Your lungs surround your heart in your chest cavity (the thorax) and consist of spongy tissue with a rich blood supply. Air passes from your nose and mouth into the trachea (windpipe) and into each lung, through two airways called the bronchi. These divide into smaller airways, called bronchioles, which divide again and end in alveoli. These are air sacs with walls just one cell thick. It's here that oxygen filters into and carbon dioxide filters out of the blood.
TIP30 is a putative tumor suppressor with decreased expression in numerous cancers including melanoma, breast cancer, and colon cancer. Lung cancer is the most common cancer worldwide, both in terms of incidence and of mortality.
To determine if TIP30 plays a role in lung cancer progression and metastasis, Tong et al examined TIP30 expression in paired cancerous and non-cancerous lung tissue. TIP30 expression was decreased in a third of non-small cell lung cancers compared with normal controls, and reduced TIP30 expression correlated with lymph node metastasis. In addition, inhibition of TIP30 expression promoted lung cancer metastasis and angiogenesis in mice,
Tong et al conclude that "TIP30 may function as a tumor suppressor gene and play important roles in suppressing the progression and metastasis of lung cancer." These findings highlight TIP30 as a potential new therapeutic for metastatic lung cancer.
Lung cancer is the second most common type of cancer in both men and women and accounts for about 15% of all cancer diagnoses.
| Treatment options for small cell lung cancers | |
|---|---|
| Stage | Common options |
| Limited | Combined chemotherapy and radiation, sometimes surgery |
| Extensive | Chemotherapy, clinical trials, supportive care |
| Treatment options for non-small cell lung cancers | |
|---|---|
| Stage | Common options |
| I | Surgery |
| II | Surgery, chemotherapy, radiation |
| IIIA | Combined chemotherapy and radiation, sometimes surgery based on results of treatment |
| IIIB | Chemotherapy, sometimes radiation |
| IV | Chemotherapy, targeted drug therapy, clinical trials, supportive care |
You and your doctor choose a cancer treatment regimen based on a number of factors, such as your overall health, the type and stage of your cancer, and your own preferences. Treatment options typically include one or more treatments, including surgery, chemotherapy, radiation therapy or targeted drug therapy.
In some cases you may choose not to undergo treatment. For instance, you may feel that the side effects of treatment will outweigh the potential benefits. When that's the case, your doctor may suggest comfort (palliative) care to treat only the symptoms the cancer is causing, such as pain.
Levothyroxine sodium (brand names: Synthroid, Levoxyl, Levothroid, Unithroid)-A synthetic version of the principal thyroid hormone thyroxine (T4), which is made and released by the thyroid gland. Levothyroxine sodium is used to treat hypothyroidism and to suppress thyroid hormone release in the management of cancerous thyroid nodules and growth of goiters. Thyroid hormone increases the metabolic rate of cells of all tissues in the body. Thyroid hormone helps to maintain brain function, food metabolism, and body temperature, among other effects. Generic is available.
acetaminophen (brand name: Tylenol)-A pain reliever and fever reducer. The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold (that is, by requiring a greater amount of pain to develop before it is felt by a person). Acetaminophen reduces fever through its action on the heat-regulating center of the brain. Generic is available.
alprazolam (brand name: Xanax)- A benzodiazepine sedative that causes dose-related depression of the central nervous system. Alprazolam is useful in treating anxiety, panic attacks, insomnia, and muscle spasms. Generic is available.
amoxicillin (brand names: Amoxil, Polymox, Trimox)-An antibiotic of the penicillin type that is effective against different bacteria such as Haemophilus influenzae, Neisseria gonorrhoea, Escherichia coli, Pneumococci, Streptococci, and certain strains of Staphylococci, particularly infections of the middle ear, tonsillitis, throat infections, laryngitis, bronchitis, and pneumonia. Amoxicillin is also used in treating urinary tract infections, skin infections, and gonorrhea. Generic is available.
atenolol (brand name: Tenormin)-A medication that blocks the action of a portion of the involuntary nervous system that stimulates the pace of the heartbeat. By blocking the action of these nerves, atenolol reduces the heart rate and is useful in treating abnormally rapid heart rhythms. Atenolol also reduces the force of heart muscle contraction, lowers blood pressure, and is helpful in treating angina. It is also used for the prevention of migraine headaches and the treatment of certain types of tremors. Generic is available.
Smoking cessation is the most important measure that can prevent lung cancer. Many products, such as nicotine gum, nicotine sprays, or nicotine inhalers, may be helpful to people trying to quit smoking. Minimizing exposure to passive smoking is also an effective preventive measure. Using a home radon test kit can identify and allow correction of increased radon levels in the home, which can also cause lung cancers. Methods that allow early detection of cancers, such as the helical low-dose CT scan, may also be of value in the identification of small cancers that can be cured by surgical resection and prevention of widespread, incurable metastatic cancer
Definition of lung cancer: Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
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 | New cases: 219,440 |
| Deaths: 159,390 |
| Detailed Guide: Lung Cancer - Non-Small Cell | |
| What's New in Non-Small Cell Lung Cancer Research and Treatment? | |
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Lung cancer research is currently being done in medical centers throughout the world. Progress in prevention, early detection, and treatment based on current research is expected to save many thousands of lives each year.
Prevention
Tobacco
At this time, many researchers believe that prevention offers the greatest opportunity to fight lung cancer. Although decades have passed since the link between smoking and lung cancers was clearly identified, scientists estimate that smoking is still responsible for about 85% to 90% of lung cancer deaths. Research is continuing on:
Diet and nutrition
Although researchers are looking for ways to use vitamins or medicines to prevent lung cancer in people at high risk, these have so far not proved successful. For now, most researchers think that simply following the American Cancer Society dietary recommendations (such as maintaining a healthy weight and eating at least 5 servings of fruits and vegetables each day) may be the best strategy.
Early detection
In the past, large studies were done to determine whether routine chest x-rays and sputum cytology testing could save lives. Most researchers concluded that these tests did not find lung cancers early enough to significantly lower the risk of death from lung cancer. However, some researchers disagree about the best way to interpret the studies' data, and the debate continues.
A large clinical trial called the National Lung Screening Trial (NLST) is under way to test whether spiral CT scanning of people at high risk of lung cancer will save lives. The results of this study should be coming out in the next few years.
Another approach uses new, sensitive tests to detect cancer cells in sputum samples.
Researchers have recently found several changes that often affect the DNA of lung cancer cells. Current studies are looking at new diagnostic tests that specifically recognize these DNA changes to see if this approach is useful in finding lung cancers at an earlier stage.
Diagnosis
Virtual bronchoscopy
This imaging test uses CT scans to create detailed 3-dimensional pictures of the airways in the lung. The images can be viewed as if the doctor were actually using a bronchoscope.
Virtual bronchoscopy has some possible advantages over standard bronchoscopy. First, it is non-invasive and doesn't require anesthesia. It also allows doctors to see some airways that might not be visible with standard bronchoscopy, such as those being blocked by a tumor. But it has some drawbacks as well. For example, it doesn't show color changes in the airways that might indicate a problem. It also doesn't allow a doctor to take samples of suspicious areas like bronchoscopy does. Still, it can be a useful tool in some situations, such as in people who might be too sick to get a standard bronchoscopy.
This test will likely become more available as the technology improves.
Treatment
Stereotactic body radiation therapy (SBRT)
Stereotactic body radiation therapy (SBRT) is a newer type of treatment. It can be used for some very early stage (small) lung cancers when surgery isn't an option, usually for other medical reasons.
Instead of giving small doses of radiation each day for several weeks, SBRT involves giving very focused beams of high-dose radiation on one or a few days. Several beams are aimed at the tumor from different angles. In order to precisely target the radiation, the person is put in a specially designed body frame for each treatment. This reduces the movement of the lung tumor during breathing. Like other forms of external radiation, the treatment itself is painless.
Early results with SBRT have been very promising, and it seems to have a low risk of complications. But because it is still a fairly new technique, there isn't much long-term data on its use.
Chemotherapy
Many clinical trials in progress are comparing the effectiveness of newer combinations of chemotherapy drugs. These studies are also providing information about reducing side effects, especially in patients who are older and have other health problems.
Doctors know that adjuvant chemotherapy after surgery may be more helpful for some people with early (stage I or II) cancers than for others, but figuring out which patients to give it to is not easy. In early studies, newer lab tests that look at patterns of certain genes in the cancer cells have shown promise in telling which people might benefit most. Larger studies of these tests are now under way to try to confirm their usefulness. Doctors are also conducting clinical trials to search for better ways to combine chemotherapy with radiation therapy and other treatments.
Targeted therapies
Researchers are learning more about the molecules within lung cancer cells that control their growth and spread. This is being used to develop new targeted therapies. Some of these treatments are already being used to treat non-small cell lung cancer. Others are now being tested in clinical trials to see if they can help people with advanced lung cancer live longer or relieve their symptoms.
Some of the drugs that are in late stage clinical trials include vandetanib (ZD6474, Zactima), DMXAA (ASA404), and motesanib (AMG 706). Some targeted drugs already approved for use against other types of cancer, such as sorafenib (Nexavar) and sunitinib (Sutent), are also being tested for use against NSCLC.
Researchers are also working on lab tests to help predict which patients will benefit from which drugs. Several clinical trials have already reported that some patients do not benefit from certain targeted therapies, whereas others have quite remarkable shrinkage of their tumors. Predicting who might benefit could save some people from trying treatments that are unlikely to work for them and would likely cause unneeded side effects.
Vaccines: Several types of vaccines for boosting the body's immune response against lung cancer cells are being tested in clinical trials. Unlike vaccines against infections like measles or mumps, these vaccines are designed to help treat, not prevent, lung cancer. One possible advantage of these types of treatments is that they seem to have very limited side effects, so they might be useful in people who can't tolerate other treatments.
Some vaccines are made up of lung cancer cells that have been grown in the lab, or even of cell components, such as parts of proteins commonly found on cancer cells. For example, L-BLP25 (Stimuvax) is a vaccine made up of a piece of a protein (MUC1) that is encased in a fat droplet (liposome) to make it more effective. A small study of patients with advanced NSCLC suggested it may improve survival time. Larger studies are under way to confirm this.
At this time, vaccines are only available in clinical trials.
| What Happens After Treatment for Non-Small Cell Lung Cancer? | |
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Completing treatment can be both stressful and exciting. You will be relieved to finish treatment, yet it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those who have had cancer.
It may take a while before your confidence in your own recovery begins to feel real and your fears are somewhat relieved. You can learn more about what to look for and how to learn to live with the possibility of cancer coming back in our document, Living With Uncertainty: The Fear of Cancer Recurrence, available at 1-800-ACS-2345 (1-800-227-2345).
Follow-up care
After your treatment is over, it is very important to keep all follow-up appointments. During these visits, your doctors will ask about symptoms, do physical exams, and may order blood tests or imaging studies such as CT scans or x-rays.
Most doctors recommend follow-up visits and CT scans every 4 to 6 months for the first 2 years after treatment, and yearly visits and CT scans after this.
Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments. This is the time for you to ask your health care team any questions you need answered and to discuss any concerns you might have.
Almost any cancer treatment can have side effects. Some may last for a few weeks to several months, but others can be permanent. Don't hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them.
If cancer does recur, treatment will depend on the location of the cancer and what treatments you've had before. It may involve surgery, radiation therapy, chemotherapy, targeted therapy, or some combination of these. For more information on how recurrent cancer is treated, see the section "How is non-small cell lung cancer treated?" For more general information on dealing with a recurrence, you may also want to see our document, When Your Cancer Comes Back: Cancer Recurrence. You can get this document by calling 1-800-ACS-2345 (1-800-227-2345).
Keep medical insurance and copies of your medical records
At some point after your cancer diagnosis and treatment, you may find yourself in the office of a new doctor. Your original doctor may have moved or retired, or you may have moved or changed doctors for some reason. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Make sure you have the following information handy:
It is also important to keep medical insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. If it happens, the last thing you want is to have to worry about paying for treatment.
Lifestyle changes to consider during and after treatment
Having cancer and dealing with treatment can be time-consuming and emotionally draining, but it can also be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even begin this process during cancer treatment.
Make healthier choices
Think about your life before you learned you had cancer. Were there things you did that might have made you less healthy? Maybe you drank too much alcohol, or ate more than you needed, or smoked, or didn't exercise very often. Emotionally, maybe you kept your feelings bottled up, or maybe you let stressful situations go on too long.
Now is not the time to feel guilty or to blame yourself. However, you can start making changes today that can have positive effects for the rest of your life. Not only will you feel better but you will also be healthier. What better time than now to take advantage of the motivation you have as a result of going through a life-changing experience like having cancer?
You can start by working on those things that you feel most concerned about. Get help with those that are harder for you. For instance, if you smoke, one of the most important things you can do to improve your chances for treatment success is to quit. Studies have shown that patients who stop smoking after a diagnosis of lung cancer have better outcomes than those who don't. If you are thinking about quitting smoking and need help, call the American Cancer Society's Quitline® tobacco cessation program at 1-800-ACS-2345 (1-800-227-2345).
Diet and nutrition
Eating right can be a challenge for anyone, but it can get even tougher during and after cancer treatment. For instance, treatment often may change your sense of taste. Nausea can be a problem. You may lose your appetite for a while and lose weight when you don't want to. On the other hand, some people gain weight even without eating more. This can be frustrating, too.
If you are losing weight or have taste problems during treatment, do the best you can with eating and remember that these problems usually improve over time. You may want to ask your cancer team for a referral to a dietitian, an expert in nutrition who can give you ideas on how to fight some of the side effects of your treatment. You may also find it helps to eat small portions every 2 to 3 hours until you feel better and can go back to a more normal schedule.
One of the best things you can do after treatment is to put healthy eating habits into place. You will be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Try to eat 5 or more servings of vegetables and fruits each day. Choose whole grain foods instead of white flour and sugars. Try to limit meats that are high in fat. Cut back on processed meats like hot dogs, bologna, and bacon. Get rid of them altogether if you can. If you drink alcohol, limit yourself to 1 or 2 drinks a day at the most. And don't forget to get some type of regular exercise. The combination of a good diet and regular exercise will help you maintain a healthy weight and keep you feeling more energetic.
Rest, fatigue, work, and exercise
Fatigue is a very common symptom in people being treated for cancer. This is often not an ordinary type of tiredness but a "bone-weary" exhaustion that doesn't get better with rest. For some, this fatigue lasts a long time after treatment, and can discourage them from physical activity.
However, exercise can actually help you reduce fatigue. Studies have shown that patients who follow an exercise program tailored to their personal needs feel physically and emotionally improved and can cope better.
If you are ill and need to be on bed rest during treatment, it is normal to expect your fitness, endurance, and muscle strength to decline some. Physical therapy can help you maintain strength and range of motion in your muscles, which can help fight fatigue and the sense of depression that sometimes comes with feeling so tired.
Any program of physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis 3 times a week. If you haven't exercised in a few years but can still get around, you may want to think about taking short walks.
Talk with your health care team before starting, and get their opinion about your exercise plans. Then, try to get an exercise buddy so that you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn’t there.
If you are very tired, though, you will need to balance activity with rest. It is okay to rest when you need to. It is really hard for some people to allow themselves to do that when they are used to working all day or taking care of a household.
Exercise can improve your physical and emotional health.
And long term, we know that exercise plays a role in preventing some cancers. The American Cancer Society, in its guidelines on physical activity for cancer prevention, recommends that adults take part in at least 1 physical activity for 30 minutes or more on 5 days or more of the week.
How about your emotional health?
Once your treatment ends, you may find yourself overwhelmed by emotions. This happens to a lot of people. You may have been going through so much during treatment that you could only focus on getting through your treatment.
Now you may find that you think about the potential of your own death, or the effect of your cancer on your family, friends, and career. You may also begin to re-evaluate your relationship with your spouse or partner. Unexpected issues may also cause concern -- for instance, as you become healthier and have fewer doctor visits, you will see your health care team less often. That can be a source of anxiety for some.
This is an ideal time to seek out emotional and social support. You need people you can turn to for strength and comfort. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support communities, or individual counselors.
Almost everyone who has been through cancer can benefit from getting some type of support. What's best for you depends on your situation and personality. Some people feel safe in peer-support groups or education groups. Others would rather talk in an informal setting, such as church. Others may feel more at ease talking one-on-one with a trusted friend or counselor. Whatever your source of strength or comfort, make sure you have a place to go with your concerns.
The cancer journey can feel very lonely. It is not necessary or realistic to go it all by yourself. And your friends and family may feel shut out if you decide not include them. Let them in -- and let in anyone else who you feel may help. If you aren't sure who can help, call your American Cancer Society at 1-800-ACS-2345 (1-800-227-2345) and we can put you in touch with an appropriate group or resource.
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making healthy choices and feeling as well as possible, physically and emotionally.
What happens if treatment is no longer working?
If cancer continues to grow after one kind of treatment, or if it returns, it is often possible to try another treatment plan that might still cure the cancer, or at least shrink the tumors enough to help you live longer and feel better. On the other hand, when a person has received several different medical treatments and the cancer has not been cured, over time the cancer tends to become resistant to all treatment. At this time it's important to weigh the possible limited benefit of a new treatment against the possible downsides, including continued doctor visits and treatment side effects.
Everyone has his or her own way of looking at this. Some people may want to focus on remaining comfortable during their limited time left.
This is likely to be the most difficult time in your battle with cancer -- when you have tried everything medically within reason and it's just not working anymore. Although your doctor may offer you new treatment, you need to consider that at some point, continuing treatment is not likely to improve your health or change your prognosis or survival.
If you want to continue treatment to fight your cancer as long as you can, you still need to consider the odds of more treatment having any benefit. In many cases, your doctor can estimate the response rate for the treatment you are considering. Some people are tempted to try more chemotherapy or radiation, for example, even when their doctors say that the odds of benefit are less than 1%. In this situation, you need to think about and understand your reasons for choosing this plan.
No matter what you decide to do, it is important that you be as comfortable as possible. Make sure you are asking for and getting treatment for any symptoms you might have, such as pain. This type of treatment is called "palliative" treatment.
Palliative treatment helps relieve these symptoms, but is not expected to cure the disease; its main purpose is to improve your quality of life. Sometimes, the treatments you get to control your symptoms are similar to the treatments used to treat cancer. For example, radiation therapy might be given to help relieve bone pain from bone metastasis. Or chemotherapy might be given to help shrink a tumor and keep it from causing a bowel obstruction. But this is not the same as receiving treatment to try to cure the cancer.
At some point, you may benefit from hospice care. Most of the time, this can be given at home. Your cancer may be causing symptoms or problems that need attention, and hospice focuses on your comfort. You should know that receiving hospice care doesn't mean you can’t have treatment for the problems caused by your cancer or other health conditions. It just means that the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult stage of your cancer.
Remember also that maintaining hope is important. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends -- times that are filled with happiness and meaning. In a way, pausing at this time in your cancer treatment is an opportunity to refocus on the most important things in your life. This is the time to do some things you've always wanted to do and to stop doing the things you no longer want to do.
| What Should You Ask Your Doctor About Non-Small Cell Lung Cancer? | |
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It is important for you to have honest, open discussions with your cancer care team. They want to answer all of your questions, no matter how minor you might think they are. Some questions to consider:
Along with these sample questions, be sure to write down some of your own. For instance, you might want more information about recovery times so you can plan your work schedule. Or you may want to ask about second opinions or about clinical trials for which you may qualify.
| Clinical Trials | |
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You may have had to make a lot of decisions since you've been told you have cancer. One of the most important decisions you will make is choosing which treatment is best for you. You may have heard about clinical trials being done for your type of cancer. Or maybe someone on your health care team has mentioned a clinical trial to you.
Clinical trials are carefully controlled research studies that are done with patients who volunteer for them. They are done to get a closer look at promising new treatments or procedures.
If you would like to take part in a clinical trial, you should start by asking your doctor if your clinic or hospital conducts clinical trials. You can also call our clinical trials matching service for a list of clinical trials that meet your medical needs. You can reach this service at 1-800-303-5691 or on our Web site at http://clinicaltrials.cancer.org. You can also get a list of current clinical trials by calling the National Cancer Institute's Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) or by visiting the NCI clinical trials Web site at www.cancer.gov/clinicaltrials.
There are requirements you must meet to take part in any clinical trial. If you do qualify for a clinical trial, it is up to you whether or not to enter (enroll in) it.
Clinical trials are one way to get state-of-the art cancer treatment. They are the only way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.
You can get a lot more information on clinical trials, in our document called Clinical Trials: What You Need to Know. You can read it on our Web site or call our toll-free number and have it sent to you.
| Detailed Guide: Lung Cancer - Non-Small Cell | |
| How Is Non-Small Cell Lung Cancer Staged? | |
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Clinical staging is the process of finding out how far a cancer has spread. Your treatment and prognosis (outlook) depend, to a large extent, on the cancer's stage.
Staging is based on the results of the physical exam, biopsies, and imaging tests (CT scan, chest x-ray, PET scan, etc.), which are described in the section, "How is non-small cell lung cancer diagnosed?"
The TNM staging system
The system used to describe the growth and spread of non-small cell lung cancer (NSCLC) is the American Joint Committee on Cancer (AJCC) TNM staging system. The TNM system describes 3 key pieces of information:
Numbers or letters appear after T, N, and M to provide more details about each of these factors. The numbers 0 through 4 indicate increasing severity. The letter X means "cannot be assessed because the information is not available."
T categories for non-small cell lung cancer
TX: Main (primary) tumor can't be assessed, or cancer cells were seen on sputum cytology but no tumor can be found.
T0: No evidence of a primary tumor.
Tis: Cancer is found only in the top layers of cells lining the air passages. It has not invaded into deeper lung tissues. This stage is also known as carcinoma in situ.
T1: The tumor is no larger than 3 centimeters (slightly less than 1¼ inches) across, has not reached the membranes that surround the lungs (visceral pleura), and does not affect the main branches of the bronchi.
T2: The tumor has 1 or more of the following features:
T3: The tumor can be any size and has 1 or more of the following features:
T4: The cancer has 1 or more of the following features:
N categories for non-small cell lung cancer
NX: Nearby lymph nodes cannot be assessed.
N0: No spread to nearby lymph nodes.
N1: Spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung (hilar lymph nodes). Affected lymph nodes are on the same side as the primary tumor(s).
N2: Spread to lymph nodes around the carina (the point where the windpipe splits into the left and right bronchi) or in the space behind the breastbone and in front of the heart (mediastinum). Affected lymph nodes are on the same side as the primary tumor.
N3: Spread to lymph nodes near the collarbone on either side, and/or spread to hilar or mediastinal lymph nodes on the side opposite the primary tumor.
M categories for non-small cell lung cancer
M0: No spread to distant organs or areas. This includes other lobes of the lungs, lymph nodes further away than those mentioned in the N stages above, and other organs or tissues such as the liver, bones, or brain.
M1: The cancer has spread to 1 or more distant sites. This can be to another lobe of the lung, to distant lymph nodes, or to other organs.
Stage grouping for non-small cell lung cancer
Once the T, N, and M categories have been assigned, this information is combined (stage grouping) to assign an overall stage of 0, I, II, III, or IV. Some stages are subdivided into A and B. The stages identify tumor types that have a similar prognosis and thus are treated in a similar way. Patients with lower stage numbers tend to have a better prognosis.
Occult cancer
TX, N0, M0: Cancer cells are seen in a sample of sputum or other lung fluids, but the location of the cancer can't be determined.
Stage 0
Tis, N0, M0: The cancer is found only in the top layers of cells lining the air passages. It has not invaded deeper into other lung tissues and has not spread to lymph nodes or distant sites.
Stage IA
T1, N0, M0: The cancer is no larger than 3 centimeters (cm) across, has not reached the membranes that surround the lungs, and does not affect the main branches of the bronchi. It has not spread to lymph nodes or distant sites.
Stage IB
T2, N0, M0: The cancer has 1 or more of the following features:
The cancer has not spread to lymph nodes or distant sites.
Stage IIA
T1, N1, M0: The cancer is no larger than 3 centimeters, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi. It has spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung (hilar lymph nodes). It has not spread to distant sites.
Stage IIB
There are 2 combinations of categories that make up this stage.
T2, N1, M0: The cancer has 1 or more of the following features:
It has also spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung (hilar lymph nodes). It has not spread to distant sites.
T3, N0, M0: The main tumor can be any size and has 1 or more of the following features:
The cancer has not spread to lymph nodes or distant sites.
Stage IIIA
There are 4 main combinations of categories that make up this stage.
T1, N2, M0: The cancer is no larger than 3 centimeters, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi. The cancer has spread to lymph nodes around the carina (the point where the windpipe splits into the left and right bronchi) or in the space behind the breastbone and in front of the heart (mediastinum). Affected lymph nodes are on the same side as the primary tumor. The cancer has not spread to distant sites.
T2, N2, M0: The cancer has 1 or more of the following features:
The cancer has also spread to lymph nodes around the carina (the point where the windpipe splits into the left and right bronchi) or in the space behind the breastbone and in front of the heart (mediastinum). Affected lymph nodes are on the same side as the primary tumor. The cancer has not spread to distant sites.
T3, N1, M0: The tumor can be any size and has 1 or more of the following features:
It has also spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung (hilar lymph nodes). It has not spread to distant sites.
T3, N2, M0: The tumor can be any size and has 1 or more of the following features:
The cancer has also spread to lymph nodes around the carina (the point where the windpipe splits into the left and right bronchi) or in the space behind the breastbone and in front of the heart (mediastinum). Affected lymph nodes are on the same side as the primary tumor. The cancer has not spread to distant sites.
Stage IIIB
There are 2 combinations of categories that make up this stage.
Any T, N3, M0: The cancer can be of any size. It may or may not have grown into nearby structures or caused pneumonia or lung collapse. It has spread to lymph nodes near the collarbone on either side, and/or has spread to hilar or mediastinal lymph nodes on the side opposite the primary tumor. The cancer has not spread to distant sites.
T4, any N, M0: The cancer has 1 or more of the following features:
The cancer may or may not have spread to nearby lymph nodes. It has not spread to distant sites.
Stage IV
Any T, Any N, M1: The cancer can be any size and may or may not have grown into nearby structures or reached nearby lymph nodes. It has spread to distant sites.
Non-small cell lung cancer survival rates by stage
The numbers below are relative survival rates calculated from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, based on people who were diagnosed with non-small cell lung cancer between 1988 and 2001. There are some important points to note about these numbers:
| Stage | 5-year Relative Survival Rate |
| I | 56% |
| II | 34% |
| III | 10% |
| IV | 2% |
These survival rates aren't broken down by substages, but the rates would likely be slightly higher than those above for the A subgroups and slightly lower for the B subgroups.
| How Is Non-Small Cell Lung Cancer Diagnosed? | |
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Most lung cancers are not found until they start to cause symptoms, at which point they are often already at an advanced stage.
Common signs and symptoms of lung cancer
Most lung cancers do not cause any symptoms until they have spread too far to be cured, but symptoms do occur in some people with early lung cancer. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed and treated while it is curable. Or, at the least, you could live longer with a better quality of life. The most common symptoms of lung cancer are:
When lung cancer spreads to distant organs, it may cause:
Some lung cancers can cause a group of very specific symptoms. These are often described as "syndromes."
Horner syndrome
Cancer of the top part of the lungs (sometimes called Pancoast tumors) may damage a nerve that passes from the upper chest into your neck. Their most common symptom is severe shoulder pain. Sometimes they also cause a group of symptoms called Horner syndrome:
Conditions other than lung cancer can also cause Horner syndrome.
Paraneoplastic syndromes
Some lung cancers may make hormone-like substances that enter the bloodstream and cause problems with distant tissues and organs, even though the cancer has not spread to those tissues or organs. These problems are called paraneoplastic syndromes. Sometimes these syndromes may be the first symptoms of early lung cancer. Because the symptoms affect other organs, patients and their doctors may suspect at first that diseases other than lung cancer cause them.
The most common paraneoplastic syndromes caused by non-small cell lung cancer are:
Most of the symptoms listed above are more likely to be caused by conditions other than lung cancer. Still, if you have any of these problems, it's important to see your doctor right away so the cause can be found and treated, if needed.
Medical history and physical exam
If you have any signs or symptoms that suggest you might have lung cancer, your doctor will want to take a medical history (health-related interview) to check for risk factors and symptoms. Your doctor will also examine you to look for signs of lung cancer and other health problems.
If symptoms and/or the results of the physical exam suggest lung cancer might be present, more involved tests will likely be done. These might include imaging tests and/or getting biopsies of lung tissue.
Imaging tests
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests may be done for a number of reasons, including to help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment has been effective.
Chest x-ray
This is often the first test your doctor will do to look for any masses or spots on the lungs. A plain x-ray of your chest can be done in any outpatient setting. If the x-ray is normal, you probably don't have lung cancer. If something suspicious is seen, your doctor may order additional tests.
Computed tomography (CT) scan
The CT or CAT scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around you while you lie on a table. A computer then combines these pictures into images of slices of the part of your body being studied. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body.
Before the CT scan, you may be asked to drink a contrast solution or receive an IV (intravenous) line through which a contrast dye is injected. This helps better outline structures in your body.
The contrast may cause some flushing (a feeling of warmth, especially in the face). Some people are allergic and get hives. Rarely, more serious reactions like trouble breathing or low blood pressure can occur. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.
CT scans take longer than regular x-rays. You need to lie still on a table while they are being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken.
In recent years, spiral CT (also known as helical CT) has become available in many medical centers. This type of CT scan uses a faster machine. The scanner part of the machine rotates around the body continuously, allowing doctors to collect the images much more quickly than standard CT. As a result, you do not have to hold your breath for as long while the image is taken. This lowers the chance of "blurred" images occurring as a result of breathing motion. It also lowers the dose of radiation received during the test. The "slices" it images are thinner, which yields more detailed pictures.
A CT scan can provide precise information about the size, shape, and position of any tumors and can help find enlarged lymph nodes that might contain cancer that has spread from the lung. CT scans are more sensitive than routine chest x-rays in finding early lung cancers.
This test can also be used to look for masses in the adrenal glands, brain, and other internal organs that may be affected by the spread of lung cancer.
CT guided needle biopsy: In some cases, a CT scan can be used to guide a biopsy needle precisely into a suspected area of cancer spread. For this procedure, you stay on the CT scanning table, while a radiologist advances a biopsy needle through the skin and toward the location of the mass. CT scans are repeated until the doctors can see that the needle is within the mass. A biopsy sample is then removed and looked at under a microscope.
Magnetic resonance imaging (MRI) scan
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. A contrast material called gadolinium is often injected into a vein before the scan to better see details.
MRI scans are a little more uncomfortable than CT scans. First, they take longer -- often up to an hour. Second, you have to lie inside a narrow tube, which is confining and can upset people with claustrophobia (a fear of enclosed spaces). Newer, "open" MRI machines can sometimes help with this if needed. The machine also makes buzzing and clicking noises that you may find disturbing. Some centers provide headphones with music to block this out.
MRI scans are most often used to look for possible spread of lung cancer to the brain or spinal cord.
Positron emission tomography (PET) scan
PET scans involve injecting glucose (a form of sugar) that contains a radioactive atom into the blood. The amount of radioactivity used is very low. Because cancer cells in the body are growing rapidly, they absorb large amounts of the radioactive sugar. A special camera can then create a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body.
This can be a very important test if you have early stage lung cancer. Your doctor can use this test to see if the cancer has spread to lymph nodes. It is also helpful in getting a better idea whether an abnormal area on your chest x-ray may be cancer.
A PET scan is also useful if your doctor thinks the cancer may have spread but doesn't know where. PET can reveal spread of cancer to the liver, bones, adrenal glands, or some other organs. It is not as useful for looking at the brain, since all brain cells use a lot of glucose.
Some newer machines are able to perform both a PET and CT scan at the same time (PET/CT scan). This allows the doctor to compare areas of higher radioactivity on the PET with the appearance of that area on the CT.
Bone scan
A bone scan can help show if a cancer has metastasized (spread) to the bones. For this test, a small amount of low-level radioactive material is injected into a vein (intravenously, or IV). The substance settles in areas of bone changes throughout the entire skeleton over the course of a couple of hours. You then lie on a table for about 30 minutes while a special camera detects the radioactivity and creates a picture of your skeleton.
Areas of active bone changes appear as "hot spots" on your skeleton -- that is, they attract the radioactivity. These areas may suggest the presence of metastatic cancer, but arthritis or other bone diseases can also cause the same pattern. To distinguish between these conditions, your cancer care team may use other imaging tests such as simple x-rays or MRI scans to get a better look at the areas that light up, or they may even take biopsy samples of the bone.
PET scans, which are often done in patients with non-small cell lung cancer, can usually show the spread of cancer to bones, so bone scans aren't needed very often. Bone scans are done mainly when there is reason to think the cancer may have spread to the bones (because of symptoms, etc.) and other test results aren't clear.
Procedures that sample tissues and cells
Symptoms and the results of imaging tests may strongly suggest that lung cancer is present, but the actual diagnosis of non-small cell lung cancer is made by looking at lung cells under a microscope. The cells can be taken from lung secretions (phlegm) or by removing the cells from a suspicious area (known as a biopsy). One or more of the tests below may be used to find out if a lung mass seen on imaging tests is indeed lung cancer. These tests can also be used to tell the exact type of lung cancer you may have and to help determine how far it may have spread.
A pathologist, a doctor who specializes in using lab tests to diagnose diseases such as cancer, will examine the cells using a microscope. If you have any questions about your pathology results or any diagnostic tests, do not hesitate to ask your doctor. If needed, you can get a second opinion of your pathology report by having your tissue specimen sent to a pathologist at another lab recommended by your doctor.
Sputum cytology
A sample of phlegm (mucus you cough up from the lungs) is viewed under a microscope to see if cancer cells are present. The best way to do this is to get early morning samples from you 3 days in a row.
Fine needle aspiration (FNA) biopsy
A needle biopsy can often be used to get a small sample of cells from a suspicious area. For this test, the skin where the needle is to be inserted is first numbed with local anesthesia. The doctor guides a thin, hollow needle into the area while looking at your lungs with either fluoroscopy (which is like an x-ray, but the image is shown on a screen rather than on film) or CT scans. Unlike fluoroscopy, CT doesn't give a continuous picture, so the needle is inserted in the direction of the mass, a CT image is taken, and the direction of the needle is guided based on the image. This is repeated a few times until the needle is within the mass.
A tiny sample of the target area is then sucked into a syringe and looked at under the microscope to see if cancer cells are present.
A possible complication of this procedure is that air may leak out of the lung at the biopsy site and into the space between the lung and the chest wall. This can cause part of the lung to collapse and can cause trouble breathing. This complication, called a pneumothorax, often gets better without any treatment. If not, it is treated by putting a small tube into the chest space and sucking out the air over a day or two.
A thin needle can also be inserted through the wall of the trachea (windpipe) or bronchus (one of the larger tubes that carry air to the lungs) using a bronchoscope (see below) in order to sample nearby lymph nodes. This procedure, called transtracheal or transbronchial fine needle aspiration, is often used to take samples of lymph nodes around the windpipe and bronchi.
Bronchoscopy
For this exam, a lighted, flexible fiber-optic tube (bronchoscope) is passed through your mouth or nose and down into the windpipe and bronchi. The mouth and throat are sprayed first with a numbing medicine. You may also be given medicine through an intravenous (IV) line to make you feel relaxed.
Bronchoscopy can help the doctor find some tumors or blockages in the lungs. At the same time, small instruments can be passed down the bronchoscope to take biopsies (samples of tissue) or samples of lung secretions to be looked at under a microscope.
Endobronchial ultrasound (EBUS)
Ultrasound is a type of imaging test that uses sound waves to create images of parts of your body. For this test, a small, microphone-like instrument called a transducer emits sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into a black and white image that is displayed on a computer screen.
For endobronchial ultrasound, a bronchoscope is fitted with an ultrasound transducer at its tip and is passed down into the windpipe. The transducer can be pointed in different directions to look at lymph nodes and other structures in the mediastinum (the area between the lungs). If suspicious areas (such as enlarged lymph nodes) are seen on the ultrasound, a hollow needle can be passed through the bronchoscope and guided by ultrasound into the abnormal structures to obtain a biopsy. The samples are then looked at under a microscope.
Endoscopic esophageal ultrasound (EUS)
This technique is similar to endobronchial ultrasound, except it involves using an endoscope (a lighted, flexible scope) that is passed down the throat and into the esophagus (the tube connecting the throat to the stomach), which lies just behind the windpipe. This is done with numbing medicine (local anesthesia) and light sedation.
The esophagus is close to some lymph nodes inside the chest to which lung cancer may spread. Ultrasound images taken from inside the esophagus can be helpful in finding large lymph nodes inside the chest that might contain lung cancer. If suspicious areas (such as enlarged lymph nodes) are seen on the ultrasound, a hollow needle can be passed through the endoscope to get biopsy samples of them. The samples are then looked at under a microscope.
Mediastinoscopy and mediastinotomy
Both of these procedures allow the doctor to look more directly at and sample the structures in the mediastinum (the area between the lungs). They are done in an operating room while you are under general anesthesia (in a deep sleep). The main difference between a mediastinoscopy and a mediastinotomy is in the location and size of the incision.
For a mediastinoscopy, a small cut is made in the front of the neck above the breastbone (sternum) and a thin, hollow, lighted tube is inserted behind the sternum. Special instruments can be passed through this tube to take tissue samples from the lymph nodes along the windpipe and the major bronchial tube areas. Looking at the samples under a microscope can show whether cancer cells are present.
Mediastinotomy also allows the doctor to look at and remove mediastinal lymph nodes while the patient is under general anesthesia. For mediastinotomy, the surgeon makes a slightly larger incision (usually about 2 inches long) between the left second and third ribs next to the breast bone. This allows the surgeon to reach lymph nodes that are not reached by mediastinoscopy.
Thoracentesis
Thoracentesis is done to find out whether or not a build-up of fluid around the lungs (pleural effusion) is the result of cancer spreading to the lining of the lungs (pleura). The build-up might also be caused by a condition such as heart failure or an infection.
For this procedure, the skin is numbed and a needle is placed between the ribs to drain the fluid. (In a similar test called pericardiocentesis, fluid is removed from within the sac around the heart.) The fluid is checked under a microscope to look for cancer cells. Chemical tests of the fluid are also sometimes useful in telling a malignant (cancerous) pleural effusion from a benign one.
If a malignant pleural effusion has been diagnosed, thoracentesis may be repeated to remove more fluid. Fluid build-up can prevent the lungs from filling with air, so thoracentesis can help the patient breathe better.
Thoracoscopy
Thoracoscopy can be done to find out if cancer has spread to the space between the lungs and the chest wall, as well as to the linings of these spaces. Most often this procedure is done in the operating room while you are under general anesthesia (in a deep sleep). The doctor inserts a lighted tube with a small video camera on the end through a small cut made in the chest wall to view the space between the lungs and the chest wall. (Sometimes more than one cut is made.) Using this, the doctor can see potential cancer deposits on the lung or lining of the chest wall and remove small pieces of tissue to be looked at under the microscope. Thoracoscopy can also be used to sample lymph nodes and fluid and assess whether a tumor is growing into nearby tissues or organs.
Lab tests of biopsy and other samples
Samples that have been collected during biopsies or other tests are sent to a pathology lab. There, a doctor views the samples under a microscope to find out if they contain cancer and if so, what type of cancer it is. Special tests may be needed to help better classify the cancer. Cancers from other organs can spread to the lungs. It's very important to find out where the cancer started, because treatment is different for different types of cancer.
Immunohistochemistry (IHC): For this test, very thin slices of the sample are attached to glass microscope slides. The samples are then treated with special proteins (antibodies) designed to attach only to a specific substance found in certain cancer cells. If the patient's cancer contains that substance, the antibody will attach to the cells. Chemicals are then added so that antibodies attached to the cells change color. The doctor who views the sample under a microscope can see this color change.
Molecular tests: In some cases, doctors may look for specific gene changes in the cancer cells that might affect how they are best treated. For example, the epidermal growth factor receptor (EGFR) is a protein that sometimes appears in high amounts on the surface of cancer cells and helps them grow. Some anti-cancer drugs target EGFR, but they only seem to work against certain cancers. Some doctors may test for changes in genes such as EGFR and K-RAS to determine if these treatments are likely to be helpful. While these tests are available in specialized labs, they are not yet widely used.
Other tests
Blood tests
Blood tests are not used to diagnose lung cancer, but they are done to get a sense of a person's overall health. For example, prior to surgery, blood tests can help tell if a person is healthy enough to have an operation.
A complete blood count (CBC) determines whether your blood has the correct number of various cell types. For example, it can show if you are anemic (have a low number of red blood cells), if you may have trouble with bleeding (due to a low number of blood platelets), or if you are at increased risk for infections (due to a low number of white blood cells). This test will be repeated regularly if you are treated with chemotherapy, because these drugs can affect blood-forming cells of the bone marrow.
Blood chemistry tests can help spot abnormalities in some of your organs. If cancer has spread to the liver and bones, it may cause abnormal levels of certain chemical in the blood. For example, spread to these areas may result in a higher than normal level of lactate dehydrogenase (LDH) in the blood.
Pulmonary function tests
Pulmonary function tests (PFTs) are often done after a lung cancer diagnosis to see how well your lungs are working (how much emphysema or chronic obstructive lung disease is present). This is especially important if surgery might be an option in treating the cancer. Because surgical removal of part or all of lung results in lower lung capacity, it's important to know how well the lungs are working beforehand. These tests can give the surgeon an idea of whether surgery is a good option, and if so, how much lung can safely be removed.
There are a few different types of PFTs, but they all basically involve having you breathe in and out through a tube that is connected to different machines.
