Lung Cancer

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About

Lung cancer is a malignant tumour that starts in the cells of the lung. Malignant means that it can spread, or metastasize, to other parts of the body. When cancer starts in lung cells, it is called primary lung cancer.

The lung is part of the respiratory system. You use your lungs when you breathe. The lungs are in the chest, one on each side of the heart. The right lung has 3 main parts, called lobes. The left lung is a bit smaller and has 2 lobes. The lungs are cushioned and protected by a thin covering called the pleura. Cells in the lung sometimes change and no longer grow or behave normally. These changes may lead to benign tumours such as hamartoma and papilloma. Benign tumours are not cancerous. But in some cases, changes to lung cells can cause cancer. Lung cancers are divided into non–small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) based on the type of cell in which the cancer started. Non–Small Cell Lung Cancer usually starts in glandular cells on the outer part of the lung. This type of cancer is called adenocarcinoma. Non–small cell lung cancer can also start in flat, thin cells called squamous cells. These cells line the bronchi, which are the large tubes, or airways, that branch off from the trachea, or windpipe, into the lungs. This type of cancer is called squamous cell carcinoma of the lung. Large cell carcinoma is another type of non–small cell lung cancer, but it is less common. There are also several rare types of non–small cell lung cancer. These include sarcoma and sarcomatoid carcinoma. Small Cell Lung Cancer usually starts in cells that line the bronchi in the centre of the lungs. The main types of small cell lung cancer are small cell carcinoma and combined small cell carcinoma (mixed tumour with squamous or glandular cells). Other types of cancer can spread to the lung, but this is not the same disease as primary lung cancer. Cancer that starts in another part of the body and spreads to the lung is called lung metastasis. It is not treated in the same way as primary lung cancer. Find out more about lung metastasis. A rare type of cancer called pleural mesothelioma is often mistakenly called a lung cancer. But pleural mesothelioma starts in the pleura covering the lung and is very different from cancer that starts in the lung.

Symptoms

A sign is something that can be observed and recognized by a doctor or healthcare professional (for example, a rash). A symptom is something that only the person experiencing it can feel and know (for example, pain or tiredness). The signs and symptoms of lung cancer can also be caused by other health conditions. It is important to have any unusual symptoms checked by a doctor.

  • A cough that worsens or doesn’t go away
  • Chest pain that is constant and made worse by deep breathing or coughing
  • Blood-stained sputum (mucus and other matter coughed up from the lungs)
  • Shortness of breath
  • Wheezing
  • Frequent chest infections (bronchitis or pneumonia)
  • Fatigue
  • Hoarseness
  • Loss of appetite
  • Weight loss
  • Collapsed lung (pneumothorax)
  • Severe shoulder pain
    • Caused by a superior sulcus tumour pressing on a nerve
  • Horner’s syndrome
    • Severe Shoulder Pain
    • Problems in one eye
      • Drooping or weakness of the eyelid
      • Smaller pupil
    • Reduced or absent perspiration on the same side of the face as the affected eye
  • Buildup of fluid around the lungs (pleural effusion)
  • Bone pain
  • Jaundice
  • Difficulty swallowing
  • Superior vena cava syndrome
  • Neurological changes
    • Weakness
    • Headache
    • Numbness in a limb
    • Dizziness
    • Seizure
  • Enlarged lymph nodes in the neck or above the collarbone

Paraneoplastic Syndromes

A paraneoplastic syndrome is a group of symptoms that occurs when substances released by cancer cells affect the normal function of other organs or tissues. Small cell lung cancer causes paraneoplastic syndromes more often than non–small cell lung cancer (the most common type of lung cancer)

  • Hypercalcemia – especially in squamous cell Lung Cancer
  • Hypercalcemia is a condition in which the amount of calcium in the blood is higher than normal
  • Signs and symptoms include:
    • Weakness
    • Lack of coordination
    • Changes in mental function
    • High blood pressure
    • Nausea and vomiting
  • Hypertrophic Osteoarthropathy
  • Signs and symptoms include:
    • Increased and sometimes painful growth of some bones, especially those in the fingertips
    • Finger clubbing (a change in the shape of the nail bed that can occur in both fingers and toes)
    • Pain and swelling of bones and joints
Treatment

Treatment for non–small cell lung cancer is given by cancer specialists (oncologists). Some specialize in surgery, some in radiation therapy and others in chemotherapy (drugs) These doctors work with the person with cancer to decide on a treatment plan

Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for non–small cell lung cancer are based on:

  • The stage
  • Whether the cancer can be removed by surgery
  • The person’s overall health and lung function
Treatment Options
  • Surgery
    • Surgery is used to treat early stage non–small cell lung cancer that can be completely removed
    • A wedge or segmental resection removes the lung tumour, along with a margin of healthy tissue around the tumour
    • A lobectomy removes the lobe of the lung that has the tumour
    • A pneumonectomy removes the whole lung
    • An extended pulmonary resection removes parts of the chest wall, diaphragm, nerves, blood vessels or other tissues near the lung
    • A sleeve resection removes a tumour from the large bronchus, along with a margin of healthy tissue around the tumour
    • Lymph nodes are removed with all types of surgery.
  • Radiation therapy
    • External beam radiation therapy may be offered:
      • As the primary treatment, with chemotherapy, for tumours that cannot be removed by surgery
      • Before surgery, usually with chemotherapy, to shrink a tumour
      • After surgery for stage IIIA non–small cell lung cancer, usually with chemotherapy, to destroy cancer cells left behind and to reduce the risk of the cancer recurring
      • Alone as the primary treatment, in people who cannot have chemotherapy or surgery
      • To relieve pain or to control the symptoms of advanced non–small cell lung cancer (palliative radiation therapy)
    • Brachytherapy may be used to remove or shrink a tumour that is blocking the airway(s)
  • Chemotherapy
    • Chemotherapy may be offered:
    • As the primary treatment, with or without radiation therapy, to destroy cancer cells
    • Before surgery or radiation therapy to shrink a tumour
    • After surgery to destroy cancer cells left behind and to reduce the risk of the cancer recurring
    • To relieve pain or to control the symptoms of advanced non–small cell lung cancer (palliative chemotherapy)
    • Endobronchial Therapies
    • Endobronchial therapies are used to:
  • Remove or shrink a tumour that is blocking the airway(s)
  • Treat non–small cell lung cancer that has not spread outside the bronchial wall when the person cannot have surgery or radiation therapy
    • The following endobronchial therapies may be used with non–small cell lung cancer:
    • Bronchial debridement
    • Stents
    • Laser surgery
    • Electrocoagulation
    • Photodynamic therapy
    • Brachytherapy
    • Cryosurgery