There are two main types of lung cancer – small cell lung cancer and non-small cell lung cancer. Although the same techniques (radiation therapy, chemotherapy, surgery) are used to treat both, your treatment will be tailored depending on your diagnosis and clinical stage. Ninety percent of lung cancers occur in individuals with a history of smoking cigarettes. Cigar and pipe smoke are potentially more dangerous; they are associated with a lung cancer risk twice that for cigarette smokers. Exposure to air pollution, radiation and industrial chemicals such as asbestos, arsenic, nickel and chromium may also increase your risk for developing lung cancer.
Overview and Symptoms
In its earliest stages, lung cancer is usually asymptomatic. Latter stage symptoms include:
- Chronic cough (lasting two weeks of longer)
- Coughing up blood
- Fever (unexplained)
- Repeated bronchitis and/or pneumonia
- Weight loss
- Loss of appetite
- Shortness of breath
In order to diagnose lung cancer, your doctor may request these tests:
- Imaging tests – such as X-ray images of your lungs to look for abnormal masses or nodules, or a CT scan to detect small lesions in your lungs that might not be detected by X-ray
- Sputum cytology – lung cancer cells can sometimes be detected in samples of sputum (the saliva and mucus formed from a cough)
- Tissue sample (biopsy) – your doctor will obtain a sample of cells, and a pathologist will review them under a microscope to look for cancerous cells
Treatment for lung cancer is highly individualized. Guidelines and protocols can change frequently based on research and treatment advances. Lung cancer therapy depends on many factors, including:
- The type of lung cancer you have
- Whether the lung cancer is confined to one location (localized) or has spread to another area (metastasized)
- Your anatomy and the shape and size of your tumor
- Your own personal medical condition and fitness for surgery
- Your response to therapy
Non-Small Cell Lung Cancer
The general treatment in early stage, non-small cell lung cancer is surgery for patients who are medically fit, followed by surveillance or chemotherapy, depending on tumor size and presence of lymph node metastasis. If for medical reasons you are not able to tolerate surgery, CyberKnife image guided therapy or Computed Tomography (CT) may be the best option for you.
If your cancer involves the lymph nodes of the mediastinum (the central area of the chest), doctors may recommend a combination of chemotherapy and radiation therapy to shrink the tumor first. Then, if possible, based on your medical condition and the location of the tumor, it may be surgically removed. If you are not able to tolerate surgery, then chemotherapy and conventional radiation therapy would be the best approach.
If your cancer is at an advanced stage, then doctors are likely to recommend a combination of chemotherapy and/or biologic agents. You will also be offered an opportunity to enroll in one of our leading-edge clinical trials.
Small Cell Lung Cancer
Treatment for limited-stage small cell lung cancer (confined to the chest area) is generally a combination of chemotherapy plus radiation. Surgery is not usually used to resect (remove) a tumor because small cell generally involves many lymph nodes in the central chest and, oftentimes, the primary tumor is not well defined. In patients who have a complete response to this treatment (complete remission), then physicians typically recommend prophylactic (protective) cranial radiation to reduce the risk of the tumor recurring in the brain. For extensive-stage small cell lung cancer, where the cancer has spread outside the chest at the time of diagnosis, usually chemotherapy alone is the treatment mainstay, with radiation in certain circumstances.
Cancer Center at BIDMCAt the Cancer Center at Beth Israel Deaconess Medical Center, our team of compassionate caregivers includes highly experienced and skilled surgeons and physicians who are thought leaders and innovators in their respective fields.