Lung cancer is the most common type of cancer worldwide - around 222,500 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.
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.
Even for Stage 4 disease we have a lot of hope. There’s a light at the end of the tunnel." Ravi Salgia, M.D., Arthur & Rosalie Kaplan Chair in Medical Oncology
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.
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.
And City of Hope is a leader in personalized medicine, including clinical trials here that are finding new and more effective drug combinations to kill lung cancer cells.
When we treat cancer at City of Hope we are not just focused high quality care and innovation — we are working to make you whole again.
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Lung cancer is the most common type of cancer worldwide — around 222,500 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.
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.
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.
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.
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:
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.
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.
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.
Having some combination of exposures, like being a smoker who also was exposed to asbestos, may increase your chances of getting lung cancer.
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.
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.
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.
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:
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.
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.
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:
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.
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.
One or a combination of tests may be used to diagnose lung cancer including several minimally-invasive procedures:
Imaging and other tests of the lungs involves looking at them without having to do surgery:
Other tests that may be used to figure out if lung cancer has spread include:
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
At the heart of your treatment at City of Hope is your individuality. We understand that you — and your specific type of lung cancer — are unique and we use that knowledge to determine the best therapy, leading to the best outcome.
Treating you as an individual starts with assembling an experienced care team led by world leaders in the biology of lung cancer. At City of Hope breakthroughs from our renowned research team move quickly to our patients. That means you get rapid access to the best treatments, including the latest therapies and clinical studies.
From research through diagnosis and treatment few cancer centers take care of lung cancer like City of Hope can.
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 therapeutic and radiological advances including:
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.
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 conditions including:
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.
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.
For patients with aggressive or recurrent disease, we routinely perform genetic tests to find mutations (abnormal changes inside a cell), allowing us to find a drug combination that works best for your specific tumor. You also may be enrolled in a clinical trial to treat the mutation driving your cancer.
Your doctor will tailor a treatment to your specific type of cancer, and work with the rest of your team to decide whether chemotherapy should be given before or after other treatments — like surgery — or alone.
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 immunotherapy treatments.
Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. Radiation may be used alone or with chemotherapy to treat lung cancer. There are two ways to deliver radiation therapy:
City of Hope uses leading-edge radiation therapy techniques:
City of Hope’s renowned thoracic physicians and researchers utilize the latest in technology and innovation to treat lung cancer, coupled with our enduring belief in providing unparalleled compassionate care. Call 800-826-4673 or request an appointment online.
Lung Cancer Research
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. It means you get something unique in cancer care - “bench to bedside” treatment. 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 clinical trials looking into early-detection for lung cancer, the newest chemotherapy treatments, targeted therapies and surgical and radiation approaches — all with the goal of helping extend life.
Current research and clinical trials include new therapies that shut down chemical pathways that influence how lung cancer develops, progresses and spreads:
A Chinese herb called the “Thunder of God Vine” — called MRx102 — is a potential new treatment for patients with lung cancer. In early studies MRx102 destroyed lung cancer cells by blocking a pathway in the body that caused lung cancer cells to grow.
Our researchers have found a protein that is active in lung cancer cells — but not healthy cells — called caPCNA. They are researching how to use what they know about caPCNA to kill small cell lung cancer cells with minimal effects on surrounding healthy cells.
For patients with soft-tissue sarcomas, the cancer most frequently spreads to their lungs. Our researchers are analyzing the genetics of those sarcomas and the sites where they spread to identify ways to stop this process.
City of Hope is working on innovative ways to activate the immune system to fight squamous cell carcinoma, which happens about 30% of the time non-small cell lung cancer is diagnosed. A therapy called nivolumab that allows a patient’s own T cells (cells in the immune system) to attack cancer cells is leading to remarkable improvements in survival and fewer side effects in patients.
Chemotherapy is designed to damage DNA in cancer cells to kill them, but cancer cells can figure out ways around this and continue repairing DNA. In an innovative clinical trial, City of Hope is exploring a compound called TRC102, which keeps cancer cells from self-repairing. TRC102 is being tested in combination with two drugs to try and make chemotherapy more effective.
Some patients with nonsmall cell lung cancer have mutations in the tumor that cause the cancer to grow, which can be treated with targeted therapy. Unfortunately, over time the cancer becomes resistant, continuing to grow again. City of Hope is exploring ways to pair existing targeted therapies with other drugs to help overcome this resistance. Early study results show that this strategy has significantly slowed tumor growth.
One treatment for patients with early stage non-small cell lung cancer is a form of radiation called stereotactic body radiation therapy (SBRT). After SBRT, clinicians typically monitor patients for two years using computed tomography imaging. However, it can be difficult to distinguish between tumor recurrence that needs further treatment and harmless treatment-associated scar tissue that requires no further action. City of Hope is the first institution to study higher-quality multiparametric Magentic resonance imaging after SBRT to get a clearer picture of treatment response sooner.
Our researchers are leading a pilot study using a video educational program to help reduce anxiety and psychological harm during lung cancer screening. The study involves finding ways to overcome barriers to screening so at-risk individuals can get the care they need.
City of Hope is developing a tobacco cessation mobile app to help smokers with lung cancer to taper down smoking and connect with each other for peer support.
We are studying survivorship care plans that give patients helpful information on treatments, side effects and follow-up, along with useful tips on eating healthy and physical activity. Data from this early study will be used to build a larger clinical trial.
Koczywas, 14203: SWOG S1400: Phase II/III Biomarker-Driven Master Protocol for Second Line Therapy of Squamous Cell Lung Cancer
This screening and multisubstudy randomized phase II/III trial will establish a method for genomic screening of similar large cancer populations followed by assigning and accruing simultaneously to a multisubstudy hybrid “Master Protocol” (S1400). The type of cancer trait (biomarker) will determine to which substudy, within this protocol, a participant will be assigned to compare new targeted cancer therapy, designed to block the growth and spread of cancer, or combinations to standard of care therapy with the ultimate goal of being able to approve new targeted therapies in this setting.
Salgia, 16035: A Phase II single-arm trial to investigate tepotinib in stage IIIB/IV adenocarcinoma of the lung with MET exon 14 (METex14) skipping alterations after failure of at least one prior active therapy, including a platinumdoublet-containing regimen
This study will look at how effective the study drug(tepotinib) is at stopping the growth and spread of lung cancer that carries a specific genetic alteration (MET exon 14 skipping alterations) and that did not respond to standard of care treatment such as chemotherapy (platinum doublet containing regimen).
Reckamp, 16208: A Phase II, open-label, multicenter, single-arm study to investigate the efficacy and safety of Atezolizumab as Neoadjuvant and Adjuvant Therapy in patients with Stage IB, II or IIIA resectable and untreated nonsmall cell lung cancer
This study is designed to evaluate the safety and efficacy of neoadjuvant and adjuvant atezolizumab in participants with Stage IB, II or IIIA NSCLC who are eligible for surgical resection with curative intent. Neoadjuvant therapy will consist of two 21-day cycles with atezolizumab. Following surgery, adjuvant therapy will consist of up to 12 months of atezolizumab in participants who demonstrate clinical benefit with neoadjuvant therapy.
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.
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).
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