Lung Cancer: Five Things You Need to Know

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More than 228,000 new cases of lung cancer will be diagnosed in the United States in 2013, according to the National Cancer Institute (NCI).

With November marking Lung Cancer Awareness Month, Pasi A. Jänne, MD, PhD, director of Dana-Farber’s Lowe Center for Thoracic Oncology, answers some key questions about the disease:

1.    What are the different types of lung cancer?

Lung cancer develops in the tissue of the lung, usually in the cells that line the air passages. There are several types of lung cancer:

Pasi A. Jänne, MD, PhD

Pasi Jänne, MD, PhD

  • Non-small cell lung cancer — Non-small cell lung cancer is named for the size of the cells when viewed under a microscope. It begins when epithelial cells inside the lining of the lungs grow rapidly or uncontrollably, often forming a tumor. This is the most common form of lung cancer.
  • Small cell lung cancer — Small cell lung cancer is also named for the size of the cells when viewed under a microscope. Affecting approximately 15 percent of lung cancer patients, it typically starts in the bronchial.
  • Mesothelioma — Although it is not technically a lung cancer, mesothelioma shares many of the same symptoms as lung cancer. Malignant mesothelioma is a disease in which cancer cells form in the linings of the organs, most often the pleura and sometimes the peritoneum.

2.    What are the risk factors for lung cancer?

The Centers for Disease Control and Prevention (CDC) estimates 90 percent of lung cancers are caused by cigarette smoke. However, there are also other risk factors:

3.    What are the symptoms of lung cancer?

Some of the more common symptoms include a cough that does not go away, trouble breathing, chest discomfort, wheezing, hoarseness and streaks of blood in mucus. Other symptoms can include loss of appetite, weight loss for no reason, and unusual tiredness.

Patients with mesothelioma may notice lumps, pain or swelling in their abdomen, or pain under the rib cage.

4.    How do doctors diagnose lung cancer?

When lung cancer is suspected, patients typically have a CT scan, MRI, or PET/CT scan to produce a detailed image of their lungs. If a mass is detected, either a fine needle biopsy, core needle biopsy, bronchoscopy, or endobronchial ultrasound (EBUS) will be done to remove a piece of tissue from a node or tumor. If necessary, surgeons may remove a tissue sample. If so, a pathologist will examine the tissue to determine whether cancer is present and, if so, the type and stage of the cancer.

5.    What are the treatment options for lung cancer?

In the case of non-small cell lung cancer, patients in early stages first undergo surgery to remove tumors. After surgery, patients may go on to chemotherapy and/or radiation treatments, depending on the stage and type of cancer. In some cases, radiation therapy may be used to eliminate early-stage tumors, instead of surgery.

Patients with small cell lung cancer typically have chemotherapy and/or radiation therapy. This is because the disease often does not have symptoms and is diagnosed at a more advanced stage where surgery would not have an impact on the progress of the cancer. Chemotherapy and/or radiation are also often the first steps for more advanced stages of non-small lung cancer.

A combined approach of surgery, radiation therapy, and chemotherapy are used to treat mesothelioma, as there is not one universally accepted standard for treatment of the disease.

Researchers are also developing several new treatment approaches for lung cancer, including immunotherapy and targeted therapy options.  All lung cancer patients at DFCI have their cancer analyzed for several genetic alterations; the results of which can help identify whether a targeted therapy is most the appropriate treatment. Through clinical trials, some of these new treatments are now available for lung cancer patients. Dana-Farber is currently offering 33 clinical trials for lung cancer and the NCI maintains a list of clinical trials at clinicaltrials.gov.

5 comments

  1. Suzanne Kingsley says:

    I am a LiFraumeni person with previous lung cancer. Is there MRI scanning for lungs? My current doctor at London’s Royal Marsden is more than reluctant to do CT monitoring scans. I would be very happy to learn that MRI scanning for lungs is possible. Could you reply? Thank you very much.

    • Dana-Farber says:

      Dear Suzanne –

      Thank you for your comment and for reading our blog. Below is a response from our Department of Imaging:

      The current standard of care for screening for lung cancer is computerized tomography (CT), as it has the ability to pick up very small pulmonary nodules. MRI has superior contrast resolution than CT, and performs well in several body parts including brain, abdomen and soft tissue. However MRI of the lungs is limited due to the poor spatial resolution and breathing artifacts. Moreover, MRI is not sensitive for the detection of small pulmonary nodules (<1 cm), and ground glass nodules (frequently seen in lung adenocarcinoma). In a recently published article looking at PET/MR evaluation of pulmonary nodules, the sensitivity of MRI to pick up nodules seen on CT was only 60%, despite advanced MRI techniques.

      Given the concerns about radiation, there has been advances made in reducing the radiation dose in CT, including the use of iterative reconstruction, which can potentially decrease the dose by 70 % without significant loss of information.

      At present, the best strategy for screening for lung cancer would be to use CT, preferably low dose CT.

      I hope this is helpful and I wish you the best.

  2. Ed Cruikshank says:

    My wife of 47 years died of adenocarsinoma of the lungs which had spread to the brain extensively before sympthoms showed up. She had had radiation for recurring breast cancer 10 years before. She was a nonsmoker,but I think the radiation treatment at the time was not state of the art. It caused multiple cardiac problems to a women who was an athlete with no problems before.

  3. Susan Bishop says:

    Both my husband and father- in-law had lung cancer. Both did not have the usual risks. Should my children have a MRI to screen for it? If they should. at what age would be best?

    Thank you

    • Dana-Farber says:

      Dear Susan –

      Thank you for your comment and for reading our blog. Similar to the above comment, here is a response from our Department of Imaging:

      The current standard of care for screening for lung cancer is computerized tomography (CT), as it has the ability to pick up very small pulmonary nodules. MRI has superior contrast resolution than CT, and performs well in several body parts including brain, abdomen and soft tissue. However MRI of the lungs is limited due to the poor spatial resolution and breathing artifacts. Moreover, MRI is not sensitive for the detection of small pulmonary nodules (<1 cm), and ground glass nodules (frequently seen in lung adenocarcinoma). In a recently published article looking at PET/MR evaluation of pulmonary nodules, the sensitivity of MRI to pick up nodules seen on CT was only 60%, despite advanced MRI techniques.

      Given the concerns about radiation, there has been advances made in reducing the radiation dose in CT, including the use of iterative reconstruction, which can potentially decrease the dose by 70 % without significant loss of information.

      At present, the best strategy for screening for lung cancer would be to use CT, preferably low dose CT.

      I hope this is helpful and I wish you the best.

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