About Lung Cancer

About Lung Cancer

Penn Medicine's Abramson Cancer Center and the Abramson Cancer Center at Pennsylvania Hospital offer hope to patients facing lung cancer. Early and accurate diagnosis and the full range of treatment options available at Penn give patients with lung cancer the best chance of being cured.

Penn's Lung Cancer Program features a comprehensive team of thoracic surgeons, pulmonologists, nurses, respiratory therapists, rehabilitation specialists, medical oncologists, radiation oncologists, and pathologists. Each provides comprehensive expertise in treating lung cancer. These specialists incorporate surgery, radiation, chemotherapy and immunotherapy to deliver integrated medicine for complex management of lung cancer.

In addition, Penn researchers are on the forefront of testing new surgical procedures, applying new drug therapies and developing the protocols for proton therapy and other radiation therapies that incorporate cutting edge technology and are changing the way lung cancer is treated.


Types of Lung Cancer

  • Small cell lung cancer
  • Non-small cell lung cancer
  • Lung carcinoid or neuroendocrine tumors
  • Mesothelioma

Lungs

Small Cell Lung Cancer (SCLC)

Small cell lung cancer, often called oat cell carcinoma and small cell undifferentiated carcinoma, makes up about 10 to 15 percent of all lung cancers.

This cancer often starts in the bronchi near the center of the chest. Although the cancer cells are small, they can divide quickly, form large tumors, and spread to lymph nodes and other organs throughout the body.

Because of these traits, surgery is rarely an option for treating small cell lung cancer and never the only treatment given. Chemotherapy, which targets cancer cells throughout the body, is an important part of treatment for all small cell lung cancers. When disease is limited to the chest, doctors often use radiation and chemotherapy together. In addition, these cells can often hide out in the brain despite successful treatment to the chest. Physicians often employ prophylactic cranial irradiation (PCI) as a precaution to prevent recurrence in the brain.

Non-small Cell Lung Cancer (NSCLC)

The most common types of lung cancer are three main sub-types of NSCLC. The cells in these sub-types differ in size, shape, and chemical make-up. Treatment for NSCLC may include surgery to remove tumors or part of the lung.

  • Adenocarcinoma: Accounts for about 40 percent of lung cancers. It is usually found in the outer part of the lung and often, though not always, occurs in people who smoke or have smoked. It is also the most common type of lung cancer seen in non-smokers; it is more common in women than in men; and it is more likely to occur in younger people than other types of lung cancer.
  • Large-cell (undifferentiated) carcinoma: About 10 to 15 percent of lung cancers are this type. It can start in any part of the lung. It tends to grow and spread quickly, making it more difficult to treat.
  • Squamous cell carcinoma: About 25 to 30 percent of all lung cancers are squamous cell carcinoma. Its development is linked to smoking and it tends to be found in the middle of the lungs, near a bronchus (airway).

Lung Carcinoid or Neuroendocrine Tumors

Carcinoid tumors start from cells from the neuroendocrine system, they are like nerve cells in some ways and like hormone-making endocrine cells in other ways. Neuroendocrine cells do not form an actual gland, but are scattered throughout the chest and abdomen.

Lung neuroendocrine cells sometimes grow out of control and form tumors. These are known as neuroendocrine tumors (NETs) or neuroendocrine cancers. NETs can develop anywhere in the body.

Other carcinoid tumors

There are two other types of lung carcinoid tumors and their differences can be seen under a microscope.

  • Typical carcinoids grow slowly and only rarely spread beyond the lungs. Nearly 90 percent of lung carcinoids are typical carcinoids. They are usually without symptoms, but can sometimes block a bronchial tube and trigger asthma symptoms.
  • Atypical carcinoids grow a little faster and are somewhat more likely to spread to other organs. Seen under a microscope, they have more cells in the process of dividing and look more like a fast-growing tumor. They are much less common than typical carcinoids.

Carcinoid tumors are sometimes also classified by where they form in the lung.

  • Central carcinoids form in the walls of large airways near the center of the lungs. Most lung carcinoid tumors are central carcinoids, and nearly all of these are also typical carcinoids.
  • Peripheral carcinoids develop in the narrower airways toward the edges of the lungs. Most peripheral carcinoids are also typical carcinoids.

Very little is known about what causes lung carcinoid tumors. They probably develop from tiny clusters of neuroendocrine cells in the lung airways called carcinoid tumorlets. Researchers still do not understand how carcinoid tumorlets develop from lung neuroendocrine cells or why tumorlets sometimes grow to become carcinoid tumors, and why others materialize, but never grow.

Mesothelioma

Mesothelioma is a rare type of malignancy that affects the lining (mesothelium) around the organs in the chest and abdomen. These cells protect organs by making a special fluid that lubricates the surfaces, allowing the lungs and other organs to move during breathing.

The mesothelium has different names in different parts of the body:

  • In the chest it is called the pleura.
  • In the belly it is called the peritoneum.
  • In the space around the heart it is called the pericardium.

There are several different subtypes of mesothelioma, including epithelioid, sarcomatoid, biphasic and desmoplastic. Epithelioid is the most common, comprising 70 to 80 percent of cases. Mesothelioma is most often attributed to exposure to airborne asbestos particles and occurs in both men and women. Asbestos is a group of naturally occurring fibrous minerals used as a fire retardant, but generally is no longer used in insulation or brake materials. The latency period between exposure and the development of mesothelioma can be as much as 40 to 50 years.

Watch a short video about mesothelioma treatment at Penn Medicine.

Lung Cancer Risk and Prevention

A risk factor is anything that affects a person's chance of getting cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be controlled to help prevent cancer. Others, like a person's age or family history, can't be changed.

Risk Factors for Lung Cancer

Having a risk factor, or even several risk factors, does not mean that someone will develop cancer. And some people who get the disease may not have had any known risk factors. It is often very hard to know how much that risk factor may have contributed to the cancer. For every risk factor listed, the risk is much higher for people who smoke.

  • Tobacco smoke: Smoking is by far the leading risk factor for lung cancer. Tobacco smoke causes nearly nine out of 10 cases of lung cancer. The longer a person has been smoking and the more packs per day smoked, the greater the risk. If a person stops smoking before lung cancer develops, the lung tissue slowly repairs itself. Stopping smoking at any age can lower the risk of lung cancer. People who don't smoke but who breathe the smoke of others may also be at a higher risk for lung cancer.
  • Radon: Radon is a radioactive gas released by the normal breakdown of uranium in soil and rocks. It is found at higher levels in the soil in some parts of the United States. Radon can't be seen, tasted or smelled. It can build up indoors and create a possible risk for cancer. The lung cancer risk from radon is much lower than that from tobacco smoke.
  • Asbestos: People who work with asbestos have a higher risk of getting lung cancer. If they also smoke, the risk is greatly increased. Those exposed to asbestos, regardless of smoking status, have a greater risk of developing mesothelioma.
  • Carcinogens found in some workplaces:
    • Radioactive ores, such as uranium
    • Inhaled chemicals or minerals like arsenic, beryllium, cadmium, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas and chloromethyl ethers
    • Diesel exhaust
  • Chest radiation: People who have had radiation therapy to the chest to treat other cancers are at higher risk for lung cancer, although the actual risk is still quite low. However, women who have radiation to the breast after a lumpectomy for breast cancer do not appear to have a higher risk of lung cancer.
  • Arsenic: High levels of arsenic in drinking water may increase the risk of lung cancer.
  • Personal and family history: People who have had lung cancer have a higher risk of getting another lung cancer. Brothers, sisters and children of people who have had lung cancer have a slightly higher risk themselves, especially if the family member developed cancer at a young age.
  • Certain vitamins: Studies have found that smokers who took beta carotene supplements actually had an increased risk of lung cancer, especially if they smoked.
  • Air pollution: Air pollution may slightly increase the risk of lung cancer, but the risk is still far less than that caused by smoking.
  • Gender, race/ethnicity and age: Lung carcinoids occur more often in women than in men; in whites than in African Americans, Asian Americans, or Hispanics/Latinos; and are usually found in people about 60 years old (slightly younger than the average age for other types of lung cancer). Carcinoids can occur in people of almost any age, and although rare they are sometimes found in children.

Preventing Lung Cancer

Avoiding certain risk factors can reduce the chance of developing lung cancer, but there is no known way to prevent all cases.

The number one thing people can do to reduce their risk of developing lung cancer is not to smoke and to avoid secondhand smoke. Penn offers a Comprehensive Smoking Treatment Program for people who need help to quit smoking.

Other steps that people can take to help reduce the risk for developing lung cancer include:

  • Testing and treating their home for radon.
  • Protecting themselves from cancer-causing chemicals at work.
  • Maintaining a good diet with lots of fruits and vegetables.

Lung Cancer Symptoms

Most lung cancers do not cause symptoms until they have grown locally or spread. Any of the following problems should be reported to a doctor. Often these symptoms are caused by something other than cancer, but if lung cancer is found, getting treatment right away can help prevent it from spreading and/or increase the chances of it being cured. The most common symptoms of lung cancer are:

  • A cough that does not go away
  • Chest pain, often made worse by deep breathing, coughing or laughing
  • Hoarseness
  • Weight loss and loss of appetite
  • Coughing up bloody or rust-colored sputum
  • Shortness of breath
  • Fatigue
  • Recurring respiratory infections, such as bronchitis and pneumonia
  • Wheezing that did not previously exist

When lung cancer spreads to distant organs, it may cause:

  • Bone pain
  • Abdominal pain or chest pain
  • Weakness or numbness of the arms or legs
  • Headache, dizziness, or seizure
  • Jaundice (yellowing) of the skin and eyes
  • Lumps near the surface of the skin, caused by cancer spreading to the skin or to lymph nodes in the neck or above the collarbone

In addition mesothelioma may cause pain in the chest due to an accumulation of fluid in the pleura, or lining around the lungs. If mesothelioma has spread beyond the chest to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

Some lung cancers can cause a group of symptoms called syndromes. Most of these symptoms are likely to be caused by something other than lung cancer, but should be checked by a doctor.

  • Horner syndrome: Cancers in the top part of the lungs may damage the nerve that passes from the upper chest into the neck, causing:
    • Severe shoulder pain
    • Drooping or weakness of the eyelid and a smaller pupil in the same eye
    • Reduced or absent sweating on the same side of the face
  • Superior vena cava syndrome: The superior vena cava is a large vein that carries blood from the head and arms back to the heart. It passes alongside the upper part of the right lung and the lymph nodes inside the chest. Tumors in this area may push on the superior vena cava causing the blood to back up in the veins. The result can be swelling in the face, neck, arms, and upper chest, and headaches, dizziness, and a change in mental function if it affects the brain.
  • Paraneoplastic syndromes: Some lung cancers make hormone-like substances that enter the bloodstream and cause problems with organs and tissues even though the cancer has not spread to those areas. For instance, squamous cell carcinoma can make abnormal levels of parathyroid-like hormone (PTH) leading to elevated calcium levels. Small cell lung cancer can elaborate abnormal amounts of anti-diuretic hormone (ADH), which can cause the sodium level to drop. These paraneoplastic syndromes are sometimes the first symptoms of lung cancer.
  • Carcinoid syndrome: Rarely, lung carcinoid tumors release enough hormone-like substances into the bloodstream to cause symptoms. Stress, heavy exercise, and drinking alcohol can bring on these symptoms or make them worse. Symptoms include:
    • Facial flushing
    • Severe diarrhea
    • Wheezing
    • Rapid heartbeat
  • Cushing syndrome: In rare cases, lung carcinoid tumors may produce something called ACTH. This substance causes the adrenal glands to make too much cortisol and other hormones, causing weight gain, weakness, high blood sugar (or even diabetes), and increased body and facial hair. This can be seen with small cell lung cancer.

Staging Lung Cancer

Staging is the process of finding out if and how far lung cancer has spread. The treatment plan and prognosis depend on the stage of the cancer. A staging system is a standard way for doctors to describe how large a cancer is and how far it has spread. The stage is based on the results of the physical exam, biopsies, and imaging tests.

TNM Staging System

The TNM staging system for lung carcinoid tumors and non-small cell lung is used to describe the:

  • Tumor
  • Nodes (lymph nodes)
  • Metastasis (if the cancer has spread)

Staging Small Cell Lung Cancer

Small cell lung cancer may also be staged as limited versus extensive. In the limited stage, the cancer is only in one lung and perhaps in lymph nodes on the same side of the chest, an area that is small enough to be treated with radiation.

If the cancer has spread to the other lung, to lymph nodes on the other side of the chest, or to distant organs, it is called extensive. Many doctors also consider cancer that has spread to the fluid around the lung as extensive stage.

The Penn Difference

Patients under the care of Penn's Lung Cancer Program benefit from a multidisciplinary team of specialists and the resources of the Abramson Cancer Center and Abramson Cancer Center at Pennsylvania Hospital. Internationally recognized specialists in pulmonology, oncology, radiation therapy and thoracic surgery are supported by a robust care who are committed to providing the most advanced treatment options, including:

  • Lung-sparing surgery and other surgical options
  • Radiation therapy including new technologies involving proton beams, Gamma Knife® and CyberKnife®.
  • Chemotherapy and biological therapies
  • Clinical trials

Penn's lung cancer team has established a national reputation with a number of noteworthy attributes including:

  • Thoracic surgeons, radiation oncologists, medical oncologists, pulmonologists and radiologists who specialize in treating lung cancer working together as a team to manage patient care.
  • Dedicated thoracic radiologists who focus entirely on images of the chest and lungs, whose experience and expertise helps them to detect lung cancer at early stages when it is most treatable.
  • A multidisciplinary lung nodule program that determines the best course of treatment or surveillance for all tumors, including benign lung nodules.
  • Supportive care including psychosocial counseling and palliative care.

The program focuses on:

  • Clinical care: Developing treatment strategies that can significantly extend and improve the life of patients.
  • Research: Scientists from basic, translational and clinical research collaborate to understand the causes of lung cancer and translate their findings into improved therapies.
  • Education: Training the physicians, surgeons and researchers of tomorrow has been a part of Penn's tradition for nearly 250 years.
  • Patient support: Cancer support programs provide nutrition counseling, emotional and spiritual support, physical and occupational therapy.
  • Psychological/caregiver support: Therapists at Penn provide support for patients and their caregiver including family therapy, individual therapy sessions, relaxation training and assessment of needs.

At Penn, patients with lung cancer and their families receive the support and education they need to understand the diagnosis as well as the vast resources available to them throughout Penn Medicine. In most cases, consultations with all physicians and team members are scheduled on the same day for the convenience of patients and their families.

Lung Cancer Diagnosis

Penn Medicine's Lung Cancer Program at the Abramson Cancer Center offers hope to patients facing lung cancer. The early and accurate diagnosis and full range of immediate options available at Penn give patients with lung cancer the best chance of being cured.

Early diagnosis of lung cancer can be difficult. The early stages of lung cancer do not usually produce any symptoms, so only a small number of lung cancers are found early. When lung cancer is found early, it is often because of tests that were being done for something else.

Read more Lung Cancer Diagnosis

Treating Lung Cancer at Penn

The lung cancer specialists at Penn Medicine develop personalized treatment plans designed to give every patient the best possible outcome. Like all of programs at Penn's Abramson Cancer Center, the lung cancer program is focused on patient-centered care and meeting the unique needs of every patient and family.

Treatment options for lung cancer include surgery, radiation therapy and systemic treatment including both chemotherapy and targeted agents, as well as combined approaches utilizing a combination of some or all of these therapies have shown promise in extending survival of some patients with early disease.

Penn's treatment options for lung cancer include:

Each of these treatment options is explained in detail below.

Read more Treating Lung Cancer at Penn

Lung Cancer Survivorship

There are more than 12 million cancer survivors living today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete. Survivorship programs at Penn’s Abramson Cancer Center and the Abramson Cancer Center at Pennsylvania Hospital are a distinct phase of lung cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle.

Read more Lung Cancer Survivorship


Nicholas Martell

Nicholas Martell was first diagnosed with prostate cancer more than ten years ago. He was healthy for many years after being treated with radiation therapy. Nick recently experienced a recurrence of his cancer. Physicians at Penn tailored his treatment

Abramson Cancer Center VideoWatch Focus on Lung Cancer Conference - Get information on the latest advances in lung cancer risk, prevention, diagnosis, treatment, symptom management and psychosocial issues.

Abramson Cancer Center VideoMedia Hub for Lung Cancer, Mesothelioma and Related Disorders - Watch Videos!

Abramson Cancer Center Video

Watch Focus on Mesothelioma Conference - Get information on the latest advances in mesothelioma risk, prevention, diagnosis, treatment, symptom management and psychosocial issues.
 


Clinical Trials

Lung Cancer Trials

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