Lung cancer is the second most frequently diagnosed cancer in both men and women (prostate cancer in men and breast cancer in women are the most frequent). However, it remains the leading cancer killer in the world.
In the U.S., approximately163,000 will die this year, more than the next three most-common cancers combined (breast, prostate and colon cancers). Approximately one third of male cancer deaths and one quarter of female cancer deaths are secondary to lung cancer.
Because lung cancer is a relatively asymptomatic disease, efforts at early detection and treatment have not been highly successful. As a result, the prognosis for most lung cancer patients remains poor. Just over 1 in 8 will be living 5 years after their diagnosis.
Researchers are developing risk assessment tools, using age, sex, smoking history and exposure to environmental carcinogens, to help identify who should get screened. Studies have proven that CAT scan screening permits diagnosis at earlier stages, and additional work is now being done to determine if mortality will be reduced by doing scans for those at risk. Current guidelines do not recommend lung cancer screening for at-risk, asymptomatic individuals.
While non-smokers can get lung cancer, smoking remains its leading cause with greater than 85 percent of deaths linked to smoking. Non-smoker lung cancer deaths are attributed to such things as occupational and environmental factors, other lung disease, and perhaps even to genetics.
Warnings about smoking have been in the media for decades. Although the rate of smoking has dropped by almost half since the Surgeon General's first report on smoking in 1964 (42 percent of adults were current smokers in 1965), progress has slowed over the last ten to fifteen years. Concurrently, the lung cancer death rate in men peaked in 1984 and has slowly declined since. The number of smoking women actually increased in the 1990s, but rates have now started to drop. The lung cancer incidence rate in women has recently leveled off.
The trends are promising, but much work remains to be done. To date, the decline in lung cancer death rates have been mostly related to the decreasing use of cigarettes in men in the 1960s and 1970s. While researchers are still working on new diagnostic and treatment technology, the single biggest factor for beating this disease lies in convincing more smokers to stop and those who have never smoked not to start.
- Over 170,000 people in the United States are diagnosed with lung cancer each year. Approximately 163,000 will die this year.
- More Americans die each year from lung cancer than from breast, prostate, and colorectal cancers combined.
- The expected 5-year survival rate for all patients in whom lung cancer is diagnosed is 15 percent compared to 63 percent for colon, 88 percent for breast and 99 percent for prostate cancer.
- The 5-year survival rate is 49 percent for cases detected when the disease is still localized. However, only 16 percent of lung cancer cases are diagnosed at an early stage.
- About 6 out of 10 people with lung cancer die within 1 year of being diagnosed with the disease. Between 7 and 8 will die within 2 years.
- Smoking is the most important cause of lung cancer in the United States. While not all smokers develop lung cancer, more than 85% of lung cancers are smoking related.
- Other risk factors include exposure to other carcinogens such as asbestos and radon gas; exposure to second hand smoke.
- A person who smokes more than 1 pack of cigarettes per day has a risk of developing lung cancer 20-25 times greater than someone who has never smoked.
- Quitting smoking, regardless of age, significantly reduces the risk of lung cancer.
- Once a person quits smoking, his or her risk for lung cancer gradually decreases. About 15 years after quitting, the risk for lung cancer approaches the level of someone who never smoked.
- Cigarette smoke contains more than 4000 chemicals, 60 of which have been identified as causing cancer.
- A person who has had lung cancer is more likely to develop a second lung cancer than the average person is to develop a first lung cancer.
Ask Your Doctor
This list of questions is a good starting point for discussion with your doctor. However, it is not a comprehensive list.
Prior to diagnosis:
- How do I determine what my risk is for developing lung cancer?
- Should I be screened:
- CT scan?
- What type of lung cancer do I have? What does it mean in terms of my prognosis?
- What stage is my lung cancer?
- Has the cancer spread to other parts of my body?
- What do the average prognosis statistics mean for me?
- What are my treatment options?
- What type of treatment do you recommend for me? Why?
- What are the side effects from my treatments?
- Do I qualify for any clinical trials? If so, how do I enroll?
Key Point 1
Lung cancer is the number one cancer killer in the U.S. However, when a lesion is found in the lungs, doctors often wait to do a biopsy because diagnostic testing is invasive and the risks of the tests are very high.
Lung cancer remains the top cause of cancer death in the U.S, with an estimated 174,500 new cases and 163,000 deaths expected this year. According to the National Cancer Institute (NCI), the overall 5-year survival rate for those with lung cancer is 15% with nearly 90 percent of patients dying within two years. The survival rate is low because lung cancer is often not detected until it has reached an advanced stage. In its early stages, lung cancer is usually asymptomatic. There are relatively few nerve endings in the lung so a small tumor doesn't cause pain or other symptoms such as cough or shortness of breath. It's only when it gets larger that it starts to cause symptoms.
The NCI suggests that catching lung cancer early - when surgery is a treatment option - improves survival substantially, and 70 percent of patients who are diagnosed early may survive at least five years. Unfortunately, early detection is often a matter of luck, when a nodule or mass is discovered because a test is being done for a different reason. Even then, proceeding to a definitive diagnosis is problematic as doctors balance the risks versus the usefulness of tests. Ultimately, tissue needs to be obtained to confirm the diagnosis of lung cancer, usually meaning an invasive procedure must be used.
Nodules can be present in the lungs for a variety of reasons, cancer being only one of them. Noncancerous lung nodules usually cause no symptoms and require no treatment. In fact, multiple nodules are frequently found in smokers, but for every hundred smokers found with one or more nodules, only two or three smokers will have cancer. The challenge is to separate the bad from the benign.
Doctors use a wide range of diagnostic tools to diagnose lung cancer.
- Medical history. To assess risk factors for developing lung cancer.
- Physical exam. To look for symptoms of lung disease and swollen lymph nodes.
- Complete blood count. To check for abnormal values of blood cells that may be indicative of a problem, though not necessarily cancer.
- Certain tests to determine electrolyte and liver function. To determine if cancer is present and has spread to other tissue or body organs.
- Sputum cytology. To evaluate the type of any abnormal cells present in mucus. This is the most risk-free and inexpensive tissue diagnostic procedure, but its value is limited since tumor cells will not always be present in sputum even if a cancer is present
- Chest X-ray. To look for a nodule or a change in a nodule from an earlier x-ray. Nodules that grow need to be aggressively evaluated.
- Computerized tomography (CT) scan. To examine for both metastatic and primary tumors. CT scans are more sensitive than standard chest x-rays in the detection of lung nodules.
- Thoracentesis. To take a sample of fluid, if some has accumulated between the lungs and chest wall, and evaluate abnormal cells.
- Bronchoscopy. To take a biopsy of cells. A tumor in the central areas of the lung or arising from the larger airways is accessible to sampling using this technique.
- Transthoracic needle biopsy. To retrieve cells for diagnosis. Needle biopsies are particularly useful when the lung tumor is peripherally located in the lung and not accessible to sampling by bronchoscopy.
- Thoracoscopy. To take a biopsy of lung tissue through several small incisions between the ribs.
- Major surgical procedures. To determine a definitive diagnosis if all other methods fail and in some cases to simultaneously remove as much tumor as possible.
Non-surgical invasive biopsy procedures do carry risk. Up to 25 percent of patients may suffer a collapsed lung as a result of a needle biopsy and half of those may need to have a chest tube inserted to re-expand the lung. The risks of bronchoscopy are lower (3 to 5 percent) than a needle biopsy and include bleeding, infection, collapse of the lung and risks of the sedative medications used to complete the procedure.
Risks of lung surgery (wedge resection, lobectomy and pneumonectomy) follow those of any major surgery. These include reactions to anesthesia, bleeding, infection, and problems restoring breathing. Pneumonia and blood clots are of particular concern in lung surgery.
Key Point 2
Lung cancer is a potentially deadly diagnosis, and the leading preventable cause of it is smoking. You can get lung cancer if you don't smoke, but smoking vastly increases your chances of developing it.
Most lung cancer is detected in advanced stages where there's a very small chance of long term survival with today's arsenal of treatments. Stage I lung cancer is when the tumor is very small and has not spread. At this stage the cancer could be cured with surgical removal. Recent studies have shown that CT scanning can detect lung cancers at an earlier stage but it is not yet proved that screening for lung cancer in asymptomatic high risk individuals improves prognosis or saves lives. Studies are now underway to prove or disprove whether CT scanning and early detection can actually reduce lung cancer deaths.
With lung cancer, "smoking cessation" can be considered equivalent to "prevention." That's because the overwhelming majority of lung cancers – in fact, greater than 85 percent – are caused by cigarette smoking.
Unfortunately, despite all accumulated knowledge on the subject recent polls indicate that:
- Many smokers continue to believe that cigarettes will not cause them harm.
- Many ex-smokers believe that they're no longer at risk for lung cancer.
The above are dangerous misperceptions. Here's the truth:
- Cigarette smoke contains about 4,000 chemical agents, including over 60 carcinogens.
- A person who smokes more than 1 pack of cigarettes per day has a risk of developing lung cancer 20-25 times greater than someone who has never smoked.
- A smoker's risk of developing lung cancer is related to the following:
- The number of cigarettes smoked
- The age at which a person started smoking
- The depth of inhalation
- The intensity of smoking (the size and frequency of puffs)
- Men who smoke cigars increase their risk of lung cancer fivefold compared to nonsmokers and risk increases the more they smoke (three or more cigars a day equals a 7.8 times greater risk). Inhaled cigar smoke results in 11.3 times the risk.
- Passive smoking, or sidestream smoke, presents another risk for lung cancer. A person living with a smoker has twice the risk of lung cancer of someone not regularly exposed to smoke. The result is 3,000 lung cancer deaths among U.S. nonsmokers each year.
- Once a person quits smoking, his or her risk for lung cancer gradually decreases although it never reaches that of a lifelong nonsmoker.
Key Point 3
There is hope for people with lung cancer if it's caught early. But finding it early is difficult because it is often asymptomatic. The best way we can slow down the rate of lung cancer cases is to get people to stop smoking. If you smoke...quit. It's never too late, and if you don't smoke, don't start.
``A cigarette is a euphemism for a cleverly crafted product that delivers just the right amount of nicotine to keep its user addicted for life before killing the person.'' World Health Organization director-general Gro Harlem Brundtland
Tobacco use is the single most preventable cause of death in the United States. It accounts for nearly one-third of all cancer deaths and greater than 85 percent of lung cancer deaths in this country each year.
Why is the percentage so high for lung cancer? First, because it doesn't cause symptoms until it really presses on something important, like an airway. Secondly, when people finally do show symptoms, those symptoms are not specific and mimic common, less serious health problems like an infection, asthma, bronchitis or even the common cold. By the time lung cancer is diagnosed, it's most often in an advanced stage where the prognosis is poor.
Lung cancer can be cured when it's caught in its very early stages. Given the issues above, however, that's unlikely to happen for most people. The better approach is not to get lung cancer in the first place and the best way to do that is to stop smoking (or being in the presence of smokers).
- The earlier a person quits, the greater the health benefit. But, it's never too late. Your risk of getting lung cancer begins to go down the day you stop smoking.
- About 10 years after quitting, an ex-smoker's risk of dying from lung cancer is 30 percent to 50 percent less than the risk for those who continue to smoke.
Quitting is hard, but the benefits are great. Help is out there and studies suggest that everyone can quite smoking with the right support. Your doctor can help with nicotine replacement therapy and personal support. The American Lung Association and others offer free online quit guides. A nationwide toll-free line, , will send callers to quit lines in their states or to operators at the National Cancer Institute. Organizations like Nicotine Anonymous offer local support groups.
Conduct an off-site search for Lung Cancer information from MedlinePlus. These up-to-date search results are based on search terms specific to Second Opinion Key Points.
Lung Cancer- main page
Asbestos- main page
Smoking- main page
Secondhand Smoke- main page
Lung Disease- main page
|American Cancer Society||Provides information on all forms of cancer and offers numerous brochures and publications for patients and healthcare professionals.|
|National Cancer Institute||This U.S. government site provides information on lung cancer treatment, screening, prevention, genetics, clinical trials and supportive care.|
|American Lung Association||The mission of the American Lung Association® is to prevent lung disease and promote lung health.|
|American Lung Association Freedom From Smoking Online||This is a free online smoking cessation program|
|Lung Cancer Alliance||The Lung Cancer Alliance is the only national non-profit organization dedicated solely to advocating for people living with lung cancer or those at risk for the disease. In addition to general information on the disease, the site includes a "Lung Cancer In The News" section.|
|Lungcancer.org||Lungcancer.org is a service of CancerCare, a national non-profit organization that provides free professional counseling, educational programs, financial assistance and practical help to people with cancer, their loved ones and the bereaved.|
Smokefree.gov is dedicated to helping people quit smoking. It allows them to choose the help that best fits their needs and includes:
One of the most common forms of cancer caused by exposure to asbestos is lung cancer. This website offers a one-stop resource on all asbestos issues ranging from occupational exposure to mesothelioma treatment options.