Avraam Karas, MD, thoracic surgeon, speaks with staff members. Surgery may be part of your lung cancer treatment, depending on your unique condition.
The lungs are two sponge-like organs found in the chest, which bring air in and out of the body. The lining around the lungs, called the pleura, helps to protect the lungs and allows them to move during breathing. The windpipe, trachea, allows air to flow into the lungs. It divides into tubes called bronchi, which divide into smaller branches called bronchioles. At the end of these small branches are tiny sacs known as alveoli.
Lung cancer starts in the lining of a lung airway or a gland in the lung. Most lung cancers start in the lining of the bronchi, but they also can begin in other areas such as the trachea, bronchioles, or alveoli. As the lung cancer grows, cancerous cells can break away and spread to other parts of the body in a process called metastasis.
As the leading cause of cancer deaths in both men and women, lung cancer often takes many years to develop and is difficult to detect at an early stage when it has a greater potential for cure. More Americans die each year from lung cancer than from breast, prostate, and colorectal cancers combined.
- Small cell lung cancer is rarer than other types, accounting for about 20 percent of all lung cancers. Small cell lung cancer is sometimes called oat cell cancer for the distinctive shape of its cells. It is fast-growing and frequently has no symptoms until it is in an advanced stage.
- Non-small cell lung cancer is the most common type of lung cancer, accounting for almost 80 percent of occurrences. Non-small cell lung cancer has no symptoms in its early stages, but typically spreads less quickly than small cell lung cancer.
- Mesothelioma is a rare cancer of the tissues that line and protect your lungs, chest (pleural mesothelioma), and abdomen (peritoneal mesothelioma). It is due to long-term asbestos exposure.
- Mixed small cell/ large cell cancer occurs when the cancer has features of both types.
- Primary lung cancer originates in the lungs.
- Metastatic disease to the lungs occurs when cancer spreads from other parts of the body through the bloodstream or lymphatic system to the lungs. Although the cancer now exists in the lungs, your doctors do not classify it as lung cancer because it did not originate in the lungs.
In addition to the two major types of lung cancer, other lung tumors can occur. Some are benign (non-cancerous) and others, like carcinoid lung tumors, are malignant (cancerous.) However, these types of lung tumors are found less than 5 percent of the time. Most of the tumors do not spread quickly and can be treated with surgery.
Risks and Prevention
Lung cancer has no symptoms in the early stages. When symptoms occur, the disease has usually reached an advanced stage. At that point, symptoms can include
- Chest pain
- Coughing that does not improve within a few weeks
- Coughing up blood
- Weight loss
Because symptoms occur when the disease is so advanced, knowing your risks is extremely important. People are at a higher risk for developing lung cancer if they were exposed to the following behaviors and substances:
- The number one cause of lung cancer is smoking. It can be attributed to more than 85 to 90 percent of all lung cancer cases. Harmful substances in tobacco damage cells in the lungs. Stopping smoking greatly reduces a person's risk for developing lung cancer.
- A recent study by the National Cancer Institute found that screening current or former heavy smokers with a computed tomography (CT) scan can reduce deaths from lung cancer (by 20 percent among those ages 55-74 with a 30-pack year history of cigarette smoking.).
- This study is the first of its kinds to confirm a significant improvement in survival in high-risk smokers who undergo screening with CT scans.
- Consider contacting MedStar Health for more information, or to determine the next step in getting screened for lung cancer.
- Asbestos is the name of a group of minerals that occur naturally as fibers and are used in certain industries. Asbestos fibers tend to break easily into particles that can float in the air and stick to clothes. When the particles are inhaled, they can lodge in the lungs, damaging cells and increasing the risk for lung cancer.
- Radon is an invisible, odorless, and tasteless radioactive gas that occurs naturally in soil and rocks. It can cause damage to the lungs and lead to lung cancer. Smokers who are exposed to radon or asbestos have an increased risk of developing lung cancer.
- Exposure to environmental tobacco smoke (ETS), or secondhand smoke, is called involuntary or passive smoking. People exposed to ETS or second-hand smoke are at risk for developing lung cancer.
- Lung diseases such as tuberculosis also increase a person's risk of developing lung cancer.
If caught in its early stages, up to 80 percent of lung cancer is potentially curable.
One of the most aggressive forms of cancer, lung cancer may continue to grow and spread into other areas of the body, causing other life-threatening problems. It is important to detect and treat lung cancer as early as possible. When a patient presents with symptoms that might suggest lung cancer or any other form of lung disease, interventional pulmonolgists will use several methods to make an accurate diagnosis.
To confirm the presence of lung cancer, MedStar Health doctors perform a biopsy, wherein a small sample of tissue is removed from the lung. A pathologist will then examine tissue under a microscope to determine if cancer is present. A number of procedures may be used to obtain this tissue
- Navigational bronchoscopy is an advanced imaging system that allows minimally invasive biopsies of lesions anywhere in the lungs. Replacing the need for high-risk invasive procedures, such as chest needle biopsies and open surgeries, navigational bronchoscopy sets the stage for earlier lung cancer diagnosis. This, in turn, boosts survival rates and eliminates the stressful wait-and-see approach after finding a questionable area on a thoracic CAT scan.
In the procedure, your surgeon uses a specialized catheter to capture a 3-D, electromagnetic map of your lungs. Once your surgeon reaches the lesion, he or she will remove the catheter and insert an ultrasound device to visualize the lesion and its position in the airway. Getting as close as possible to the lesion, your surgeon will use tiny surgical instruments to remove enough tissue for a quick biopsy.
The navigational bronchoscopy procedure is painless with general anesthesia, often taking about an hour, with patients remaining comfortable. We offer endoscopic and endobronchial ultrasound at the same time as your navigational bronchoscopy test, so there is no need to make two trips or have two surgical procedures that require anesthesia.
- Endoscopic and endobronchial ultrasound are advanced diagnostic technologies that provide real-time imaging of abnormalities inside the chest. These procedures are so effective, they can sometimes eliminate additional phases of testing. The real-time technology used in endoscopic and endobronchial ultrasounds has a long learning curve, and few physicians are prepared to perform them. However, MedStar Health specialists are well-trained to perform these procedures accurately.
- Fine-needle aspirations require your physician to insert a needle into the tumor. Tissue and cells are then removed from the abnormality inside your lungs or your lymph nodes. In some cases, your doctor will recommend using an ultrasound or CT scan as a guide for the needle.
- During a mediastinoscopy, your thoracic surgeon makes an incision at the top of the breastbone, and inserts a thin, lighted tube to see inside the chest.
- To check sputum cytology, a patient's sputum (phlegm) is stained and examined under the microscope to look for malignant tumor cells.
- In a thoracentesis, your doctor checks the fluid in your chest, also called the pleural fluid. The area is numbed and a needle is inserted into the chest to draw out some of the fluid.
- A thoracoscopy lets your doctor view your lungs and chest cavity internally. Your doctor will make several small incisions in your chest and back and insert a lighted narrow tube to check the areas for any abnormalities.
- Thoracotomy is a procedure wherein a thoracic surgeon opens the chest with a long incision and remove any abnormalities or lymph nodes for further examination in the lab.
Some of the diagnostic procedures described in this section are also used as surgical treatments to remove the cancer. Depending on the staging (how far the cancer is spread), your thoracic team will create an appropriate treatment regimen personalized for you. This treatment regimen is based on currently available scientific evidence and research designed for optimal results in cancer treatment.
Effectively treating lung cancer may require some combination of surgery, radiation, and chemotherapy, all of which are available through MedStar Health.
At MedStar Health, a group of cancer specialists who are skilled and experienced in lung cancer treatment meets weekly to discuss new cases and develop individualized treatment plans. We base our plan on advanced treatment techniques, the latest technology and what works best for you and your family.
The team will likely recommend any of the following treatment options:
- 3D Conformal Radiotherapy is a radiation therapy technique that sculpts radiation beams to the shape of a tumor. This is ideal for tumors that have irregular shapes or for those that are close to healthy tissues and organs. We view a tumor in three dimensions with the help of imaging, then deliver radiation beams from several directions to the tumor.
- Intensity-Modulated Radiation Therapy (IMRT) uses devices that allow the radiation beams to move and change intensity depending on what kind of tissue they are targeting. This flexibility allows different areas of a tumor to receive different amounts of radiation and helps protect healthy tissue from unnecessary radiation exposure.
- Image-Guided Radiation Therapy (IGRT) uses high-quality imaging technology to create images of targeted areas of a tumor during the radiation procedure. Using these images, your radiation oncology team carefully adjusts radiation beams and doses to best fit the size, shape, and location of the tumor during your treatment session.
- Stereotactic Body Radiotherapy (SBRT) is a new form of radiotherapy that uses high doses of radiation to target smaller lesions within the lungs. With a highly targeted dose of radiation, your treatment team can safely deliver radiation to very small regions with a high probability of destroying that particular tumor.
- 4-D Motion and gating uses a 4-D computerized tomography scanner to plan treatment, monitor tumor motion while you breathe, and provide gated delivery during treatment. Gating allows us to treat the tumor at its smallest dimension during one phase of your breathing cycle. This limits the radiation delivered to healthy tissue.
We also offer two advanced lung cancer treatments:
CyberKnife® radiation is a breakthrough technology used to treat many types of inoperable or surgically difficult tumors. It is especially successful for treating lung cancer. Lung cancer can be challenging to treat with conventional radiation because tumors in the lungs move as you breathe. This natural movement makes it difficult to focus radiation on the tumor itself and exposes surrounding healthy tissue to unnecessary doses of radiation.
CyberKnife avoids this problem, while effectively controlling or destroying lung cancer cells. With an advanced combination of computer and imaging technology, CyberKnife identifies the exact location of the lung tumor, coordinates with the Synchrony® Respiratory Tracking System (which follows the tumor's movement as you breathe), and accurately focuses radiation on the tumor without affecting surrounding healthy tissue.
Video-Assisted Thoracic Surgery (VATS) is a minimally invasive surgical technique used to diagnose and treat problems in your chest, as well as alleviate symptoms of lung cancer. It can be used in a variety of procedures, including biopsy, surgery, or removing excess fluid or air from around the lungs. Since only very small incisions are needed, healing is fast with minimal pain and complications.
Lung cancer patients often have challenges with breathing. Helping patients breathe more easily and go about their daily lives is an essential part of what our lung cancer team considers a priority. To that end, MedStar Health offers our palliative care program. Palliative care is the branch of medicine that helps patients alleviate their pain and discomfort during a long or chronic illness, utilizing the following methods: