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Lung Cancer and Tumors

Lung cancer is one of the most common cancers in both men and women. The vast majority of lung cancers occur in cigarette smokers although only 15% of cigarette smokers will eventually develop lung cancer. After quitting smoking the risk of developing lung cancer declines gradually. By 15 years, this risk is nearly the same as that of a lifelong nonsmoker. Lung cancer is the most common cause of cancer-related death but, despite its bad reputation, is not uniformly fatal. In fact, if it is caught early it can usually be cured!

Lung cancers are generally divided into two types: small-cell cancer of the lung and non-small-cell cancer of the lung. The distinction between these two types, based upon their appearances under a microscope, is clinically important because the two have different patterns of growth and spread. The clinical differences dictate that small-cell cancers are generally treated with chemotherapy and/or radiation therapy but not with surgery, while non-small-cell cancers can sometimes be removed surgically. There are several subtypes of non-small-cell cancer of the lung: adenocarcinoma, bronchoalveolar cell carcinoma, squamous cell carcinoma, and large cell carcinoma but the clinical approach to these different cancers is the same (hence their grouping together). Nonsmokers who developed lung cancer almost always have adenocarcinoma or bronchoalveolar cell carcinoma.

Lung cancer is often first detected as a "spot" on the lung as seen on a chest x-ray. Luckily, most "spots" that are found turn out to be benign (noncancerous). However, when a "spot" is discovered it must be followed closely, biopsied or removed in order to prove that is not a cancer.

Once non-small-cell lung cancer is diagnosed attention turns toward staging the tumor (i.e. determining the extent of local, lymph gland, and/or distant (metastatic) spread) in order to choose the best course of therapy. The evaluation will seek to determine the resectability of the cancer (i.e. is it at a stage at which it can be removed surgically without leaving behind any residual cancer cells?) and the patient's operability (i.e. are the patient's lung function and general conditioning good enough to survive and thrive after the operation?). This evaluation might include measurements of lung function (pulmonary function tests), additional x-rays and scans, and/or a panel of blood tests. Occasionally, resectability cannot be absolutely determined until the chest has been explored surgically.

For small-cell cancer the testing may be similar but the goal is to be sure there are no sites of distant spread that may require special treatment above and beyond basic chemotherapy and radiation therapy.

Once the staging evaluation is complete a course of treatment is chosen. Again, for small-cell cancer this will usually be chemotherapy and/or radiation therapy. In a potentially resectable non-small-cell cancer the best chance at cure lies in surgical removal. Surgery usually requires a large incision in the chest with removal of the portion of lung that contains the cancer. The first portion of the surgery may be geared toward completing the staging and, thereby, finally determining the resectability of the cancer. In situations where the patient is felt to be a poor operative candidate or where the cancer is deemed to be unresectable then the treatment of choice may be chemotherapy and/or radiation therapy. In some instances resectability can be reassessed after chemotherapy and/or radiation therapy (i.e. sometimes a nonresectable tumor can become resectable after successful chemotherapy and/or radiation therapy). After treatment is completed the patient will require careful follow-up for 5 to 10 years for signs of recurrence.

Benign (non-cancerous) lung tumors usually present as a round "spot" on the chest x-ray. The most common type of benign tumor is a hamartoma, which contains a mixture of cartilage, fat, calcium, and inflammation. Less common benign lung tumors include hemangiomas (blood vessel tumors), lipomas (fat-containing tumors), leiomyomas (tumors that contain elements of muscle), and neurofibromas (tumors that contain neuronal or nerve tissue). They tumors are usually asymptomatic (cause no symptoms). The principle clinical problem these benign masses present is that they must be differentiated from cancerous lung nodules. Depending on the patient's age and smoking history as well as the appearance of the nodule on chest x-ray or CT scan, the physician may choose to observe, biopsy, or have these nodules removed. Positive emission tomography scanning (PET scanning) of these nodules may help distinguish benign from malignant nodules. A pulmonary nodule that has been stable in size for greater than two years is usually considered to be benign.

Occasionally single or multiple lung nodules prove to be metastases (distant spread) from cancers that arise in other parts of the body such as the breast, kidneys or colon. In this case, the primary tumor is almost always treated non-surgically with chemotherapy or radiation therapy.

Are You at High Risk for Lung Cancer?

  1. Are you a current or former smoker who smoked one pack a day for at least 10 years?
  2. Have you had prolonged exposure to asbestos at home or at work?
  3. Have you had prolonged exposure to second-hand smoke?
  4. Lung cancer has no symptoms in the early stages. Once symptoms occur, the disease has usually reached an advanced stage. Early detection of small tumors is possible with a multidetector CT Scan of the lung.

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