Condition Basics

What is lung cancer?

Lung cancer is the out-of-control growth of abnormal cells in the lungs. These cells can invade nearby tissues and form tumours. Lung cancer can start anywhere in the lungs and affect any part of the respiratory system.

The main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is the most common type. SCLC usually grows quickly and is more likely to spread than NSCLC.

What causes it?

Most lung cancer is caused by smoking. But sometimes lung cancer develops in people who have never smoked. A few people get lung cancer after being exposed to other harmful substances. Cancer may also be caused by gene changes that happen as you get older.

What are the symptoms?

The first signs of lung cancer may include a new cough or a cough that doesn't go away, wheezing, or feeling short of breath. Other signs may include chest pain and blood in mucus that is coughed up.

How is it diagnosed?

Your symptoms, your medical history, and any history of cancer in your family will help your doctor decide how likely it is that you have lung cancer. You may need tests to be sure. Lung cancer is usually first found on a chest X-ray or a CT scan.

How is lung cancer treated?

Treatment for lung cancer is based on the type and stage of the cancer and other things, such as your overall health. The main treatments are surgery to remove the cancer, radiation therapy, and chemotherapy. There are also other options, such as immunotherapy or targeted therapy. A clinical trial may be a good choice.

How can you lower your risk?

Some lung cancers can't be prevented. But if you smoke, quitting smoking is the best step you can take to prevent lung cancer. If you want to quit, your doctor can recommend medicines or other ways to help.

Cause

Lung cancer is often caused by cigarette smoking. Tobacco smoke contains carcinogens. These are substances that cause cancer. They damage lung cells, and over time the damaged cells can turn into lung cancer.

Sometimes lung cancer develops in people who have never smoked. A few people get lung cancer after being exposed to other harmful substances, including asbestos, radioactive dust, radon, or radiation such as X-rays. Cancer also may be caused by gene changes (mutations) that occur as you get older.

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What Increases Your Risk

Most lung cancers are caused by cigarette smoking. Smoking cigars or a pipe also put you at risk.

Your risk of getting lung cancer is higher:

• The longer you smoke.
• The more cigarettes you smoke each day.

Quitting smoking lowers your risk. And your risk keeps going down as long as you don't smoke. Cutting down may help.

If you live with a smoker, you are at more risk than a person who doesn't.

Being exposed to certain chemicals like arsenic or asbestos puts you at risk. Exposure to radiation, radon gas, or air pollution also puts you at risk.

Some gene changes can increase your risk.

Smoking, exposure to cancer-causing substances, and gene changes are risk factors. Having one or more risk factors can make it more likely that you will get lung cancer. But some people who get lung cancer don't have any of these risk factors.

Lowering Your Risk

Most lung cancers are caused by smoking. If you use tobacco, you can help lower your risk for lung cancer by quitting.

You may be able to make other changes in your life that can help lower your risk.

• Avoid working in jobs where you are exposed to asbestos, arsenic, or second-hand smoke.
• Check the radon level in your home. If the level is high, lowering it can reduce your risk.
• Don't have chest X-rays you don't need.

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Symptoms

Symptoms of lung cancer may include:

• Coughing symptoms, such as:
  • A new cough or a cough that doesn't go away.
  • In smokers who have a chronic cough, a change in how severe their cough is or how much they cough.
  • Coughing up blood or bloody mucus.
• Chest symptoms, such as:
  • Chest, shoulder, or back pain that doesn't go away and often gets worse with deep breathing.
  • New wheezing.
  • Shortness of breath.
  • Hoarseness.
• General symptoms, such as:
  • Swelling in the neck and face.
  • Difficulty swallowing.
  • Weight loss and loss of appetite.
  • Increasing fatigue and weakness.
  • Recurring respiratory infections, such as pneumonia.

If lung cancer spreads, there may be other symptoms. For example, if it spreads to the spine or bones, it may cause pain in the back or other bones or cause weakness in the arms or legs. If it spreads to the brain, it may cause seizures, headaches, or vision changes.

What Happens

Lung cancer can start anywhere in the lungs and may affect any part of the respiratory system. This can cause breathing or heart problems, such as:

• Pleural effusion, which is the buildup of fluid between the outer lining of the lungs and the chest wall. This is a common condition with lung cancer.
• Coughing up large amounts of bloody sputum.
• Collapse of a lung (pneumothorax).
• Blockage of the airway (bronchial obstruction).
• Recurrent infections, such as pneumonia.
• Pericardial effusion, which is the buildup of fluid in the space between the heart and the sac around the heart (pericardium). This condition is not common with lung cancer.

As lung cancer grows, it may spread (metastasize) to other parts of the body. Lung cancer is classified in stages, which describe how far the cancer has grown and spread.

The long-term outcome (prognosis) for lung cancer depends on how much the cancer has grown and spread.

When to Call a Doctor

Call 9-1-1 or other emergency services immediately if you:

• Have new or sudden chest pain that is crushing or squeezing, is getting more intense, or occurs with any other symptoms of a heart attack, such as shortness of breath and nausea.
• Have new or sudden difficulty breathing.
• Are coughing up a lot of blood (not just streaks of blood or a small amount of blood mixed with a lot of mucus) from your lungs.
• Have been vomiting and feel that you may pass out when you sit up or stand.

Call your doctor now if you have:

• Laboured, shallow, rapid breathing with shortness of breath or wheezing, even when you are resting.
• Swelling of your neck and face.

Call your doctor to find out if you should be seen if you:

• Have new chest pain (more than just discomfort when you cough) that lasts a long time and gets worse when you breathe deeply.
• Develop symptoms of pneumonia, such as shortness of breath, cough, and fever.
• Have a cough that produces a small amount of bloody (bright red or rust-coloured) mucus.
• Often cough up yellow or green mucus from your lungs (not post-nasal drainage) for longer than 2 days.
• Often vomit from coughing.
• Have a cough that lasts longer than 4 weeks.
• Breathe normally when you are at rest but are very short of breath after any physical exercise.
• Have increasing fatigue for no apparent reason.
• Lose weight for no clear reason.

If you have been diagnosed with cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.

Examinations and Tests

Your doctor will first do a physical examination and ask about your medical history to find out your risk for lung cancer and look for any lung problems. The examination may include a chest X-ray and blood test.

If your examination suggests that you may have lung cancer, your doctor may recommend other tests, such as:

• PET scan, CT scan, or a PET-CT scan.
• Tissue sampling. Doctors can use a variety of tests to examine tissue or fluid samples under a microscope and look for cancer cells. Tests include:
  • Sputum cytology.
  • Thoracentesis.
  • Biopsy.

Screening tests for lung cancer

Screening tests help your doctor look for a problem before you have symptoms. This increases your chances of finding the problem early, when it's more treatable. Screening won't prevent cancer. And it may not find all lung cancers.

Lung cancer screening is only recommended for people ages 55 to 74 who are or were heavy smokers.^{footnote 1} That means people who have a smoking history of at least 30 pack years. A pack year is a way to measure how much you have smoked.

Lung cancer screening is done with a low-dose CT scan. A CT scan uses X-rays, or radiation, to make detailed pictures of your body. Experts recommend that screening be done in medical centres that focus on finding and treating lung cancer.

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Treatment Overview

Treatment for lung cancer is based on the type and stage of the cancer and other things, such as your overall health. Surgery, radiation, and chemotherapy are the main treatments for both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Other treatments that may be used for both types include immunotherapy, laser therapy, and endoscopic stent placement. NSCLC may also be treated with thermal ablation, photodynamic therapy, or targeted therapy.

Your doctor may suggest a clinical trial.

Your doctor will talk with you about your options and then make a treatment plan.

Some people use complementary therapies along with medical treatment. Therapies like acupuncture or massage may help you cope with the symptoms and stress of cancer. Talk with your doctor about any of these options you would like to try.

Surgery

Surgery may be an option if your doctor thinks all of the cancer can be removed. Nearby lymph nodes may also be removed to find out if the cancer has spread.

To remove the cancer, the doctor may take out:

• A small wedge of lung (wedge resection) or a larger piece of the lung (segmentectomy).
• The affected lobe of the lung. (This is called a lobectomy.)
• The affected lobe and part of the bronchus. (This is called a sleeve resection).
• The whole lung. (This is called a pneumonectomy.)

Lung surgery may be done through one cut (incision) in the chest (thoracotomy). Or it may be done through several small cuts, using a tiny camera and special tools. (This is called video-assisted thoracic surgery, or VATS.) Your doctor can help you understand which type of surgery is best for you.

Radiation therapy

This uses high-dose X-rays to destroy cancer cells and shrink tumours. Radiation therapy is often used with surgery or chemotherapy to treat lung cancer. It may be used alone if surgery can't be done.

Radiation therapy may also be used to:

• Keep cancer from spreading to the brain. Radiation to the head is called prophylactic cranial irradiation (PCI).
• Relieve symptoms. It may help ease pain from bone tumours or shrink tumours that make it hard to breathe or swallow.

Radiation therapy for lung cancer is usually given by a machine outside the body (external radiation). In some cases, it's given by placing substances inside the body (internal radiation, or brachytherapy).

Chemotherapy

These medicines kill fast-growing cells, including cancer cells and some normal cells. They may be given before or after surgery to help destroy any remaining cancer cells. Chemotherapy and radiation may be given together. (This is called chemoradiation.)

These medicines are often put into a vein. Sometimes they are taken as a pill. The medicines travel through your body to kill cancer cells both inside and outside the lung area.

Other treatments

Other treatment options for both NSCLC and SCLC include:

Immunotherapy.

This treatment helps your immune system fight cancer. It may be given along with chemotherapy.

Laser therapy.

This uses a highly focused beam of light to destroy cancer cells.

Endoscopic stent placement.

If a tumour blocks your airway, the doctor can insert a small hollow tube (stent) to help you breathe more easily.

Photodynamic therapy (PDT).

A special light activates a medicine to destroy cancer cells. The doctor can use a bronchoscope to treat tumours in the airways.

NSCLC may also be treated with:

Thermal ablation.

This uses extreme cold or heat to destroy cancer cells. Cryotherapy (or cryosurgery) is a type of ablation that uses cold. Radiofrequency ablation uses heat.

Targeted therapy.

These medicines attack only cancer cells, not normal cells. They help keep cancer from growing or spreading.

Some of these medicines target certain tumour markers in the cancer cells. If the cancer has a tumour marker that can be targeted, you may be given one or more of these medicines.

Treatment for metastatic cancer

Treatment for metastatic lung cancer is based on many things. These include the type and location of the cancer, your overall health, and what matters to you. The main treatments are targeted therapy, chemotherapy, and immunotherapy. Other treatments, such as radiation therapy, may help relieve symptoms. A clinical trial may be a good choice.

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Supportive Care

Hospice palliative care is a type of care for people who have a serious illness. It's different from care to cure your illness, called curative treatment. Hospice palliative care provides an extra layer of support that can improve your quality of life—not just in your body, but also in your mind and spirit. Sometimes hospice palliative care is combined with curative treatment.

The kind of care you get depends on what you need. Your goals guide your care. You can get both hospice palliative care and care to treat your illness. You don't have to choose one or the other.

Hospice palliative care can help you manage symptoms, pain, or side effects from treatment. It may help you and those close to you better understand your illness, talk more openly about your feelings, or decide what treatment you want or don't want. It can also help you communicate better with your doctors, nurses, family, and friends.

End-of-life care

It can be hard to live with an illness that cannot be cured. But if your health is getting worse, you may want to make decisions about end-of-life care. Planning for the end of your life does not mean that you are giving up. It is a way to make sure that your wishes are met. Clearly stating your wishes can make it easier for your loved ones. Making plans while you are still able may also ease your mind and make your final days less stressful and more meaningful.

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Self-Care

• Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• Follow your doctor's instructions to relieve pain. Use pain medicine when you first feel pain, before it becomes severe. Taking pain medicines regularly is often the best way to keep pain under control.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early. Eating smaller portions more often may help as well.
• Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows.
• Do not smoke. Smoking can make your cancer symptoms worse. But not smoking will make your treatment work better and may help you live longer. Continuing to smoke may delay healing after surgery. And treatments like chemotherapy and radiation therapy may not work as well if you continue to smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• If you use oxygen, do not smoke, light a cigarette, or use a flame while your oxygen is on. Smoking while using oxygen can lead to fire and even explosion.
• If you have nausea, try to eat several small meals a day. When you feel better, eat clear soups and mild foods until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• Take steps to control your stress and workload. Learn relaxation techniques.
  • Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them.
  • Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress.
  • Express yourself with art. Try writing, crafts, dance, or art to relieve stress. Some dance, writing, or art groups may be available just for people who have cancer.
  • Be kind to your body and mind. Getting enough sleep, eating a healthy diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and help reduce stress.
  • Get help if you need it. Discuss your concerns with your doctor or counsellor.
• If you have not already done so, prepare an advance care plan. An advance care plan provides instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.

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Complementary Treatments

Some people use complementary therapies along with medical treatment. They may help relieve the symptoms and stress of cancer or the side effects of cancer treatment. Therapies that may be helpful include:

• Acupuncture to relieve pain and other symptoms.
• Meditation or yoga to relieve stress.
• Massage and biofeedback to reduce pain and tension.
• Breathing exercises to help you relax.

Talk with your doctor about any of these options you would like to try. And let your doctor know if you are already using any complementary therapies. They are not meant to take the place of standard medical treatment. But they may help you feel better and cope better with treatment.

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Getting Support

Relationships take on new importance when you're faced with cancer. Your family and friends can help support you. You may also want to look beyond those who are close to you.

• Reach out to your family and friends.

  Remember that the people around you want to support you, and asking for help isn't a sign of weakness.

• Tell them how they can help.

  Your friends and family want to help, but some of them may not know what to do. It may help to make a list. For example, you might ask them to:

  • Run errands or pick up kids.
  • Deliver meals or groceries to your home.
  • Drive you to appointments.
  • Go to doctor visits with you and take notes.
• Look for help from other sources.

  Places to turn for support include:

  Counselling.

  Counselling can help you cope with cancer and the effect cancer is having on your life. Different types of counselling include family therapy, couples therapy, group counselling, and individual counselling.

  Your health care team.

  Your team should be supportive. Be open and honest about your fears and concerns. Your doctor can help you get the right medical treatments, including counselling.

  Spiritual or religious groups.

  These groups can provide comfort and may be able to help you find counselling or other social support services.

  Social groups.

  Social groups can help you meet new people and get involved in activities you enjoy. Focus on activities that bring you comfort, such as spending time outdoors or being with children.

  A cancer support group.

  Cancer support groups offer support and practical advice. You can hear others talk about:

  • What it's like to live with cancer.
  • Practical ways to manage your cancer treatment and its side effects.
  • Ways to cope with your illness.

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