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Lung Cancer
Overview
Lung cancer is the most common type of cancer worldwide — around 228,150 new cases will be diagnosed in the United States this year, mostly among smokers. A growing number of cases are being found in people who never smoked, which means factors like the environment or genetics may be involved.
If you have been diagnosed with lung cancer, or if you may be at high risk of developing it, the specialists at City of Hope will provide you with the information and expertise you need.
- What is lung cancer?
- What are the types of lung cancer?
- Are you at risk for lung cancer?
- What are the signs and symptoms of lung cancer?
- Who should get screened for lung cancer?
- Tests for diagnosing lung cancer
- What are the newest treatments for lung cancer?
- What are the different approaches to lung cancer surgery?
- Learn more about our lung and thoracic doctors.
- What lung cancer clinical trials are being offered?
Request a consultation
City of Hope’s world-renowned thoracic care team use the latest technology and innovation to treat lung cancer while providing compassionate care. Call 800-826-4673 or request an appointment online.
Request an Appointment Online
800-826-4673Even for Stage 4 disease we have a lot of hope. There’s a light at the end of the tunnel." Ravi Salgia, M.D., Ph.D., Arthur & Rosalie Kaplan Chair in Medical Oncology
Ravi Salgia, M.D., Ph.D.
City of Hope, located in southern California, is a nationally recognized leader in the research and treatment of lung cancer. We are one of the few facilities designated as a comprehensive cancer center by the National Cancer Institute.
For more than a decade, U.S. News & World Report has named City of Hope one of the top cancer hospitals in America, as well as named a high performing hospital for lung cancer surgery.
We bring together a broad array of expertise from multiple specialties and are unmatched in our rapid “bench-to-bedside” record of translating leading-edge research into real-world treatments.
It is our multidisciplinary approach, combined with our dedication to advancing cancer care, that results in our superior survival outcomes data compared to SEER LA, making City of Hope the best choice for lung and thoracic cancer treatment in the region.
Our commitment to providing the best care and the best quality of life possible for you includes:
- Lung experts who regularly treat aggressive and late-stage cancer, including complicated cases other institutions may have deemed untreatable
- Minimally invasive techniques, including laparoscopic and robotic surgery, that injure the body less, make recovery faster and improve outcomes
- Video-assisted thoracoscopic surgery, using advanced computer and video technology to perform minimally invasive biopsies and surgeries
- Precision medicine techniques such as targeted therapy, CAR T cell therapy, immunotherapy regimens tailored to individual patients and pioneering lung cancer clinical trials
- Genetic tests to figure out your lung tumor’s specific biology and tailor your treatments to stop it from growing
- Ultraprecise radiation therapy techniques including helical TomoTherapy and 4D computed tomography scanning
- Compassionate care from staff who communicate openly and truly listen to patient and family concerns
- Supportive care services that provide exceptional family and survivorship programs
- Smoking Cessation Program
NEWS & BREAKTHROUGHS
What is lung cancer?
Lung cancer is the most common type of cancer worldwide — around 228,150 new cases will be diagnosed in the United States this year, mostly among smokers. A growing number of cases are being found in people who never smoked, which means factors like the environment or genetics may be involved.
Lung cancer is considered either nonsmall cell or small cell, which describes how the cells look when viewed under a microscope.
What are the types of lung cancer?
There are three main kinds of lung cancer — small cell, nonsmall cell and carcinoid lung tumors. Of these, nonsmall cell is by far the most common, while small cell lung cancer, which tends to spread quickly, is found in 10 to 15 percent of cases. Fewer than 5 percent of lung cancers are lung carcinoid tumors.
Nonsmall cell lung cancer
- Adenocarcinoma is the most common type of nonsmall cell lung cancer; it begins in the deepest parts of the breathing passages, called the alveoli. This type of lung cancer is most common in people who have never smoked.
- Squamous cell carcinoma starts in the flat, thin cells lining the inside of the airways. It tends to develop in the bronchi, near the middle of the lungs.
- Large cell carcinoma is an aggressive type of lung cancer, with large abnormal looking cells, that tends to grow and spread quickly. It can begin in any part of the lungs.
- Other types of disease called adenosquamous carcinoma and sarcomatoid carcinoma are rare types of nonsmall cell lung cancer.
Small cell lung cancer
Small cell lung cancer is sometimes called oat cell lung cancer, because the small, oval-shaped cancer cells resemble oats when viewed under a microscope. It is an aggressive cancer, most common in smokers, that tends to grow fast and spread quickly to other parts of the body. About 10 to 15 percent of all lung cancers are small cell cancers.
Pulmonary metastases
Cancer that comes from another part of the body to the lungs is called pulmonary metastasis. These cancer types are defined by the organ in which they started, and are not technically lung cancer. For example, breast cancer cells that travel to the lungs are considered breast cancer that has metastasized (spread) to the lungs.
Some common cancers that spread to the lungs include bladder cancer, breast cancer, colon cancer, kidney cancer, melanoma, ovarian cancer, thyroid cancer and sarcoma.
Pulmonary neuroendocrine tumors
Neuroendocrine tumors form from endocrine cells, which are scattered throughout the body and release hormones into the blood in response to signals from the nervous system. Such tumors can form in various parts of the body, including the lungs.
Pulmonary neuroendocrine tumors include:
- Large cell neuroendocrine carcinoma. This subtype of nonsmall cell lung cancer is rare and tends to grow quickly.
- Typical carcinoid tumor. These tumors tend to grow slowly and rarely spread beyond the lungs.
- Atypical carcinoid tumor. About 10 percent of carcinoid tumors are atypical. They more closely resemble fast-growing tumors and are somewhat more likely to spread than typical carcinoid tumors.
How lung cancer develops
Lung tissue is some of the most sensitive in the body, and its health is largely affected by what you breathe in. Inhaling things like cigarette smoke, air pollution or the fumes from other substances like certain household products — along with certain genetic factors — may lead to harmful changes to cells in your lungs.
Getting lung cancer
Your lungs are a tree-like series of connected tubes surrounded by thick, spongy lobes. There are three lobes in the right lung and two on the left (to make space for the heart).
When you breathe in, air travels down through a large tube called the trachea, then branches out through a network of smaller tubes in the lungs called the bronchi and bronchioles — and finally ends up inflating tiny air sacs called alveoli.
Getting lung cancer means abnormal cells in your lungs are growing and dividing at a rapid pace — so fast that cells in your immune system that fight disease cannot keep up.
Besides damaging lung tissue, clusters of those abnormal cells — called tumors — can block your airways, causing problems like cough, chest pain and sometimes bleeding.
If it is caught early, lung cancer may be treated with surgery. In more advanced cases, cancer cells will have spread from one lung to another or moved to other parts of the body — a process called metastasis. Lung cancer that has metastasized tends to go to the adrenal gland, bones, brain or liver.
Some first steps for finding lung cancer involve your doctors identifying any signs and symptoms you are experiencing; performing screening tests to identify whether they are due to lung cancer — and finding out whether the disease has spread.
What increases your risk of lung cancer?
Things that put you at higher risk of getting lung cancer are called risk factors. Most people who get lung cancer are smokers, but in around 20 percent of cases nonsmokers will get lung cancer.
Risk factors for lung cancer
- Smoking cigarettes is responsible for between 80 to 90 percent of lung cancer deaths in men and women — and the more you smoke the higher your risk. Just being around cigarette smoke also can affect your risk: Being exposed to secondhand smoke at home or work increases the chances of lung cancer by 20 to 30 percent.
- Being exposed to radon is the second leading cause of lung cancer. It occurs naturally in soil, water and rock and can be found in homes, buildings and schools.
- Tiny fibers of asbestos can be breathed in and become lodged in lung tissue. Until a few decades ago, asbestos was a common ingredient in things like building materials, steam pipes, vehicle brake shoes and plastics. Asbestos was banned as a new material decades ago, but still is present in the environment.
- Exposure to materials like uranium, arsenic, vinyl chloride, coal products, mustard gas, diesel exhaust and others may increase your risk of lung cancer.
- Breathing in air pollution like diesel engine exhaust, metals, dust and solvents — found in products like paint, personal care products, nail polish remover and household cleaners — may increase your risk for lung cancer.
- Having a family history, like parents or siblings with lung cancer, increases your risk.
- Older age makes you more likely to get cancer. Close to 90 percent of people diagnosed with lung cancer are 55 or older.
- Other lung diseases like COPD (chronic obstructive pulmonary disease) or pulmonary fibrosis increase your risk of getting lung cancer.
Having some combination of exposures, like being a smoker who also was exposed to asbestos, may increase your chances of getting lung cancer.
Prevention
The best way to reduce your risk for lung cancer is to stop smoking. Other things like testing your home for radon and avoiding secondhand smoke also may help. Exercising and eating a healthy diet also may reduce your risk of lung cancer.
Are you a smoker?
Do you know what's in cigarette smoke? Find out by watching the video below.
If you are a current or former smoker, you may reduce your risk of dying of lung cancer by getting screened for lung cancer with a low dose radiation computed tomography scan of your lungs. Lung cancer screening is safe, painless and saves lives. And research shows that chemotherapy works more effectively, and there are fewer complications from surgery, in nonsmokers.
What are the signs and symptoms of lung cancer?
Most lung cancers do not cause symptoms until they have grown very large or have spread. That is when symptoms like cough, chest pain and breathing problems come on and do not go away. It also may be found during a chest X-ray or a screening test for some other condition.
Early lung cancer symptoms
- a cough that does not go away
- shortness of breath or other breathing problems like wheezing
- constant chest pain
- coughing up blood or rust-colored spit
- a raspy, hoarse or high-pitched voice
- frequent lung infections like pneumonia and bronchitis
- arm or shoulder pain
- weight loss that you cannot explain
- clubbing of fingers
Later lung cancer symptoms
Once lung cancer has progressed, your symptoms may be different since later-stage cancer affects other parts of the body — like the brain or bones. Later-stage lung cancer symptoms may include:
- drooping eyelids
- pain or tenderness in your bones or joints
- bone fractures
- facial paralysis
- changes to your voice like hoarseness
- difficulty swallowing
- shoulder pain
- weakness
- nail problems
- swelling in your face or arms
These symptoms could mean lung cancer or they might be a completely different issue. It is important to get screened to find out if these symptoms are because of cancer or some other medical problem.
Lung cancer screening
Screening increases your chances of catching lung cancer at an early stage, when it is easier to treat, and may find other diseases like emphysema or heart disease. Getting screened at a comprehensive cancer center is one way to ensure you get the best and lowest-dose scan.
At City of Hope we do low dose spiral computed tomography scanning, which uses the minimum dose of radiation possible to accurately detect lung cancer. Our screening methods are proven to decrease what are called false positives — test results that say you have cancer when you don’t — and help you avoid unnecessary or invasive procedures.
Who should be screened?
Lung cancer screening is likely to be of most benefit to you if you are, or were, a heavy smoker. Even if you do not have symptoms you should get a lung cancer screening if you are:
- between ages 55 to 77 and
- have smoked the equivalent of a pack a day for 30 years (for instance, smoking two packs a day for 15 years, or three packs a day for 10 years), and
- still are smoking or have quit sometime during the past 15 years
Screening may be an option for patients who smoked the equivalent of a pack a day for fewer than 30 years, but also have a serious risk factor for lung cancer. Speak with your doctor to discuss your options.
If you have questions about the City of Hope lung cancer screening program, please call 626-218-9410 or email us at [email protected].
You may also call 626-218-9410 or email us at [email protected] if you require assistance to quit smoking.
Lung cancer diagnosis
To accurately diagnose lung cancer, City of Hope uses a combination of leading-edge screening methods and a team of doctors whose sole focus is treating lung cancer. Our team of thoracic specialists combines its deep expertise with advanced technology to provide you with the most accurate diagnosis — leading to the most effective treatment.
If screening shows lung cancer is possible, a tiny piece of tissue from the lung (a biopsy) may be removed and examined under a microscope to find cancer cells. Cancer cells also are tested for genetic markers, since tumors with specific markers may respond better to certain treatments.
Your team is looking for the type of tumor, the stage it is in and whether certain genetic problems or mutations (abnormal changes inside a cell) are driving the cancer. All of this information can help give you the most specific and tailored treatment possible.
Testing for lung cancer
One or a combination of tests may be used to diagnose lung cancer including several minimally-invasive procedures:
- Sputum cytology is mucus or phlegm (also called sputum) you cough up from your lungs that is examined under a microscope to check for cancer cells.
- Needle biopsy is a thin, hollow needle that is guided to a mass in the lung. A pathologist looks at the sample under a microscope to check for cancer.
- Bronchoscopy uses a flexible tube called a bronchoscope that is guided through the mouth or nose into the airways of the lungs. This procedure gets samples of lung tissue and fluid, and locates and fixes things like lung blockages.
- Endobronchial ultrasound uses a narrow, flexible camera that is guided into the airways. This allows the surgeon to see lymph nodes through the windpipe and take a sample with a needle.
- Electromagnetic navigation bronchoscopy uses technology similar to a car’s GPS (global positioning system) to find tumors in the smallest airways of the lungs using an ultrathin catheter (tube).
- Pulmonary function testing is a group of tests that measure how well your lungs function. These tests typically measure things such as breathing rate, lung volume, inflammation in the lungs and how well gases such as oxygen move back and forth between the lungs and the bloodstream. Pulmonary function testing is usually done after lung cancer is diagnosed to determine how well the lungs are working prior to surgery.
- Molecular testing analyzes tumor tissues to look for certain proteins or genetic changes that are commonly associated with lung cancer. Identifying the genetic changes present in a tumor helps the medical team design a targeted therapy approach that is mostly likely to work against that tumor type.
Imaging
Imaging and other tests of the lungs involves looking at them without having to do surgery:
- Low-dose spiral computed tomography (CT) scan is a first-line screening method at City of Hope that uses low-dose X-rays to scan the body in a spiral path. The images that come out of this scan appear as “slices” of the body from different points of view. CT scans are more likely than routine X-rays to find lung tumors. A large study showed that CT scans decreased the risk of dying from lung cancer.
- Chest X-ray for lung cancer looks for any mass or spot on the lungs.
- Positron emission tomography (PET) uses a radioactive tracer to locate cancer cells and measure cancer their activity. PET also may be used to determine if the cancer has spread from the lungs to other areas of the body.
- Brain MRI (magnetic resonance imaging) uses magnets and radio waves to create a series of pictures of the brain — a common site where lung cancer spreads.
- Bone scan is a test that can determine whether lung cancer has spread to the bones. A small amount of radioactive material is injected into the blood. This material collects in areas of the skeleton where the bone has been affected by cancer, which can be detected with a special camera.
Other tests that may be used to figure out if lung cancer has spread include:
- Thoracentesis, a procedure that involves inserting a hollow needle through the chest wall, removing fluid and sending it to a lab to check for cancer cells.
- Cervical mediastinoscopy, which involves first making a small cut to the neck, then guiding a scope with a camera on it through the middle part of the chest to remove samples from lymph nodes.
- Thoracoscopy, when a small tube with a video camera at the tip is used to look at the outer part of the lungs and chest wall to locate and sample any abnormal tissue.
Lung cancer stages
What stage lung cancer is in depends on things like the size of the tumor and whether it has spread to other areas of the body.
Stage 1 cancer
Lung cancer is confined to the lung, meaning it has not spread to any other part of the body — like the chest wall. This tumor is in deeper lung tissue but still surrounded by normal tissue.
Stage 2 cancer
This tumor tends to be larger than those found in Stage 1 and will have either spread to nearby lymph nodes or other tissues nearby like the chest wall, diaphragm, pleura (membranes that surround the lungs), bronchus or heart tissue.
Stage 3 cancer
In most cases, tumors in this stage have spread to lymph nodes near the windpipe and middle chest area. Stage 3 disease may also involve more than one malignant tumor in the lung that has spread to other organs like the heart, esophagus or trachea.
Stage 4 cancer
Tumors are in both lungs or in the fluid between the pleura — the protective membranes that surround the lungs. In this stage, lung cancer may have spread to other parts of the body like the bones, liver, brain or adrenal glands.
There is no typical story because when a person is diagnosed with lung cancer today, I don’t know what I’m going to be treating them with in five years. But I very well likely will be treating them in five years — and that’s a new story for lung cancer." Karen Reckamp, M.D., M.S., co-director, Lung Cancer and Thoracic Oncology Program
Newest treatments for lung cancer
Lung cancer is a disease whose treatments change rapidly. Your team at City of Hope combines leading-edge technologies — like minimally invasive, laparoscopic and robotic surgery — with the latest targeted therapy, immunotherapy and radiological advances.
Surgery
At City of Hope, our experienced thoracic specialists perform advanced procedures not available at other centers — and are among the best when it comes to high-quality, minimally invasive thoracic surgery for lung cancer. Surgery on the lung is delicate, and preserving as much tissue as possible requires both experience and skill. Our surgical team includes highly trained leaders in lung surgery who regularly take on complex cases — including some deemed untreatable at other facilities.
Types of lung cancer surgery
- Lobectomy is the removal of an entire lobe of the lung. This is the most common type of surgery to treat lung cancer.
- Segmentectomy is the removal of a large segment of a lobe of the lung.
- Wedge resection is the removal of a piece of lung (smaller than a segment).
- Pneumonectomy is the removal of the entire lung on one side.
- Sleeve resection involves removing part of the airway, with or without the lobe of the lung, and sewing the airway back together. This procedure is usually done to avoid removing the entire lung.
Approaches to lung cancer surgery
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Robotic-assisted surgery is also performed through several small incisions. This procedure uses a tiny video camera to view the inside of the chest, as well as robotically controlled instruments that surgeons operate with hand and foot controls.
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VATS (video-assisted thoracoscopic surgery) is performed through small incisions. Surgeons insert long instruments and a tiny video camera through the incisions, allowing them to perform the same procedures that would be done in a thoracotomy without having to spread the ribs.
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Thoracotomy is traditional open surgery, in which a large incision is made in the chest and the ribs are spread in order to reach the lung tissue.
Immunotherapy
Cancer immunotherapy is a treatment that harnesses parts of a patient’s own immune system to fight cancer. One way that cancer cells grow out of control is by tricking the immune system so that it does not attack them. Immunotherapy works by helping the body’s immune system recognize and destroy cancer cells. Immunotherapy treatments work in a variety of ways. Some boost the body’s overall immune response, for example. Others work by injecting manmade versions of immune system proteins to attack cancer cells. Immunotherapy drugs have been approved for treating some types of lung cancer. In some cases, these medications work better than conventional chemotherapy.
Meanwhile, the field of immunotherapy is rapidly evolving. Researchers at City of Hope’s Department of Immuno-Oncology are among the scientists working to develop and test new lung cancer immunotherapy treatments.
Targeted therapy
Targeted therapy begins with understanding the unique biology of an individual’s cancer, then finding the best treatments based on that biology. With targeted therapy, the medical team will choose medications to target the specific gene changes, or mutations, in a particular cancer.By analyzing the unique genetic makeup of a tumor, our specialists can design more personalized therapies to block cancer growth. Compared to conventional chemotherapy drugs, medications that target specific mutations often have better response rates. In many cases, targeted therapies are also less toxic to healthy cells, which can mean fewer side effects for patients. Learn more about lung cancer targeted therapies.
Radiation therapy
- Helical TomoTherapy
- 4D CT (computed tomography) scanning
- Intensity modulated radiation therapy and image-guided radiation therapy
- Stereotactic body radiation
Chemotherapy
Chemotherapy for lung cancer is using cancer drugs to interfere with cancer cells’ ability to grow and divide. Different drug combinations work in different ways to fight cancer cells.
Learn more about chemotherapy.
Smoking Cessation Program
Learn more about the Smoking Cessation Program.
Lung cancer and thoracic experts
Whether you are diagnosed at Stage 1 or Stage 4, comprehensive care is at the core of your lung cancer treatment at City of Hope. Our surgeons, oncologists, supportive care and pain management specialists — and other team members — are in frequent communication about the best path for your treatment so that you receive care of the highest caliber. Call 800-826-4673 or request an appointment online.
Lung Cancer/Thoracic Surgery
Medical Oncology
Clinical Specialties
- Medical Oncology
- Head and Neck Cancers
- Lung Cancers
Radiation Oncologists
Pulmonary Medicine
Clinical Specialties
- Co-director, Smoking Cessation and Lung Cancer Screening Program
- Pulmonary and Critical Care Medicine
Diagnostic Radiology
Lung Cancer Research
Research Focus
- Pallative Care
- Quality of Life
- Pain Management
- End-of-Life Care
- Interprofessional Education
Research Focus
- Understanding the factors that drive the use of novel and established cancer genomic tests and therapies
- Identifying gaps in lung cancer prevention, research and care
- Designing interventions to improve the delivery of cancer medicine
Research Focus
- Cancer biology
- Peptides directed against cancer associated PCNA has therapeutic potential in breast cancer
- New molecular target for neuroblastoma therapy
- NIH/NCI Cancer Center Support Grant
- A structure/function analysis of a tumor specific protein
- caPep: mechanistic evaluation of an agent for neuroblastoma
- Development of novel agents, technologies, and markers for the better diagnosis, prognosis, screening, prevention and treatment of breast cancer
Research Focus
- Identifying new therapies to combat therapy resistance in lung cancer
- Targeting specific epigenetic changes to improve platinum sensitivity in lung cancer
- Studying barriers to lung cancer screening
Research Focus
- Lung cancer
- Mesothelioma
- Immunotherapy
- Targeted therapies
- Prevention of toxicities
- Drug development
- Database development
- Mechanisms of metastases
- Value-based genomics
Research Focus
- To develop and test interventions to improve patient-and family-centered care and surgical (lung cancer, GI cancers, colorectal cancer) outcomes
Lung cancer research and clinical trials
Getting lung cancer treatment at City of Hope means you are steps away from labs where exciting new therapies for lung cancer are being developed. That means the new and award-winning lung cancer research we are conducting moves quickly from the lab to our patients’ bedside.
City of Hope patients have access to a wide variety of lung cancer clinical trials such as the newest immunotherapy treatment and targeted therapy approaches — all with the goal of helping extend life.
For more information on a specific clinical trial or to sign up, please call 626-218-1133.
IMMUNOTHERAPY
- NCT03709706: Pilot Immunotherapy With Autologous T-cells Specific for New York Esophageal Antigen-1 (NY-ESO-1)/ Cancer-testis Antigen-2 (LAGE-1a)-Positive Advanced Non-small Cell Lung Cancer (NSCLC) Either Alone or in Combination With Pembrolizumab
- NCT02927301: Phase II study in NSCLC: A Study of Atezolizumab as Neoadjuvant and Adjuvant Therapy in Resectable NSCLC—Lung Cancer Mutation Consortium 3
- NCT02592577: Phase I study in NSCLC : MAGE A10c796T for Advanced NSCLC
TARGETED THERAPY
Living with lung cancer
Getting lung cancer is frightening and devastating. Getting through it and figuring out how to live a long life takes layers of support. When you come to City of Hope, you get access to a strong support network, including staff to help you and your family at every step in your journey. That includes everything from talk therapy to meditation to being connected with a patient navigator. Supportive care is not just about improving your mood and quality of life — it has been shown in studies to extend life.
Learn more about the resources listed below at our Living with Cancer or Supportive Care Medicine sites.
- Pain management
- Side effects
- Quitting smoking
- Pulmonary rehabilitation to improve breathing
- Navigating the health care system
- Your emotional, social and spiritual health
- Staying healthy and active
- Healthy cooking and eating
- Caregiver skills
- Improving communication with family, partners and loved ones
For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE).
Hopeful.org
To connect with fellow cancer fighters, caregivers and supporters alike, join our Community of the Hopeful today.
Hopeful.org is an online community, a space for everyone who has been touched by cancer to make connections, share their stories, offer support and seek advice.
It features new stories weekly on everything from recipes to news about immunotherapy and other groundbreaking treatments. No one should have to go through cancer alone, and Hopeful ensures that every person will have a supportive community to lean on.
With the burden of cancer greatly lifted, the Taylors are on their next big adventure of building a family.
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