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. 

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

Lung-cancer-cells-iStock-529407626

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

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

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

Living With Lung Cancer

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?

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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

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

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

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.


chemistry-is-496442732.jpg

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.

Lung Cancer Treatment Options

Choosing The Right Lung Cancer Treatment For You

Lung Cancer: Choosing the Best Treatments

[Lung cancer is the most common cancer in the world.](http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/lung-cancer-statistics) In 2012, 1.8 million new cases were diagnosed. Yearly, there are an almost equal number of deaths from lung cancer. In the United States, 225,000 new cases are diagnosed annually, and there are 160,000 fatalities a year due to this cancer.

Cases of [lung cancer](http://www.healthcentral.com/slideshow/7-signs-and-symptoms-of-lung-cancer) have grown steadily over the past several decades. In 1958, lung cancer was the most common cause of cancer death in men. By 1985, it was the most common cause of death among women, reflecting the delayed “catch up” that reflected increasing numbers of women smoking as a regular habit. In recent years, lung cancer deaths have showed some decline in the U.S. (but not yet globally), reflecting a decline in rates of smoking and also more effective treatments for [lung cancer](http://www.healthcentral.com/slideshow/5-facts-about-non-small-cell-lung-cancer).

[Risk factors](http://www.healthcentral.com/slideshow/8-myths-about-lung-cancer) that contribute to lung cancer have been studied extensively. [Smoking](http://www.healthcentral.com/slideshow/14-lesser-known-risks-of-smoking) is still the clear front runner, associated with over 90 percent of lung cancer cases. Still, growing attention is now being paid to cases of [lung cancer](https://www.healthcentral.com/condition/lung-cancer) in non-smokers, and there has been an accelerated effort to identify other factors that are contributing to lung cancer rates, especially in women. 

Some of those [identified factors](https://www.cancer.org/cancer/non-small-cell-lung-cancer/causes-risks-prevention/risk-factors.html) include:

- __Radiation therapy__ received as treatment for other malignancies
- __Environmental toxins__: Exposure to second-hand smoke, occupational exposure to asbestos and metals including chromium, arsenic and polycyclic aromatic hydrocarbons. The International Agency for Research on Cancer (IARC) has a <a href="http://monographs.iarc.fr/ENG/Classification/" target="_blank">classification for many substances that have carcinogenic potential</a>.
- __Other medical conditions__ that increase the tendency for malignant transformation in the lung. Some examples include [pulmonary fibrosis](https://www.healthcentral.com/condition/pulmonary-fibrosis), HIV, and inflammatory conditions such as [ulcerative colitis](https://www.healthcentral.com/article/what-are-the-types-of-ulcerative-colitis) and polymyositis.
- __Genetic factors__: This is determined by familial history and the implications are also used to determine the response to specific therapy.
- __Dietary factors__: Some substances such as phytoestrogens (soy) and cruciferous vegetables have been shown to reduce the risk of lung cancer, but in one study that looked at [beta-carotene](https://www.healthcentral.com/article/supplements_may_raise_cancer_risk), results showed an increase of cancer in smokers who used this supplement. More research on dietary factors is needed.
- __Radon exposure__: This is a radioactive isotope of uranium that persists as remnants in the ground soil.

### What are the best strategies when screening for lung cancer?

The accumulated knowledge we now have of the variety of risk factors has helped to drive more opportunities to identify high-risk individuals who should undergo early intervention to mitigate some of these risk factors. Finding these individuals for early and robust screening of lung cancer is important.  

Doing regular chest x-rays on individuals who smoke is something that has made sense. In fact, if a smoker is [diagnosed with lung cancer](https://www.healthcentral.com/article/just-diagnosed-with-lung-cancer-10-tips-for-coping) and did not undergo routine chest x-rays, their doctor could be subject to a malpractice lawsuit. The truth is that long term studies have failed to demonstrate that <a href="http://jamanetwork.com/journals/jama/fullarticle/1104579" target="_blank">“yearly chest x-rays on smokers reduced mortality.”</a>  Since reducing mortality is the end goal, the U.S. Preventive Services Task Force now recommends against excessive use of chest x-rays as a screening measure. <a href="https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html" target="_blank">The protocol is to consider use of chest x-ray screening on an individual basis.</a> 

The recent National Lung Screening Trial that used low radiation CT scanners showed that using this tool for screening resulted in lower mortality rates. Medicare now pays for CT scans on asymptomatic patients who have risk factors. There are however a number of restrictions on the use of this screening tool. For example, a former smoker who quit smoking over 15 years ago is not considered a candidate for a CT scan, although this person may rightfully believe that he is not risk free and should have coverage for this type of screening. Patients under these circumstances would have to pay out-of-pocket.

The importance of screening rests in the fact that [by the time a tumor is discovered, there will likely have been a large generation of cells that have already divided and spread](https://www.healthcentral.com/article/i-was-diagnosed-with-a-lung-nodule-now-what). There are now screening blood tests that can identify early stages of some cancers (prostate and ovarian cancer). There are no current blood screening tests for lung cancer, however. 

Lung cancer typically starts with a normal cell that has proteins involved in regulating cell division and death, allowing for an orderly transition from old cells to new.  When this orderly regulation is disrupted or lost, cells divide at a faster rate.  This is important because it means that anything that can alter the structure of these proteins, such as [oxidative stress](https://www.healthcentral.com/article/smoking-copd-and-the-role-of-antioxidants), will prompt the process that further alters the structure and function of these proteins, and will likely instigate cancer.

The proteins that allow unrestricted cell growth are called oncogenes. They stimulate cell growth without being controlled by proteins that would normally suppress that growth. It’s like driving a car, stepping on the gas -- and the accelerator gets stuck. The car continues to speed up regardless of the driver’s desire. It’s an out-of-control situation.

The most frequently mentioned oncogene in lung cancer is called the <a href="https://www.nature.com/scitable/topicpage/cell-cycle-control-by-oncogenes-and-tumor-14191459" target="_blank">KRAS mutation</a> which is responsible for 10-30 percent of all adenocarcinomas).

<a href="https://www.nature.com/scitable/topicpage/cell-cycle-control-by-oncogenes-and-tumor-14191459" target="_blank">The process starts insidiously.</a> First there are areas of pre-cancerous cells that show the early changes in the proteins but are not affected by the irregular growth.  As these cells change and mutate with further cell division, they produce chemicals that cause the growth of more blood vessels. These blood vessels nourish the process and they eventually become cancer cells. Even then, it will take many divisions and growth cycles (months) until the growing tumor (nodule) blocks one of the small airways and can be visualized on a chest x-ray.

__Next: [Diagnosis and Classification of Lung Cancer](https://www.healthcentral.com/article/diagnosis-and-classifications-of-lung-cancer)__



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Lung cancer is the most common cancer in the world. Here's what you should know about the causes, screening options, and how lung cancer is diagnosed.

Lung Cancer Causes, Screening, Diagnostics

Lung Cancer: Causes, Screening, and Diagnostics

Lung Cancer: Causes, Screening and Tools for Diagnosis

Non-small-cell [lung cancer](https://www.healthafter50.com/cancer/article/what-is-lung-cancer) is the most common cause of metastatic brain disease, and whole-brain radiation therapy along with steroids has been widely used to prolong survival and improve quality of life in those patients.

However, there has been no strong evidence to determine whether this approach is better than supportive care alone.

To provide clarity, investigators recruited 538 patients from 2007 to 2014 with lung cancer metastases to the brain to participate in the Quality of Life After Treatment for Brain Metastases (QUARTZ) trial. Patients received optimal supportive care plus whole-brain radiation therapy or optimal supportive care alone.

Average survival for patients assigned to supportive care plus whole-brain radiation therapy was 64.4 days compared with 59.5 days for the group that received supportive care only.

The researchers also assessed the patients’ combined length and quality of life (quality-adjusted years of life, or QALY) and found a difference of just 4.7 days in favor of the whole-brain radiation therapy group. The rate of serious adverse side effects was similar in both groups, most commonly infections and neurologic or pulmonary problems. 

The QUARTZ researchers concluded that whole-brain radiation therapy provides little additional benefit, and omitting it does not affect quality of life or survival. One possible exception: The investigators note that for patients younger than age 60, whole-brain radiation therapy might offer a survival advantage.

*[Source: LANCET, published online, Sept. 4, 2016](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31391-5/abstract)*

Radiotherapy for Lung Cancer That Has Spread to Brain

Radiotherapy for Lung Cancer That Has Spread to Brain-iStock-108270897-hero

After lung cancer metastasizes to the brain, whole-brain radiation therapy is often recommended. However, a recent study shows little effect on quality of life or survival.

Radiotherapy for Lung Cancer That Has Spread to the Brain

Radiotherapy for Lung Cancer That Has Spread to Brain-iStock-108270897-promo

Does radiation therapy help after lung cancer spreads to the brain? This research says it does very little.

This May Not Work After Lung Cancer Spreads

Stephen C. Mathai, M.D., M.H.S.

Lung Cancer in the Brain, Should You Do Radiotherapy?

The overall five-year survival rate for patients in the United States with [lung cancer](https://www.healthafter50.com/cancer/article/what-is-lung-cancer) is approximately 17 percent, according to the National Cancer Institute. Fewer than half of all patients who undergo surgery for lung cancer survive as long as five years. But new data suggest that some older lung cancer patients who have surgery may beat those odds.

Researchers linked data from the Society of Thoracic Surgeons (STS) and the General Thoracic Surgery Database (GTSD) with claims data from the Centers for Medicare and Medical Services (CMS).

The GTSD data included 37,009 records for patients 65 years of age and older who underwent lung cancer surgery between 2002 and 2012. When linked with CMS data, the researchers had access to additional information on long-term outcomes and survival from the records of 26,055 patients.

The researchers found that survival in older patients was longer than expected. The median survival following lung cancer surgery for Stage I disease was 6.7 years—nearly two years longer than the NCI’s five-year survival rate.

The five-year survival rates for selected older patients with Stage III or Stage IV lung cancer who had surgery were 29.9 percent and 26.7 percent, respectively.

Your doctor will consider many factors before recommending lung cancer surgery. These findings can help doctors and patients make more informed decisions about this treatment.

[Annals of Thoracic Surgery, June 2016](http://www.annalsthoracicsurgery.org/article/S0003-4975(16)30136-9/abstract)

Lung Cancer Surgery: Better Odds for Older Patients

Lung Cancer Surgery: Better Odds for Older Patients-iStock-535041991-hero

After surgery for lung cancer, less than half of patients survive five years. But this study found that survival in older lung cancer patients who got surgery was actually longer than expected.

Older lung cancer patients who get surgery may have longer average survival than younger patients, according to this study.

Is Older Better With Lung Cancer Surgery?

When you have advanced NSCLC, you'll hear a lot of terms you might not understand. From adenocarcinoma to thoracentesis, here are definitions for the most common advanced lung cancer terms you'll hear.

Non-Small Cell Lung Cancer Terms

Cut through the confusing language around advanced lung cancer with this guide to the most common terms you might hear from your doctor.

NSCLC Medical Terms Decoded

Advanced Non-Small Cell Lung Cancer Terms and Definitions

18 Terms You Need to Know About Advanced Lung Cancer 

There are two main types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung carcinoma (SCLC). Learn the differences between the types and more. 

Lung Cancer Types

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

That’s right, there isn’t just one—but more than a dozen—different types and subtypes of lung cancer you can get. We asked the experts to walk us through the multiple variations of this challenging disease.

Let's Talk About Lung Cancer Types

What Are the Different Types of Lung Cancer?

Todd Gersten, MD

Vast majority of lung cancer cases are non-small cell

Types of non-small cell lung cancer

Most patients with early stage lung cancer are asymptomatic

The three most common symptoms

Quality-of-life issues

Smoking greatly increases a person's risk 

Survival rate varies by stage 

New testing for early detection underway

Tori Tomalia was 37 and a non-smoker when she was diagnosed with [lung cancer](https://www.healthcentral.com/collection/living-with-lung-cancer) in 2013, questioning why the disease was striking her.

As a child, she’d had bone cancer and spent most of a year at the Mayo Clinic in Rochester, Minnesota. When she told her childhood doctor about the lung cancer diagnosis, she said they’d never seen lung cancer in a former bone cancer patient.

“I’m that one in a million,” she says.

[Things have changed in the cancer world](https://www.healthcentral.com/article/the-newest-technologies-to-treat-lung-cancer) since her first stint with it: Drugs and treatments that were experimental at the time are now the norm. Chemo is easier to deal with. While her current treatment comes with exhaustion and a bit of brain fog, she spends quality time with her kids and husband — and has even embarked on a new career.

__Health Central (HC): How/when were you [diagnosed](https://www.healthcentral.com/article/lung-cancer-causes-screening-and-tools-for-diagnosis)?__

__Tori:__ It was the typical story, where I had a nagging cough and didn’t feel well — and didn’t think too much about it. It was January, when everyone was sick. The doctor said, “Oh, it’s probably asthma.” But it kept getting worse until a CT scan showed a huge tumor in my left lung. More testing revealed it had spread through my spine, shoulder blade, hip, and liver.

I was stunned. I thought that the way you get lung cancer was from smoking, so I didn’t understand how it was possible.

__HC: How did it change your life?__

__Tori:__ It changed it completely. At the time, I was in grad school and working on campus and directing a show; incredibly busy. My kids were 4, 2, and 2. I basically quit a lot of things; I was really sick, so I kind of had to put the brakes on everything.

__HC: How did it inspire you to start a new business?__

__Tori:__ My husband and I had already talked about opening a theater one day, but we’d always put it off, saying maybe when the kids are older, etc. But it had been percolating in our minds again, and there was this day I felt rotten. I said to my husband, “I don’t even know why I’m putting myself through this. It feels pointless.” He turned to me and said, “Maybe everything we do is pointless — why don’t we open a Pointless brewery and theater and make our pointless dreams come true?”

Plus there were practical factors: I couldn’t work a full-time job, and my good energy, I wanted to spend with my kids. So we thought maybe we could design a life for our family where I could still contribute, but let my health be my priority. We’ve decided to make this life happen.

We opened on Dec. 31, 2015. It’s going so well that we had to get extra space for our improv classes. My husband is a co-artistic director and does a lot of brewing the beer and hosting the shows. I’m the catchall person: I answer a lot of emails, I do stuff behind the scenes like marketing and posters.

__HC: How has theater been helpful?__

__Tori:__ I went to speak to a group of social workers once, and they commented that opening the theater was probably my own kind of therapy. I think it was, even though it was unconscious. It’s a way to think about the future in a safer way. My future is so uncertain, but I can imagine where Pointless could be in five years. It can exist beyond me. Whereas thinking about my family or kids is heartbreaking.

__HC: What have you learned that could help someone else in your position?__

__Tori:__ It’s both a good and a bad thing, but you have to stand up for yourself and your care. There was a mix-up early on in the trial I’m in where the doctors misread one of my scans and kicked me out of the trial. I spoke up, and they figured it out. In the beginning I wouldn’t have done that. But it’s been five years; I feel like I’ve earned a degree in patient advocacy.

I also found out I had the [ROS1 mutation](https://www.curetoday.com/articles/ros1-testing-is-increasingly-important-in-lung-cancer). That was a huge lesson in being my own advocate. I started diving in to what I could learn about lung cancer and reading about mutations. I wanted doctors to test me for every single thing that exists, but I only had a little biopsy tissue left. I told my doctors that I had a hunch that I have ROS1, and I asked them to test me just for that — and it turned out I was right. There’s hopeful treatment for it, so that opened a whole new path for me.

There’s a phrase I learned from a man I knew with [stage 4 cancer](https://www.healthcentral.com/slideshow/what-to-know-advanced-stage-lung-cancer): “stage 4 is no time to be timid.” 



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Tori Tomalia had bone cancer when she was young, then she was diagnosed with lung cancer as an adult. Here's her story, and how her experience inspired her to start a new business.

Tori Tomalia had bone cancer when she was young, then she was diagnosed with lung cancer as an adult. Here's her story.

Tori's One-In-a-Million Cancer Diagnosis 

A One-In-a-Million Lung Cancer Diagnosis 

'One In A Million': Lung Cancer Diagnosis Sparks Career Change

Stage 4 lung cancer is the most advanced stage of the disease. Here's what you should know about the specific symptoms, treatments, and survival rates of advanced lung cancer.

Advanced Stage Lung Cancer

iS-All About the Advanced Stage of Lung Cancer-iStock-490025288

Learn the specific symptoms, treatment options, and survival rates with advanced, stage 4 lung cancer.

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Living With Lung Cancer

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