What You Need to Know About Lung Cancer

June 14, 2018
Jyoti Patel, MD, FASCO

Dr. Jyoti D. Patel is Professor of Medicine and Director of Thoracic Oncology at the University of Chicago and is the Cancer.Net Associate Editor for lung cancer.

Lung cancer is responsible for more cancer deaths than any other cancer in men and women.share on twitter In fact, it claims more than 150,000 American lives every year. Despite these astonishing numbers, many people know very little about this disease. This is what everyone should know about lung cancer.

  1. Anyone can get lung cancer. In fact, 1 in 16 people in the United States will be diagnosed in their lifetime—that’s a new diagnosis every 150 seconds! And although smoking is the most common cause of lung cancer, almost two-thirds of all new diagnoses are in people who have never smoked or are former smokers. In fact, up to 30,000 Americans who have never smoked get lung cancer every year.

  2. Symptoms of lung cancer can be nonspecific. Lung cancer may not produce noticeable symptoms in the early stages, and many people aren’t diagnosed until the disease has advanced. But people who develop any of the following problems should see a health care provider who can evaluate these symptoms and develop a diagnostic plan:

    • A new cough that does not go away

    • Changes in a chronic cough

    • Shortness of breath or you are more easily winded

    • Pain in the chest area

    • Persistent wheezing

    • A raspy or hoarse voice

    • Unplanned weight loss

    • Bone pain

    • Worsening headaches

  3. Screening for lung cancer can save lives. As with many other cancers, a key to surviving lung cancer is catching it in its earliest stages, when it is most treatable. For patients who have small, early-stage lung cancer, the cure rate can be as high as 80% to 90%. Cure rates drop dramatically as the tumor becomes more advanced and involves lymph nodes or other parts of the body. Screening with low-dose spiral computed tomography (CT) scan has been proven to reduce lung cancer deaths in people at high risk for lung cancer. In fact, the National Lung Screening Trial found a 20% reduction in deaths from lung cancer among current or former heavy smokers who were screened with low-dose spiral CT, compared to those screened with a chest X-ray. Because CT scans can also give “false-positive” results—by mistaking scar tissue or noncancerous lumps for cancer—they’re recommended only for people at high risk. In these individuals, the benefits of early detection outweigh the risks of potential false positives. Lung cancer screening is recommended for people who meet these criteria:

    • Between 55 and 80 years old

    • At least a 30 pack-year smoking history (1 pack-year is the same as smoking 1 pack of cigarettes every day for an entire year)

    • Good health and no signs of lung cancer

    • No CT scan in the past year

  4. There are different kinds of lung cancer. About 80% to 85% of lung cancer diagnoses are non-small cell lung cancer (NSCLC), and there are 3 main subtypes:

    • Adenocarcinoma. This is the most common subtype of cancer, but also much more common in people who never smoked, younger patients, and women.

    • Squamous cell cancer. This is more commonly linked to a history of smoking. It develops in the airways of the lungs.

    • Large cell carcinoma. This is an uncommon type of lung cancer, accounting for less than 10% of cases

    Small cell lung cancer (SCLC) accounts for around 10% to 15% of all lung cancers and very rarely develops in someone who has not smoked. 

  5. Targeted therapies work. Up to a quarter of lung cancer tumors carry a genetic mutation—a genomic “glitch” that is driving the cancer’s growth—that may be targeted with available medications. This type of cancer treatment is called targeted therapy. All patients with advanced adenocarcinoma should have their tumors tested for genetic mutations such as EGFR, ALK, ROS1, and BRAF. And, because there are new and emerging targets being found in research, it is reasonable to do wider testing to look for other mutations as well. Oral medicines for patients with some of mutations are highly effective; they can shrink tumors significantly, work for a long time, and provide people with lung cancer with a good quality of life.

  6. Immunotherapy helps people with a broad range of lung cancers live longer.  Immunotherapy is type of cancer treatment that works by boosting or activating your immune system, so it recognizes and kills cancer cells. Researchers are investigating 4 main kinds of immunotherapies for lung cancer: checkpoint inhibitors, monoclonal antibodies, therapeutic vaccines, and adoptive cell therapy. Four immunotherapy drugs, all checkpoint inhibitors, have been approved to treat NSCLC. For patients with tumors with high levels of a biomarker called PD-L1, pembrolizumab (Keytruda) works better than chemotherapy as a first therapy. For tumors with low or no expression of PD-L1, drugs such as atezolizumab (Tecentriq) and nivolumab (Opdivo) can be effective as second treatments. Sometimes, combining immunotherapy and chemotherapy initially may also improve outcomes. Recent research also showed that giving the checkpoint inhibitor durvalumab (Imfinzi) after radiation therapy improved the time until the cancer progressed in people with locally advanced NSCLC. There are a number of clinical trials that are also investigating how immunotherapy can be combined with surgery for patients with early-stage, curable lung cancer.

  7. Early palliative care for people with advanced lung cancer improves outcomes. People with lung cancer who receive palliative or supportive care as part of their treatment are shown to be more satisfied with their treatment, have better symptom management, and live longer. Palliative care is a plan that prevents and treats suffering and addresses the physical, intellectual, emotional, social, and spiritual needs that are unique to each patient. Palliative care gives patients control of their care by giving them the opportunity to tell doctors and nurses what kind of treatment they want or may not want to receive.

  8. Lung cancer is tough, but we are making headway through discoveries from clinical trials. We have made tremendous advances in our understanding of cancer biology. These gains have a direct impact on people with cancer. Unfortunately, only 3% of Americans with cancer participate in clinical trials, so often we don’t have enough information to generalize what we learn from clinical trials to patients who are not as well represented in trials, such as older adults and those with other medical problems. Read other blog posts about recent research on lung cancer.

  9. You’re not in this alone. The lung cancer community is growing. Many people have been touched by lung cancer. It affects more than 220,000 Americans every year. There are lots of active support groups for patients and family caregivers, so no one has to face a lung cancer diagnosis alone.