If you've been diagnosed with early stage lung cancer, symptoms like fatigue, loss of appetite, and changes in your fingernails could be indications that your lung cancer has metastasized.

Signs Lung Cancer Has Advanced

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.

iS-What Are the Risk Factors for Lung Cancer-iStock-539329628-promo

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

Everything you need to know about lung cancer, including signs, types, stages, survival rates, and more.

More info on Lung Cancer

Lung Cancer

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

We've got the doctor-approved details on causes, symptoms, treatments, and a jillion other facts and tips that can make life with lung cancer easier.

Let's Talk About Lung Cancer

Lung Cancer Symptoms, Causes, Treatments, Surgeries, and more

iS-Signs Your Lung Cancer Has Advanced or Metastasized-iStock-839871556-promo

Fatigue, loss of appetite, and changes in your fingernails could be signs that your lung cancer has metastasized.

10 Signs That Lung Cancer Has Spread

Lung Cancer: Signs It Has Advanced

Fatigue is sign lung cancer has advanced

Cough that won’t go away could be an issue

Shortness of breath could indicate spread of lung cancer

Loss of appetite could mean your lung cancer has metastasized

Pain symptom of advanced lung cancer

Hoarse voice could be indication of advanced lung cancer

Difficulty swallowing could be another sign of lung cancer advancement

Changes in the shape of your fingers and nails possible symptom

Edema potential symptom of advanced lung cancer

Other symptoms of lung cancer spread

iStock-495867223-3

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

Living With Lung Cancer

Signs Your Lung Cancer Has Advanced

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. 

There are two major types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Here's what you should know about how they're different, and the symptoms and subtypes for each type.

iS-What's the Difference Between Non-Small Cell Lung Cancer and Small Cell Lung Cancer-iStock-531981340

Learn about the symptoms and subtypes of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), and how the two types are different.

Do You Know the Two Types of Lung Cancer?

Lung Cancer Types and Subtypes Explained

What's the Difference Between Non-Small Cell Lung Cancer and Small Cell Lung Cancer?

branches and flowers in the shape of lungs

GettyImages-1042128970

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

Treating Lung Cancer Without Surgery

Rajal Patel, M.D.

Medical Reviewer

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.

bench-accounting-C3V88BOoRoM-unsplash

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?

kate-sade-2zZp12ChxhU-unsplash

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

About 55 to 90 percent of people with lung cancer will have shortness of breath, formally called dyspnea. Treating the complications of lung cancer—such as fluid in the lungs, infections, anxiety, pain, disordered breathing, or radiation-induced inflammation—can do a lot to help you breathe easier.

Middle age woman stretching in an outdoor exercise class.

iStock-538196126-promo

A common side effect of lung cancer is shortness of breath, which can be uncomfortable and even frightening. Here are some ways to manage the challenge.

Catching Your Breath With Lung Cancer

Try These Suggestions for Shortness of Breath in Lung Cancer

Why am I short of breath?

How common is shortness of breath?

Breathless, even when you have enough oxygen

First treat the underlying cause

Palliative care for shortness of breath

Acupuncture and acupressure

Mind-body and relaxation techniques

Are you still smoking?

Avoid infections and stay hydrated

Exercise, pillow props, and supplemental oxygen

Incentive spirometer

Manage anxiety

Treat the side effects of cancer therapies

Take charge of your dyspnea

Lung Cancer: Managing Shortness of Breath

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.

iStock-475994237

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

Nobody deserves lung cancer, but people can be quick to blame lung cancer patients for their condition, especially if they smoked. Here's how you can fight the stigma through education, support groups, and advocacy.

A circle of hands holding out lung cancer awareness ribbons.

iStock-847506470-promo

Don't get drawn into the blame game of believing you deserve lung cancer because you were a smoker. No one deserves cancer, and you can fight the stigma.

Lung Cancer Stigma: Fighting the Blame Game

Jerry Kennard, Ph.D.

Lung Cancer Stigma: Fight to Urge to Blame 

How lung cancer stigma develops

Lung cancer stigma punishes the victim

Recognize smoking is not the only risk factor

Educate to combat lung cancer stigma

Join lung cancer support groups

Talk to your doctors about stigma

Embrace your supporters; avoid finger-pointers

You can’t change the past

Get involved in lung cancer advocacy

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

iS-Preventing non-small cell lung cancer recurrence-iStock-935760226-Promo

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

man running through hills-stage-7-photography-cdhtUbXmXIw-unsplash

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

Grace Suh M.D.

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

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

Changing you diet can help control lung cancer symptoms or nausea from treatment. Here are 7 ways to eat a good diet, including fresh vegetables, smoothies, and bland, but not boring, options when you feel sick.

iStock-530558373.jpg

Whether you have nausea from chemotherapy, want to cut sugar after surgery, or simply seek to manage your lung cancer symptoms, a healthy diet can help.

7 Helpful Diet Changes With Lung Cancer

Lung Cancer and Nutrition: 7 Delicious Tips

Seven Delicious Ways to Support Your Lung Cancer Treatment

Non-small cell lung cancer

Treating by subtypes

Subtypes of non-small cell lung cancer

Less common subtypes of non-small cell lung cancer

Signs and symptoms

Treatments for non-small cell lung cancer

Small cell lung cancer

Subtypes of small cell lung cancer

Most aggressive form of lung cancer: small cell lung cancer

Symptoms of small cell lung cancer

Treatment for small cell lung cancer

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 

Follow Us

Living With Lung Cancer

Featured