Understanding lung cancer
What do your lungs and a tennis court have in common? Here’s the answer: they’re about the same size. It may be hard to imagine, but the surface area of both your lungs is about the same size as a tennis court.1 It's also a fact that more people die each year of lung cancer than colon, breast and prostate cancers combined. That’s almost 25% of all cancer deaths. That may be hard to take in. But there’s some good news: the number of new lung cancer cases seems to be dropping because of advances in early detection and treatment — and more people are quitting smoking. In fact, if caught early enough, some lung cancers can be cured.2
For how common and dangerous lung cancer is, you may not know much about it. Lung cancer develops when cells in the lungs grow abnormally, cluster together and form a tumor. These abnormal changes to cell DNA often happen when you breathe in or are exposed to harmful toxins (like smoking, for example). To understand how these cancers form, it’s helpful to know the different types of lung cancer.3
What are the types of lung cancer?
There are two main types of lung cancer — small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Let’s take a closer look at the details.4,5
Non-small cell lung cancer (NSCLC)
This kind is more common (about 80% of cases). The 3 main subtypes of NSCLC are adenocarcinomas, squamous cell carcinomas and large cell carcinomas. These cancers typically grow and spread at a slower rate than SCLC. The following subtypes are grouped together because they often have a similar treatment and outlook.4,5
- Adenocarcinoma: Often found in an outer area of the lung, this kind of NSCLC forms in the cells of epithelial tissues (the major tissue in glands responsible for all kinds of functions, like making mucus). This subtype is often linked to smokers, but it’s also the most common type of lung cancer in non-smokers.
- Squamous cell carcinoma: Typically found in the central part of your lungs, this cancer starts in the squamous cells that line the inside of the bronchus (main airway).
- Large-cell carcinoma: This can develop anywhere in the lungs and usually grows faster than the two cancers listed above.
Small cell lung cancer (SCLC)
The 2 subtypes of SCLC are small cell carcinoma and mixed small cell/large cell carcinoma. Basically, these two subtypes are named based on which cells the cancer starts in. This kind of cancer is usually linked to smoking cigarettes and may often be treated with chemotherapy or radiation. And because it grows quickly, the cancer in about 70% of people with SCLC may have already spread by the time they get diagnosed. .4,5
There’s a third, less common type of lung cancer, called a carcinoid tumor. They grow slower than other types of lung cancer.
For many other types of cancer, there’s usually at least one kind of screening to help people without symptoms catch cancer early. Things like mammograms, pelvic exams and rectal exams. But, checking for something inside your chest without even knowing if anything is there may be a harder task. 6,7
- Chest X-ray: This has been used to help find early signs of lung cancer, but it’s been shown that it doesn’t really help people live longer.8
- Low-dose CT scan: More recently, this screening has been done in high-risk people (like current or former smokers). This CT scan can help spot abnormal areas in the lungs. For some people, getting yearly low-dose CT scans to check for early signs of lung cancer may help lower their risk of dying from it.
Since symptoms usually don’t show up until after the cancer has spread, a regular screening may be a good choice if you’re at a higher risk for developing lung cancer. Be sure to talk with your doctor and learn the pros and cons of having regular screenings.
If something shows up on a screening test, or there are other reasons to believe you may have lung cancer, your doctor will likely order some tests to know for sure. That might include:
- Imaging tests: If you didn’t already have a chest X-ray or low-dose CT scan, you might have one of those done.
- Sputum cytology: If you’re coughing up sputum (mucus from the lower airways), your doctor might analyze it under a microscope to see if you’re coughing up lung cancer cells.
- Biopsy: There are a few different biopsies your doctor can do to collect a tissue sample and test it for cancer.
There are a handful of other tests your doctor might want to do, but the only way to accurately diagnose lung cancer is to perform some kind of biopsy so those lung tissue cells can be closely looked at. Talk with your doctor about which test(s) might be best for you. It’ll likely depend on your health, risk level and comfort level with each test.
Symptoms typically don’t show up until after the lung cancer has spread. Those might include things like:9, 10
- A new cough that doesn’t go away
- Coughing up blood (even just a little)
- Shortness of breath
- Chest pain that gets worse with deep breaths, coughing or laughing
- Hoarseness or wheezing
- Recurring infections, like bronchitis or pneumonia
- Unexplained weight loss
- Bone pain
- Loss of appetite
Visit your doctor if you notice any of these symptoms. They may be something else, but it’s important to let your doctor know in case a screening is recommended.
Cells often mutate or change when you breathe in or are exposed to toxins. Unfortunately, harmful pollutants are around many of us every day. In fact, there are officially 187 hazardous toxins. If you have a history of smoking cigarettes or have had lots of exposure to harmful toxins, you may be at a higher risk. Here’s a breakdown of some main risk factors:11
- Tobacco smoke: Smoking is the number 1 cause of lung cancer. It’s linked to about 90% of all cases.11 Even if you’re a nonsmoker exposed to secondhand smoke, you may be at a greater risk.
- Radon: Radon is a colorless, odorless radioactive gas that naturally exists in soil. And, it’s the second-leading cause of lung cancer.11 If this gas seeps up through the soil and into your home, it may greatly increase your chances.
- Hazardous chemicals: Working with things like asbestos, uranium, arsenic, petroleum and nickel may increase your risk. If you’re exposed to these chemicals or other dust and fumes at work, talk to someone in charge of employee safety.
- Particle pollution: There are a number of small solid and liquid particles (like the ones in exhaust smoke) that live in the air we breathe. Being exposed to a lot of particle pollution may increase your risk.
- Radiation: If you’ve had radiation therapy on your lungs, your chances may increase — especially if you’re a smoker.
- Genes: If a family member has been diagnosed with lung cancer, you may have a greater risk.
While you can’t necessarily prevent lung cancer, there are many lifestyle changes you can make to help lower your risk. Here are some ideas:12
- Don’t smoke: The best way to reduce your risk of lung cancer is to stay away from tobacco — even secondhand smoke. Did you know if you stop smoking before cancer develops, your damaged lung tissue starts to repair itself? If you currently use tobacco, it might be time to consider quitting.
- Avoid exposure to toxins: Stay away (or limit your exposure) to the chemicals listed above and any other cancer-causing agents. Consider conducting a home radon test for peace of mind.
- Be aware of the air you breathe: Think about where you spend most of your time. How’s the air quality? Is there a construction zone nearby creating lots of dust? Or maybe the new couch you bought was treated with chemicals and now you may be breathing that in. Consider buying an indoor air monitor, air purifier or even purifying house plants to keep an eye on and help clean the air going into your lungs.
- Research what you buy: Chances are, there are chemicals in almost everything you buy. Think about things like furniture, house paint and treated flooring. Have you ever noticed a smell coming from a new mattress or area rug? That’s off-gassing, which produces those toxic particles. Check out what’s in the products you’re buying before you purchase. If chemicals are unavoidable, keep the room well ventilated while your new product settles in.
The treatment for lung cancer depends on your health, type and stage of cancer, and your personal preferences. Talk with your doctor and care team about which treatment(s) might be best for you. Your options could include:13
- Surgery: There are a few different procedures where your surgeon might remove part or all of your affected lung. Plus, lymph nodes may also be removed to check if the cancer has spread.
- Radiation: This could be used before surgery to shrink your tumor or after surgery to help kill any remaining cancer cells. Otherwise, it can be used with chemotherapy as the main treatment.
- Chemotherapy: Like radiation, chemo medicines can be used before or after surgery. It can be used on its own or along with radiation to help kill the cancer cells.
- Stereotactic body radiotherapy: Think of radiation, but on steroids. This intense treatment uses a lot of radiation beams directed at the tumor from multiple angles. It may be used for people who aren’t able to have surgery or for cancers that have spread to other parts of the body.
- Targeted drug therapy: This approach targets a cancer’s weaknesses and blocks the cancer so medicine can head in there to kill it.
- Immunotherapy: This approach works a little like a vaccine — but for lung cancer. It may help your body recognize and fight off cancer cells.
Who should I see if I’m concerned about lung cancer?
If you think you might have symptoms of lung cancer or you’re concerned about your risk level, visit your primary care provider (the doctor or provider you might see for your yearly exam). Bring a list of your symptoms, health history, concerns and questions. If you’ve had screenings done in the past, like a chest X-ray or CT scan, have those images sent to your primary clinic before your appointment. Depending on how your conversation goes, your doctor may order more tests, or refer you to a specialist, like a pulmonologist (lung expert) or oncologist (cancer expert).13