Frequently Asked Questions about Lung Cancer

Q: What is lung cancer?
A: Lung cancer is cancer that begins in the lungs. It is the second most common cancer in women.

There are two major types of lung cancer: small cell lung cancer and non-small cell lung cancer. Approximately 80 percent of people with lung cancer have non-small cell cancer, while 20 percent have small cell lung cancer. The earlier that lung cancer is detected, the better the chance it will be cured. It is difficult, however, to detect lung cancer in its early stages.

There are two main types of lung cancer: non-small cell lung cancer and small cell lung cancer. The doctor can determine what kind of cancer a woman has by looking at the cancer cells under a microscope. Non-small cell and small cell lung cancer grow and spread in different ways and therefore have different treatments. Nonsmall cell lung cancer usually grows and spreads more slowly than small cell lung cancer.

Q: Who gets lung cancer?
A: Doctors estimate that over 90 percent of lung cancer cases are related to smoking. However, a small percentage of people who get lung cancer do not have a history of smoking or being around secondhand smoke. So, not all smokers get lung cancer and not all lung cancer patients were smokers.

There is really no way to know for sure if a woman is going to get lung cancer.

Q: What are the risk factors of lung cancer?
A: Certain factors can make one woman more likely to get lung cancer than another woman. These are called risk factors. Although such risk factors do exist, a woman who has one or more risk factors will not necessarily get lung cancer. In fact, a woman can have all the risk factors and still not get lung cancer, or a woman can have no known risk factors and still get the disease.

However, there are things that make some people more likely to get it. Many risk factors linked with lung cancer have to do with using tobacco. Many of these risk factors can be controlled. Risk factors for getting lung cancer include:

• Cigarettes. Smoking cigarettes causes lung cancer. Tobacco contains substances called carcinogens. Carcinogens harm cells in the lungs. After a while, these damaged cells may turn into cancer. The longer a woman smokes and the more cigarettes a woman smokes per day, the higher the chance that that woman will develop lung cancer.
• Cigars and pipes. Women who smoke cigars and pipes have a higher risk of developing lung cancer than women who don’t smoke. If the woman has smoked for a long time, she has an even higher chance of developing lung cancer. A woman’s risk of lung cancer also depends on how much she smokes every day.
• Secondhand smoke. If women are around smokers, they have a higher risk of getting lung cancer. For example, a non-smoker who lives with a heavy smoker has a higher risk of developing lung cancer than someone who does not spend time around a smoker. Being around secondhand smoke is called involuntary or passive smoking.
• Radon. Radon is a gas that is found in soil and rocks. You can’t see, smell, or taste radon, but it can harm the lungs. Women who work in mines or live in houses with radon have a higher risk of developing lung cancer.
• Asbestos. Asbestos is a group of minerals used in shipbuilding, insulation, and some kinds of car repairs. If a woman breathes in tiny pieces of asbestos, they can get stuck in the lungs and harm the cells of the lungs. Women who are around asbestos have a higher chance of getting lung cancer. Their risk is much higher if they also smoke.
• Pollution. Women who breathe in a lot of air pollution over a long period of time have a higher risk of developing lung cancer.
• Lung diseases. Women who have lung diseases like tuberculosis (TB) have a greater chance of getting lung cancer. Lung cancer sometimes develops when there is scar tissue from TB in the lungs.
• Medical history. A woman who had lung cancer before has a higher chance of getting lung cancer again. If the woman quits smoking after having lung cancer, the chance of getting it again is reduced.

Q: What can a woman do about risk factors?
A: Since it is known that smoking tobacco causes most cases of lung cancer, a woman who smokes would benefit from quitting as soon as possible, even after being diagnosed with lung cancer. When a woman quits smoking, her risk of getting the disease declines over time. Non-smokers can benefit from never starting and from staying away from those who do smoke.

Smoking is known as a controllable risk factor. Quitting greatly reduces a woman’s chances of getting lung cancer. In fact, quitting smoking can greatly reduce a woman’s risk of many other cancers as well. These include cancers of the bladder, pancreas, larynx, mouth, esophagus, pharynx, and kidney. There are many ways to quit smoking. Women who would like to quit smoking should talk to their doctor about creating a plan to quit.

Q: What are the symptoms of lung cancer?
A: Women with lung cancer may not notice signs of the disease in its early stages. In fact, many lung cancers are found through a chest x-ray taken for other reasons.

When early lung cancer does cause symptoms, they are often health problems that smokers have anyway. For example, some early signs of lung cancer include shortness of breath and the inability to exercise without feeling out of breath or having a cough.

Common symptoms of lung cancer in its later stages include:

• Sudden shortness of breath
• A cough that doesn’t go away and gets worse over time
• Pneumonia or bronchitis occurring more than usual
• Constant chest pain
• Pain in the upper back that remains in one place and is constant for several days or weeks
• Shortness of breath, wheezing, or hoarseness
• Swelling of the neck and face
• Loss of appetite or weight loss
• Coughing up of blood
• Fatigue

These symptoms may be caused by lung cancer or by other, less serious conditions. It is important to check with a doctor to be sure.

Q: How is lung cancer diagnosed?
A: In order to determine why a woman is having lung cancer-like symptoms, the doctor will find out the woman’s medical history, smoking history, and family history of cancer, and other risk factors the woman has been exposed to. The doctor might also perform a physical exam, a chest x-ray, and other tests. If the doctor suspects the patient has lung cancer, he or she may perform a sputum cytology. In a sputum cytology, the doctor looks at cells from the mucus in the lungs. These exams may lead the doctor to decide that the woman doesn’t need any more tests, and that she does not have lung cancer.

However, it is sometimes necessary to perform biopsies such as a bronchoscopy, needle biopsy, thoracentesis, or thoracotomy to diagnose lung cancer.

Q: What are the types of treatment for lung cancer?
A: Treatment for lung cancer is either local or systemic. Local treatments remove, destroy, or control the cancer cells in one certain area. Surgery and radiotherapy are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the entire body. Chemotherapy is a systemic treatment. A patient may have just one treatment or a combination of different treatments.

Goals of Treatment
Different types of treatments have different goals. Below is a list of various treatments and their goals.

Surgery. The goal of surgery is to remove the tumor from the lung, while leaving as much of the lung as possible intact. Sometimes the entire lung must be removed.

Photodynamic therapy (PDT). The goal of PDT is to treat early stage non-small cell lung cancer by destroying cancer cells through a combination of a photosensitizing and a laser light.

Radiotherapy. The goal of radiation therapy is to kill cancer cells using x-rays. This treatment is used to shrink a tumor before surgery or to get rid of any remaining cancer cells after surgery. It may also be used by itself without surgery.

Chemotherapy. The goal of chemotherapy in treating lung cancer is to reduce the chance that the cancer will spread to other parts of the body, or to treat the cancer that is outside of the lung area. Chemotherapy may be given after surgery to reduce this chance. If given after surgery, it is called adjuvant chemotherapy. If it is given before surgery it is called neoadjuvant chemotherapy.

Q: Should everyone get a second opinion?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion, including if the person is not comfortable with the treatment decision, if the type of cancer is rare, if there are different ways to treat the cancer, if there may be clinical trials available for this type of cancer; or if the person is not being treated by a lung cancer expert.

Q: How can someone get a second opinion?
A: There are many ways to get a second opinion:

• The person’s primary doctor may be able to recommend a specialist such as a surgeon, medical oncologist, radiation oncologist, or plastic surgeon. Sometimes these doctors work together at cancer centers or programs.
• The Cancer Information Service (1-800-4-CANCER) informs callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
• Patients can get names of doctors from their local medical society, a nearby hospital, a medical school, or local cancer advocacy groups, as well as from other people who have had that type of cancer.
• The Directory of Medical Specialists lists doctors by state and specialty, and gives information about their background. This resource is in most public libraries.

Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors conduct clinical trials to learn about how well new treatments work and what their side effects are. If they look promising, they are then compared to what is the current treatment to see if it works better or has fewer side effects. People who participate in these studies may benefit from access to new treatments before the Food and Drug Administration (FDA) approves them. Participants also help further our understanding of cancer and help future cancer patients.

Reviewed By: Gail Wilkes, RN, MS, OCN
Oncology Nurse Specialist, Massachusetts General Hospital, Boston, Massachusetts.
Reviewed By: Graeme Fisher, M.D.
UMASS Medical Center, Worcester, MA
Reviewed By: Teresa Knoop, RN, MSN, AOCN
Cancer Information Nurse Specialist, Vanderbilt-Ingram Cancer Center, Nashville, TN