Lung Cancer

Lung cancer is a type of cancer that forms in the tissues of the lungs, most often in the cells that line air passages. It occurs when these cells start to grow and multiply uncontrollably, usually as a result of exposure to toxins such as tobacco smoke, radiation and asbestos.

Lung Cancer Treatment in Tucson, AZ

What is Lung Cancer?

Lung cancer is a type of cancer that starts in the lungs. The lungs are two spongy organs in the chest that take in oxygen and remove carbon dioxide from the blood. The air we breathe enters the lungs and passes through tiny air sacs called alveoli. The alveoli are surrounded by a network of small blood vessels called capillaries.

Lung cancer starts when abnormal cells begin to grow out of control in the lungs. These abnormal cells can form tumors, which can interfere with the normal functioning of the lungs.

Types of Lung Cancer

There are two main types of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).

SCLC is the less common of the two types, accounting for about 15 percent of all lung cancer cases. It is more likely to spread (metastasize) to other parts of the body than NSCLC, most often the brain. This cancer is strongly associated with cigarette smoking (95% of cases). This cancer often presents when the cancer is advanced (⅔ of cases) with 10-15% of patients presenting to their doctor with disease in the brain. After two years, the incidence of disease in the brain is 50-80%. It is very important that patients with this type of cancer have an MRI of the brain as part of the staging process.

NSCLC is the most common type of lung cancer, accounting for about 85 percent of all cases. There are three subtypes of NSCLC:

– Adenocarcinoma

– Squamous cell carcinoma

– Large cell carcinoma

Adenocarcinoma is the most common type of NSCLC, accounting for about 40 percent of all cases. It arises from the epithelial cells that line the alveoli.

Squamous cell carcinoma arises from the squamous cells that line the air passages of the lungs. It accounts for about 30 percent of all NSCLC cases.

Large cell carcinoma is the least common type of NSCLC, accounting for about 10 percent of all cases. It can arise from any type of lung cell.

What are the symptoms of Lung Cancer?

The symptoms of lung cancer depend on the size and location of the tumor. Small tumors may not cause any symptoms. If a tumor is large enough to interfere with the normal functioning of the lungs, it may cause shortness of breath, persistent coughing (with or without blood often called ‘rusty colored sputum’ or spit), or chest pain when you breathe in. Lung cancer may also cause other symptoms, such as fatigue, weight loss.

How is lung cancer diagnosed?

If you have symptoms that suggest you may have lung cancer, your doctor will order some tests to confirm the diagnosis. These tests may include a chest x-ray, a computed tomography (CT) scan, and likely a biopsy.

• Chest x-ray: This is a quick, painless test that uses low-dose radiation to take pictures of the inside of the chest.
• CT scan of the chest: This is a painless test that uses x-rays and computers to create detailed pictures of the inside of the chest.It has much more detail than an x-ray.
• Biopsy: A biopsy is an invasive and necessary procedure in which a small sample of tissue is taken from the lungs and examined for cancer cells. It can be performed by a pulmonologist or an interventional radiologist, two different types of specialists. A biopsy will require a consultation first after which the procedure can be scheduled. It usually takes about a week to get results. We can then send genetic testing out on your biopsy specimen.

Once lung cancer has been diagnosed, your doctor will order additional tests to determine the stage of the cancer. The stage is a measure of how far the cancer has spread. This is typically a PET/CT (which examines the entire body) and an MRI of the brain.

There are four stages of lung cancer:

Stage I: The cancer is confined to the lungs and has not spread to other parts of the body.

Stage II: The cancer has remained in the lung, but it can involve other areas like the airways, the lining of the lung, or can collapse part of the lung.

Stage III: The cancer has remained in the lungs, but can involve lymph nodes, the chest wall, certain nerves, the heart, or have a second tumor deposit.

Stage IV: The cancer has spread to other parts of the body, such as the brain or liver. When the cancer has spread to multiple organs or tissues , it is very difficult to treat but there are still options. Usually genetic testing is critical to determine if there are specific drugs that may benefit you.

What are the treatments for lung cancer?

The treatment for lung cancer depends on the stage of the cancer, the type of cancer, your age and overall health, and your preferences.

• Surgery is the most common treatment for early-stage lung cancer (Stage I-II) The surgeon removes the part of the lung that contains the tumor, as well as some surrounding tissue. This procedure is called a lobectomy.
  • If the cancer is too large to be removed with a lobectomy, the surgeon may remove the entire lung. This procedure is called a pneumonectomy.
• Radiation therapy is a treatment that uses high-dose x-rays or other forms of energy to kill cancer cells. When patients prefer to have radiation, it can be delivered in just 5 treatments to cure lung cancer (Stage I-II) with a technique called Stereotactic Body Radiotherapy (SBRT). This is non-invasive. Sometimes, surgery is felt to be too risky for a patient, and SBRT is recommended alone.
• Chemotherapy: is a treatment that uses drugs to kill cancer cells. It is usually used to treat lung cancer that has spread to other parts of the body (lymph nodes, or when it spreads beyond the lungs). This can be done WITH radiation, and we refer to this as concurrent chemoradiation (meaning the chemotherapy is delivered at the same time as the radiation). Radiation is daily, and chemotherapy is usually once a week or every 2-3 weeks.
• Chemoradiation (both treatments):
  • Concurrent chemoradiation followed by immunotherapy (below) is the standard of care for Stage III Non-Small Cell Lung Cancer (NSCLC) and for Stage I-III Small Cell Lung Cancer (SCLC).
• Targeted therapy: is a treatment that targets specific molecules involved in the growth and spread of cancer cells. If genetic testing is done on your tumor, then targeted therapy can be applied and is specific to your tumor.
• Immunotherapy: is a treatment that uses the body’s immune system to fight cancer cells. It is usually used to treat lung cancer that is stage III or stage IV, or if it has come back after treatment.

If you have lung cancer, your doctor will work with you to develop a treatment plan that is right for you.

What are the side effects of lung cancer treatment?

The side effects of lung cancer treatment depend on the type of treatment you receive. Surgery, radiation therapy, and chemotherapy can all cause side effects.

Side effects of surgery may include pain, infection, and bleeding. Side effects of radiation therapy may include fatigue, skin irritation, and difficulty swallowing.

Side effects of chemotherapy may include nausea, vomiting, and hair loss.

Targeted therapy and immunotherapy can also cause side effects. The most common side effects of targeted therapy are fatigue, diarrhea, and skin rash. The most common side effects of immunotherapy are fatigue, diarrhea, and flu-like symptoms.Pneumonitis can occur with immunotherapy, which is a sterile (eg. not bacterial or viral) inflammation of the lung.

If you experience any side effects from your treatment, be sure to talk to your doctor. There are often ways to manage or reduce side effects.

Side effects of radiation depend on where you are pointing the radiation. They can include fatigue, chest hair loss, skin itching / redness (light), difficulty swallowing, cough, and later a condition called radiation pneumonitis which is a sterile (non-bacterial or viral) inflammation of the lung.

What is the role of radiation therapy in Lung Cancer?

Radiation therapy is a treatment that uses high-dose x-rays or other forms of energy to kill cancer cells. It can be used in ALL STAGES and ALL TYPES of lung cancer.

• SCLC small cell lung cancer
  • Stage I-III (Limited Stage) SCLC:
    • Stage I Consider lobectomy and chemotherapy after
    • Stage II-III: usually concurrent chemoradiation
      • Limited stage: Consider prophylactic cranial irradiation (PCI) vs MRI brain surveillance
  • Stage IV (Extensive Stage) SCLC: chemotherapy and immunotherapy up front. Palliative radiation to help with symptoms as needed; thoracic consolidation with 10 radiation treatments to the chest if there is a response to chemotherapy.
    • Extensive stage: MRI brain surveillance, consider prophylactic cranial irradiation (PCI)
• NSCLC non-small cell lung cancer
  • Early NSCLC (Stage I-II): SBRT, usually 3-5 treatments every other day
  • Locally advanced NSCLC (Stage III): concurrent chemoradiation, with radiation being usually 30 treatments, once a day for 10 minutes followed by immunotherapy
  • Non-chemotherapy candidates (Stage III): 15 treatments of radiation alone, once a day for 10 minutes
  • Metastatic (Stage IV): Palliative indications (usually 10 treatments) to improve breathing or bleeding; or SBRT for small spots outside of the lung as long as there are only a few (</= 5, known as oligometastatic NSCLC).

Radiation therapy in this setting is given externally, which means the radiation comes from a machine outside of the body..

Radiation therapy can be used to ablate/destroy visible tumors, to kill remaining microscopic (not visible to the naked eye or on a CT scan) cancer cells that remain after surgery, or to relieve symptoms caused by the cancer.

What is the prognosis for someone with lung cancer?

The prognosis for someone with lung cancer depends on the stage of the cancer, the type of cancer, and the person’s age and overall health.

These are statistics that are taken from clinical trials. Individual cases will vary based on age, performance status, genetic testing, and tolerance to therapy.

Non-Small Cell Lung Cancer

• Stage I: the 5-year survival rate: 77-92%.
• Stage II: the 5-year survival rate is 53-60%
• Stage III: the 5-year survival rate is 13-43% *
• Stage IV: the 5-year survival rate is up to 10% (42% **)

Small-Cell Lung Cancer

• Stage I: the 5-year survival rate is 40-60%
• Stage II-III: the 5-year survival rate is 20-26%
• Stage IV: the 5-year survival rate is up to 10%

Lung cancer is a very serious disease and it is important to get early diagnosis and treatment. If you have any symptoms suggestive of lung cancer, it is important to see your doctor right away.

Risk Factors for Lung Cancer

There are several risk factors for lung cancer, including:

• Smoking: Cigarette smoking is the number one risk factor for lung cancer. The risk increases with the number of cigarettes smoked per day and the number of years that a person has been smoking. Quitting smoking reduces the risk of lung cancer.
• Secondhand smoke: Exposure to secondhand smoke increases the risk of lung cancer.
• Asbestos: Exposure to asbestos fibers increases the risk of lung cancer.
• Radon: Radon is a gas that is found naturally in the environment. It can seep into homes and buildings through cracks in the foundation. Exposure to high levels of radon increases the risk of lung cancer.
• Arsenic: Exposure to arsenic, which is found in water, air, and soil, increases the risk of lung cancer.
• Vinyl chloride: Exposure to vinyl chloride, which is used in the manufacture of plastics, increases the risk of lung cancer.
• Family history: Having a family member with lung cancer increases the risk of developing the disease.
• Lung conditions: Having a lung condition such as chronic obstructive pulmonary disease (COPD) or emphysema increases the risk of lung cancer.

How can you reduce your risk of getting lung cancer?

• There are several things you can do to reduce your risk of getting lung cancer:
• Do not smoke cigarettes or use other tobacco products. If you do smoke, quitting is the best thing you can do for your health.
• Avoid exposure to secondhand smoke.
• Avoid exposure to harmful chemicals, such as asbestos and radon.
• Eat a healthy diet and get regular exercise.
• If you are at high risk for lung cancer, talk to your doctor about getting screened. Screening is a way to find cancer early, when it is most likely to be curable.

We are here to help

Lung cancer can be a frightening diagnosis, but with the help of our experienced team of doctors and nurses, you can feel confident that you’re getting the best possible treatment. We believe that each patient is unique and deserves their own specific care plan, so we will work with you to find the best option for your situation.

Whether it’s surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy or a combination of treatments, we will create a plan that gives you the best chance for a full recovery. If you have any questions or concerns, don’t hesitate to call us.

We are here to help you through this difficult time.