Breathe Easier: Your Lung Cancer Questions Answered

Did you know? In Missouri, lung cancer is the most common type of non-skin cancer among both men and women. Kan Huang, MD, PhD, MS, a medical oncologist and hematologist, and the medical director of the Infusion Center at the Phelps Health Delbert Day Cancer Institute (DDCI), answers frequently asked questions about the disease.

What is lung cancer and what are the different types?

Cancer is a disease in which the cells in the body grow out of control. Lung cancer often forms in the cells of the bronchi that connect the windpipe to the lungs. Lung cancer also can begin in smaller branches of the bronchi, called bronchioles, or alveoli.

Lung cancer is the leading cause of cancer-related deaths in the United States, accounting for one in four cancer deaths. There are two major types of lung cancer, which are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).

These two types of lung cancers look differently under the microscope, behave differently and are treated differently. In general, SCLC behaves more aggressively than NSCLC. SCLC also tends to spread earlier and often results in a poorer outcome, even with treatment.

There also are different types of NSCLC, which include adenocarcinoma, squamous cell lung cancer and large cell lung cancer, all of which are treated differently.

To put it into perspective, about 13% of all lung cancers are SCLC, and 84% are NSCLC.

Who is most at risk for lung cancer? What are risk factors for lung cancer?

Cigarette smoking is the number one risk factor for lung cancer. In the United States, cigarette smoking is linked to about 80% to 90% of lung cancer cases. Besides smoking, exposure to certain chemicals such as asbestos, as well as previous radiation, also are considered to be risk factors for lung cancer. Having parents, siblings or a child with lung cancer increases an individual’s risk of having lung cancer, too.

Lung cancer can happen in both men and women. According to the American Cancer Society, the chance that a man will develop lung cancer in his lifetime is about 1 in 15; for a woman, the risk is about 1 in 17. These numbers include both people who smoke and those who don't smoke. For people who smoke the risk is much higher, while for those who don't, the risk is lower.

What are the signs and symptoms of lung cancer?

The signs and symptoms of lung cancer depend on where the lung cancer started, the size of the cancer and if any other organ(s) are involved. The most common symptoms include a new persistent cough, coughing up blood (even a small amount), shortness of breath, chest pain, change of voice and unexplained weight loss. If the cancer has spread to the bone(s), patients also could have bone pain. If the cancer has spread to the brain, patients may experience headaches and/or vision changes.

How is lung cancer diagnosed? What tests would patients undergo to see if they have lung cancer? Can lung cancer be detected with a blood test?

Lung cancer is often diagnosed from an imaging study, most commonly from an X-ray or CT (computed tomography) scan. To confirm the diagnosis, we often have to do a biopsy. We either biopsy the suspected lung mass, or we biopsy the spot where we suspect the cancer is.

Even with today's technology, we don't currently have a blood test to detect lung cancer. However, there are several big research projects in the works. Hopefully, in the future, there will be a simple blood test to detect lung cancer.

What are the different treatment options for lung cancer?

One treatment option for lung cancer is surgery, where a surgeon removes the cancerous tissue. We also have the option of chemotherapy, where oncologists (cancer doctors and providers) use special medication to shrink or kill the lung cancer. This medication is typically infused through the vein.

Our cancer care team also may use radiation, which uses high energy rays similar to an X-ray, but in a higher dose to kill the lung cancer. We have a new generation of cancer treatments for lung cancer, including immunotherapy. Immunotherapy is engineered by antibodies (proteins that your immune system makes to help fight infection) produced in response to activate the immune system to recognize and kill the lung cancer cells. For certain lung cancer patients, we also can treat them with targeted therapy, which can be administered via an infusion or a pill. These treatments specifically look for cancer and attack their weaknesses. Immunotherapy and targeted therapies are usually less toxic – and more effective – than traditional chemotherapy.

Treatment for lung cancer is highly individualized, depending on each case. The specific treatment depends on the stage and the type of lung cancer. Sometimes patients may need surgery, chemotherapy and radiation. Other patients may just need surgery.

No two lung cancers are treated the same. Different factors affect the treatment decision, such as a patient’s general health and whether they can tolerate more aggressive treatment versus treatment to temporarily control the cancer growth.

Can I be treated at the DDCI for lung cancer?

At the DDCI, we provide almost all of the lung cancer treatment here, excluding lung cancer surgery, which often requires a specialized or thoracic surgeon. (Thoracic surgeons have special training in operating on organs inside the chest, including the heart and lungs.) For these types of surgeries, patients would typically have to travel elsewhere.

Everything else, however, can be done here. We have radiation oncologists, doctors who give radiation. We can give chemotherapy, immunotherapy and targeted therapy. We also have general surgeons here for other types of cancer surgeries. This way, patients don’t have to travel far, especially when they might not be feeling well.

Does Phelps Health offer clinical trials?

The DDCI offers clinical trials for our patients. We have a great clinical trial team here. If patients are interested in participating in a clinical trial, our team will discuss the benefits and the risks to help patients decide if a clinical trial is in their best interest.

Can a person get lung cancer again after being treated?

Yes, having lung cancer in the past puts an individual at a higher risk for developing lung cancer again, particularly if they continue to smoke.

Looking forward: What lifestyle advice would you give to someone who has had lung cancer?

If they haven’t already, the individual needs to stop smoking. For local smoking cessation resources, visit quitnow.net.

Smokers and former smokers are at a higher risk for heart disease. In addition, lung cancer treatments, including radiation, certain chemotherapy and immunotherapy, also can increase a patient’s chances of getting heart disease. For these reasons, eating a balanced diet and staying physically active are both highly encouraged. At the DDCI, we have a dietitian who gives patients advice on what to eat and how to maintain their weight during cancer treatment.