What You Need
To Know About™
Lung
National Cancer Institute
Cancer
U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
National Institutes of Health
National Cancer Institute Services
This is only one of many free booklets for
people with cancer.
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your family, and your friends.
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1–800–4–CANCER (1–800–422–6237)
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About This Booklet
This National Cancer Institute (NCI) booklet is for you—
someone who has just been diagnosed with lung cancer.
Words that may be new to you are shown in bold. See the
Words To Know section on page 25 to learn what a new word means and how to pronounce it.
This booklet is about medical care for people with lung cancer. Learning about medical care for lung cancer can help you take an active part in making choices about your care.
You can read this booklet from front to back. Or, you can read only the sections you need right now.
This booklet has lists of questions that you may want to ask your doctor. Many people find it helpful to take a list of questions to a doctor visit. To help remember what your doctor says, you can take notes. You may also want to have a family member or friend go with you when you talk with the doctor—to take notes, ask questions, or just listen.
Contents
The Lungs
Your lungs are a pair of large organs in your chest. They are part of your respiratory system.
Air enters your body through your nose or mouth. It
passes through your windpipe (trachea) and through each
bronchus, and goes into your lungs.
When you breathe in, your lungs expand with air. This is how your body gets oxygen.
When you breathe out, air goes out of your lungs. This is how your body gets rid of carbon dioxide.
Lymph node
Windpipe
Right main
Left main
bronchus
bronchus
Lobe
Lobe
of lung
of lung
Diaphragm
Two layers of pleura
This is a picture of the lungs and nearby tissues.
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Your right lung has three parts (lobes). Your left lung is smaller and has two lobes.
Inside the chest are two thin layers of tissue (the pleura).
One layer covers the lungs and the other layer lines the inside of your chest.
Cancer Cells
Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the lungs.
Normal cel s in the lungs and other parts of the body grow and divide to form new cel s as they are needed. When normal cel s grow old or get damaged, they die, and new cel s take their place.
Sometimes, this process goes wrong. New cel s form when the body doesn’t need them, and old or damaged cel s don’t die as they should. The buildup of extra cel s often forms a mass of tissue called a growth or tumor.
Tumors in the lung can be benign (not cancer) or malignant
(cancer):
■■ Benign tumors:
• Are rarely a threat to life
• Don’t invade the tissues around them
• Don’t spread to other parts of the body
• Usual y don’t need to be removed
■■ Malignant tumors (lung cancer):
• May be a threat to life
• Can invade nearby organs and tissues
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• Can spread to other parts of the body
• Often can be removed but may grow back
Lung cancer cel s can spread by breaking away from a lung tumor. They can travel through blood vessels or lymph
vessels to reach other parts of the body. After spreading, cancer cel s may attach to other tissues and grow to form new tumors that may damage those tissues.
When lung cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cel s and the same name as the primary (original) tumor. For example, if lung cancer spreads to the bones, the cancer cel s in the bones are actual y lung cancer cel s. The disease is metastatic lung cancer, not bone cancer. For that reason, it is treated as lung cancer, not bone cancer.
Types of Lung Cancer
In 2012, more than 226,000 Americans will be diagnosed with lung cancer.
The most common types are named for how the lung cancer cel s look under a microscope:
■■ Small cell: The cel s of small cell lung cancer look small under a microscope. About 1 of every 8 people with lung cancer has small cell lung cancer.
■■ Non-small cell: The cel s of non-small cell lung cancer
are larger than the cel s of small cell lung cancer.
Most (about 7 of every 8) people diagnosed with lung cancer have non-small cell lung cancer. It doesn’t grow and spread as fast as small cell lung cancer, and it’s treated differently.
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Because most people who get lung cancer were smokers, you may feel like doctors and other people assume that you are or were a smoker (even if you aren’t or weren’t).
Whether or not you were a smoker, it’s important for you to protect your body now from smoke. Avoid secondhand smoke from smokers near you.
If you smoke, talk with an expert about quitting. It’s never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.
To get help with quitting smoking…
■■ Go online to Smokefree.gov.
■■ Call NCI’s Smoking Quitline at 1-877-44U-QUIT
(1-877-448-7848).
■■ Sign up for the free mobile service SmokefreeTXT to get tips and encouragement to quit. To sign up, text the word QUIT to IQUIT (47848) from your mobile phone.
Or, go to http://smokefree.gov/smokefreetxt/
Signup.aspx.
Staging Tests
After you learn that you have lung cancer, you may need staging tests to help with decisions about treatment. Staging tests can show the stage (extent) of lung cancer, such as whether cancer cel s have spread to other parts of the body.
When lung cancer spreads, cancer cel s are often found in nearby lymph nodes. Lung cancer cel s can spread from the 4
lung to almost any other part of the body, such as the brain, bones, other lung, liver, or adrenal gland.
Staging tests may include…
■■ CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your chest, abdomen, brain, or other parts of your body. You’ll receive contrast
material by injection into a blood vessel in your arm or hand. For a CT scan of the abdomen, you may receive contrast material by mouth also. The contrast material makes abnormal areas easier to see. The pictures from a CT scan can show the lung tumor’s size. The pictures can also show cancer that has spread to your liver, adrenal glands, brain, or other organs.
■■ PET scan: Your doctor may use a PET scan to get a better view of the tumor in the lung or to find cancer that has spread. You’ll receive an injection of a small amount of radioactive sugar. A machine makes computerized
pictures of the sugar being used by cel s in the body.
Because cancer cel s use sugar faster than normal cel s, areas with cancer cel s look brighter on the pictures.
■■ MRI: A strong magnet linked to a computer is used to make detailed pictures of your head or spine. An MRI
can show whether cancer has spread to these areas.
Sometimes contrast material is used to make abnormal areas show up more clearly on the picture.
■■ Bone scan: A small amount of a radioactive substance will be injected into a blood vessel. The radioactive substance travels through your bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of your bones. Because higher amounts of the radioactive 5
substance collect in areas where cancer is present, the pictures can show cancer that has spread to the bones.
Other tests may be needed. For example, your doctor may remove samples of lymph nodes or other tissues to see whether lung cancer has spread.
Questions you may want to ask your doctor about tests
■■ What type of lung cancer do I have?
■■ Has the cancer spread from the lung? If so, to where?
■■ May I have a copy of test results?
Stages
The stage of lung cancer depends mainly on…
■■ The size of the lung tumor
■■ How deeply the tumor has invaded nearby tissue, such as the chest wall
■■ Whether lung cancer cells have spread to lymph nodes or other parts of the body
Stages of Non-small Cell Lung Cancer
Doctors describe the stages of non-small cell lung cancer using the Roman numerals I, II, III, and IV. Stage I is early-
stage cancer, and Stage IV is advanced cancer that has spread to other parts of the body, such as the bones.
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You can find pictures of the stages and other information on NCI’s website at http://www.cancer.gov/cancertopics/
types/lung.
Occult Stage Lung Tumor
Tumor cel s are found in sputum, but CT scans and other imaging tests don’t show a lung tumor.
Stage 0 Lung Tumor
Abnormal cel s 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. It is not an invasive cancer.
Stage I Lung Cancer
The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is surrounded by normal tissue, and it doesn’t invade nearby tissues, such as the chest wal .
The tumor is no more than 5 centimeters (about 2 inches) across. Cancer cel s are not found in nearby lymph nodes.
1 cm
2 cm
4 cm
5 cm
© 2007 Terese Winslow. U.S. Govt has certain rights
A tumor that is 5 centimeters across is about the size of a lime.
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Stage II Lung Cancer
The lung tumor is smaller than 7 centimeters across, and cancer cel s are found in nearby lymph nodes.
Or, cancer cel s are not found in nearby lymph nodes. The lung tumor is more than 5 centimeters across, or it invades nearby tissues, such as the chest wal , diaphragm, pleura, main bronchus, or tissue that surrounds the heart. More than one malignant tumor may be found within the same lobe of the lung.
Stage III Lung Cancer
The tumor may be any size. More than one malignant tumor may be found within the lung.
Cancer cel s may be found in lymph nodes on either side of the chest or the neck. The tumor may have invaded nearby organs, such as the heart, esophagus, or trachea.
Stage IV Lung Cancer
Malignant tumors are found in both lungs. Or, the lung cancer has spread to other parts of the body, such as the brain, bones, liver, or adrenal glands. Or, cancer cel s are found in fluid between the two layers of pleura. (See page 1
for picture of pleura.)
Stages of Small Cell Lung Cancer
Most doctors describe the stages of small cell lung cancer with two stages:
■■ Limited stage: Cancer is found only on one side of the chest.
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■■ Extensive stage: Cancer is found in the lung and also in tissues on the other side of the chest. Or, lung cancer is found in distant organs, such as the brain, or in fluid between the two layers of pleura. (See page 1 for picture of pleura.)
Instead of limited and extensive stage, some doctors describe the stages of small cell lung cancer using the Roman numerals I, II, III, and IV (see Stages of Non-small
Treatment
People with lung cancer have many treatment options.
Treatment options include…
■■ Surgery
■■ Radiation therapy
■■ Chemotherapy
■■ Targeted therapy
The treatment that’s right for you depends mainly on the type and stage of lung cancer. You may receive more than one type of treatment.
At any stage of lung cancer, care is available to control pain and manage breathing problems, to relieve the side effects
of treatment, and to ease emotional concerns. You can get information about coping with symptoms and side effects on NCI’s website at http://www.cancer.gov/cancertopics/
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Also, you can get information about coping from
NCI’s Cancer Information Service at 1–800–4–CANCER
(1–800–422–6237). Or, chat using NCI’s instant messaging service, LiveHelp (https://livehelp.cancer.gov).
Doctors Who Treat Lung Cancer
Your health care team will include specialists. There are many ways to find doctors who treat lung cancer:
■■ Your doctor may be able to refer you to specialists.
■■ You can ask a local or state medical society, or a nearby hospital or medical school for names of specialists.
You and your doctor will develop a treatment plan.
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■■ NCI’s Cancer Information Service can give you
information about treatment centers near you. Call
1–800–4–CANCER (1–800–422–6237). Or, chat using LiveHelp (https://livehelp.cancer.gov), NCI’s instant messaging service.
■■ Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.
Your health care team may include the following specialists:
■■ Chest surgeon: A chest surgeon (thoracic surgeon) specializes in surgery on the lungs and other organs inside the chest. You may wish to find an expert in lung cancer surgery.
■■ Thoracic surgical oncologist: A thoracic surgical
oncologist is a surgeon who specializes in surgeries on lung tumors and other tumors found inside the chest.
■■ Medical oncologist: A medical oncologist is a doctor who specializes in treating cancer with drugs, such as
chemotherapy and targeted therapy.
■
■
Radiation oncologist: A radiation oncologist is a doctor who specializes in treating cancer with radiation therapy.
Your health care team may also include an oncology nurse, a
social worker, and a registered dietitian. If you have trouble breathing, your doctor may refer you to a pulmonologist
(lung specialist) or a respiratory therapist.
Your health care team can describe your treatment options, the expected results of each option, and the possible side effects. Because cancer treatments often damage healthy cel s and tissues, side effects are common. These side effects depend on many factors, including the type of treatment.
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Side effects may not be the same for everyone, and they may even change from one treatment session to the next.
You and your health care team can work together to develop a treatment plan.
Lung cancer is hard to control with current treatments.
For that reason, many doctors encourage people with this disease to consider taking part in a research study (clinical
trial) of new treatment methods. Research studies are an important option for people with any stage of lung cancer.
See the Cancer Treatment Research section on page 24.
Questions you may want to ask your doctor about
treatment options
■■ What are my treatment options? Which do you
recommend for me? Why?
■■ What are the expected benefits of each kind of
treatment?
■■ What are the risks and possible side effects of each treatment? How can side effects be managed?
■■ What can I do to prepare for treatment?
■■ Will I need to stay in the hospital? If so, for how long?
■■ What is the treatment likely to cost? Will my insurance cover it?
■■ How will treatment affect my normal activities?
■■ Would a treatment research study be right for me?
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Second Opinion
Before starting treatment, you might want a second opinion about your diagnosis and treatment options. Some people worry that the doctor will be offended if they ask for a second opinion. Usual y the opposite is true. Most doctors welcome a second opinion. And many health insurance
companies will pay for a second opinion if you or your doctor requests it. Some insurance companies actual y require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor’s diagnosis and treatment recommendation.
Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you’ve looked at all of your options.
You may want to get a second opinion before starting treatment.
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It may take some time and effort to gather your medical records and see another doctor. In most cases, it’s not a problem to take several weeks to get a second opinion. The delay in starting treatment usual y will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with lung cancer need
treatment right away. For example, a doctor may advise a person with small cell lung cancer not to delay treatment more than a week or two.
Surgery
Surgery may be an option for people with early-stage lung cancer.
The surgeon usual y removes only the part of the lung that contains cancer. Most people who have surgery for lung cancer will have the lobe of the lung that contains the cancer removed. This is a lobectomy. In some cases, the surgeon will remove the tumor along with less tissue than an entire lobe, or the surgeon will remove the entire lung. The surgeon also removes nearby lymph nodes.
After lung surgery, air and fluid will collect in the chest. A chest tube that was inserted during surgery will allow the fluid to drain. Also, a nurse or respiratory therapist will teach you coughing and breathing exercises. You’ll need to do these exercises several times a day. The chest tube will be removed a few days after surgery.
The time it takes to heal after surgery is different for everyone. Your hospital stay may be a week or longer. It may be several weeks before you return to normal activities.
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Medicine can help control your pain after surgery. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.
Questions you may want to ask your doctor
about surgery
■■ What kind of surgery do you suggest for me?
■■ How will I feel after surgery?
■■ If I have pain, how can we control it?
■■ How long will I be in the hospital?
■■ Will I have any lasting side effects?
■■ When