Lung Cancer
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Small Cell Lung Cancer
Non-Small Cell Lung
Small Cell Lung Cancer
Small cell lung cancer is a disease in which malignant (cancer) cells form
in the tissues of the lung.
The lungs are a pair of cone-shaped breathing organs that are
found within the chest. The lungs bring oxygen into the body when breathing
in and take out carbon dioxide when breathing out. Each lung has sections
called lobes. The left lung has two lobes. The right lung, which is slightly
larger, has three. A thin membrane called the pleura surrounds the lungs.
Two tubes called bronchi lead from the trachea (windpipe) to the right and
left lungs. The bronchi are sometimes also involved in lung cancer. Small
tubes called bronchioles and tiny air sacs called alveoli make up the inside
of the lungs.
There are two types of lung cancer: small cell lung cancer and
non-small cell lung cancer. This summary provides information on small cell
lung cancer.
These three types include many different types of cells. The
cancer cells of each type grow and spread in different ways. The types of
small cell lung cancer are named for the kinds of cells found in the cancer
and how the cells look when viewed under a microscope:
- Small cell carcinoma (oat cell cancer).
- Mixed small cell/large cell carcinoma.
- Combined small cell carcinoma.
Smoking tobacco is the major risk factor for developing small cell lung
cancer.
Cigarette smoking is the most common cause of lung cancer. Risk
factors for small cell lung cancer include:
- Smoking cigarettes, cigars, or pipes now or in the past.
- Being exposed to second hand smoke.
- Being exposed to asbestos or radon.
Possible signs of small cell lung cancer include coughing, chest pain, and
shortness of breath.
These and other symptoms may be caused by small cell lung cancer
or by other conditions. A doctor should be consulted if any of the following
problems occur:
- A cough that doesnft go away.
- Shortness of breath.
- Chest pain that doesnft go away.
- Wheezing.
- Coughing up blood.
- Hoarseness.
- Swelling of the face and neck.
- Loss of appetite.
- Unexplained weight loss.
- Unusual tiredness.
Tests and procedures that examine the lungs are used to detect (find) and
diagnose small cell lung cancer.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray
is a type of energy beam that can go through the body and onto film, making
a picture of areas inside the body.
- Physical exam and history: An exam of the body to check general signs
of health, including checking for signs of disease, such as lumps or anything
else that seems unusual. A history of the patientfs health habits and past
illnesses and treatments will also be taken.
- Sputum cytology: A microscope is used to check for cancer cells in the
sputum (mucus coughed up from the lungs).
- Laboratory tests: Medical procedures that test samples of tissue, blood,
urine, or other substances in the body. These tests help to diagnose disease,
plan and check treatment, or monitor the disease over time.
- Bronchoscopy: A procedure to look inside the trachea and large airways
in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is
inserted through the nose or mouth into the trachea and lungs. Tissue samples
may be taken for biopsy.
- Fine needle aspiration biopsy: The removal of part of a lump, suspicious
tissue, or fluid, using a thin needle. A pathologist views the tissue or
fluid under a microscope to look for cancer cells. This procedure is also
called a needle biopsy.
- Thoracentesis: Removal of fluid from the pleural cavity (the space between
the lungs and chest wall) through a needle inserted between the ribs.
Certain factors affect prognosis (chance of recovery) and treatment options.
- The stage of the cancer (whether it is in the chest cavity only or has
spread to other places in the body).
- The patientfs gender and general health.
- The blood level of lactate dehydrogenase (LDH), a substance found in
the blood that may indicate cancer when the level is higher than normal.
For most patients with small cell lung cancer, current treatments do not
cure the cancer.
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After small cell lung cancer has been diagnosed, tests are done to find
out if cancer cells have spread within the chest or to other parts of the
body.
The process used to find out if cancer has spread within the
chest or to other parts of the body is called staging. The information gathered
from the staging process determines the stage of the disease. It is important
to know the stage in order to plan treatment. The following tests and procedures
may be used in the staging process:
- Bone marrow biopsy: The removal of a small piece of bone and bone marrow
by inserting a needle into the hipbone or breastbone. A pathologist views
both the bone and the bone marrow samples under a microscope to look for
signs of cancer.
- CT scan (CAT scan) of brain, chest, and abdomen: A procedure that makes
a series of detailed pictures of areas inside the body, taken from different
angles. The pictures are made by a computer linked to an x-ray machine.
A dye may be injected into a vein or swallowed to help the organs or tissues
show up more clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio
waves, and a computer to make a series of detailed pictures of areas inside
the body. This procedure is also called nuclear magnetic resonance imaging
(NMRI).
- Radionuclide bone scan: A procedure to check if there are rapidly dividing
cells, such as cancer cells, in the bone. A very small amount of radioactive
material is injected into a vein and travels through the bloodstream. The
radioactive material collects in the bones and is detected by a scanner.
- PET scan (positron emission tomography scan): A procedure to find malignant
tumor cells in the body. A small amount of radionuclide glucose (sugar)
is injected into a vein. The PET scanner rotates around the body and makes
a picture of where glucose is being used in the body. Malignant tumor cells
show up brighter in the picture because they are more active and take up
more glucose than normal cells.
The following stages are used for small cell lung cancer:
In limited stage, cancer is found in one lung, the tissues between
the lungs, and nearby lymph nodes only.
In extensive stage, cancer has spread outside of the lung in
which it began or to other parts of the body.
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Recurrent small cell lung cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come back in the chest,
central nervous system, or in other parts of the body.
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There are different types of treatment for patients with small cell lung
cancer.
Different types of treatment are available for patients with
small cell lung cancer. Some treatments are standard (the currently used
treatment), and some are being tested in clinical trials. Before starting
treatment, patients may want to think about taking part in a clinical trial.
A treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the gstandardh treatment,
the new treatment may become the standard treatment.
Surgery may be used if the cancer is found in one lung and in
nearby lymph nodes only. Because this type of lung cancer is usually found
in both lungs, surgery alone is not often used. Occasionally, surgery may
be used to help determine the patientfs exact type of lung cancer. During
surgery, the doctor will also remove lymph nodes to see if they contain cancer.
Laser therapy (the use of an intensely powerful beam of light to kill cancer
cells) may be used.
Even if the doctor removes all the cancer that can be seen at
the time of the operation, some patients may be offered chemotherapy or radiation
therapy after surgery to kill any cancer cells that are left. Treatment given
after the surgery, to increase the chances of a cure, is called adjuvant
therapy.
Chemotherapy is a cancer treatment that uses drugs to stop the
growth of cancer cells, either by killing the cells or by stopping the cells
from dividing. When chemotherapy is taken by mouth or injected into a vein
or muscle, the drugs enter the bloodstream and can reach cancer cells throughout
the body (systemic chemotherapy). When chemotherapy is placed directly into
the spinal column, an organ, or a body cavity such as the abdomen, the drugs
mainly affect cancer cells in those areas. The way the chemotherapy is given
depends on the type and stage of the cancer being treated.
Radiation therapy is a cancer treatment that uses high-energy
x-rays or other types of radiation to kill cancer cells. There are two types
of radiation therapy. External radiation therapy uses a machine outside the
body to send radiation toward the cancer. Internal radiation therapy uses
a radioactive substance sealed in needles, seeds, wires, or catheters that
are placed directly into or near the cancer. Prophylactic cranial irradiation
(radiation therapy to the brain to reduce the risk that cancer will spread
to the brain) may also be given. The way the radiation therapy is given depends
on the type and stage of the cancer being treated.
Other types of treatment are being tested in clinical trials.
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- Combination chemotherapy and radiation therapy to the chest, with or
without radiation therapy to the brain.
- Combination chemotherapy with or without radiation therapy to the brain
in patients with complete response.
- Combination chemotherapy with or without radiation therapy to the chest.
- Surgery followed by chemotherapy or chemotherapy plus radiation therapy
to the chest, with or without radiation therapy to the brain.
- Clinical trials of new chemotherapy, surgery, and radiation treatments.
- Chemotherapy.
- Combination chemotherapy.
- Combination chemotherapy with or without radiation therapy to the brain
for patients with complete response.
- Radiation therapy to the brain, spine, bone, or other parts of the body
where the cancer has spread, as palliative therapy to relieve symptoms
and improve quality of life.
- Clinical trials of new chemotherapy treatments.
Treatment of recurrent small cell lung cancer may include the
following:
- Radiation therapy as palliative therapy to relieve symptoms and improve
quality of life.
- Chemotherapy as palliative therapy to relieve symptoms and improve quality
of life.
- Laser therapy, surgical placement of devices to keep the airways open,
and/or internal radiation therapy, as palliative therapy to relieve symptoms
and improve quality of life.
- Clinical trials of chemotherapy.
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Non-Small Cell Lung
Non-small cell lung cancer is a disease in which malignant (cancer) cells
form in the tissues of the lung.
The lungs are a pair of cone-shaped breathing organs that are
found within the chest. The lungs bring oxygen into the body and take out
carbon dioxide, which is a waste product of the bodyfs cells. Each lung has
sections called lobes. The left lung has 2 lobes. The right lung, which is
slightly larger, has 3 lobes. A thin membrane called the pleura surrounds
the lungs. Two tubes called bronchi lead from the trachea (windpipe) to the
right and left lungs. The bronchi are sometimes also involved in lung cancer.
Tiny air sacs called alveoli and small tubes called bronchioles make up the
inside of the lungs.
There are 2 types of lung cancer: non-small cell lung cancer
and small cell lung cancer.
There are 5 types of non-small cell lung cancer.
The 5 types of non-small cell lung cancer have different kinds
of cancer cells. The cancer cells of each type grow and spread in different
ways. The types of non-small cell lung cancer are named for the kinds of
cells found in the cancer and how the cells look when viewed under a microscope:
- Squamous cell carcinoma: Cancer that begins in squamous cells, which
are thin, flat cells that look like fish scales. This is also called epidermoid
carcinoma.
- Adenocarcinoma: Cancer that begins in cells that have glandular (secretory)
properties.
- Large cell carcinoma: Cancer in which the cells are large and look abnormal
when viewed under a microscope.
- Adenosquamous carcinoma: Cancer that begins in cells that look flattened
when viewed under a microscope. These cells also have glandular (secretory)
properties.
- Undifferentiated carcinoma: Cancer cells that do not look like normal
cells and multiply uncontrollably.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend
on the following:
- The stage of the cancer (whether it is in the lung only or has spread
to other places in the body).
- The tumor size.
- The type of lung cancer.
- Whether there are symptoms.
- The patientfs general health.
For most patients with non-small cell lung cancer, current treatments do
not cure the cancer.
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After lung cancer has been diagnosed, tests are done to find out if cancer
cells have spread within the lungs or to other parts of the body.
The process used to find out if cancer has spread within the
lungs or to other parts of the body is called staging. The information gathered
from the staging process determines the stage of the disease. It is important
to know the stage in order to plan treatment. The following tests and procedures
may be used in the staging process:
- Physical exam and history: An exam of the body to check general signs
of health, including checking for signs of disease, such as lumps or anything
else that seems unusual. A history of the patientfs health habits and past
illnesses and treatments will also be taken.
- Radiologic exams: The use of radiation or other imaging methods to find
signs of cancer. Radiologic tests for non-small cell lung cancer include:
- Chest x-ray: An x-ray of the organs and bones inside the chest. An
x-ray is a type of energy beam that can go through the body and onto
film, making a picture of areas inside the body.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures
of areas inside the body, taken from different angles. The pictures
are made by a computer linked to an x-ray machine. A dye may be injected
into a vein or swallowed to help the organs or tissues show up more
clearly. This procedure is also called computed tomography, computerized
tomography, or computerized axial tomography.
- PET scan (positron emission tomography scan): A procedure to find
malignant tumor cells in the body. A small amount of radionuclide glucose
(sugar) is injected into a vein. The PET scanner rotates around the
body and makes a picture of where glucose is being used in the body.
Malignant tumor cells show up brighter in the picture because they
are more active and take up more glucose than normal cells.
- Laboratory tests: Medical procedures that test samples of tissue, blood,
urine, or other substances in the body. These tests help to diagnose disease,
plan and check treatment, or monitor the disease over time.
- Lymph node biopsy: The removal of all or part of a lymph node. A pathologist
views the tissue under a microscope to look for cancer cells. One of the
following types of biopsies may be done:
- Excisional biopsy: The removal of an entire lymph node.
- Incisional biopsy: The removal of part of a lymph node.
- Core biopsy: The removal of part of a lymph node using a wide needle.
- Needle biopsy: The removal of part of a lymph node using a thin needle.
This procedure is also called a fine-needle aspiration biopsy.
- Bronchoscopy: A procedure to look inside the trachea and large airways
in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is
inserted through the nose or mouth into the trachea and lungs. Tissue samples
may be taken for biopsy.
- Mediastinoscopy: A surgical procedure to look at the organs, tissues,
and lymph nodes between the lungs for abnormal areas. An incision (cut)
is made at the top of the breastbone and a thin, lighted tube is inserted
into the chest. Tissue and lymph node samples may be taken for biopsy.
- Anterior mediastinotomy: A surgical procedure to look at the organs and
tissues between the lungs and between the breastbone and spine for abnormal
areas. An incision (cut) is made next to the breastbone and a thin, lighted
tube is inserted into the chest. Tissue and lymph node samples may be taken
for biopsy. This is also called the Chamberlain procedure.
In the occult (hidden) stage, cancer cells are found in sputum
(mucus coughed up from the lungs), but no tumor can be found in the lung
by imaging or bronchoscopy, or the primary tumor is too small to be assessed.
In stage 0 (carcinoma in situ), cancer is limited to the lung
and is found in a few layers of cells only. It has not grown through the
top lining of the lung.
In stage I, the cancer is in the lung only, with normal tissue
around the tumor. Stage I is divided into stages IA and IB, based on the
size of the tumor.
In stage II, cancer has spread to nearby lymph nodes or to the
chest wall (the ribs and muscles that make up the area of the body between
the neck and the abdomen), the diaphragm (the thin muscle below the lungs
and heart that separates the chest from the abdomen), the mediastinal pleura
(the thin membrane that covers the outside of the lungs in the area near
the heart), or the parietal pericardium (the outer layer of tissue that surrounds
the heart). Stage II is divided into stage IIA and stage IIB, based on the
size of the tumor and whether it has spread to the lymph nodes.
In stage III, cancer has either:
- spread to the lymph nodes in the mediastinum (the middle area between
the lungs that contains the heart, major blood vessels, and other structures);
or
- spread to the lymph nodes on the opposite side of the chest or in the
lower neck.
Stage III is divided into stage IIIA (which is sometimes treated
with surgery) and stage IIIB (which is rarely treated with surgery).
In stage IV, cancer has spread to other parts of the body or
to another lobe of the lungs.
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Recurrent non-small cell lung cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come back in the brain,
lung, or other parts of the body.
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At diagnosis, patients can be divided into 3 treatment groups based on the
stage of the cancer:
Non-small cell lung cancer that can be treated with surgery.
Stage 0, stage I, and stage II non-small cell lung cancer can
often be removed by surgery. Radiation therapy may be used to treat patients
who have other medical problems and cannot have surgery.
Non-small cell lung cancer that has spread to nearby tissue or to lymph
nodes.
Non-small cell lung cancer that has spread to nearby tissue
or to lymph nodes can be treated with one of the following:
- Radiation therapy alone.
- Radiation therapy and chemotherapy or other kinds of treatment.
- Surgery alone.
Non-small cell lung cancer that has spread to other parts of the body or
to another lobe of the lungs.
Radiation therapy may be used as palliative therapy to shrink
the cancer and to relieve pain in patients who have non-small cell lung cancer
that has spread to other parts of the body. Chemotherapy may be used to treat
some patients.
Three types of surgery are used:
- Wedge resection: A surgical procedure to remove a tumor (lump) and a
small amount of normal tissue around it.
- Lobectomy: A surgical procedure to remove a whole lobe (section) of the
lung.
- Pneumonectomy: Surgery to remove one whole lung.
Chemotherapy is a cancer treatment that uses drugs to stop the
growth of cancer cells, either by killing the cells or by stopping the cells
from dividing. When chemotherapy is taken by mouth or injected into a vein
or muscle, the drugs enter the bloodstream and can reach cancer cells throughout
the body (systemic chemotherapy). When chemotherapy is placed directly in
the spinal column, a body cavity such as the abdomen, or an organ, the drugs
mainly affect cancer cells in those areas. The way the chemotherapy is given
depends on the type and stage of the cancer being treated.
Radiation therapy is a cancer treatment that uses high-energy
x-rays or other types of radiation to kill cancer cells. There are two types
of radiation therapy. External radiation therapy uses a machine outside the
body to send radiation toward the cancer. Internal radiation therapy uses
a radioactive substance sealed in needles, seeds, wires, or catheters that
are placed directly into or near the cancer.
Radiosurgery is a method of delivering radiation directly to
the tumor with little damage to healthy tissue. It does not involve surgery
and may be used to treat certain tumors in patients who cannot have surgery.
The way the radiation therapy is given depends on the type and
stage of the cancer being treated.
Laser therapy is a cancer treatment that uses a laser beam (a
narrow beam of intense light) to kill cancer cells.
Other types of treatment and prevention are being tested in clinical trials.
These include the following:
Photodynamic therapy (PDT) is a cancer treatment that uses a
drug that is not active until it is exposed to light. When exposed to light,
the cancer cells are killed.
Chemoprevention is the use of drugs, vitamins, or other substances
to reduce the risk of developing cancer or to reduce the risk cancer will
recur (come back).
New combinations of treatments are being studied in clinical
trials.
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Occult Non-Small Cell Lung Cancer
Tests are done to find the main tumor (cancer). Lung cancer
that is found at this early stage can usually be cured by surgery. Tests
may include the following:
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray
is a type of energy beam that can go through the body and onto film, making
a picture of areas inside the body.
- Bronchoscopy: A procedure to look inside the trachea and large airways
in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is
inserted through the nose or mouth into the trachea and lungs. Tissue samples
may be taken for biopsy.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures
of areas inside the body, taken from different angles. The pictures are
made by a computer linked to an x-ray machine. A dye may be injected into
a vein or swallowed to help the organs or tissues show up more clearly.
This procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
Treatment of stage 0 non-small cell lung cancer may include
the following:
- Surgery to remove a small portion of the lung where the cancer cells
are found.
- Clinical trials of photodynamic therapy using an endoscope.
Treatment of stage I non-small cell lung cancer may include
the following:
- Surgery to remove a small portion of the lung or a lobe of the lung.
- External radiation therapy (for patients who cannot have surgery or choose
not to have surgery).
- Clinical trials of chemotherapy following surgery.
- Clinical trials of chemoprevention following other therapy.
- Clinical trials of photodynamic therapy using an endoscope.
Treatment of stage II non-small cell lung cancer may include
the following:
- Surgery to remove the tumor (a small portion of the lung, a lobe of the
lung, or an entire lung) and lymph nodes.
- External radiation therapy (for patients who cannot have surgery or choose
not to have surgery).
- Clinical trials of chemotherapy following surgery.
- Clinical trials of external radiation therapy following surgery.
Treatment of stage IIIA non-small cell lung cancer may include
the following:
- Surgery alone.
- External radiation therapy alone.
- Chemotherapy combined with other treatments.
- Surgery and external radiation therapy.
- Clinical trials of combined treatments.
Treatment of stage IIIB non-small cell lung cancer may include
the following:
- External radiation therapy alone.
- Chemotherapy combined with external radiation therapy.
- Chemotherapy combined with external radiation therapy, followed by surgery.
- Chemotherapy alone.
- Clinical trials of combined treatments.
Treatment of stage IV non-small cell lung cancer may include
the following:
- External radiation therapy as palliative therapy, to relieve pain and
other symptoms and improve the quality of life.
- Chemotherapy.
- Laser therapy and/or internal radiation therapy.
- Clinical trials of chemotherapy.
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Treatment of recurrent non-small cell lung cancer may include
the following:
- External radiation therapy as palliative therapy, to relieve pain and
other symptoms and improve the quality of life.
- Chemotherapy alone.
- Surgery (for some patients who have a very small amount of cancer spread
to the brain).
- Laser therapy or internal radiation therapy.
- Radiosurgery (for certain patients who cannot have standard surgery).
- Clinical trials of new treatments.
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AAT Deficiency
