Lung Cancer – The Facts and the Future

Not counting skin cancer, lung cancer is the second most common cancer in both men and women in the United States, behind prostate cancer in men and breast cancer in women. Knowing these statistics, the best thing a smoker can do is quit right away. Current and ex-smokers will want to check their eligibility for yearly screenings, covered at the end of this article.

Types of Lung Cancer

There are two main types of lung cancer: Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC), also called Oat Cell Carcinoma.

• Non-Small Cell Lung Cancer (NSCLC) accounts for 80%-85% of lung cancer cases. It tends to grow and spread more slowly than SCLC. There are three main subtypes of NSCLC:
  • Adenocarcinoma, usually found in the outer parts of the lungs, is the most common type of lung cancer in non-smokers
  • Squamous Cell Carcinoma, often located in the central part of the lungs, is strongly associated with smoking
  • Large Cell Carcinoma can occur in any part of the lung and tends to grow and spread faster than adenocarcinoma or squamous cell carcinoma
• Small Cell Lung Cancer (SCLC) accounts for about 15% of lung cancers. Usually associated with smoking, this is an aggressive cancer that spreads quickly to other parts of the body.

Mesothelioma, another type, is a rare cancer of the chest lining that accounts for roughly 5% of all lung cancer cases. Most often caused by asbestos exposure, mesothelioma takes a long time to develop and can appear as late as 50 years after exposure to asbestos.

Lung nodules are small masses of tissue that may be benign, precancerous, or metastatic tumors. Once a nodule is found, your doctor may opt to remove it right away or wait and watch for any changes.

Symptoms of Lung Cancer

One of the reasons lung cancers are so dangerous is that symptoms don’t tend to occur until the disease is relatively advanced. What’s more, many of these cancers grow rapidly. Most lung cancers are not diagnosed until at least stage 2. Small cell lung cancer is often not found until stage 3 or 4. The below symptoms can occur at any stage, but they don’t tend to be noticeable before stage 3:

1. Persistent cough
2. Chest pain that may worsen when you laugh, cough, or breathe deeply
3. Shortness of breath, especially during physical exertion
4. Wheezing sound with breathing
5. Coughing up blood or blood-tinged mucous
6. Unintended weight loss and low appetite
7. Fatigue and lack of energy
8. Recurring pneumonia or bronchitis
9. Persistent hoarseness
10. Swelling in the face or neck due to enlarged lymph nodes or tumors

Causes and Risk Factors

By now, most people are well acquainted with the dangers of cigarette smoking, which is linked to 80% - 90% of lung cancer deaths. However, because lung cancer also occurs in non-smokers, symptoms should never be ignored just because a person has never smoked. The odds of developing lung cancer increase with age, especially in those over 65. Men have had historically higher rates of lung cancer than women, but the has gap narrowed in recent years. The risk factors for lung cancer include:

• Cigarette smoking and using other tobacco products such as cigars or pipes. Vaping can also be dangerous.
• Exposure to secondhand smoke. According to the CDC, secondhand smoke exposure increases a non-smoker’s risk of developing lung cancer by 20–30% and causes over 7,300 lung cancer deaths each year in the US.
• Exposure to radon, a naturally occurring radioactive gas that can accumulate in homes.
• Inhalation of asbestos fibers, commonly associated with certain occupations such as construction, ship building, firefighting, or automotive repair.
• Long term exposure to polluted air.
• Family history of lung cancer.
• Previous history of lung diseases such as COPD or pulmonary fibrosis.
• Occupational exposure to carcinogens such as arsenic, diesel exhaust, silica, or chromium.

Treatment Options

Surgery to remove the tumor is almost always the first step unless a cancer is exceptionally large or has metastasized to other parts of the body. The goal of surgery is to remove the tumor and a margin of healthy tissue around it. Smaller tumors can often be removed through minimally invasive surgery. The type of surgery depends on the size and location of the tumor.

If a tumor is very small and only in the lung, surgery may be all the treatment required. For larger tumors, chemotherapy or radiation may be used before surgery, to shrink the cancer, or after surgery to neutralize any cells that may have been left behind. If surgery isn't an option, combined chemotherapy and radiation therapy may be the initial treatment.

Radiation therapy treats cancer with powerful, targeted radiation energy beams.

Chemotherapy treats cancer with medication, either intravenously or in pill form. A combination of medicines is usually prescribed in a series of treatments over weeks or even months.

Stereotactic body radiotherapy, sometimes called stereotactic radiosurgery, is a highly targeted radiation treatment that treats a tumor from multiple angles via radiation beams. This treatment may be an option for people with small tumors who are not good candidates for surgery.

Targeted therapy uses drugs to treat genetic mutations in cancer cells, which can stop or shrink the cancer. Targeted therapy may be used for cancer that is recurrent or has spread.

Immunotherapy helps the body's own immune system recognize and kill cancer cells. Immunotherapy may be used after surgery to get rid of any remaining cancer cells. It may also be able to slow the growth of a tumor in cases where surgery is not an option.

Recent Advances and Promising Research

In recent years, science has made remarkable inroads in the treatment of lung cancer, and the research continues. New targeted therapies specific to certain genetic mutations are being tested. Combination treatments that combine chemotherapy with immunotherapy or radiation are being developed to improve efficacy. Radiation therapy technology is becoming increasingly precise, minimizing the damage to surrounding tissues. “Liquid biopsies,” non-invasive tests that can detect genetic mutations, are in the works, allowing for more personalized treatment. Research continues into therapies that can be deployed before (neoadjuvant) or after (adjuvant) surgery to improve patient outcomes. Learn more about the latest treatment options and advances.

Low Dose CT Scan Screenings

The earlier a lung cancer is found, the better the prognosis. El Camino Health offers a low dose CT scan screening using low amounts of radiation that can pick up nodules and potential tumors early. You may be eligible for a free screening if you meet certain criteria, such as:

• Are between the ages of 55 and 80 years
• Have a history of heavy smoking, often defined as a minimum of 20 pack-years (such as one pack a day for 20 years, or two packs a day for 10 years)
• Are a current smoker or quit within the past 15 years
• Are healthy enough to undergo potential treatment if lung cancer is detected

The screening is often done on a yearly basis. If abnormalities are found, additional testing will be needed.

Completing a health risk assessment can help determine if you are at risk. Learn more.

Talk to your doctor to see if you a low dose CT scan screening is right for you. For help finding a doctor, click here.

This article appeared in the November 2024 edition of the HealthPerks newsletter.