides (lobectomy) and dissection and removal of the mediastinal lymph nodes (MLND). This procedure is usually performed through an incision on the back and requires the ribs to be spread apart (right).

Advances in minimally invasive surgery are improving treatment outcomes for many lung cancer patients. Video Assisted Thoracoscopic Surgery (VATS), a minimally invasive technique, is resulting in better outcomes and decreased recovery times. VATS lobectomy can accomplish the same cancer operation as the traditional open procedure, but requires only three or four small incisions and does not involve spreading of the ribs. VATS is an option for selected lung cancer patients, particularly those have a small tumor in the outer regions of the lung .

Radiation Therapy
External beam radiation treatment is most often used in conjunction with surgery, but it can also be combined with chemotherapy as an alternative to surgery.

The following types of radiation therapy are used with this disease:

• Virtual CT simulation
• Intense modulated Radiation Therapy (IMRT)
• Volumetric Modulated Arc Therapy (VMAT)
• Image guided radiation therapy (IGRT)
• Stereotactic Body Radiation Therapy (SBRT)
• Gating/4D CT

We have been pioneers in radiosurgical treatments of lung tumors since 2001 and have accumulated extensive experience having treated a great many patients, achieving a high rate of success in lesions treated (99% local control) with very low toxicity rates (1%).

Chemotherapy
Chemotherapy, the use of drugs to destroy tumors, is usually used along with surgery in lung cancer patients. Chemotherapy can make the tumormore manageable before surgery, or to destroy lingering cancer cells at the tumor site after surgery.

Photodynamic Therapy (PDT)
Photodynamic therapy involves a light-sensitive chemical injected into the body, where it remains longer in cancer cells than it does in normal cells. The chemical is activated with a laser that initiates the destruction of cancer cells. PDT is best used on very small tumors, or to reduce some symptoms of lung cancer.