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Lung Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Lung Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Lung cancer affects more than 200,000 Americans each year. Although cigarette smoking is the main cause, anyone can develop lung cancer. Lung cancer is always treatable, no matter the size, location, whether the cancer has spread, and how far it has spread.

About the lungs

When a person inhales, the lungs absorb oxygen from the air and bring the oxygen into the bloodstream for delivery to the rest of the body. As the body’s cells use oxygen, they release carbon dioxide. The bloodstream carries carbon dioxide back to the lungs, and the carbon dioxide leaves the body when a person exhales. The lungs contain many different types of cells. Most cells in the lung are epithelial cells. Epithelial cells line the airways and make mucus, which lubricates and protects the lung. The lung also contains nerve cells, hormone-producing cells, blood cells, and structural or supporting cells.

About lung cancer

Lung cancer begins when cells in the lung change and grow uncontrollably, forming a mass called a tumor, a lesion, or a nodule. A lung tumor can begin anywhere in the lung. A tumor can be cancerous or benign. Once a cancerous lung tumor grows, it may or may not shed cancer cells. These cells can be carried away in blood or float away in the fluid, called lymph, that surrounds lung tissue. Lymph flows through tubes called lymphatic vessels that drain into collecting stations called lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes are located in the lungs, the center of the chest, and elsewhere in the body. The natural flow of lymph out of the lungs is toward the center of the chest, which explains why lung cancer often spreads there first. When a cancer cell moves into a lymph node or to a distant part of the body through the bloodstream, it is called metastasis.

Types of lung cancer

There are two major types of lung cancer: non-small cell and small cell.

Non-small cell lung cancer (NSCLC). NSCLC comes from epithelial cells and is the most common type. NSCLC may also be described based on the type of epithelial cell where the cancer starts. Adenocarcinoma starts in cells that produce mucus. Squamous or epidermoid carcinoma begins in the cells that line the airways. Large cell carcinoma begins in cells other than the two types described above.

Small cell lung cancer. Small cell lung cancer begins in the nerve cells or hormone-producing cells of the lung. The term “small cell” refers to the size and shape of the cancer cells as seen under a microscope.

It is important for doctors to distinguish NSCLC from small cell lung cancer because the two types of cancer are usually treated in different ways. The type of lung cancer, such as NSCLC or small cell, and stage of the disease (discussed later in the Stages section) determine what type of treatment is needed.

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If you would like additional introductory information, explore these related items. Please note these links take you to other sections on Cancer.Net:

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Lung Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 224,210 adults (116,000 men and 108,210 women) in the United States will be diagnosed with lung cancer. Lung cancer is the second most common cancer and the leading cause of cancer death for men and women. It is estimated that 159,260 (86,930 men and 72,330 women) from this disease will occur this year.

The one-year survival rate is the percentage of people who survive at least one year after the cancer is detected excluding those who die from other diseases. For all people with lung cancer, the one-year survival rate is 43%. The five-year survival rate is 17%.

Lung cancer makes up 13% of all cancer diagnoses and 27% of all cancer deaths. For men, death rates have declined consistently for the past two decades, recently at a rate of about 2.9% each year. The death rates for women with lung cancer have declined 1.4% per year. For unclear reasons, black men have the highest incidence and the lowest survival rates of lung cancer.

These statistics should not be taken as a death sentence. It is important to remember that statistics do not apply to an individual person. No doctor can tell a person how long he or she will live with lung cancer. Some patients with advanced lung cancer can live many years after diagnosis. Sometimes, patients who are told that their lung cancer is curable do not live as long as those who are told that their lung cancer cannot be cured. The important thing to remember is that lung cancer is treatable at any stage, and these treatments have been proven to help people with lung cancer live longer with better quality of life.

Furthermore, these estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. Because survival statistics are often measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2014.

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Lung Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find a basic drawing about the common body parts affected by this disease. To see other pages, use the menu on the side of your screen.

Lung Anatomy
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For medical illustrations about the different stages of lung cancer, please visit the Stages section.

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Lung Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. Most lung cancer occurs in people who smoke or in those who have smoked in the past. However, people who don’t smoke can also develop lung cancer, so it is important for all people to learn about the risk factors and signs and symptoms of lung cancer.

The following factors may raise a person’s risk of developing lung cancer:

Tobacco. Tobacco smoke damages cells in the lungs, causing the cells to grow abnormally. The risk that smoking will lead to cancer is higher for people who smoke heavily and/or for a long time. Regular exposure to smoke from someone else’s cigarettes, cigars, or pipes can increase a person’s risk of lung cancer, even if that person does not smoke. This is called environmental or “secondhand” tobacco smoke.

Asbestos. These are hair-like crystals found in many types of rock and are often used as fireproof insulation in buildings. When asbestos fibers are inhaled, they can irritate the lungs. Many studies show that the combination of smoking and asbestos exposure is particularly dangerous. People who work with asbestos in a job such as shipbuilding, asbestos mining, insulation, or automotive brake repair and who smoke have a higher risk of developing lung cancer. Using protective breathing equipment reduces this risk.

Radon. This is an invisible, odorless gas naturally released by some soil and rocks. Exposure to radon has been associated with an increased risk of some types of cancer, including lung cancer. Most hardware stores have kits that test home radon levels, and basements can be ventilated to reduce radon exposure.

Prevention

Research continues to look into what factors cause lung cancer and what people can do to lower their personal risk. There is no proven way to completely prevent lung cancer, but there may be steps you can take to lower your risk. Talk with your doctor if you have concerns about your personal risk of developing lung cancer.

The most important way to prevent lung cancer is to avoid tobacco smoke. People who never smoke have the lowest risk of lung cancer. People who smoke can reduce their risk of lung cancer by stopping smoking, but their risk of lung cancer will still be higher than people who never smoked. Attempts to prevent lung cancer with vitamins or other treatments have not worked. For instance, beta-carotene, a drug related to vitamin A, has been tested for the prevention of lung cancer. It did not reduce the risk of cancer. In people who continued to smoke, beta-carotene actually increased the risk of lung cancer.

Screening

Based on results from the National Lung Screening Trial, several groups, including ASCO, have developed recommendations for lung cancer screening with a test called a low-dose helical or spiral computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors.

CT scanning is not recommended for every person who smokes. The current recommendations are discussed below.

The United States Preventive Services Task Force recommends that people age 55 to 80 who have smoked for 30 pack years or more or who have quit within the past 15 years receive screening for lung cancer with low-dose CT scans each year, and screening can stop after a person has not smoked for 15 years or develops a health problem that would shorten their life or prevent them from being able to have surgery for lung cancer. A pack year is equal to smoking 20 cigarettes (1 pack) a day each year, about 7,305 cigarettes per year.

ASCO recommends the following lung cancer screening schedules for people who currently smoke or who have quit smoking:

  • Yearly screening with a low-dose CT scan is recommended instead of screening with a chest x-ray or no screening for people age 55 to 74 who have smoked for 30 pack years or more or who have quit within the past 15 years.
  • CT screening is not recommended for people who have smoked for less than 30 pack years, are younger than 55 or older than 74, have quit smoking more than 15 years ago, or have a serious condition that could affect cancer treatment or shorten a person's life.

Learn more about ASCO’s recommendations for lung cancer screening in current or former smokers and information on lung cancer screening from the National Cancer Institute.

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Lung Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with lung cancer may experience the following symptoms or signs. Sometimes people with lung cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Fatigue
  • Cough
  • Shortness of breath
  • Chest pain, if a tumor spreads to the lining of the lung or other parts of the body near the lungs
  • Loss of appetite
  • Coughing up phlegm or mucus
  • Coughing up blood

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

For people with lung cancer who have no symptoms, their lung cancer may be noticed on a chest x-ray or CT scan performed for some other reason, such as checking for heart disease. Most people with lung cancer are diagnosed when the tumor grows, takes up space, or begins to cause problems with parts of the body near the lungs. A lung tumor may also make fluid that can build up in the lung or the space around the lung or push the air out of the lungs and cause the lung to collapse. This prevents oxygen from getting in the body and carbon dioxide from leaving the body by blocking the flow of air into the lungs, or by using up the space normally required for oxygen to come in and carbon dioxide to go out of the lung.

Although lung cancer can spread anywhere in the body through a process called metastasis, it most commonly spreads to the lymph nodes, other parts of the lungs, bones, brain, liver, and structures near the kidneys called the adrenal glands. Metastases from lung cancer can cause further breathing difficulties, bone pain, abdominal or back pain, headache, weakness, seizures, and/or speech difficulties. Rarely, a lung tumor can release hormones that cause problems such as low blood sodium levels or high blood calcium levels.

Symptoms such as fatigue, feeling out-of-sorts or unwell, and loss of appetite are not necessarily caused by metastases. Cancer anywhere in the body can cause a person to feel unwell in a general way. Loss of appetite can cause weight loss. Fatigue and weakness can further worsen a person’s ability to breathe.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Lung Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread from the lung. Some tests may also determine which treatments may be the most effective. A biopsy is the only way to make a definitive diagnosis of lung cancer. Imaging tests may be used to find out whether the cancer has spread, but they can never be used alone to diagnose lung cancer. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Size, location, and type of cancer suspected
  • Age and medical condition
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose and stage lung cancer:

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. In recent years, doctors have learned it is helpful to have a larger tumor sample in order to determine the subtype of NSCLC and to do additional molecular testing (see below). If not enough of the tumor is removed to do these tests, another biopsy may be needed. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. If cancer cells are found, the pathologist will determine if it is small cell lung cancer or NSCLC, based on what it looks like when seen through a microscope.

Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. There are several genes that may be changed, called mutations, in a lung tumor that can help the cancer grow and spread. These mutations are found in the tumor, and not in normal cells in the body, so they are not inherited or passed down to your children. Mutations that are known to contribute to cancer growth often occur on one or more of several genes, including EGFR, ALK, KRAS, BRAF, and HER2. Results from testing for these mutations help decide whether your treatment options include a type of treatment called targeted therapy, which can be directed at specific mutations (see Treatment Options). Mutations for which targeted therapies exist are much more likely to occur in patients with the adenocarcinoma type of lung cancer and in patients who never smoked.

More procedures that doctors use to collect tissue for the diagnosis and staging of lung cancer are listed below:

Sputum cytology. If lung cancer is suspected, the doctor may ask a person to cough up some phlegm so it can be looked at under a microscope. A pathologist can find cancer cells mixed in with the mucus. However, sputum cytology provides a smaller amount of tissue than is needed to completely diagnose lung cancer and perform molecular testing (see above).

Bronchoscopy. In this procedure, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the main windpipe, and into the breathing passages of the lungs. A surgeon or a pulmonologist may perform this procedure. A pulmonologist is a medical doctor who specializes in the diagnosis and treatment of lung disease. The tube lets the doctor see inside the lungs. Tiny tools inside the tube can take samples of fluid or tissue so the pathologist can examine them. Patients are given mild anesthesia during a bronchoscopy. Anesthesia is medication to block the awareness of pain.

Needle aspiration/core biopsy. After numbing the skin, a special type of radiologist, called an interventional radiologist, removes a sample of the lung tumor for testing. This can be done with a smaller needle or a larger needle depending on how large of a sample is needed. The doctor uses the needle to remove a sample of tissue for testing. Often, the radiologist uses a chest CT scan or special x-ray machine called a fluoroscope to guide the needle. In general, a core biopsy provides more tissue than a needle aspiration, which is needed for diagnosis and molecular testing (see above).

Thoracentesis. After numbing the skin on the chest, a needle is inserted through the chest wall and into the space between the lung and the wall of the chest where fluid can collect. The fluid is removed and checked for cancer cells by the pathologist.

Thoracotomy. This procedure is performed in an operating room, and the patient receives general anesthesia. A surgeon then makes an incision in the chest, examines the lung directly, and takes tissue samples for testing. A thoracotomy is the procedure surgeons most often use to completely remove a lung tumor.

Thoracoscopy. Through a small cut in the skin of the chest wall, a surgeon can insert a special instrument and a small video camera to assist in the examination of the inside of the chest. Patients need general anesthesia for this procedure, but recovery time may be shorter with a thoracoscopy because of the smaller incisions that are used. This procedure may be referred to as video-assisted thoracoscopic surgery or VATS.

Mediastinoscopy. A surgeon examines and takes a sample of the lymph nodes in the center of the chest underneath the breastbone by making a small incision at the top of the breastbone. This procedure also requires general anesthesia and is done in an operating room.

Bone marrow aspiration and biopsy. This is a test used occasionally for small cell lung cancer. These two procedures are similar and often done at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. The sample(s) are then analyzed by a pathologist. A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The skin in that area is usually numbed with medication beforehand, and other types of anesthesia may be used. 

Imaging tests

In addition to biopsies and surgical procedures, imaging scans are very important in the care of people with lung cancer. However, no test is perfect, and no scan can diagnose lung cancer. Only a biopsy can do that. Chest x-ray and scan results must be combined with a person’s medical history, a physical examination, blood tests, and information from the biopsy to form a complete story about where the cancer began and whether or where it has spread.

CT scan. This test produces images that allow doctors to see the size and location of a lung tumor and/or lung cancer metastases. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.  

Magnetic resonance imaging (MRI) scan. This test also produces images that allow doctors to see the location of a lung tumor and/or lung cancer metastases and measure the tumor’s size. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. MRI scanning does not work well to take pictures of parts of the body that are moving, like your lungs, which move with each breath you take. For that reason, the MRI scan is rarely used to look at the lungs. However, it may be helpful to find lung cancer that has spread to the brain.

Scans are also available that use radioactive molecules, called tracers, injected into the blood to show where cancer is possibly located, such as:

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. PET scans (see above) have been replacing bone scans to find lung cancer that has spread to the bones.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

Finding out where the cancer started

Lung cancer starts in the lungs. Many other types of cancer start elsewhere in the body and spread to the lungs when they metastasize. For example, breast cancer that has spread to the lungs is still called breast cancer. Therefore, it is important for doctors to know if the cancer started in the lungs or elsewhere.

To find where the cancer started, your doctor will take into account your symptoms and medical history, physical examination, how the tumor looks on x-rays and scans, and your risk factors for cancer. A pathologist can perform tests on the biopsy sample to help find out where the cancer began, and the doctor may recommend other tests to rule out specific types of cancer. If, after these considerations, the doctor is still not sure where the cancer started, the doctor may give a diagnosis of metastatic cancer “of unknown primary.” Most treatments for metastatic cancer of unknown primary that are first found in the chest are the same as those for metastatic lung cancer.

Stopping smoking

Even after lung cancer is diagnosed, it is still beneficial to quit cigarette smoking. People who stop smoking have an easier time with all treatments, feel better, live longer, and have a lower risk of developing a second lung cancer or other health problems. Stopping smoking is never easy and even harder when facing the diagnosis of lung cancer. People who smoke should seek help from family, friends, programs for quitting smoking, and health care professionals. None of the products available to quit smoking interfere with cancer treatment. Learn more about stopping tobacco use after a cancer diagnosis.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.

Lung Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

In general, a lower number stage of lung cancer is linked with a better outcome. However, no doctor can predict how long a patient will live with lung cancer based only on the stage of disease because lung cancer is different in each person, and treatment works differently for each tumor.

Cancer stage grouping

The stage of both small cell and non-small cell lung cancer is described by a number, zero (0) through four (Roman numerals I through IV). One way to determine the staging of lung cancer is to find out whether the cancer can be completely removed by a surgeon. To completely remove the lung cancer, the surgeon must remove the cancer, along with the surrounding, normal lung tissue.

Stage 0

This is called in situ disease, meaning the cancer is “in place” and has not grown into nearby tissues and spread outside the lung.

Lung Cancer Stage 0

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Stage I

A stage one (I) lung cancer is a small tumor that has not spread to any lymph nodes, making it possible for a surgeon to completely remove it. Stage I is divided into two substages: stage IA or stage IB, based on the size of the tumor. Smaller tumors, such as those less than 3 centimeters (cm) wide are stage IA, and slightly larger ones, such as those more than 3 cm but less than 5 cm wide, are stage IB.

Lung Cancer Stage IA

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Lung Cancer Stage IB

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Stage II

Stage two (II) lung cancer is divided into two substages: stage IIA or IIB. A stage IIA cancer describes a tumor larger than 5 cm but less than 7 cm wide that has not spread to the nearby lymph nodes or a small tumor less than 5 cm wide that has spread to the nearby lymph nodes.

Lung Cancer Stage IIA

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Stage IIB lung cancer describes a tumor larger than 5 cm but less than 7 cm wide that has spread to the lymph nodes or a tumor more than 7 cm wide that may or may not have grown into nearby structures in the lung but has not spread to the lymph nodes. 

Lung Cancer Stage IIB

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Sometimes, stage II tumors can be removed with surgery, and other times, more treatments are needed.

Stage III

Stage three (III) lung cancers are classified as either stage IIIA or IIIB. For many stage IIIA cancers and nearly all stage IIIB cancers, the tumor is difficult, and sometimes impossible, to remove. For example, the lung cancer may have spread to the lymph nodes located in the center of the chest, which is outside the lung. Or, the tumor may have grown into nearby structures in the lung. In either situation, it is less likely that the surgeon can completely remove the cancer because removal of the cancer must be performed bit by bit.

Lung Cancer Stage IIIA

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Lung Cancer Stage IIIB

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Stage IV

Stage four (IV) means the lung cancer has spread to more than one area in the other lung, the fluid surrounding the lung or the heart, or distant parts of the body through the bloodstream. Once released in the blood, cancer can spread anywhere in the body, but it is more likely to spread to the brain, bones, liver, and adrenal glands. It is called stage IVA when the cancer has spread within the chest or IVB when it has spread outside of the chest.

Lung Cancer Stage IV

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In general, surgery is not successful for most stage III or IV lung cancers. Lung cancer can also be impossible to remove if it has spread to the lymph nodes above the collarbone, or if the cancer has grown into vital structures within the chest, such as the heart, large blood vessels, or the main breathing tubes leading to the lungs. The doctor will recommend other treatment options.

Recurrent: Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010), published by Springer-Verlag New York, www.cancerstaging.net

Prognosis

The type and stage of lung cancer and the patient’s overall health influence prognosis. Although lung cancer is treatable at any stage, only certain stages of lung cancer can be cured.

Doctors measure a patient’s general strength and health using an index known as performance status. Patients who are strong enough to go about their daily activities without assistance and work outside the home can safely receive chemotherapy, radiation therapy, and/or surgery. Treatment may not be as effective for patients with bone or liver metastases from lung cancer, excessive weight loss, ongoing cigarette use, or pre-existing medical conditions, such as heart disease or emphysema.

It is important to note that a patient’s age has never been useful in predicting whether a patient will benefit from treatment. The average age of patients with lung cancer in the United States is 71. A patient’s age should never be used as the only reason for deciding what treatment is best, especially for older patients who are otherwise physically fit and have no medical problems besides lung cancer.

Information about the cancer’s stage and prognosis will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Lung Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

There are four basic ways to treat lung cancer: surgery, radiation therapy, chemotherapy, and targeted therapy. Each treatment option is described below, followed by an outline of common treatment plans by the type and stage of cancer. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

A surgical oncologist is a doctor who specializes in treating cancer using surgery. For lung cancer, a thoracic surgeon is specially trained to perform lung cancer surgery. The goal of surgery is the complete removal of the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of normal lung tissue. A “negative margin” means that when the pathologist examines the lung, or piece of lung that has been removed by the surgeon, no cancer was found in the healthy tissue surrounding the tumor.

The following types of surgery may be used for lung cancer:

Lobectomy. The lungs have five lobes, three in the right lung and two in the left lung. For NSCLC, the removal of an entire lobe of the lung in a procedure called a lobectomy is often the most effective type of surgery, even when the lung tumor is very small.

A wedge. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of normal lung.

Segmentectomy. This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer developed.

Pneumonectomy. If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung.

Radiofrequency ablation. Radiofrequency ablation (RFA) is the use of a needle inserted into the tumor to destroy the cancer with an electrical current. It is sometimes used for a lung tumor that cannot be removed with the other types of surgery listed above.

The time it takes to recover from lung surgery depends on how much of the lung is removed and the health of the patient before surgery. Talk with your health care team about what to expect before your surgery, including recovery time and possible side effects. Learn more about cancer surgery.

Adjuvant therapy

Adjuvant therapy is treatment that is given after surgery to lower the risk of the lung cancer returning. Adjuvant therapy may include radiation therapy, chemotherapy, and possibly targeted therapy. Each therapy is described below. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. It also can decrease the risk of recurrence, though there is always some risk that the cancer will come back.

Along with staging, other tools can help determine prognosis and help you and your doctor make decisions about whether adjuvant therapy would be helpful in your treatment. The website Adjuvant! Online (www.adjuvantonline.com) is one tool that your doctor can access to interpret a variety of factors that are important for making treatment decisions. This website should only be used with the help of your doctor.

Read more about ASCO's recommendations for adjuvant treatment for lung cancer. In addition, ASCO provides several Decision Aids to help patients talk with their doctors about the risks and benefits of chemotherapy after surgery. Consider using one of the following decision aids to start a discussion with your doctor about adjuvant therapy: stage IB, stage II, or stage III.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. If you need radiation therapy, you will be asked to see a specialist called a radiation oncologist, a doctor who specializes in giving radiation therapy to treat cancer. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks. When radiation treatment is given using implants, it is called internal radiation therapy, or brachytherapy. However, brachytherapy is rarely used for lung cancer.

Like surgery, radiation therapy cannot be used to treat widespread cancer. Radiation only destroys cancer cells directly in the path of the radiation beam. It also damages the normal cells in its path; for this reason, it cannot be used to treat large areas of the body.

Sometimes, CT scans (see Diagnosis) are used to plan out exactly where to direct the radiation to lower the risk of damaging healthy parts of the body. This is called intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). It is not an option for all patients, but it may be used for patients with early disease and small tumors when surgery is not an option.

Patients with lung cancer who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, patients may also develop a sore throat and have difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation was directed. Most side effects go away soon after treatment is finished.

If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends. About 15% of patients develop this condition, called radiation pneumonitis. If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications, such as prednisone (multiple brand names). Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. Typically, the scarring does not cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath. For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of normal lung tissue exposed to radiation (see above).

Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. It has been shown to improve both the length and quality of life for people with lung cancer of all stages. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). Most chemotherapy used for lung cancer is given by IV injection.

A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. The type of lung cancer you have (adenocarcinoma or squamous cell carcinoma) will affect which drugs are used for chemotherapy. Newer chemotherapy regimens cause fewer side effects and are as effective as older treatments. ASCO provides treatment recommendations for chemotherapy for lung cancer. Learn more about adjuvant chemotherapy and chemotherapy for stage IV lung cancer.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, diarrhea, and hair loss. Nausea and vomiting are often avoidable; learn more about preventing nausea and vomiting caused by cancer treatment. These side effects usually go away once treatment is finished.

Chemotherapy may also damage normal cells in the body, including blood cells, skin cells, and nerve cells. This may cause low blood counts, an increased risk of infection, hair loss, mouth sores, and/or numbness or tingling in the hands and feet. Your medical oncologist can often prescribe drugs to help relieve many of these side effects. Hormone injections are also used to prevent white and red blood cell counts from becoming too low.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. For some lung cancers, abnormal proteins are found in unusually large amounts in the cancer cells. Running tests to find these proteins can help doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted treatments.

For lung cancer, the following types of targeted therapy may be used, particularly in clinical trials. Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Anti-angiogenesis therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Bevacizumab (Avastin) is an anti-angiogenic drug given along with chemotherapy for lung cancer. The risk of serious bleeding for patients taking bevacizumab is about 2%. However, it is more common for patients with squamous cell carcinoma, so bevacizumab is usually not recommended for patients with this type of NSCLC.

Drugs that work on specific mutations in cancer cells. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of lung cancer.

  • Erlotinib (Tarceva) is a drug that blocks the EGFR. This drug has been shown to work better than chemotherapy if the lung cancer has a mutation in the EGFR gene. It is approved by the U.S. Food and Drug Administration (FDA) for patients with locally advanced and metastatic NSCLC and as a maintenance therapy for patients with NSCLC that has not grown or spread after at least four cycles of chemotherapy. This medication is a pill that can be taken by mouth. The side effects of erlotinib include a rash that looks like acne, and diarrhea.
  • Gefitinib (Iressa) is another drug that blocks the EGFR. This treatment is only available in Europe and Asia.
  • Gilotrif (Afatinib) was approved by the FDA in 2013 as an initial treatment for NSCLC. It is a type of drug called a tyrosine kinase inhibitor (TKI) that works by stopping uncontrolled cell growth caused by a mutation in the EGFR gene.
  • Crizotinib (Xalkori) is another type of targeted therapy approved by the FDA for advanced NSCLC that has a mutation in the ALK gene.
  • Ceritinib (Zykadia) is an additional targeted therapy for NSCLC with an ALK gene mutation. It is approved by the FDA for patients when the cancer worsens while they are receiving crizotinib or if they cannot take crizotinib.

Combining treatments

Most people with lung cancer receive more than one type of treatment from more than one specialist. This is called a multidisciplinary team approach. For example, chemotherapy can be given before or after surgery or before, during, or after radiation therapy. Patients should have a sense that their doctors have a coordinated plan of care and are working effectively with one another. If patients do not feel that the surgeon, radiation oncologist, and/or medical oncologist are communicating effectively with them or each other about the goals of treatment and the plan of care, patients should discuss this with their doctors or seek additional opinions before treatment.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

The following treatments may be given to help relieve the symptoms of lung cancer:

  • A tumor in the chest that is bleeding or blocking the lung passages can be shrunk with radiation therapy.
  • During a bronchoscopy (See Diagnosis), lung passages blocked by cancer can be opened to improve breathing.
  • A surgeon can use a laser to burn away a tumor or place a stent to prop open an airway.
  • Medications are used to treat cancer pain. Most hospitals and cancer centers have pain control specialists who provide pain relief, even for very severe cancer pain. Many drugs used to treat cancer pain, especially morphine, can also relieve shortness of breath caused by cancer. Learn more about managing cancer pain.
  • Medications can be used to suppress cough, open closed airways, or reduce bronchial secretions.
  • Prednisone or methylprednisolone (multiple brand names) can reduce inflammation caused by lung cancer or radiation therapy and improve breathing.
  • Extra oxygen from small, portable tanks can help make up for the lung’s reduced ability to extract oxygen from the air.
  • Medications are available to strengthen bones, lessen bone pain, and help prevent future bone metastases.
  • Appetite stimulants and nutritional supplements can improve appetite and reduce weight loss.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Treatment of NSCLC by stage

Stage I and II. In general, stage I and stage II NSCLC are treated with surgery. Surgeons cure many patients with an operation. Before or after surgery, a patient may be referred to a medical oncologist. Some patients with large tumors or signs that the tumor has spread to the lymph nodes may benefit from chemotherapy before the surgery, called neoadjuvant chemotherapy or induction chemotherapy, or adjuvant chemotherapy to reduce the chance the cancer will return. Radiation therapy may be used to treat and cure a lung tumor when surgery is not recommended.

Stage III. Stage III NSCLC has spread to the point that surgery or radiation therapy alone is usually not enough to cure the disease for most people. Patients with stage III disease also have a high risk of the cancer returning, either in the same place or distantly, even after successful surgery or radiation therapy. For this reason, doctors generally do not recommend immediate surgery, and sometimes suggest chemotherapy before surgery.

After chemotherapy, patients with stage III NSCLC may still have surgery, especially if chemotherapy is effective in shrinking the cancer. However, some patients with stage III NSCLC do not receive surgery. Instead, they may be given a combination of chemotherapy and radiation therapy. Chemotherapy may be given either before or at the same time as the radiation therapy. This method has shown to improve the ability of radiation therapy to shrink the cancer and to lower the risk of the cancer returning.

Chemotherapy given at the same time as radiation therapy is more effective than chemotherapy given before radiation therapy, but causes more side effects. Patients who have received both chemotherapy and radiation therapy for stage III disease may still go on to have surgery. However, there is debate among doctors whether surgery is needed for patients when radiation therapy has worked well, and if radiation therapy is needed in patients whose cancer disappears after chemotherapy.

For most patients with stage III NSCLC, the tumor is unresectable, meaning it cannot be removed with surgery. This may be because the surgeon feels that an operation would be too risky, or that the tumor cannot be removed completely. For patients with unresectable NSCLC, with no signs of spread of cancer to distant sites or to the fluid around the lung, a combination of chemotherapy and radiation therapy can still be used to try to eliminate the cancer.

Stage IV NSCLC. Patients with stage IV NSCLC typically do not receive surgery or radiation therapy. Occasionally, doctors may recommend surgery for a brain or adrenal gland metastasis if that is the only place the cancer has spread. Radiation therapy can also be used to treat a metastasis located in only one area, such as the brain. However, patients with stage IV disease have a very high risk of the cancer spreading or growing in another location. Most patients at this stage of NSCLC receive only chemotherapy.

The goals of chemotherapy are to shrink the cancer, relieve discomfort caused by the cancer, prevent the cancer from spread further, and lengthen a patient’s life. Chemotherapy can rarely make metastatic lung cancer disappear. However, doctors know from experience that the cancer will usually return. Therefore, patients with stage IV disease are never considered “cured” of their cancer no matter how well chemotherapy works. Treatment often continues as long as it is controlling the cancer’s growth. Chemotherapy has been proven to improve both length and quality of life for patients with stage IV NSCLC. If the cancer worsens or causes too many severe side effects, the treatment may be stopped, and patients would continue to receive palliative care.

To help patients talk with their doctor about chemotherapy for stage IV NSCLC, ASCO has created several decision aids. These tools provide information on the risks and benefits of chemotherapy, help for thinking through the decision, and other issues for patients to consider. Use these decision aids to begin a discussion with your doctor: First-line chemotherapy, second-line chemotherapy, second-line or third-line chemotherapy with erlotinib, or third-line or fourth-line chemotherapy.

Treatment of small cell lung cancer

As with NSCLC, the treatment of small cell lung cancer depends on the stage. Small cell lung cancer spreads quickly, so chemotherapy is the primary treatment for all patients. You may hear your doctor refer to limited stage, which means there are no signs that the cancer has spread, or extensive stage, which means that the cancer that has spread, to describe your small cell lung cancer.

The most commonly used chemotherapy regimen is etoposide (Toposar, VePesid, Etopophos) plus cisplatin (Platinol) or carboplatin (Paraplatin). For patients with limited stage small cell lung cancer, chemotherapy plus radiation therapy to the chest is given twice a day. Radiation therapy is best when given during the first or second month of chemotherapy. Patients with extensive stage cancer receive chemotherapy for three to six months.

Surgery is rarely used for patients with small cell lung cancer and is only considered for patients with very early-stage disease, such as cancer in a small lung nodule. In those situations, chemotherapy, with or without radiation therapy, is given after surgery.

In patients whose cancer has shrunk after chemotherapy, radiation therapy to the head lessens the risk that the cancer will spread to the brain. This is called prophylactic cranial irradiation (PCI), and it has been shown to lengthen the lives of these patients.

Like patients with later-stage NSCLC, patients with small cell lung cancer of any stage face the risk that their cancer can return, even when its growth is controlled. All patients with small cell lung cancer should have regular follow-up care with their doctors, including x-rays, scans, and check-ups.

Metastatic lung cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. You may want to seek a second opinion before starting treatment so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Chemotherapy is not as effective as radiation therapy or surgery to treat lung cancer that has spread to the brain. For this reason, lung cancer that has spread to the brain is treated with radiation therapy, surgery, or both. Most patients with brain metastases from lung cancer receive radiation therapy to the entire brain. This can cause side effects such as hair loss, fatigue, and redness of the scalp. With a small tumor, a type of radiation therapy called stereotactic radiosurgery can focus radiation only on the tumor in the brain and lessen the side effects.

Supportive care will also be important to help relieve symptoms and side effects. Radiation therapy or surgery may also be used to treat metastases that are causing pain or other symptoms. Bone metastases that weaken major bones can be treated with surgery, and the bones can be reinforced using metal implants.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

Lung Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with lung cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These studies evaluate new drugs and methods of treatment, new approaches to existing treatments, and new prevention methods. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating lung cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with lung cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor will list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also explain all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must detail what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for lung cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Lung Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about lung cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Personalized therapy. Researchers are looking at specific features of lung tumors that can predict whether a specific chemotherapy or targeted therapy may be effective. To collect this information, patients are increasingly being asked to have additional analyses of the tumor samples taken when the disease is first diagnosed. In many patients for whom chemotherapy is recommended, the amount of tumor tissue removed during the biopsy to diagnose their cancer is not enough for these additional studies. These patients may be asked to have another biopsy to help plan treatment and, if part of a clinical trial, to help researchers find better ways to treat lung cancer.

Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. For example, the PD-1 pathway may be critical in the immune system’s ability to control cancer growth. Blocking this pathway with PD-1 and PD-L1 antibodies has stopped or slowed the growth of NSCLC for some patients. These results are leading to more research on using this pathway to help the immune system control lung cancer growth.

Better techniques for surgery and radiation therapy. Doctors are finding ways to improve the effectiveness of surgery and radiation therapy while reducing the side effects of these procedures. For example, a current study is comparing the removal of the cancer and the nearby lung tissue with lobectomy for early-stage NSCLC. Other studies are looking at video-assisted thoracoscopic surgery (VATS), which allows the surgery to be done through smaller openings in the chest, and stereotactic radiation therapy, which is used to focus radiation more directly on the cancer and spare healthy tissue. Advances in all types of treatment will improve doctors’ ability to combine chemotherapy, radiation therapy, and surgery for the treatment of all stages of lung cancer.

Improved screening. Lung cancer is more successfully treated in its early stages, which has raised interest in screening people for lung cancer before it causes symptoms. Advances in imaging techniques, such as low-dose, helical CT scanning, are currently being researched, and may help find better ways to diagnose lung cancer early. In the future, molecular features in the blood or sputum may suggest lung cancer is present before it can be seen on a CT scan. Genetic testing to learn which people have a higher risk of lung cancer is also being researched.

Stopping tobacco use. Even with the best methods for the early detection and treatment of lung cancer, the best way to save lives from lung cancer is through programs to quit cigarette smoking. For most people, lung cancer is a highly preventable disease. Even for people with lung cancer, stopping smoking lets people live longer, lowers side effects, and lessens the chance of getting a second lung cancer. Quitting smoking is hard at any time, and even more so during cancer treatment. The health care team can help make it easier to quit smoking with nicotine replacement and other techniques. Research continues into new ways to help people stop smoking.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current lung cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding lung cancer, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Lung Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for lung cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects can vary for each person with lung cancer and depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.  

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with lung cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Your doctor can work with you to watch for side effects and make changes to your treatment as needed to relieve those side effects. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor. 

The next section provides information about coping with a lung cancer diagnosis. Use the menu on the side of your screen to select Living with Lung Cancer, or you can select another section, to continue reading this guide.

Lung Cancer - Living With Cancer

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn more about coping with the emotional aspects of being diagnosed with lung cancer. To see other pages, use the menu on the side of your screen.

Because lung cancer is associated with smoking, patients may feel that they will not receive as much support or help from people around them because they believe that others will think that their behavior caused the disease. The truth is that most smokers do not develop lung cancer, and not all patients with lung cancer smoke. Lung cancer is a disease that can affect anyone. In fact, most people who get lung cancer today have either stopped smoking years earlier or never smoked.

For most patients, a diagnosis of lung cancer is extremely stressful. Some patients with lung cancer develop anxiety and, less commonly, depression. Patients and their families should not be afraid to express the way they are feeling to doctors, nurses, and social workers. The health care team is there to help, and many team members have special training and experience that can make things easier for patients and their families.

In addition to emotional support and education, the doctor may prescribe anti-anxiety medication and occasionally, an antidepressant. He or she may refer the patient to a counselor, psychologist, social worker, or psychiatrist. Furthermore, patients and their families should be aware that there are resources available in the community to help people living with lung cancer. Some patients feel comfortable discussing their disease and experiences throughout treatment with their doctor, nurse, family, friends, or other patients through a support group. These patients may also join a support group or advocacy group in order to increase awareness about lung cancer and to help fellow patients who are living with this disease.

A lung cancer diagnosis is serious. However, patients can be hopeful that their doctors can offer them effective treatment. They may also be able to take some comfort knowing that the advances being made in the diagnosis and treatment of lung cancer will provide more and more patients with a chance for cure.

Learn more about the counseling, finding a support group, and being a cancer advocate.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Lung Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Each year, tens of thousands of people are cured of lung cancer in the United States. After treatment for lung cancer ends, your doctor will outline a program of tests and visits to monitor your recovery and to check that the cancer has not returned. This plan may include regular physical examinations and/or medical tests. In addition, ASCO offers cancer treatment summaries and survivorship care plans for both small cell lung cancer and NSCLC to help keep track of the treatment you received and create a plan once treatment ends. During this period, tell your doctor or nurse about any new problem that lasts for more than two weeks.

People treated for lung cancer may continue to have side effects, even after treatment ends. Common post-treatment problems include pain, fatigue, and shortness of breath. Feelings of depression and anxiety may also continue after treatment, and fear of the cancer returning is very common. Often people feel that they have less support once treatment has ended and that there is less assistance available from their doctors, nurses, and other programs, such as support groups. Your doctor, nurse, and social worker can help you develop a plan to manage any problems that persist after treatment. Read more about what comes next after cancer treatment.

Nothing helps recovery more than stopping smoking. There are many tools and approaches available. Be sure to get help from your family, friends, nurses, and doctors—it is difficult to stop on your own.

People who develop lung cancer are at higher risk for developing a second lung cancer. Your doctor will recommend scans to monitor for a recurrence, so any new cancer can be found as early as possible.

People recovering from lung cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Survivors of lung cancer who have smoked cigarettes in the past also have a high risk of heart disease, stroke, emphysema, and chronic bronchitis. Certain cancer treatments can further increase these risks. Even for those who don’t smoke, healthy lifestyle choices after cancer are important for overall well-being.

Many patients wonder if certain foods or nutrients can help keep a cancer from worsening or recurring. It is important to remember that many different foods and nutrients have long been studied, but finding a specific link between a food and cancer is difficult. Learn more about the role of nutrition in cancer care, and talk with your doctor to develop a plan that is best for your needs.

Moderate physical activity can help rebuild your strength and energy level. Recovering patients, even those using oxygen, are encouraged to walk for 15 to 30 minutes each day to improve their heart and lung functioning. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level.

Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Lung Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

For all patients with lung cancer:

  • What type of lung cancer do I have?
  • What is the stage of my lung cancer? What does this mean?
  • Can you explain my pathology report (laboratory test results) to me?
  • What are my treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • Should I see other doctors to assist in my care, such as a thoracic surgeon, radiation oncologist, medical oncologist, and/or pulmonologist? What is the role of each doctor?
  • Who will be coordinating my overall treatment and follow-up care?
  • Who else will be part of my health care team, and what does each member do?
  • What treatment plan do you recommend? Why?
  • Do I need additional scans or biopsies in order to plan my treatment?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • What are the possible side effects of this treatment, both in the short term and the long term?
  • In addition to treating my cancer, what can be done to treat my symptoms?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • If I’m participating in a clinical trial, what are the costs I need to pay? What is covered by my health insurance?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

For patients who will have surgery:

  • What type of surgery will I have? Will lymph nodes be removed?
  • How long will the operation take?
  • How long will I be in the hospital?
  • Can you describe what my recovery from surgery will be like?

For patients who will receive chemotherapy or targeted therapy:

  • What are the names of the drugs, and how will they be given?
  • What are the side effects of each medication? What side effects or problems should I watch for?
  • What can be done to lessen these side effects?
  • How often will I need to visit the doctor to receive the therapy, and how long will each visit take?
  • Will I be able to go to and return from this treatment on my own, or should I arrange to have assistance?
  • What are the recommendations for people who take their medication at home?

For patients who will receive radiation therapy:

  • How will my treatment be planned? What types of scans will be used?
  • Where will I receive radiation therapy?
  • How often will I receive radiation therapy?
  • How much time will each treatment take?
  • How much of the normal lung will be included in the radiation field?
  • Is it possible for me to receive chemotherapy with my radiation therapy? If so, what are the added side effects of giving the chemotherapy at the same time, compared with one after another?
  • Will I be able to go to and return from this treatment on my own, or should I arrange to have assistance?

For patients considering a clinical trial:

  • What are my options for standard treatment?
  • What other treatments through clinical trials are available to me?
  • How will my experience differ if I enroll in this clinical trial, as opposed to standard treatment. For example, are there different risks, extra tests, a different time commitment, schedule, or costs?
  • What is the goal of this clinical trial? Is this a phase I, II, or III clinical trial? What does this mean?
  • Where will I receive the clinical trial treatment?

For patients who have completed their treatment:

  • What are the chances that my cancer will return?
  • Is there anything more I can do to reduce the chance that my cancer will return?
  • What follow-up tests will I need and how often will I need them?
  • What tests will I have during my follow-up visit?

For patients who smoke:

  • What are the benefits of me quitting smoking?
  • How can you help me to quit smoking?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Lung Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Lung Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a cancer specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

- Review dictionary articles to help understand medical phrases and terms used in cancer care and treatment.

- Read more about the first steps to take when newly diagnosed with cancer.

- Find out more about clinical trials as a treatment option.

- Learn more about coping with the emotions that cancer can bring, including those within a family or a relationship.

- Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for people with this type of cancer.

- Explore next steps a person can take after active treatment is complete.

This is the end of Cancer.Net’s Guide to Lung Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.