Whether you’re facing a lung-cancer diagnosis yourself or are worried about having a higher-than-average risk, you deserve answers. And clear ones, too. That’s what we’re here for. HealthCentral’s number-one priority is to share the realities, the challenges, and the very best options available to you to handle your diagnosis—or the possibility of one. We teamed up with top experts in the field—plus people who’ve been where you are now—to give you the knowledge and courage you need. We’ll get through this together.
We went to some of the nation's top experts in lung cancer to bring you the most up-to-date information possible.
Jacob Sands, M.D.Thoracic Medical Oncologist and Instructor in Medicine
Jorge Gomez, M.D.Medical Director of the Thoracic Oncology Program and World Trade Center Oncology Clinic
Elisabeth Dexter, M.D.Thoracic Surgeon and Quality Assurance Officer for the Department of Thoracic Surgery
What Is Lung Cancer, Anyway?
Like all forms of cancer, lung cancer begins with a plain-and-simple genetic mutation. Cells that were once healthy begin to grow abnormally, and thanks to that DNA glitch, they get themselves stuck in a place of perpetual replication. Eventually, the now-wonky cells clump together to form a mass (or tumor). The tumor then works to weaken and destroy otherwise healthy lung tissue, which makes breathing and the act of moving oxygen throughout the body exceedingly more difficult.
Right this minute, about 13% of all new cancer cases in the United States start in the lung. While that might not seem like a ton, it actually is. Lung cancer is the second-most common cancer in both men and women in the US, with more than 228,000 people diagnosed with lung cancer each year. The disease is usually classified into two main types:
Non-small cell lung cancer (NSCLC): This type of lung cancer is often slow-growing and accounts for as many 85% of all lung cancer cases, according to The American Cancer Society. There are quite a few types of non-small cell lung cancers. The most common:
squamous cell carcinoma, which starts in the thin, flat cells lining the lungs
large-cell carcinoma, which often starts along the lungs’ outer edges
adenocarcinoma, which begins in the cells that line the tiny air sacs of the lungs
Small cell lung cancer: There are two main types of small cell lung cancer (aka oat cell cancer): small cell carcinoma and combined small cell carcinoma. Up to 15% of all lung cancers are SCLC, which tend to grow and spread faster than non-small cell.
What Causes Lung Cancer in the First Place?
Yes, it’s true that anyone with lungs can get lung cancer. It’s also true that smoking tobacco is, by far, the biggest risk factor for developing the disease. The reason: With every puff of a cigarette, 250 known dangerous chemicals are pulled into the lungs. And at least 69 of those chemicals have been proven to cause cancer.
Those chemicals, called carcinogens, can then go on to damage DNA. And since DNA is in charge of how cells reproduce and function, when it gets beat up like this, it can cause cells to mutate and grow erratically, leading to cancer. Cigarette smoke is so dangerous, in fact, that The U.S. Environmental Protection Agency, the U.S. Surgeon General, and other organizations have classified secondhand smoke as a carcinogen, as well.
Of course, smoking cigarettes, cigars and/or pipes—or being subjected to their passive smoke—is not the only cause of lung cancer. Here are other factors that can increase your chances of developing the disease:
Radon: This odorless and colorless radioactive gas is naturally found in decaying elements in the soil. If it seeps into inadequately ventilated buildings or structures (like your basement) it can be inhaled and damage lung cells. You can test your home for radon with a DIY kit.
Workplace chemicals: Arsenic, asbestos, cadmium, chromium, nickel, some petroleum products, and uranium are among the most dangerous chemicals.
Air pollution or particle pollution: Regularly breathing in particles emitted from wood stoves, vehicles, wildfires, power plants and more is thought to play a role in developing lung cancer.
Genetics: Your family history of lung cancer can also play a part in your personal risk. For instance, individuals who inherit DNA changes in chromosome 6 are more susceptible to lung cancer than others, even if they’ve never smoked.
Radiation therapy: Cancer survivors who’ve had radiation therapy to their chest are at a slightly higher risk of lung cancer down the road. For instance, a woman’s risk of developing lung cancer after breast-cancer radiation is approximately 1 in 200.
History of lung disease: People with chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis are at increased risk. It’s thought that, in part, COPD increases oxidative stress, which damages DNA in the lungs, spurring lung cancer.
Should I Be Screened for Lung Cancer?
Answer these yes/no questions find out:
Are you between the ages of 55 and 80 and in relatively good health?
Have you been smoking or did you previously smoke (at least) a pack a day for 30 years or two packs a day for 15 years?
Do you still smoke or did you quit within the last 15 years?
Lung cancer is tricky. There are very few nerve endings inside the lungs, which means a tumor growing there might as well be protected by stealth technology.
Translation: Early symptoms of lung cancer are hard to notice because there’s rarely pain or discomfort. Instead, most lung cancer cases don’t cause any worrisome signs until the disease has become advanced, or even spread to other parts of the body (we know…scary).
However, if you’re aware of even the most subtle signs of lung cancer, seek medical help when you first notice symptoms—and make sure you get screened if you’re at higher risk—you have a significantly better shot of getting your lung cancer diagnosed at an earlier stage, when treatments are more likely to be effective. While signs vary from person to person, here’s what to watch for:
Persistent cough that worsens with time (this is the most common symptom)
Shortness of breath or wheezing when active
Coughing up blood or bloody phlegm
Developing a hoarse voice
Consistent chest pain, especially when breathing in deeply
Repeated lung infections, such as bronchitis or pneumonia
Real talk: Having a cough does not mean you have lung cancer. Even having some wheezing doesn’t mean you have cancer. These types of respiratory symptoms are super common among all of us.
And, to make matters more murky, many people who are at the highest risk for lung cancer, cough or wheeze because of other conditions, like chronic obstructive pulmonary disease (COPD).
However, any new, unexplained shortness of breath or intractable cough should always prompt an ASAP physician visit. And any symptom that isn’t resolving quickly—and by quickly we mean anywhere from a few days to a couple of weeks—should be evaluated, as well.
How Do Doctors Diagnose Lung Cancer?
Many people discover they have lung cancer incidentally. Or, rather, the suspicion of lung cancer is not what brought them to the doctor’s office in the first place. In fact, lung cancer is often found on an X-ray or CT scan being done for a totally different reason. However, if the worry of lung cancer has brought you to your doctor’s office, here’s what you can expect from your visit:
Medical and family history: Have you had radiation therapy in the past? Any lung cancer in the family?
Risk factors: Do you smoke now or have you in the past? Any contact with radon, asbestos, or other worrisome chemicals?
Symptoms: Got a persistent cough? Does it hurt to breathe in deeply?
Physical exam: Enlarged lymph nodes? Fluid around the lungs?
If red flags are raised, you’ll get further testing. Some of them will include imaging tests, such as:
Chest X-ray: Quite often, this is the first test your doctor will order. If there’s something suspicious on the scan, more testing will be ordered.
LDCT scan: Low-dose computed tomography scans are like amped up X-rays that take numerous super-detailed cross-sectional images of the body.
PET scan: Here, a small amount of radioactive material is injected into your bloodstream. That material is then able to, essentially, clump around tumors making them visible to the radiologist.
MRI scan: Magnetic resonance imaging uses radio waves and strong magnets to garner detailed images of soft tissues.
Imaging tests are incredibly helpful in the diagnosis of lung cancer, but they don’t offer for-sure answers. For that, your doctor will need to use a microscope to examine tissues or fluid taken from your lungs. Here are some ways in which that is done:
Sputum test (or sputum cytology): You’ll have to cough up mucus (aka sputum) during your visit; the lab will check to see if it contains cancer cells.
Thoracentesis: Got fluid around your lungs? Your doctor may insert a hollow needle between your ribs in order to suck some out to analyze.
EBUS (endobronchial ultrasound): This is kinda like a colonoscopy but for the other end. A thin flexible tube (a bronchoscope) fitted with a teeny camera and a fine needle is threaded into your lungs via your mouth or nose. This allows your physician to take a closer look at your lungs and extract cell samples. And yes, you’re completely knocked out for this one.
FNA (fine-needle aspiration biopsy): If the thin tube above can’t quite reach your suspicious spot, you may need a hollow needle inserted through your chest wall, instead. This is done with the help of a special CT scan that helps the doctor see where to go. You’ll likely get some IV meds to relax you and some local anesthetic where the needle is inserted.
If cancer cells are detected in any of the above tests, you’ll get even more tests to help determine what specific type of lung cancer you have; the stage; how quickly or slowly the cancer may progress or spread; and which treatment options are right for you.
Even when it’s caught early, some people with lung cancer aren’t healthy or strong enough to undergo surgery to remove the tumor. Fortunately, there is another option.
What's the Best Treatment for Lung Cancer?
There is no one-treatment-fits all for lung cancer patients. Your medical team may order something totally different than what your cousin’s neighbor’s sister had. Your treatment depends on the type of cancer you have; what stage (how much it’s spread) your cancer is at; and your overall health.
No matter which treatments you forge ahead with, there’s one thing that’s for certain: If you’re currently a smoker, you have to stop. Kicking the habit, even after a lung-cancer diagnosis, yields better outcomes than if you continued smoking, according to research in the journal Oncology. Here’s an overview of your treatment ops.
The idea of surgery can be scary and overwhelming. But for certain patients, especially those with localized (meaning the cancer hasn’t spread) early-stage non-small cell lung cancer, surgery offers the best chance to cure the disease.
Lobectomy: Here, the entirety of one cancer-laden lobe (or section of your lung) is removed. If two lobes are taken, that’s a bilobectomy.
Sleeve lobectomy (aka sleeve resection): One lobe get removed, but so does the main bronchus (aka air passage) of your sick lung.
Segmentectomy: With a segmentectomy, or segmental resection, up to four segments of your impacted lobe can be removed, sparing the rest of the lobe.
Wedge resection: Your tumor and the area of tissue surrounding the tumor is removed, or resected, with a pie-slice-shaped cut. This option removes less tissue than a lobectomy and segmentectomy and is recommended if the cancer is contained to a small area.
Pneumonectomy: This is the big one in which your entire cancer-affected lung is removed. This is generally only done if your cancer can’t be totally resected via another means or if your tumor is in holding center court in your lungs.
You’ve heard of chemotherapy. You know that one of its most tell-tale side effects is losing your hair. The reason that happens? The powerful medications used in chemotherapy kill normal, healthy cells right along with cancer cells. Unfortunately, there’s no cell discrimination here. Chemo is normally administered intravenously, and it can be utilized at various points of treatment for various reasons, like to shrink your tumor prior to surgery or to kill cancer cells.
While chemotherapy meds shoot willy-nilly at all cells, targeted therapy is more precise, zeroing in on just the cancer cells. This type of treatment, however, does not work on all lung cancers. To determine if this may be an option for you, your physician may test your tumor for certain mutations (errors or changes in DNA) that can be inhibited by drugs designed specifically for that mutation.
This option relies on powerful, high-energy X-rays to kill cancer cells. External-beam radiation therapy is when the cancer-killing rays are delivered by a big ol’ machine outside the body. This is what’s most often used. For others, internal radiation therapy (aka brachytherapy) is an option, where a radioactive source is placed directly at your tumor site.
Immunotherapy is a very promising, and new, option. With it, drugs are used to empower your very own immune system to recognize cancer cells as the enemy and bully them out of your system. Right now, several lung cancer immunotherapy drugs are FDA approved and in use for people with advanced-stage lung cancer.
How Serious Is Lung Cancer?
We’re not going to sugarcoat it: Lung cancer is a big deal. It’s the leading cancer killer for both men and women in the US. But it doesn’t have to be this way. One of the main reasons that lung cancer is so dangerous is that it’s not spotted early enough for treatments to be their most effective. When lung cancer is detected and treated early, before it has spread, survival rates jump. For example, the five-year survival rate for localized lung cancer is 51% higher than for those cancers that have spread to other organs.
Plus, early detection, thanks to low-dose CT screening, can decrease lung cancer mortality by up 20% among certain high-risk people. Right now, there are about 8 million American who are considered high-risk for lung cancer who should get screened every year. If just half of those folks actually went ahead and got screened, 12,000+ lung cancer deaths could be prevented each year. And remember, if you quit smoking before you turn 40, you can reduce your chance of dying prematurely from a smoking-related disease by 90%. Quit by age 54? You can still whittle down your chances by two-thirds.
What Steps Can I Take Today to Lung Cancer Prevention?
The big hitters will be of no surprise to you: Don’t start smoking; quit smoking if you’re already doing it; and avoid exposure to secondhand smoke. If you manage to kick your cigarette, cigar, or pipe habit before lung cancer develops, your damaged lung tissue will gradually begin to heal and repair itself.
Not only will your lung function begin to improve within three months of quitting, by 10 years out, your risk of lung cancer can decrease anywhere from 30% to 60%, according to the National Cancer Institute. Plus, in that same time frame, you will have halved your chance of dying from lung cancer.
If 10 years seems like a long time, know this: Most people diagnosed with lung cancer are 65 or older, with the average age of diagnosis hovering around 70. So you may have more time to right the course than you think.
Other preventative steps to take:
Test your home for radon. It’s the number one cause of lung cancer among non-smokers, according to estimates by the EPA, which recommends that all homes be tested. You can easily pick a radon detector up at any hardware store.
Eat fruits and vegetables. Consuming a healthy diet, filled with plenty of produce may also help lower your risk of lung cancer. Of course, if you’re smoking at the same time you're filling up on salads and smoothies, you’re dampening much of the benefits.
Limit exposure to carcinogenic chemicals. If you suspect you’re being exposed to dangerous chemicals at work, ask your employer to give you Safety Data Sheets (SDSs) on each of the chemicals that you may be in contact with. Handing this info over to you is required by law.
Where Can I Find Lung Cancer Communities?
There are about 541,000 American alive today who’ve heard their doctor say, “You have lung cancer.” It’s a benefit to you to find those people. Share your stories. Share what works and what doesn’t at home or at the doctor’s office. Some places to start:
Follow because: In 2011, Janet Freeman-Daily got the news: Non-small cell lung cancer. A shocking diagnosis, especially since she never smoked a day in her life. Today, she’s an influential lung-cancer advocate, a co-moderator #LCSM (Lung Cancer Social Media) chat on Twitter, and in remission since 2013. Start here for the Cliff Notes version of her journey thus far.
Follow because: This blog is not written by a lung cancer patient. Instead, it’s written by the wife of a lung cancer patient. Here, Kathy chronicles the daily ins-and-outs of being in a young family struck by disease. (Her husband Jeff was diagnosed in 2013 at the age of 42.) It’s a compelling and touching insight into how lung cancer deeply affects all involved.
Follow because: He dons the role of Medal of Honor recipient, has fought in Afghanistan as a special forces medic, and serves as part of the U.S. Secret Service Counter Assault Team. Now he takes on probably his biggest enemy yet: lung cancer.
Follow because: Her bio says it all, “She believed she could, so she did.” She’s a 10-year-strong cancer thriver with the trifecta of cancers: lung, bone, and brain. Ten years and going strong in life, love, and adventures that make you swoon.
Top Lung-Cancer Related Podcasts
Lung Cancer Voices. When we say voices, we mean all the voices: From oncologists, patients, caregivers, healthcare professionals, and leading lung cancer researchers. They’re breaking it down into layman lung language so you can understand the latest, greatest, and most inspiring of the lung cancer world.
The Stupid Cancer Show. They said it—but we can’t agree more. Cancer is stupid—especially when you have to tell your kids, or you’re diagnosed while pregnant, or you yourself are a kid. Any way you slice it—stupid. While this podcast covers all walks of life with all walks of cancer, there is a two-part episode specifically about lung cancer that will have you hooked.
Top Support Groups and Nonprofits
I Had Cancer. This site is a treasure trove of support. Sign up; search for “Lung Cancer;” and other members of I Had Cancer with the same diagnosis pop right up, ready for you to message. You can also take a more passive route (no shame!) and simply read first-person accounts on cancer-specific topics, like how to deal with chemo side effects.
The American Lung Association. In addition to offering lots of up-to-date info on all things lungs, ALA also features the Lung HelpLine and the Tobacco QuitLine, both of which are staffed with experts to help navigate questions related to either your diagnosis or your desire to quit smoking. It’s free to use and you can either call 1-800-LUNGUSA or send your question via their website.
LUNGevity LifeLine Support Program. This unique matchmaking service hooks up newly diagnosed lung cancer patients with survivors (or family members and caregivers of survivors). The been-there-beat-that volunteers mentor and encourage newbies with their experience and hope. You can connect via email or phone.
Here’s the thing: E-cigs haven’t been around very long and a lung cancer diagnosis typically develops decades from exposure. So it would be misleading to draw conclusions about lung cancer risks at this point. However, there are toxins in e-cigarettes. They are not safe.
What is the most aggressive form of lung cancer?
Small cell lung cancer, which makes up about 10% to 15% of all lung cancers, is the most aggressive form of the disease.
What percentage of lung cancer is smoking responsible for?
It’s estimated that smoking is responsible for almost 90% of all lung cancer cases.
What accounts for the majority of cases of lung cancer?
Adenocarcinoma, a non-small cell lung cancer, accounts for almost 39% of all lung cancer cases. Squamous cell carcinoma is the second most common lung cancer, accounting for 20% of all cases. Large cell carcinoma makes up less than 3%.
Genetic Lung Cancer Influence:Cancer Research. (2010). “A susceptibility locus on chromosome 6q greatly increases risk lung cancer risk among light and never smokers.” ncbi.nlm.nih.gov/pmc/articles/PMC2855643/
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.