Lung Cancer

Risk factors are traits that may put people at greater risk of developing lung cancer.

• Tobacco: Smoking tobacco is the leading risk factor responsible for nine out of 10 cases.
• Secondhand Smoke: Nonsmokers who breathe the tobacco smoke of others are at increased risk.
• Radon: Exposure to high indoor radon levels at home or work can damage lungs and lead to cancer. Radon is an odorless radioactive gas produced naturally by rocks and soil.
• Asbestos: Inhaled asbestos particles can cause damage that leads to lung cancer or mesothelioma, a cancer that starts in the lining of the lung.

• Persistent cough
• Hoarseness or wheezing
• Shortness of breath
• Sputum (spit or phlegm) streaked with blood
• Recurring bronchitis or pneumonia
• Weight loss or loss of appetite
• Chest pain

Benefits related to lung cancer screening have been clearly proven for the following individuals:

• Adults between the ages of 50 and 80*
• A 20 pack-year smoking history
• A current smoker or someone who has quit smoking within the last 15 years
• Individuals who are asymptomatic (no signs/symptoms of lung cancer)
• Patients should be in good enough health to withstand and recover from surgery and oncology treatment 

*Medicare coverage up to age 77

There are two main types of lung cancer. Treatment varies because each type grows and spreads in different ways.

• Non-small cell lung cancer, the most common, is often associated with smoking. Three subtypes differ in size, shape and chemical composition.
• Small cell lung cancer accounts for about 20 percent of cases.

Physicians use several techniques to locate abnormal areas and determine the extent of the disease. These tools provide critical information used to develop an individualized treatment plan.

• Chest X-rays are used to identify spots on the lung.
• Computed tomography (CT) offers precise information about the size, shape and location of the tumor.
• Lo- dose CT (spiral CT) gives more detailed pictures than a chest X-ray. It can find small tumors and exposes patients to less radiation than a standard CT.
• Magnetic resonance imaging (MRI) produces detailed pictures of soft tissue that determine if cancer has spread to the brain and spinal cord.
• Positron emission testing (PET) helps determine if cancer has spread to lymph nodes or elsewhere.
• Combined PET/CT provides enhanced capabilities for imaging lung cancer that is sometimes difficult to identify on a typical CT scan.
• Bone scans are used to detect whether lung cancer has spread to the bone.

During a bronchoscopy, physicians use a lighted, flexible tube called a bronchoscope to detect tumors or suspicious cells. Tissue samples can be removed from the bronchial passages for analysis.

Mediastinoscopy is a surgical staging procedure using a long, thin, flexible, lighted tube to view and biopsy the area behind the breastbone and between the lungs, or mediasteium, This allows the medical team to determine whether or not cancer had spread to any lymph nodes in that area.

Guided by computed tomography (CT) imaging, doctors use a fine needle to remove or aspirate tissue samples that are not accessible during a bronchoscopy.

This procedure uses a device known as the iLogic or SuperDimension system, a navigational system for the lungs. Aided by a video monitor, the physician guides a flexible catheter through very delicate vessels of the bronchial tree to reach small lung lesions for biopsy and, in some cases, treatment.

Endobronchial ultrasound, or EBUS, is used to diagnose and stage lung cancer without conventional surgery. The device is inserted through a bronchoscope in the airway, allowing doctors to view and biopsy lymph nodes or another area of concern.

A small flexible tube with an ultrasound machine on the tip is placed inside the esophagus. The device can examine growths and tumors located in the wall of the esophagus or in the structures surrounding the esophagus.

Surgery is used to treat non-small cell lung cancers that have not spread beyond the lung. The three most common surgical procedures are:

• wedge resection or segmentectomy to remove of a small section of the lung
• lobectomy to remove an entire section of the lung
• pneumonectomy to remove an entire lung

Learn more about Surgery at Greenwich Hospital

Patients may receive anti-cancer drugs known as chemotherapy, even after surgery. The drugs destroy cancer cells that may be present in nearby tissue or that have spread to other parts of the body. Chemotherapy, often combined with radiation therapy, is commonly used to treat small cell lung cancer.

Radiation oncologists can administer high doses of radiation to lung tumors while sparing the surrounding healthy tissue. Daily radiation is often used in combination with chemotherapy or surgery to treat advanced lung cancers. Radiosurgery is a non-invasive treatment with high-dose, focused radiation that can cure small tumors in patients who cannot undergo conventional surgery. Radiation therapy can also be used to relieve pain, bleeding and swallowing problems sometimes caused by lung cancer.