Smokers, African Americans, older people, and younger women (even those who’ve never smoked) are at risk for this disease—although men still die most often from it. Get the facts to put your risk in perspective.

Lung Cancer Risk Factors

Maybe you think that only smokers and old people get it. Or that chemo and radiation are the only real treatments. Time to correct these false notions, and many others, when it comes to this disease. We’ll tell you all we know.

Lung Cancer Myths

Only smokers get it? Nope. Chemo and radiation are the only treatments? Think again. Learn the truth about this disease.

10 Myths About Lung Cancer, Debunked

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Is this a scary thought? Yep. But we'll help you put your personal lung cancer risk in perspective.

Everyone's at Risk for Lung Cancer (Even Non-smokers)

- __Deaths and Cigarettes:__ Centers for Disease Control and Prevention. (2020). “What are the Risk Factors for Lung Cancer?” [cdc.gov/cancer/lung/basic_info/risk_factors.htm](https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm)
- __Smoking-Related Deaths:__ Johns Hopkins Medicine. (n.d.). “Former Smokers: What’s Your Risk for Lung Cancer?” [hopkinsmedicine.org/health/conditions-and-diseases/lung-cancer/former-smoker-whats-your-risk-for-lung-cancer](https://www.hopkinsmedicine.org/health/conditions-and-diseases/lung-cancer/former-smoker-whats-your-risk-for-lung-cancer)
- __Mortality Rates for Lung Cancer:__ *The New England Journal of Medicine*. (2020). “The Effect of Advances in Lung Cancer Treatment on Population Mortality.” [nejm.org/doi/10.1056/NEJMoa1916623](https://www.nejm.org/doi/10.1056/NEJMoa1916623)
- __Stats on Smoking:__ Centers for Disease Control and Prevention. (2019). “Current Cigarette Smoking Among Adults in the United States.” [cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm](https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm)
- __Numbers for Non-Smokers:__ American Cancer Society. (2019). “Lung Cancer Risks for Non-Smokers.” [cancer.org/latest-news/why-lung-cancer-strikes-nonsmokers.html](https://www.cancer.org/latest-news/why-lung-cancer-strikes-nonsmokers.html)
- __The Never-Smokers Mystery:__ *UpToDate*. (2020). “Lung Cancer in Never-Smokers.” [uptodate.com/contents/lung-cancer-in-never-smokers](https://www.uptodate.com/contents/lung-cancer-in-never-smokers)
- __Age and Lung Cancer:__ *Journal of Thoracic Disease*. (2016). “Lung Cancer in Elderly.” [ncbi.nlm.nih.gov/pmc/articles/PMC5124601/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124601/)
- __DNA Repair and Age:__ *InTechOpen*. (2019). “The Role of DNA Repair in Cellular Aging Process.” [intechopen.com/books/dna-repair-an-update/the-role-of-dna-repair-in-cellular-aging-process](https://www.intechopen.com/books/dna-repair-an-update/the-role-of-dna-repair-in-cellular-aging-process)
- __Women vs. Men Lung Cancer Rates:__ Lung Cancer Research Foundation. (2020). “Facts About Women and Lung Cancer.” [lungcancerresearchfoundation.org/women-and-lung-cancer/](https://www.lungcancerresearchfoundation.org/women-and-lung-cancer/)
- __Women and Lung Cancer:__ American Lung Association. (2020). “Lung Cancer Fact Sheet.” [lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet](https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet)
- __Young Women and Lung Cancer:__ *International Journal of Cancer*. (2020). “Lung Cancer Incidence in Young Women Vs. Young Men.” [cancer.org/latest-news/study-young-women-now-have-higher-rate-for-lung-cancer-than-men-worldwide.html](https://www.cancer.org/latest-news/study-young-women-now-have-higher-rate-for-lung-cancer-than-men-worldwide.html)
- __Explanation of “Adenocarcinoma”:__ American Cancer Society. (2019). “What is Lung Cancer.” [cancer.org/cancer/lung-cancer/about/what-is.html](https://www.cancer.org/cancer/lung-cancer/about/what-is.html)
- __Young Women and Lung Cancer Causes:__ American Cancer Society. (2020). “Study: Young Women Now Have Higher Rates for Lung Cancer Than Men Worldwide.” [cancer.org/latest-news/study-young-women-now-have-higher-rate-for-lung-cancer-than-men-worldwide.html](https://www.cancer.org/latest-news/study-young-women-now-have-higher-rate-for-lung-cancer-than-men-worldwide.html)
- __Racial Disparities and Lung Cancer:__ Centers for Disease Control and Prevention. (2010). “Racial/Ethnic Disparities and Geographic Differences in Lung Cancer Incidence --- 38 States and the District of Columbia, 1998—2006. [cdc.gov/mmwr/preview/mmwrhtml/mm5944a2.htm](https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a2.htm)
- __Race, Economics, and Power Factors in Lung Cancer Deaths:__ The Guardian. (2016). “Why Cancer is More Deadly When You’re Black.” [theguardian.com/commentisfree/2016/may/26/cancer-deadly-black-treatment-race-economics](https://www.theguardian.com/commentisfree/2016/may/26/cancer-deadly-black-treatment-race-economics)
- __Black People and Lung Cancer Cases and Deaths:__ American Cancer Society. (2019). “Gap in Cancer Death Rates Between Blacks and White Narrows.” [cancer.org/latest-news/gap-in-cancer-death-rates-between-blacks-and-whites-narrows.html](https://www.cancer.org/latest-news/gap-in-cancer-death-rates-between-blacks-and-whites-narrows.html)
- __Lung Cancer Racial Differences:__ *JNCI Cancer Spectrum*. (2020). “Changes in Black-White Difference in Lung Cancer Incidence among Young Adults.” [academic.oup.com/jncics/article/4/4/pkaa055/5894724](https://academic.oup.com/jncics/article/4/4/pkaa055/5894724)
- __Success Rate of Black Women Quitting:__ Centers for Disease Control. (2019). “African Americans and Tobacco Use.” [cdc.gov/tobacco/disparities/african-americans/index.htm](https://www.cdc.gov/tobacco/disparities/african-americans/index.htm)
- __Lung Cancer and Education Level:__ *Journal of the American College of Radiology*. (2020). “Education Level Predicts Appropriate Follow-Up of Incidental Findings From Lung Cancer Screening.” [jacr.org/article/S1546-1440(19)31477-2/fulltext](https://www.jacr.org/article/S1546-1440(19)31477-2/fulltext)
- __Radon and Other Chemicals That Pose Risks:__ United States Environmental Protection Agency. (n.d.). “Health Risk of Radon.” [epa.gov/radon/health-risk-radon](https://www.epa.gov/radon/health-risk-radon)
- __Genetics and Lung Cancer:__ *Oncology Letters*. (2016). “Familial Risk for Lung Cancer.” [ncbi.nlm.nih.gov/pmc/articles/PMC5351216/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351216/)


Who's at Risk for Lung Cancer? Just About Everyone

Smokers and Former Smokers

Never-Smokers

Older Adults

Women

*Younger* Women

African Americans

The Less Educated

Exposure to Toxic Gases, Minerals, or Chemicals

Family History of Lung Cancer

Never Screened

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The latest wisdom on how to manage lung cancer, including insights from caregivers and survivors. 

Living With Lung Cancer

While early detection remains important, targeted therapies and a new focus on post-op  lifestyle choices together are improving survival rates and lowering tumor recurrence, even among those who catch lung cancer in later stages.

Of the two major forms of lung cancer: non-small cell lung cancer (NSCLC) is the most common. Here are 8 facts to know about NSCLC, including common symptoms, survival rates, and new testing options.

Non-Small Cell Lung Cancer

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Of the two major forms of lung cancer: non-small cell lung cancer (NSCLC) is the most common. Here are 8 facts to know about NSCLC.

What Do You Know About NSCLC?

Non-Small Cell Lung Cancer: 8 Facts About NSCLC

8 Facts About Non-Small Cell Lung Cancer

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Lung cancer claims more lives than any other cancer in the U.S.—but new treatment options may soon change that.

The Future Is Bright for Lung Cancer Treatments

- __Clinical Trial on Exercise and Relaxation for Lung Cancer:__ National Institutes of Health. (2020.) “Resiliency Among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT).” [clinicaltrials.gov/ct2/show/NCT04229381](https://www.clinicaltrials.gov/ct2/show/NCT04229381)

- __Clinical Trial on Immunotherapy and Chemo Combination:__ ClinicalTrials.gov. (2020.) “A Study of Nivolumab and Ipilimumab Combined With Chemotherapy Compared to Chemotherapy Alone in First Line NSCLC (CheckMate 9LA).” [clinicaltrials.gov/ct2/show/NCT03215706](https://clinicaltrials.gov/ct2/show/NCT03215706)

- __FDA Approval of Immunotherapy and Chemo Combination:__ U.S. Food and Drug Administration. (2020.) “FDA approves nivolumab plus ipilimumab and chemotherapy for first-line treatment of metastatic NSCLC.” [fda.gov/drugs/drug-approvals-and-databases/fda-approves-nivolumab-plus-ipilimumab-and-chemotherapy-first-line-treatment-metastatic-nsclc](https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-nivolumab-plus-ipilimumab-and-chemotherapy-first-line-treatment-metastatic-nsclc)

- __Lung Cancer Statistics:__ The Center for Disease Control and Prevention. (2020.) “Lung Cancer Statistics.” [cdc.gov/cancer/lung/statistics/](https://www.cdc.gov/cancer/lung/statistics/)

- __Lung Cancer Survival Rates:__ The American Lung Association. (2020.) “Lung Cancer Fact Sheet.” [lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet](https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet)

- __Study on Resistance to Targeted Therapies:__ *Nature*. (2020.) “Resistance to targeted therapies as a multifactorial, gradual adaptation to inhibitor specific selective pressures.” [nature.com/articles/s41467-020-16212-w](https://www.nature.com/articles/s41467-020-16212-w)

- __Targeted Treatment for KRAS Mutation Study:__ *Frontiers in Oncology*. (2019.) “New Horizons in KRAS-Mutant Lung Cancer: Dawn After Darkness.” [frontiersin.org/articles/10.3389/fonc.2019.00953/full](https://www.frontiersin.org/articles/10.3389/fonc.2019.00953/full)

- __Osimertinib Study Results Presented at May 2020 ASCO Meeting:__ American Society of Clinical Oncology. (2020). “Osimertinib as adjuvant therapy in patients (pts) with stage IB–IIIA EGFR mutation positive (EGFRm) NSCLC after complete tumor resection: ADAURA.” [meetinglibrary.asco.org/record/191929/abstract](https://meetinglibrary.asco.org/record/191929/abstract)


Aradhana Ghosh, M.D.

Medical Reviewer

Say Hello to Personalized Cancer Treatment

New Drugs Attack Lung Cancer-Causing Mutations

Immunotherapy Helps Your Body Work Smarter, Not Harder

Immunotherapy Has Been Shown to Increase Survival Rates

Immunotherapy Combos May Be a Better Treatment for Some

Treatment-Resistant Lung Cancer Presents a Stubborn Challenge

Understanding the Resistance Process Is Key

An Exciting New Treatment for Early-Stage Lung Cancer

The Big Push Is for an Increased Cure Rate

Research on Lifestyle Choices Offers Good News, Too

The Emotional and Physical Sides of Lung Cancer Can’t Be Ignored

The Future for Lung Cancer Treatment Offers Real Hope

Research shows that 30 minutes of gentle exercise each day can help expand lung function and build strength after lung cancer surgery. We’ll show you all the moves.

Lung Cancer Exercises

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These gentle, effective exercises will help you rebuild strength, endurance, and energy after your lung cancer procedure.

10 Ways to Build Strength After Lung Cancer Surgery

- __Non-Small Cell Lung Cancer:__ American Cancer Society. (2020). “Key Statistics for Lung Cancer.” [cancer.org/cancer/lung-cancer/about/key-statistics.html](https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html)
- __Lung Cancer and Exercise:__ Cochrane Database of Systematic Reviews. (2019). “Exercise training after lung surgery for people with non-small cell lung cancer.” [cochrane.org/CD009955/LUNGCA_exercise-training-after-lung-surgery-people-non-small-cell-lung-cancer](https://www.cochrane.org/CD009955/LUNGCA_exercise-training-after-lung-surgery-people-non-small-cell-lung-cancer) 


Grace Suh M.D.

10 Strength-building Exercises to Try After Lung Cancer Surgery

Start Exercising Slowly, One Step at a Time

How to Do the NSCLC Workout

Diaphragmatic Breathing

Rows

Shoulder Raises

Step Ups

Standing Hip Abductions 

Mini Squats

Standing Heel Raises

Doorway Chest Stretch

Overhead Side Stretch

Child’s Pose

For a long time, people with early-stage lung cancer didn’t have many options if they were too sick to have surgery. Stereotactic body radiation therapy (SBRT) not only provides these patients with highly effective, noninvasive treatment, it also gives them the hope they need. 

branches and flowers in the shape of lungs

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Sterotactic body radiation therapy (SBRT) gives people with inoperable lung cancer new hope. 

Treating Lung Cancer Without Surgery

Rajal Patel, M.D.

What Usually Happens

A Nonsurgical Lung Cancer Treatment

What Is SBRT?

How SRBT Works

Who SRBT Is For 

A Patient's Experience With SRBT

How SRBT Compares to Standard Radiation Therapy

SBRT for Other Lung Cancer Patients

An Immune Boost from SRBT?

The Latest Progress

SBRT Drawbacks and Side Effects

Radiation Pneumonitis

Finally Cancer-free

Lung cancer can cause fatigue, nausea, and others issues. From planned meal prep to cleaning and financial assistance, here are resources that can help during your cancer treatment and beyond.

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From planned meal prep to cleaning and financial assistance, here are some of the resources that can help during your cancer treatment and beyond.

Need Help With Lung Cancer?

Michael Hunter, M.D.

Helpful Resources for Lung Cancer Patients

Meal Train: Organize Food Needs

Free House Cleaning Available

CaringBridge: An Online Journal to Connect You to Others

LungMATCH: One Stop Shop

Need Financial Assistance?

Legal Help Is Close by

Patient Advocate Foundation Can Help With All Those Difficult Questions

Continuing Your Career

Community Resources Provide Useful Info

10 Resources to Help You As a Lung Cancer Patient

It is possible to balance lung cancer treatment with working, but there are several issues to consider as you move forward. Should you tell your employer and co-workers? Will side effects make this necessary anyway? Which days during a chemo regimen will you feel sickest? Can work give you a welcome distraction during your illness?

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If you’re in lung cancer treatment and plan to keep working, here are some common issues to keep in mind.

Navigating Work During Lung Cancer Treatment

Lung Cancer Treatment and Work: Planning and Managing Tips

Think Ahead

Disclosure

Timeline

Initial Treatment

Vacation Time Usage

Managing Symptoms and Side Effects

Gauging Emotional Reactions

Immune Health

Letting Coworkers Know

Rights and Policies

Be Realistic

Managing Lung Cancer at Work

Technically, stage 4 lung cancer doesn’t have a cure. But with the advent of immunotherapy, some patients with stage 4 non-small cell lung cancer are living for years with their disease in check. 

After a decade or so of not much progress for lung cancer, doctors and researchers are using words like “game changer,” “a new era,” and even, with cautious optimism, “cure” to describe the recent advances in immunotherapy. 

“I think that we’re just seeing the tip of the iceberg for how these types of treatments can improve these patients’ lives—from those with metastatic cancer to an earlier stage disease—in the hopes that we can increase the chance of cure,” says Dr. Julie Brahmer, Co-Director of the Upper Aerodigestive Department at the Bloomberg~Kimmel Institute for Cancer Immunotherapy at the Johns Hopkins Kimmel Cancer Center, who spoke with HealthCentral in a phone interview.

Dr. Thomas Marron, Assistant Director of Early Phase and Immunotherapy Trials at the Tisch Cancer Institute and an Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai, says some of his patients have even completed two years of immunotherapy, been taken off, and have been living off therapy for two years. 

“The majority of people on the current regimens are still going to die of lung cancer, but they’re living longer—and it appears that about 10 to 20 percent are being cured,” says Dr. Marron, who also spoke to HealthCentral in a phone interview.

When Dr. Marron was in med school and grad school in the 2000s, immunotherapy seemed so far-fetched that people joked about it being a cure. Then in 2014 came the first FDA approval of an [immunotherapy drug](https://www.nytimes.com/2014/09/05/business/merck-wins-approval-of-novel-immune-system-drug-for-cancer.html) targeting a protein found on certain immune cells called [PD-1](https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pd-1), for use after chemotherapy. Now, every few weeks seems to bring about a new development in how the drugs can be used. There have been 35 approvals so far, Dr. Marron notes. 

The promise of immunotherapy doesn’t necessarily mean the end of chemo for all lung cancer patients. “In many cases, it’s the synergy between the chemo and the immunotherapy that produces results,” Dr. Marron says. “The chemo is sometimes needed to activate the immune system. And in some cases, single-drug [immunotherapy directed at PD-1 or PD-L1 proteins](https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/immune-checkpoint-inhibitors.html) doesn’t seem to help.”

But in other cases, immunotherapy works so well that patients can skip chemotherapy altogether. [One of the recent studies](https://www.nejm.org/doi/full/10.1056/NEJMoa1606774) showed that if at least 50 percent of tumor cells are positive for PD-L1, it’s better to use the immunotherapy drug pembrolizumab, alone than standard chemotherapy as a first-line treatment. That’s because PD-L1 is a marker of how well a patient is likely to respond to immune therapy. Think of PD-L1 as a stop sign, Marron explains, that prevents your immune system from attacking the tumor. Pembrolizumab is able to tear down those stop signs, so that your own immune system can get through and kill the cancer cells creating the tumor.

“It’s the immune system’s way of spreading the word to party in the tumor,” Dr. Marron says.

Other studies have shown that for tumors with lower levels of PD-L1, a combination of chemo and immunotherapy works best. 

There’s still much research to be done on other protein markers besides PD-L1. When immunotherapy isn’t balanced just right, the immune system can get overactivated, resulting in toxicity.

“The holy grail is to find the combination of the most efficient and least toxic, and we’re not quite there yet,” Dr. Marron says.

While some of the new treatment options are life-changing, the excitement needs to be tempered with a dose of reality, Dr. Brahmer says.

“While this gives great hope, not everyone is suited to receiving these drugs,” she says. “So talking with your primary physician and working with an experienced team is very important.”


Illustration of immunotherapy targeting lung cancer cells.

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Illustration of immunotherapy targeting lung cancer cells

In some cases of advanced non-small cell lung cancer, immunotherapy works so well that patients can skip chemotherapy altogether. Other cases do better with a combination of chemo and immunotherapy. Patients are living longer with immunotherapy in their regimens, and it appears that 10 to 20 percent are being cured.

With immunotherapy, some patients with stage 4 non-small cell lung cancer can skip chemotherapy altogether and are living for years with their disease in check.

Immunotherapy: A Cure for Some Lung Cancers?

Immunotherapy: A Game Changer for Advanced Lung Cancer 

Skip Chemo, Go Directly to Immunotherapy: A Game Changer for Patients With Advanced Non-Small Cell Lung Cancer

People with non-small cell lung cancer can improve their cancer surgery outcomes, breathing capacity, muscle strength, range of motion, and psychological well-being through gentle aerobic exercise, strength training, and stretching.

If you've had lung cancer, there no guarantee you won't have a relapse, but there are things you can do to stack the odds in your favor, including diet, exercise, and regular lung cancer screenings.

Preventing NSC Lung Cancer Recurrence

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While it’s impossible to completely shield yourself from lung cancer relapse, there are some things you can do to stack the odds in your favor.

Prevent Non-Small Cell Lung Cancer Recurrence

Preventing Non-Small Cell Lung Cancer Recurrance

Preventing Non-Small Cell Lung Cancer Recurrence

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Non-small cell lung cancer patients who exercise can improve their breathing, strength, and range of motion while reducing side effects, fatigue, and anxiety.

Working Out with Non-Small Cell Lung Cancer

With Non-Small Cell Lung Cancer, Exercise is Beneficial

Lung Cancer Can Pose Exercise Challenges

You Can Exercise at Any Point in Lung Cancer Treatment

Lung Cancer Means Simpler Exercise Goals

Aerobic Exercise, Built Up Slowly, Improves Lung Capacity

Strength Training Helps Rebuild Lost Muscle Mass

Breathing Techniques Improve Respiration and Relaxation

Stretching Helps Improve Breathing and Range of Motion

Good Posture Increases Lung Capacity

Lung Cancer Side Effects Require Caution

Check Out Fitness Classes Designed for Cancer Patients

Exercise Helps Throughout the Non-Small Cell Lung Cancer Journey

We all know smoking is a risk factor for lung cancer, but there are other risk factors you might not know about, including radon, asbestos, and a family history of lung cancer.

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It’s not just smoking that causes lung cancer. Here are other common risk factors you might not know about.

What Are the Risk Factors for Lung Cancer?

Lung Cancer Risk Factors: More Than Just Smoking

Don’t forget second hand smoke, too

Radon is lung cancer risk factor

Asbestos exposure can raise your lung cancer risk

Industrial chemicals: Not good for lung cancer risk

Environmental hazards are also a risk factor in lung cancer

Had tuberculosis? You’re at a higher lung cancer risk

Genetics play role in lung cancer

Previous radiation treatment can raise your lung cancer risk

Beta carotene supplement risky for lung cancer

Military service: Even this raises your lung cancer risk

Every year, more than 228,000 people in the U.S. are diagnosed with lung cancer. Discover more about the screening process and how to get tested.

More Info on Lung Cancer!

Lung Cancer Screening

We went to some of the nation’s top experts in lung cancer to bring you the most up-to-date information possible.

Lung Cancer Screening and Prevention

The first step in your fight against lung cancer is avoiding it in the first place. While no one is completely immune to the disease, there are steps you can take to drastically cut your risk.

Let’s Talk About Lung Cancer Screening and Prevention

Lung Cancer Screening & Testing

Preventing lung cancer relapse

Quit smoking to prevent lung cancer relapse

Eat foods to lower your lung cancer risk

Avoid saturated fat to reduce lung cancer risk

Raise your heart rate and lower your cancer risk

Predict lung cancer recurrence with precision medicine

Consider post-surgical nanotech drug delivery

Get follow-up lung cancer screenings

Coping with the fear of lung cancer recurrence

If lung cancer returns

Parts [1](https://www.healthcentral.com/article/lung-cancer-causes-screening-and-tools-for-diagnosis), [2](https://www.healthcentral.com/article/diagnosis-and-classifications-of-lung-cancer) and [3](https://www.healthcentral.com/article/lung-cancer-choosing-the-best-treatments) of this series of articles have set the stage for a discussion about the newest approaches to treat lung cancer. Surgery is still the preferred treatment for non-small cell lung cancer (NSCLC), while small cell type lung cancer so easily spreads due to the fragility of the cancer cells that surgery is rarely considered. Complete resection of the tumor, when possible, offers the best assurance of cure and long term survival.
 
Within the NSCLC category, the decision to treat surgically will depend on whether the patient can stand the surgery and be able, post-surgery, to live a reasonably good life with the remaining lung function after the resection. 

The other consideration is the extent of the spread of the tumor; this is when the TNM staging system becomes important. Stages I and II are considered “amenable and responsive to surgical resection.” These are tumor without lymph node involvement (stage I) or with involvement of the lymph nods in the involved lung (stage II). Stage III is when lymph nodes in the chest space between the lungs (mediastinal) are affected. When the mediastinal lymph nodes are on the same side of the involved lung, it’s classified stage IIIA. If they are on the opposite side then it’s classified as stage IIIB. Stage IIIA is also considered to be a candidate for surgical resection.

Chemotherapy post-surgery (called adjuvant chemo) is recommended for all tumors classified as stage II. In addition to chemotherapy, post-surgery radiation therapy is recommended when the excised tumor has cancer cells that extend to the margins of the excised area (called R1) – which “suggests” that every last cell may not have been removed during the resection – and for all stage III lung cancers.

### Surgical procedures that may be used to resect lung cancer include:

__Lobectomy:__ This is the surgical resection of a single lobe of the lung. It is the optimal treatment measure because it leaves the other lobes intact and helps to preserve better lung function because there is no disruption of the blood supply.  The procedure is done by either opening the chest (open thoracotomy), or by using a solid tube (thoracoscope) inserted between the ribs, guided by video (VATS). This last procedure has the advantage of being minimally invasive. Both approaches require general anesthesia. Tumors located towards the center of the lungs are not amenable to lobectomy.

__Limited sublobar (wedge) resection:__ This is an option for patients who cannot tolerate a full lobe resection because of co-morbid chronic illnesses or advanced age. The procedure is limited to treating tumors that are less than 3 cm. The procedure is done with VATS. The data on long term survival after this procedure is conflicting, but is more favorable for stage I lung cancer

__Intra operative brachytherapy:__ This procedure involves implanting a radioactive seed at the edge of the resected tissue. Its purpose is to decrease the incidence of local cancer recurrence.  Initial data on results have been promising. This is especially useful for those with positive tumor margins (R1)

__Mediastinal Lymph node dissection:__ Indicated for those with stage II or III lung cancers, lymph nodes located in various sites in the chest are chosen to be dissected based on samples taken during the surgery via frozen sections. The rate of success depends on the accuracy of the staging of the tumor, and precisely identifying the involved lymph nodes. 

### The options for radiation therapy include:

__Stereotactic body radiation therapy:__ This technique delivers a number of high radiation dose to a small area by multiple convergent beams. This technique allows for a rapid limiting of the dose at the edges the tumor, which helps to prevent harm to the normal tissue. This is particularly useful for those with advanced COPD.

__Conventional radiation therapy:__ This involves numerous sessions of lower doses of radiation, to a wider area mapped out on the outer chest. This approach is used when the tumor is too large for stereotactic therapy.  The potential complications are that radiation alters the white cells contained in the lung’s alveolar sacs and the resulting inflammation can cause scarring and fibrosis of the lungs. This can occur to the uninvolved lung, with consequences presenting up to two years post- treatment. 

__High dose brachytherapy:__ This approach is used in cases where the tumor is evident inside the opening of the airways and causing obstruction. A catheter is inserted via bronchoscopy, placed next to the tumor, and then a radioactive seed is presented to the tumor. This approach protects healthy tissue, allowing high doses via precise placement. 

### Chemotherapy options include:

The most common chemotherapy agents used are <a href="http://www.ofichem.com/en/cytostatics-cisplatin/" target="_blank">Cisplatinum</a> and <a href="https://www.drugs.com/cdi/carboplatin.html" target="_blank">Carboplatin</a> combined with <a href="https://www.ncbi.nlm.nih.gov/pubmed/8106152" target="_blank">Taxol or Taxotere</a>. <a href="https://www.drugs.com/gemzar.html" target="_blank">Gemzar</a> (gemzitabine) is a newer agent, and its action, similar to other chemotherapeutic agents is to interfere with the cell division by targeting DNA.  Like the other agents, it initially targets cells that divide at faster rates (which can, unfortunately, sometimes include “healthy cells” – a negative side effect).

Specific protocols guide the chemotherapy treatment. A standard course can be administered over one to three weeks and then repeated for a total of six courses, with rest periods in between each course.

While cancer cells are being “killed,” other normal cells are affected and possibly killed resulting in unwanted side effects like [anemia](http://www.healthcentral.com/encyclopedia/hc/anemia-3168970/), low white blood cell count (impaired immune function), and low platelet count (bleeding issues). Depending on how severe the side effects, chemotherapy may be discontinued. 

As mentioned in the earlier columns in this series, the advent of targeted cell therapy has greatly improved patient outcomes.

Overall, the long term survival rate of lung cancer has been a disappointing 10 to 15 percent. <a href="https://seer.cancer.gov/statistics/summaries.html" target="_blank">This is primarily because 70 percent of patients are diagnosed withadvanced stage III disease</a>. The survival can be as high as 73 percent with stage IA. This data is provided by the largest series in lung cancer, National Cancer Institute’s <a href="https://seer.cancer.gov/" target="_blank">Surveillance, Epidemiology and End Results (SEER) Program.</a> The keys to improved survival outcomes in lung cancer rest on: 
- Identification of high risk groups and mitigating the risk factors;
- Identification of unique cellular markers in an individual which help to improve formulation of therapy options;
- Improved diagnostic and surgical techniques which can be obtained in tertiary centers that can handle a large volume of cases;
- Improved identification of unique features of different tumors through special stains and cellular markers;
- Specific targeted therapy with new and ever-emerging biological agents.




The Newest Technologies to Treat Lung Cancer-iStock-94463987

Early-stage lung cancer can often be treated with surgery, but there are now many treatment options available. Here's a look at the latest surgical procedures, radiation, and chemotherapies for lung cancer.

Learn about the latest treatments available for lung cancer, including cutting-edge surgical procedures, radiation, and chemotherapies.

The Newest Technologies to Treat Lung Cancer

Lung Cancer: Cutting-Edge Technologies for Treatment 

Once the diagnosis of cancer is made, cell type and the patient’s condition (as discussed in [Part 2 on lung cancer](https://www.healthcentral.com/article/diagnosis-and-classifications-of-lung-cancer)) will determine treatment. Remember that all lung cancers are identified as either small cell carcinoma (with staging) or non-small cell lung cancer (NSCLC) with staging. 

Now with the latest advancements in treatment known as “target-directed therapy,” the biopsy tissue is examined in depth, undergoing even more intensive classification of the NSCLC tumors. This approach led to the World Health Organization's (WHO) 2015 new classification of lung cancer, based on __histology__ and not extent and spread, which the TNM system (tumor, node, metastases) used.

Special stains are introduced to the biopsy that further help to differentiate the cell types. These special stains are also useful in distinguishing when the tumor is “a primary mass from the lung” or if it is due to metastases from a bladder, breast, colon, kidney, or prostate cancer, among others.

In the past, [squamous cell cancer](http://www.health.harvard.edu/cancer/squamous-cell-carcinoma-of-the-lung) was the most common type of non-small cell lung cancer. Now, it’s been outpaced by <a href="https://www.drugs.com/health-guide/adenocarcinoma-of-the-lung.html" target="_blank">adenocarcinoma</a>, which accounts for approximately one half of all lung cancer cases. 

There are several theories for this. One is that the type of cigarettes available changed with time along with smoking patterns. The new cigarettes have filters and low tar so smokers tend to finish the cigarette, unlike previously when only half or two thirds of the cigarette was smoked. As you smoke the cigarette close to the filter, different carcinogens that accumulate (nitrosoamines), and they’re linked to adenocarcinoma risk. 

In addition, there are many environmental and food sourced nitrosamines (e.g., charred meat) that may influence the prevalence of adenocarcinoma. Expect to hear more about these carcinogens as vaping and smokeless cigarettes become even more popular.

Adenocarcinoma tissue (obtained from a biopsy) is further tested for mutations in:

<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256436/" target="_blank">Epidermal growth factor receptor (EGFR)</a>, which is more common in women with no smoking history. These patients can be treated with the biological agents <a href="https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/targeted-therapies.html" target="_blank">Erlotinib (Tarceva) and Gefitinib (Iressa)</a>.  

<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888755/" target="_blank">EML4-Alk translocation</a> is an abnormal configuration of the DNA, where two genes fuse, and the abnormal protein that is produced promotes uncontrolled growth of cells. These patients are treated with a biological agent called Crizotinib (Xalkori) that has been known to achieve 60 percent response rate.

<a href="https://www.mycancergenome.org/content/disease/lung-cancer/kras/" target="_blank">KRAS mutation</a> (discussed in Part 1 on lung cancer) is an oncogene that promotes uncontrolled growth of cells, leading to a genetic risk of lung cancer. It occurs in approximately 25 percent of all patients with NSCLC. <a href="https://www.cancer.gov/publications/dictionaries/cancer-drug?cdrid=734824" target="_blank">Selinexor</a> is currently recommended for treatment, though the efficacy is still not fully known and more research is needed.

Other features of the adenocarcinoma can be identified to help predict behavior of the tumor and prognosis, as well.

The good news is that all these variables help to direct individualized treatment for every patient, rather than having one protocol for all adenocarcinoma lung patients, as in the past.

Another change is the help that the new classification provides. Previously there was a type of cancer, bronchoalveolar cell carcinoma, which was often confused with a pneumonia diagnosis on standard chest x-rays. Delayed diagnosis often occurred. It is now identified as <a href="https://radiopaedia.org/articles/adenocarcinoma-in-situ-minimally-invasive-adenocarcinoma-and-invasive-adenocarcinoma-of-lung" target="_blank">adenocarcinoma in situ</a>, and treated and staged the same way as other adenocarcinomas, with an excellent prognosis. 

<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744181/" target="_blank">Squamous cell lung cancer</a> is the second most common kind of non-small cell lung cancer. It arises in the inner portion of the lung, which makes it more difficult to resect. It is more strongly associated with smokers and comprises 20-30 percent of the NSCLC. It is associated with 40,000 - 50,000 deaths per year in the U.S. In contrast to adenocarcinoma, advancements in treatment have been slow to identify biologic agents.

<a href="https://www.verywell.com/large-cell-carcinoma-of-the-lungs-2249356" target="_blank">Large cell lung cancer</a> is the rarest form of NSCLC.  It is often made as a diagnosis of exclusion and not infrequently referred as “non-small cell lung cancer not otherwise classified” (NSCLS-NOS) as suggested by the WHO classification. It usually grows in the periphery of the lung and is often amenable to surgery.

<a href="https://www.cancer.org/cancer/small-cell-lung-cancer/about/key-statistics.html" target="_blank">Small cell lung cancer</a> comprises 15 percent of all the cancers and is rarely found in non-smokers. Its name reflects the size of the cells that are similar in size to blood lymphocytes with the nucleus taking up most of the cell. These cancer cells are extremely fragile, breaking easily and leading to high rate of spread. That’s why resection is not recommended for this type of cancer.

Newer biological agents, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24955707" target="_blank">PD-1 inhibitors</a>, have been developed for small cell cancer.  The mechanism of these drugs (<a href="https://www.ncbi.nlm.nih.gov/books/NBK26873/" target="_blank">programmed death</a>) is to help prevent lymphocytes from exhaustion as they fight off the tumors.  The lymphocytes can then be far more effective battling and destroying the cancer cells.  These PD-1 inhibitors include <a href="https://www.cancer.gov/about-cancer/treatment/drugs/nivolumab" target="_blank">Nivolumab (Opdivo)</a> and <a href="https://www.cancer.gov/about-cancer/treatment/drugs/pembrolizumab" target="_blank">Pembrolizumab (Keytruda)</a>.

<a href="http://www.cancer.net/cancer-types/neuroendocrine-tumor" target="_blank">Neuroendocrine tumors</a> have the ability to secrete hormones that act on distant sites causing changes in the body’s natural steroids, sodium and calcium levels, among other functions. They comprise groups from the small cell, large cell and a non-malignant type of tumor called carcinoid. Despite being “different cancers,” these all share a similar origin, arising from remnants of embryonal cells. In this case, changes in the above mentioned levels may actually point to diagnosis of this type of lung cancer tumor. 

The goal in treatment of lung cancer continues to focus on finding more targeted therapies with fewer side effects.


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Once lung cancer has been diagnosed, typed and classified, your doctor will help you decide the best way to treat it. Here's what you should know about the latest advancements in treatment, known as target-directed therapy.

Target-directed therapy can help ensure you get the best treatment for your condition after lung cancer has been diagnosed, typed and classified.

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