Involve. Supporting you. Supporting your patients with cancer
As a healthcare provider, you participate in every aspect of care for patients facing a cancer diagnosis. Use this section to refresh your knowledge of lung cancer or share the information with patients who are facing a lung cancer diagnosis.
- Facts and Statistics
- Risk Factors
- Screening and Early Detection
- Diagnosis and Staging
- Lung Cancer Treatment Options
Facts and Statistics
According to the American Cancer Society, in the US:
- Lung cancer is the second most common cancer in men (after prostate cancer) and women (after breast cancer).
- In 2009, approximately 219,440 new cases of lung cancer are expected to be diagnosed.
- The lifetime risk of developing lung cancer is 1 in 13 for men and 1 in 16 for women; however, in smokers, this risk is much higher.
- Lung cancer is by far the leading cause of cancer death among both men and women, with an estimated 159,000 deaths from lung cancer expected in 2009.
Risk Factors
Multiple factors contribute to the risk of developing lung cancer. Some of the risk factors below can be avoided, while others, like family history, are unavoidable.
- Smoking: Smoking is the primary cause of lung cancers and is responsible for more than 80% of all lung cancer cases. All tobacco products may increase the risk of lung cancer, including cigarettes, pipes, cigars, and low tar or "light" cigarettes.
- Exposure to Secondhand Smoke: Breathing in the smoke of others also increases the risk of lung cancer. Some studies indicate that spouses of smokers have a 30% greater risk of developing lung cancer.
- Exposure to Dangerous Substances: Exposure to specific carcinogens such as arsenic, asbestos, radon, uranium, mustard gas, coal products, and gasoline may increase the risk of lung cancer. Smokers that are exposed to these substances may be at an even greater risk.
- Use of Beta Carotene: Use of pharmacological doses of beta carotene is directly related to an increased risk of lung cancer and mortality in smokers.
- Radiation Therapy to the Chest: Chest exposure to radiation therapy may increase the risk of lung cancer, especially in smokers.
- Lung Diseases: Certain lung diseases, such as silicosis and berylliosis, increase the risk of developing lung cancer.
- Previous Lung Cancer: Patients who have already been diagnosed with lung cancer have an increased risk of developing recurrent lung cancer.
- Family History of Lung Cancer: Individuals with a close relative diagnosed with lung cancer, such as a parent or sibling, are at an increased risk of developing lung cancer.
- Air Pollution: Some studies indicate that living in cities with more air pollution may increase the risk of lung cancer.
- Eating Habits: Some studies have shown that eating a diet low in fruits and vegetables may increase the risk of lung cancer among smokers and those exposed to secondhand smoke.
Screening and Early Detection
Screening for early lung cancers is difficult, and most screening tests have not shown promise in the ability to detect early lung cancers or reduce the risk of death. Because of this, screening for lung cancer is not routine.
One screening test, the spiral CT (computed tomography) scan, has successfully detected lung cancers early in people who smoke or who have smoked in the past. However, this method of lung cancer screening has not been shown to reduce the risk of death due to lung cancer. In addition, it may identify lung abnormalities that are not cancerous, which may lead to unnecessary tests and even surgeries. The National Lung Screening Trial is an ongoing clinical trial testing the benefits of spiral CT scanning in people at high risk of developing lung cancers.
Due to the limitations of screening for early lung cancers, the role of nurses in educating patients on how to reduce their risk factors and recognize signs and symptoms is even more important.
Diagnosis and Staging
Several options are available for the diagnosis of lung cancer:
- Physical Exam and Medical History: During a physical exam, healthcare providers check for lung cancer signs and other possible health problems. A medical history also may be used to assess lung cancer risk.
- X-Rays and Scans: Chest X-rays, CT scans , MRI (magnetic resonance imaging), positron emission tomography (PET), and bone scans may be used to determine the presence of lung cancer. Bone scans are indicated only for patients with non-small cell lung cancer (NSCLC) who have symptoms or who have had previous tests that indicate the cancer may have spread to the bones.
- Lung Cancer Tissue and Cell Testing: After the above diagnostic tests have been completed, a biopsy may be used to confirm a diagnosis of lung cancer, the type of lung cancer, and whether the cancer has spread.
Once lung cancer is diagnosed, the disease is staged:
| Lung Cancer TNM Staging Guide | |
|---|---|
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ |
| T1 | Tumor ≤3 cm in surrounding tissue with no evidence of invasion |
| T2 |
Tumor with features of size or extent:
|
| T3 | Tumor of any size that directly invades any of the following:
|
| T4 | Tumor of any size that
|
| Lung Cancer TNM Staging Guide | |
|---|---|
| Regional Lymph Nodes (N) | |
| NX | Regional lymph node metastases cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension of the primary tumor |
| N2 | Metastasis to ipsilateral mediastinal and/or subcarinal lymph node(s) |
| N3 | Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s) |
| Lung Cancer TNM Staging Guide | |
|---|---|
| Distant Metastases (M) | |
| MX | Distant metastasis cannot be assessed |
| M0 | No distant metastasis |
| M1 | Distant metastasis present (M1 includes separate tumor nodule[s] in a different lobe [ipsilateral or contralateral]) |
Lung Cancer Treatment Options
- Surgery: For patients with NSCLC, surgery is a standard treatment, with several types of surgery available. A wedge resection, removal of the tumor with a small section of lung, is appropriate for patients with a small tumor in a favorable location or for patients with limited lung function. A lobectomy, the removal of the entire lobe of the involved lung, is necessary in other patients. On occasion, a pneumonectomy, the removal of the entire affected lung, may be required. Other surgeries used to treat NSCLC include lobectomy and segmentectomy (removal of part of a lung section). In addition, lymph nodes may be removed to determine if, and how far, the cancer may have spread.
- Radiation Therapy: Radiation therapy is a common treatment for lung cancer, the 2 common types being external beam radiation therapy and brachytherapy. Radiation therapy is often combined with surgery and is important in the treatment of all types of lung cancer. It may be recommended before surgery to shrink a tumor to make it easier for the surgeon to remove. Radiation may be used after surgery if there are worrisome risk factors that make it likely for a tumor to come back in the chest. Sometimes radiation is used instead of surgery if surgery is considered too dangerous for the patient or if a tumor is too extensive to be removed with surgery.
- Chemotherapy: Chemotherapy is a standard treatment for some patients with NSCLC. Small cell lung cancer is very responsive to chemotherapy, and most patients with small cell lung cancer are offered chemotherapy.
- Targeted Therapy/Biologic Therapies: Biologic therapy uses the patient's immune system to fight cancer.
- Photodynamic Therapy: During photodynamic therapy, the patient is injected with a drug that is sensitive to a specific type of light and preferentially taken up by cancer cells. After injection, a light is shone on the tumor, the drug is activated, and cancer cells are killed. Photodynamic therapy is used occasionally in the treatment of lung cancer with lesions in the airway.
- Clinical Trials: Clinical trials give patients access to investigational approaches and treatments that often are not otherwise available. There are both benefits and drawbacks to participation in clinical trials that patients and healthcare providers should discuss.
Continue reading about Colorectal Cancer.