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Home > Cancer Information > Thoracic Cancer > Lung Cancer

Lung Cancer

Lung cancer is very common and is becoming more common, especially among women. Lung cancer is the leading cause of death from cancer in the U.S. and most other countries. Worldwide, its incidence is increasing at a rate of half a percent a year, a very fast growth rate for a disease.

On this page:

Risk Factors and Prevention
Lung Cancer Types
Screening and Diagnosis
Evaluation
Clinical Trials
Research
Support Group
Thoracic Oncology Clinical Program
Care Team Members
Web Resources

Risk Factors and Prevention

About 85 to 90 percent of all lung cancers are caused by cigarette smoking. Other factors include exposure to potential cancer-causing substances, such as asbestos and organic chemicals, air pollutants, and environmental (passive or second-hand) smoking. Thus, the most effective way to reduce the incidence of lung cancer is for people to quit smoking. See the Web Links section of this page for links to more information.

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Lung Cancer Types

The two main types of lung cancer are Nonsmall-Cell Lung Cancer (NSCLC) and Small-Cell Lung Cancer (SCLC). About 75 to 80 percent of people diagnosed with lung cancer have NSCLC; the rest of people have SCLC.

NSCLC has three major subtypes: adenocarcinoma, squamous carcinoma, and large cell carcinoma. The subtypes are based on the tumor cells' appearance under the microscope.

Distinguishing between NSCLC and SCLC is very important because the treatment of each type is very different.

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Screening and Diagnosis

Patients are typically discovered to have lung cancer because of a new respiratory symptom (such as a cough) or because of an incidental abnormality found on a chest x-ray, done for screening or other reasons. A number of options exist to either verify or rule out the presence of lung cancer.

First, for most patients a computed tomography (CT) scan of the chest is obtained. A CT scan can reveal much information about any abnormality in the lungs and its relationship to surrounding structures. Important features assessed on a chest CT scan include the lymph nodes along the trachea (windpipe), the liver, and the adrenal grands — three potential sites to which lung cancer may spread.

Other diagnostic tests include endobronchial ultrasonography, bronchoscopy, needle biopsy, video-assisted thoracoscopic biopsy, and positron-emission tomography (PET) scanning.

To diagnose and stage lung cancer and many different tumors of the chest region, the thoracic surgeons of University of Minnesota Physicians are now performing endobronchial ultrasonography (EBUS). EBUS is a new diagnostic tool that will add very significantly to the diagnosis and staging of lung cancer and other thoracic diseases. Learn more about EBUS on the University of Minnesota Physicans Web site.

Bronchoscopy is an outpatient procedure. A small flexible tube is inserted into the airways, allowing the doctor to visualize the airway anatomy of the lungs. Bronchoscopy is most useful for abnormalities in the central or inner part of the lung. For abnormalities on the outer surface of the lung, bronchoscopy is typically not as useful.

Conversely, needle biopsy, performed by inserting a needle between the ribs into an abnormality in the lung, is most useful for abnormalities on the outer surface of the lung. Needle biopsy is performed under local anesthesia and under CT scan or x-ray guidance.

Video-assisted thoracoscopic lung biopsy is a surgical procedure. A scope is placed into the chest through small holes made on the side of the chest wall. The surface of the lung can then be visualized on a television monitor. Other small holes may be made on the surface of the chest. The surgeon can then manipulate the lung with instruments and biopsy it. The inside of the chest wall can also be visualized and any fluid that may be present removed.

PET scanning is a relatively new technique that may be useful in detecting tumors of the lung and other sites on the body. A radioactive substance is injected that is taken up preferentially by tumors, which can then be visualized on a camera screen. Occasionally, an abnormality of the lung has an appearance so suggestive of lung cancer that no further diagnostic tests are performed; the lung and its abnormal lesion are removed surgically. This most frequently occurs in patients with a long history of smoking and an x-ray finding of a mass with typical characteristics of lung cancer.

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Evaluation

Patients with non-small-cell lung cancer are evaluated in three steps:

First, the primary tumor is investigated. Important issues are its relationship to surrounding structures in the chest and any possible invasion of these structures. Invasion may preclude surgical removal.

Second, the doctor must learn whether or not the tumor has spread to other sites. When lung cancer has spread to other areas in the body, it is typically to the lymph nodes along the windpipe or to the brain, bones, liver, or adrenal glands. For certain patients, specific scans of these organs are performed if the doctor is concerned about tumor spread.

In most patients being considered for surgical removal of a non-small-cell lung cancer, the lymph nodes along the windpipe are biopsied by a procedure called mediastinoscopy. This procedure is performed under general anesthesia through a small incision just above the breast bone. The surgeon biopsies multiple lymph nodes to determine whether or not spread has occurred.

Third, the patient's functional status is evaluated. In patients with non-small-cell lung cancer who may undergo surgery, either to remove a part of or a whole lung, the evaluation of their breathing reserve is important. Of particular concern is how short of breath they become with exercise. Functional status helps determine how much lung can be removed safely. Additional studies are done that specifically measure lung function.

Treatment of non-small-cell lung cancer is very dependent on the stage of the tumor. Once the studies have determined whether spread has occured to lymph nodes or other organs, the patient is typcially assigned to a clinical stage of disease. If the tumor has spread outside of the chest to an organ such as the liver or adrenal glands, then surgery is generally not performed, instead chmotherapy or radiation, or a combination is used. If the tumor has spread to the lymph nodes along the windpipe, chemotherapy with or without radiation is used; for certain patients, surgical resection may be performed later. For most other patients, surgery is the primary treatment.

In small-cell lung cancer, chemotherapy with or without radiation is the primary treatment. For patients with very specific indications, other treaments are available. Photodynamic therapy consists of injecting a cancer-killing drug. The drug is then taken up by the cancer cells and, when exposed to a specific wavelength of light, kills cancer cells. This therapy is used to treat very early lesions that can be seen on bronchoscopy or that are blocking an airway and limiting a patient's ability to breathe.

Another treatment is bronchial artery chemotherapy. It consists of injecting chemotherapy drugs into a small artery supplying the lung. This therapy is another form of local treatment either of early tumors or of tumors that are blocking an airway. It avoids the problems of systemic toxicity seen with intravenous administration of chemotherapy.

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Clinical Trials

Clinical trials are (human research) studies that evaluate the effectiveness of new interventions for patients. Such interventions have already been tested in laboratories and showed enough promise to be pursued further.

Different types of cancer clinical trials include prevention trials, early detection trials, and treatment trials. If you take part in a clinical trial, you may benefit from a new drug, procedure, or symptom-control method while helping scientists evaluate its effectiveness.

The Thoracic Cancer Clinical Team of the University of Minnesota Cancer Center is actively engaged in both national and regional clinical trials for various thoracic cancers.

Contact our program coordinators (Teri Kast, 612-273-5396 or Amy Erickson, 612-273-7075) for more information about clinical trials.

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Research

Scientists in the Cancer Center's Carcinogenesis and Chemoprevention Research Program are focusing their efforts on understanding tobacco's role in the carcinogenic process and to develop practical cancer prevention methods. For news about the latest research, see the links in the Related Links box above.

Support Group

Living with a serious disease isn't easy. Cancer patients and those who care about them face many problems and challenges. Finding the strength to cope is easier when people have helpful information and support services. Support groups for lung cancer patients abound in the U.S.; to find the nearest one, visit the support groups page on the Lung Cancer Alliance Web site.

You can also find a list of upcoming cancer-related events and educational workshops on the Cancer Center's Education and Events page.

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Thoracic Oncology Clinical Program

The University of Minnesota Cancer Center's Thoracic Oncology Program offers thoracic cancer patients a comprehensive approach to diagnosis, treatment, and after-treatment support.

This multidisplinary program consists of specialists in thoracic surgery, oncology, radiotherapy, and pathology. These specialists meet weekly in the multidisciplinary thoracic oncology conference. They review information about all patients currently undergoing therapy at Fairview-University Medical Center and help determine the best treatment plan for each.

Also available are smoking cessation programs; the Hospice Program, which provides supportive services to dying patients; and social work services for emotional support and counseling.

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Care Team Members

For more information about lung cancer specialists at the University of Minnesota and how to schedule an appointment, visit the University of Minnesota Physicians Web site. The links below go to physician profiles on the University of Minnesota Physicians Web site. To return to this site, either bookmark this page or use your browser's back button.