Keeping on Top of Your Condition
Understanding the Cancer Process
All types of cancer develop in our cells, the body's basic unit of
life. To understand cancer, it is helpful to know how normal cells become
cancerous.
The body is made up of many types of cells. Normally, cells grow,
divide, and produce more cells as needed to keep the body healthy and
functioning properly. Sometimes, however, the process goes astray -- cells
keep dividing when new cells are not needed. The mass of extra cells forms
a growth or tumor.
Tumors can be benign
or malignant.
Benign tumors are not cancer. They often can be removed and, in
most cases, they do not come back. Cells in benign tumors do not spread to
other parts of the body. Most important, benign tumors are rarely a threat
to life.
Malignant tumors are cancer. Cells in malignant tumors are
abnormal and divide without control or order. These cancer cells can
invade and destroy the tissue
around them. Cancer cells can also break away from a malignant tumor and
enter the bloodstream or lymphatic
system (the tissues and organs that produce, store, and carry
white blood cells that fight infection and other diseases). This process,
called metastasis,
is how cancer spreads from the original (primary) tumor to form new
(secondary) tumors in other parts of the body.
The Lungs
The lungs, a pair of sponge-like, cone-shaped organs, are part of the
respiratory
system. The right lung has three sections, called lobes;
it is a little larger than the left lung, which has two lobes. When we
breathe in, the lungs take in oxygen, which our cells need to live and
carry out their normal functions. When we breathe out, the lungs get rid
of carbon dioxide, which is a waste product of the body's cells.
The
lungs
|
Understanding Lung Cancer
Cancers that begin in the lungs are divided into two major types, non-small
cell lung cancer and small
cell lung cancer, depending on how the cells look under a
microscope. Each type of lung cancer grows and spreads in different ways
and is treated differently.
Nonsmall cell lung cancer is more common than small cell lung
cancer, and it generally grows and spreads more slowly. There are three
main types of non-small cell lung cancer. They are named for the type of
cells in which the cancer develops: squamous
cell carcinoma (also called epidermoid
carcinoma), adenocarcinoma,
and large
cell carcinoma.
Small cell lung cancer, sometimes called oat
cell cancer, 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.
| Cancers that begin in the lungs are divided into
two major types, non-small cell lung cancer and small cell lung
cancer, depending on how the cells look under a microscope. Each
type of lung cancer grows and spreads in different ways and is
treated differently. |
Lung Cancer: Who's at Risk?
Researchers have discovered several causes of lung cancer -- most are
related to the use of tobacco.
-
Cigarettes. Smoking cigarettes causes lung cancer. Harmful
substances, called carcinogens,
in tobacco damage the cells in the lungs. Over time, the damaged cells
may become cancerous. The likelihood that a smoker will develop lung
cancer is affected by the age at which smoking began, how long the
person has smoked, the number of cigarettes smoked per day, and how
deeply the smoker inhales. Stopping smoking greatly reduces a person's
risk for developing lung cancer.
-
Cigars and Pipes. Cigar and pipe smokers have a higher risk of
lung cancer than nonsmokers. The number of years a person smokes, the
number of pipes or cigars smoked per day, and how deeply the person
inhales all affect the risk of developing lung cancer. Even cigar and
pipe smokers who do not inhale are at increased risk for lung, mouth,
and other types of cancer.
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Environmental Tobacco Smoke. The chance of developing lung
cancer is increased by exposure to environmental tobacco smoke (ETS) --
the smoke in the air when someone else smokes. Exposure to ETS, or
secondhand smoke, is called involuntary or passive smoking.
-
Radon.
Radon is an invisible, odorless, and tasteless radioactive gas that
occurs naturally in soil and rocks. It can cause damage to the lungs
that may lead to lung cancer. People who work in mines may be exposed to
radon and, in some parts of the country, radon is found in houses.
Smoking increases the risk of lung cancer even more for those already at
risk because of exposure to radon. A kit available at most hardware
stores allows homeowners to measure radon levels in their homes. The
home radon test is relatively easy to use and inexpensive. Once a radon
problem is corrected, the hazard is gone for good.
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Asbestos.
Asbestos is the name of a group of minerals that occur naturally as
fibers and are used in certain industries. Asbestos fibers tend to break
easily into particles that can float in the air and stick to clothes.
When the particles are inhaled, they can lodge in the lungs, damaging
cells and increasing the risk for lung cancer. Studies have shown that
workers who have been exposed to large amounts of asbestos have a risk
of developing lung cancer that is 3 to 4 times greater than that for
workers who have not been exposed to asbestos. This exposure has been
observed in such industries as shipbuilding, asbestos mining and
manufacturing, insulation work, and brake repair. The risk of lung
cancer is even higher among asbestos workers who also smoke. Asbestos
workers should use the protective equipment provided by their employers
and follow recommended work practices and safety procedures.
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Pollution. Researchers have found a link between lung cancer
and exposure to certain air pollutants, such as by-products of the
combustion of diesel and other fossil fuels. However, this relationship
has not been clearly defined, and more research is being done.
-
Lung Diseases. Certain lung diseases, such as tuberculosis
(TB), increase a person's chance of developing lung cancer. Lung cancer
tends to develop in areas of the lung that are scarred from TB.
-
Personal History. A person who has had lung cancer once is
more likely to develop a second lung cancer compared with a person who
has never had lung cancer. Quitting smoking after lung cancer is
diagnosed may prevent the development of a second lung
cancer.
Researchers continue to study the causes of lung cancer and to search
for ways to prevent it. We already know that the best way to prevent lung
cancer is to quit (or never start) smoking. The sooner a person quits
smoking the better. Even if you have been smoking for many years, it's
never too late to benefit from quitting.
| The best way to prevent lung cancer is to quit,
or never start, smoking. |
Recognizing Lung Cancer Symptoms
Common signs and symptoms of lung cancer include:
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A cough that doesn't go away and gets worse over time
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Constant chest pain
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Coughing up blood
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Shortness of breath, wheezing, or hoarseness
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Repeated problems with pneumonia
or bronchitis
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Swelling of the neck and face
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Loss of appetite or weight loss
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Fatigue
These symptoms may be caused by lung cancer or by other conditions. It
is important to check with a doctor.
Diagnosing Lung Cancer
To help find the cause of symptoms, the doctor evaluates a person's
medical history, smoking history, exposure to environmental and
occupational substances, and family history of cancer. The doctor also
performs a physical exam and may order a chest x-ray
and other tests. If lung cancer is suspected, sputum
cytology (the microscopic examination of cells obtained from a deep-cough
sample of mucus in the lungs) is a simple test that may be useful in
detecting lung cancer. To confirm the presence of lung cancer, the doctor
must examine tissue from the lung. A biopsy
-- the removal of a small sample of tissue for examination under a
microscope by a pathologist
-- can show whether a person has cancer. A number of procedures may be
used to obtain this tissue:
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Bronchoscopy.
The doctor puts a bronchoscope
(a thin, lighted tube) into the mouth or nose and down through the
windpipe to look into the breathing passages. Through this tube, the
doctor can collect cells or small samples of tissue.
-
Needle
aspiration. A needle is inserted through the chest into the
tumor to remove a sample of tissue.
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Thoracentesis.
Using a needle, the doctor removes a sample of the fluid that surrounds
the lungs to check for cancer cells.
-
Thoracotomy.
Surgery to open the chest is sometimes needed to diagnose lung cancer.
This procedure is a major operation performed in a hospital.
Staging the Disease
If the diagnosis is cancer, the doctor will want to learn the stage (or
extent) of the disease. Staging is done to find out whether the cancer has
spread and, if so, to what parts of the body. Lung cancer often spreads to
the brain or bones. Knowing the stage of the disease helps the doctor plan
treatment. Some tests used to determine whether the cancer has spread
include:
-
CAT
(or CT) scan (computed tomography). A computer linked to an
x-ray machine creates a series of detailed pictures of areas inside the
body.
-
MRI
(magnetic resonance imaging). A powerful magnet linked to a computer
makes detailed pictures of areas inside the body.
-
Radionuclide
scanning. Scanning can show whether cancer has spread to
other organs, such as the liver. The patient swallows or receives an
injection of a mildly radioactive substance. A machine (scanner)
measures and records the level of radioactivity in certain organs to
reveal abnormal areas.
-
Bone
scan. A bone scan, one type of radionuclide scanning, can
show whether cancer has spread to the bones. A small amount of
radioactive substance is injected into a vein. It travels through the
bloodstream and collects in areas of abnormal bone growth. An instrument
called a scanner measures the radioactivity levels in these areas and
records them on x-ray film.
-
Mediastinoscopy/Mediastinotomy.
A mediastinoscopy can help show whether the cancer has spread to the
lymph nodes in the chest. Using a lighted viewing instrument, called a
scope, the doctor examines the center of the chest (mediastinum)
and nearby lymph nodes. In mediastinoscopy, the scope is inserted
through a small incision in the neck; in mediastinotomy, the incision is
made in the chest. In either procedure, the scope is also used to remove
a tissue sample. The patient receives a general anesthetic.
Treatment for Lung Cancer
Treatment depends on a number of factors, including the type of lung
cancer (non-small or small cell lung cancer), the size, location, and
extent of the tumor, and the general health of the patient. Many different
treatments and combinations of treatments may be used to control lung
cancer, and/or to improve quality of life by reducing symptoms.
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Surgery
is an operation to remove the cancer. The type of surgery a doctor
performs depends on the location of the tumor in the lung. An operation
to remove only a small part of the lung is called a segmental or wedge
resection.
When the surgeon removes an entire lobe of the lung, the procedure is
called a lobectomy.
Pneumonectomy
is the removal of an entire lung. Some tumors are inoperable (cannot be
removed by surgery) because of the size or location, and some patients
cannot have surgery for other medical reasons.
-
Chemotherapy
is the use of anticancer drugs to kill cancer cells throughout the body.
Even after cancer has been removed from the lung, cancer cells may still
be present in nearby tissue or elsewhere in the body. Chemotherapy may
be used to control cancer growth or to relieve symptoms. Most anticancer
drugs are given by injection directly into a vein (IV)
or by means of a catheter,
a thin tube that is placed into a large vein and remains there as long
as it is needed. Some anticancer drugs are given in the form of a
pill.
-
Radiation
therapy, also called radiotherapy, involves the use of
high-energy rays to kill cancer cells. Radiation therapy is directed to
a limited area and affects the cancer cells only in that area. Radiation
therapy may be used before surgery to shrink a tumor, or after surgery
to destroy any cancer cells that remain in the treated area. Doctors
also use radiation therapy, often combined with chemotherapy, as primary
lung cancer treatments instead of surgery. Radiation therapy may also be used to
relieve symptoms such as shortness of breath. Radiation for the
treatment of lung cancer most often comes from a machine (external
radiation). The radiation can also come from an implant (a small
container of radioactive
material) placed directly into or near the tumor (internal
radiation).
-
Photodynamic
therapy (PDT), a type of laser therapy, involves the use of
a special chemical that is injected into the bloodstream and absorbed by
cells all over the body. The chemical rapidly leaves normal cells but
remains in cancer cells for a longer time. A laser
light aimed at the cancer activates the chemical, which then kills the
cancer cells that have absorbed it. Photodynamic therapy may be used to
reduce symptoms of lung cancer -- for example, to control bleeding or to
relieve breathing problems due to blocked airways when the cancer cannot
be removed through surgery. Photodynamic therapy may also be used to
treat very small tumors in patients for whom the usual treatments for
lung cancer are not appropriate.
Clinical
trials (research studies) to evaluate new ways to treat cancer
are an option for many lung cancer patients. In some studies, all patients
receive the new lung cancer treatment. In others, doctors compare different therapies
by giving the new treatment to one group of patients and the usual
(standard) therapy to another group. Through research, doctors are
exploring new and possibly more effective ways to treat lung cancer.
Treating Nonsmall Cell Lung Cancer
Patients with non-small cell lung cancer may be treated in several
ways. The choice of lung cancer treatment depends mainly on the size, location, and
extent of the tumor. Surgery is the most common way to treat this type of
lung cancer. Cryosurgery,
a treatment that freezes and destroys cancer tissue, may be used to
control symptoms in the later stages of non-small cell lung cancer.
Radiation therapy and chemotherapy may also be used to slow the progress
of the disease and to manage symptoms.
Treating Small Cell Lung Cancer
Small cell lung cancer spreads quickly. In many cases, cancer cells
have already spread to other parts of the body when the disease is
diagnosed. In order to reach cancer cells throughout the body, doctors
almost always use chemotherapy. Treatment may also include radiation
therapy aimed at the tumor in the lung or tumors in other parts of the
body (such as in the brain). Some patients have radiation therapy to the
brain even though no cancer is found there. This treatment, called prophylactic
cranial irradiation (PCI), is given to prevent tumors from forming
in the brain. Surgery is part of the treatment plan for a small number of
patients with small cell lung cancer.
Side Effects of Lung Cancer Treatment
The side
effects of cancer treatment depend on the type of treatment and
may be different for each person. Side effects are often only temporary.
Doctors and nurses can explain the possible side effects of treatment, and
they can suggest ways to help relieve symptoms that may occur during and
after lung cancer treatment.
-
Surgery for lung cancer is a major operation. After lung
surgery, air and fluid tend to collect in the chest. Patients often need
help turning over, coughing, and breathing deeply. These activities are
important for recovery because they help expand the remaining lung
tissue and get rid of excess air and fluid. Pain or weakness in the
chest and the arm and shortness of breath are common side effects of
lung cancer surgery. Patients may need several weeks or months to regain
their energy and strength.
-
Chemotherapy affects normal as well as cancerous cells. Side
effects depend largely on the specific drugs and the dose (amount of
drug given). Common side effects of chemotherapy include nausea and
vomiting, hair loss, mouth sores, and fatigue.
-
Radiation therapy, like chemotherapy, affects normal as well
as cancerous cells. Side effects of radiation therapy depend mainly on
the part of the body that is treated and the treatment dose. Common side
effects of radiation therapy are a dry, sore throat; difficulty
swallowing; fatigue; skin changes at the site of treatment; and loss of
appetite. Patients receiving radiation to the brain may have headaches,
skin changes, fatigue, nausea and vomiting, hair loss, or problems with
memory and thought processes.
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Photodynamic therapy makes the skin and eyes sensitive to
light for 6 weeks or more after treatment. Patients are advised to avoid
direct sunlight and bright indoor light for at least 6 weeks. If
patients must go outdoors, they need to wear protective clothing,
including sunglasses. Other temporary side effects of PDT may include
coughing, trouble swallowing, and painful breathing or shortness of
breath. Patients should talk with their doctor about what to do if the
skin becomes blistered, red, or swollen.
Today, because of what has been learned in clinical trials, doctors are
able to control, lessen, or avoid many of the side effects of treatment.
| Doctors and nurses can explain the possible side
effects of treatment, and they can suggest ways to help relieve
symptoms that may occur during and after treatment.
|
The Importance of Followup Care
Followup care after lung cancer treatment is very important.
Regular checkups ensure that changes in health are noticed, and if the
cancer returns or a new cancer develops, it can be treated as soon as
possible. Checkups may include physical exams, chest x-rays, or lab tests.
Between scheduled appointments, people who have had lung cancer should
report any health problems to their doctor as soon as they appear.
Providing Emotional Support
Living with a serious disease, such as cancer, is challenging. Apart
from having to cope with the physical and medical challenges, people with
cancer face many worries, feelings, and concerns that can make life
difficult. They may find they need help coping with the emotional as well
as the practical aspects of their disease. In fact, attention to the
emotional and psychological burden of having cancer is often part of a
patient's treatment plan. The support of the health care team (doctors,
nurses, social workers, and others), support groups, and
patient-to-patient networks can help people feel less alone and upset, and
improve the quality of their lives. Cancer support groups provide a safe
environment where cancer patients can talk about living with cancer with
others who may be having similar experiences. Patients may want to speak
to a member of their health care team about finding a support group.
Questions for Your Doctor
This booklet is designed to help you get information you need from your
doctor, so that you can make informed decisions about your health care. In
addition, asking your doctor the following questions will help you further
understand your condition. To help you remember what the doctor says, you
may take notes or ask whether you may use a tape recorder. Some people
also want to have a family member or friend with them when they talk to
the doctor -- to take part in the discussion, to take notes, or just to
listen.
Diagnosis
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What tests can diagnose lung cancer? Are they painful?
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How soon after the tests will I learn the results?
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What type of lung cancer do I have?
Treatment
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What lung cancer treatments are recommended for me?
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What clinical trials are appropriate for my type of cancer?
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Will I need to be in the hospital to receive my lung cancer treatment? For how
long?
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How might my normal activities change during my
lung cancer treatment?
Side Effects of Lung Cancer Treatment
Followup
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After treatment, how often do I need to be checked? What type of
followup care should I have?
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Will I eventually be able to resume my normal activities?
The Health Care Team
Resources
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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