There are many people today that are effected one way or another by lung cancer and don’t really know that much about the disease. I was recently seriously affected by it. My uncle, Will, passed away on September 17, 2000. He was diagnosed with lung cancer in 1996. It was extremely hard on the entire family. At first nobody really knew anything about the disease except that it was very rare for it to be cured. So then we decided to do some research and learn more about everything that our uncle was going through.
Most lung cancers start in the lining of the bronchi and are thought to develop over a period of many years. There first may be areas of precancerous changes in the lung. These changes do not form a mass or tumor and cannot be seen on an x-ray and they do not cause symptoms. If these precancerous changes turn into true cancer, malignant cells begin to grow. The cancer cells may produce chemicals that cause new blood vessels to form nearby. These new blood cells nourish the cancer cells can continue to grow and form tumor large enough to seen on x-rays. Cancer cells can break away from the original tumor and spread to other parts this is called metastasis. Lung cancer is a life-threatening disease because it often spreads in this way even before x-rays can detect it.
There are two major types of lung cancer. The first type is small cell lung cancer (SCLC). The secondtype is non-small cell lung cancer (NSCLC). Sometimes a lung cancer may have characteristics of both types. This is called mixed small/large cell carcinoma.
About 20% of all lung cancers are small cell lung cancer. It is named simply for the size of the cancer cells. Even though the cells are small, they can multiply quickly and form large tumors, and can spread to lymph nodes and other organs such as the bones, brain, adrenal glands and liver. Small cell lung cancer often starts in the bronchi and towards the center of the lungs. Smoking almost always causes this type.
Non-small cell cancer accounts for almost 80% of lung cancers. It has three sub-types. The sub-types differ in the size, shape, and chemical make-up. The first sub-type is squamous cell carcinoma and accounts for almost 30% of lung cancers. It is associated with a history of smoking and tends to be found centrally near a bronchi. Another sub-type is adenocarcinoma. This accounts for about 40% of lung cancers and is found in the outer region of the lung. There is one type of adenocarcinoma, bronchioloalveolar carcinoma, has a better prognosis than any other type of lung cancer. The last type of NSCLC is large-cell undifferentiated carcinoma. It accounts for about 10% of lung cancers and may appear in any part of the lung and it tends to grow and spread quickly resulting in a poor prognosis.
During the year 2000, there were about 164,100 new cases of lung cancer. It accounts for about 13.4% of all new cancers. The average age of people diagnosed with lung cancer is 60 and is unusual under the age of 40. Lung cancer is the leading cause of cancer death among both men and women. By the end of 2000, there will be an estimated 156,900 deaths from lung cancer, accounting for 28.4% of all cancer deaths. More people die of lung cancer than of colon, breast, and prostate, and prostate cancers combined (American Cancer Society, 2000). Fewer men will have died of lung cancer than in the previous years. This probably reflects the drop in the number of young men who smoke. On the other hand, more women will have died of lung cancer by the end of 2000 than in the previous year. The increase in their death rate is slowing but it hasn’t begun to drop just yet.
There are many risk factors for lung cancer. The most important factor is tobacco smoking. More than 80% of lung cancers are thought to be a result of smoking. The longer a person smokes and the more packs per day, the higher the risk. If person stops smoking before a cancer develops, the damaged lung tissue starts to gradually return to normal. After ten years an ex-smokers risk still doesn’t compare to that ofaperson who never smoked. But the ex-smokers risk is still lower than those who continue to smoke. Nonsmokers who breathe in the smoke of others, second hand smoke, are also at an increased risk for lung cancer.
Another important factor for lung cancer is asbestos. Death from lung cancer is about seven times more likely to occur among asbestos workers than among the general workers. Asbestos workers that smoke have a 50 – 90% of a greater risk of developing a type of cancer that starts from the pleura (layer of cells that line the outer surface of the lung).
Radon is a radioactive gas produced by the natural breakdown of uranium that cannot be seen, tasted or smelled. Outdoors there is so little radon that it really isn’t that much of a concern. It is when it is indoors that it becomes a problem. IT is more concentrated and becomes a risk for cancer. Some houses in the United States are built over soil with natural uranium deposits that can create high indoor radon levels.
Personal and medical history also comes into play with lung cancer. People who already have lung cancer have an increased risk of developing another lung cancer. Brothers, sisters and children of those who have had lung cancer may have a slightly higher risk of lung cancer themselves. It is difficult to say how much of this excess risk is due to inherited factors and how much is due to second hand smoke.
Symptoms of lung cancer often do not appear until the disease has advanced, so only about 15% of lung cancer cases are found in the early stages before the cancer has spread to nearby lymph nodes or other parts of the body. The five-year survival rate for people with lung cancer is about 50% if there is no evidence of cancer in lymph nodes at the time of surgery. In many others, the spread of their cancer has already occurred, even if not detected by current medical tests. When all lung cancer stages are considered together the five-year survival rate is only 14%.
Although most lung cancers do not cause any symptoms until they have spread too far to be cured, symptoms do occur in some patients with early lung cancer. The most common symptoms of early lung cancer are: a cough that does not go away, chest pain that is often aggravated by deep breathing, hoarseness, bloody or rust-colored phlegm, and new onset of wheezing. This is all before the lung cancer spreads to distant organs. Once this happens the symptoms worsen to bone pain, neurological changes, jaundice and masses near the surface of the body. These symptoms are also common with noncancerous diseases so the only way to find out what you are experiencing is to go to the doctor and run some tests.
Doctors use one or more methods to find out if the disease is really present. The first thing that a doctor will do is go over your medical history and give you a physical exam. The medical history will check for risk factors and symptoms and the physical exam will provide information about signs of lung cancer and other health problems.
Another test that they will do is use imaging tests. One test is a computed tomography. This will provide information about the size, shape, and position of a tumor and can help find enlarged lymph nodes that might contain cancer that has spread. A CT is more sensitive than a routine x-ray in finding early lung cancers. It involves a special machine that rotates around the body taking x-ray pictures from many angles. A computer then combines their pictures into a very detailed cross-sectional image. Another image test that doctors would use is a magnetic resonance imaging scan (MRI). An MRI uses powerful magnets, radio waves, and computers to take detailed cross-sectional images. The images are similar to those of a CT scan and are particularly useful in detecting spread of lung cancer to the brain or spinal cord. But unlike CT scanning, an MRI does not involve x-rays.
Doctors will also do a needle biopsy. The needle biopsy involves a needle being guided into the mass while the lungs are being viewed with fluoroscopy. A sample of the mass is removed and looked at under the microscope to see if cancer cells are present. A bronchoscopy is also used. This is when a fiber optic, flexible, lighted tube is passed through the mouth into the bronchi. This helps find centrally located tumors or blockages in the lungs while the patient is sedated.
After diagnosis there are many options for treatment. One option is surgery. Surgery may be used to remove the cancer and some of the surrounding lung tissue. If a section of the lung is removed, it is called a lobectomy. If the entire lung is removed, the surgery is called a pneumonectomy. The patient usually returns home after one or two weeks in the hospital. People whose lungs are in good condition (other than the presence of the cancer) can usually return to normal activities. On the other hand, if the lungs are also affected by noncancerous diseases like emphysema or chronic bronchitis, removal of a lobe or more extensive surgery may lead to long-term shortness of breath. Some patients with lung cancers that have spread to certain sites like the brain may benefit from removal of a brain metastasis. This involves a craniotomy (surgery through a whole in the skull).
Chemotherapy is also an option. Chemotherapy uses anticancer drugs that are given into a vein or by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has metastasized to organs beyond the lung. Chemo may be given as the main treatment or as an addition to surgery. Chemotherapy drugs kill cancer cells but also damage some normal cells. Temporary side effects include nausea and vomiting, loss of appetite or hair, and mouth sores. Some side effects disappear within a few days after treatment.
Radiation therapy is another common option. Radiation therapy uses high-energy radiation to kill cancer cells. After surgery, radiation therapy can be used to kill very small deposits of cancer that cannot be seen and removed during surgery. Radiation can be used to relieve symptoms of lung cancer such as pain, bleeding, difficulty swallowing, and problems caused by brain metastasis. Side effects of radiation may include mild skin problems, nausea, vomiting, and fatigue. These often go away after a short while. Radiation may also make the side effects of chemotherapy worse. This sort of therapy to large areas of the brain can sometimes result in significant changes in brain function. Symptoms may include memory loss, headache, difficulty thinking, or diminished sexual desire. There are other treatments such as using the clinical trials of experimental drugs or alternative methods. The only thing that is wrong with those methods is that they aren’t medically proven.
After diagnosis and treatment is also an important aspect of lung cancer. Doctors frequently go over the patient’s medical history and give numerous physical exams. Mainly to check for recurring cancer or any abnormal symptoms. It is extremely important to notify the doctor of any abnormalities that the patient discovers. This way there is a chance of detecting any new cancer.
Doing this research paper made me look back at what my uncle went through. He had his entire left lung removed. He never really did get back to normal activities. He had an oxygen tank anywhere that he had to be. He had one at his house, his summerhouse, his job and even one for the train rides back and forth to work, just incase anything happened. He eventually started to have problems with his balance and fell often. The last time he fell was on a subway platform on his way to work. That was his last day at work two years ago. During his last year of life, they found cancer again in his brain and he had a craniotomy. After that he never did get better. He went into the hospital on Wednesday with pneumonia, and passed away that Sunday. The doctors said that at the time of his death he didn’t have any cancer in his body.
This paper was hard for me to do. It made me take a step back and learn what my uncle was going through. I also learned about all of the treatments. It was amazing to find that most of the cases of lung cancer are related to smoking. And the amount of people who still smoke makes me so angry. The only thing that gives some hope for decreased amounts of lung cancer is that less young people are smoking. Hopefuly one day lung cancer will be a rare disease and not so many people will be affected by it.
American Cancer Society. Cancer Facts and Figures 2000. Atlanta, Ga: American Cancer Society; 2000
American Joint Committee on Cancer. Lung. AJCC Cancer Staging Manual. 5th Edition Philadelphia, Pa:Lippincott-Raven; 1997: 127-133.
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PDQ database. Lung Cancer. Bethesda, Md: National Cancer Institute; 200. Available at:
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