Lung Cancer

Topic Overview

What is lung cancer?

Lung cancer starts when abnormal cells grow out of control in the lung. They can invade nearby tissues and form tumors. Lung cancer can start anywhere in the lungs and affect any part of the respiratory system .

The cancer cells can spread, or metastasize, to the lymph nodes and other parts of the body.

What causes lung cancer?

Most lung cancer is caused by smoking. Secondhand smoke also can cause lung cancer. Lung cancer is the leading cause of cancer deaths.

Being exposed to arsenic, asbestos, radioactive dust, or radon can increase your chances of getting lung cancer. People who are exposed to radiation at work or elsewhere have a higher chance of getting lung cancer.

What are the symptoms?

Early lung cancer doesn't usually cause any symptoms. This is why it's not usually found early.

In its advanced stage, cancer may affect how your lungs work. The first signs of lung cancer may include:

• Coughing.
• Wheezing.
• Feeling short of breath.
• Having blood in any mucus that you cough up.

If you have these symptoms and are worried about lung cancer, call your doctor.

Lung cancer may spread to the chest and then to other parts of the body. For example, if it spreads to the spine or bones, it may cause pain in the back or other bones or weakness in the arms or legs. If it spreads to the brain, it may cause seizures, headaches, or vision changes.

How is lung cancer diagnosed?

Your doctor will check your symptoms and ask questions about whether you smoke or have been exposed to another person's smoke or to any cancer-causing substances. He or she will also ask about your medical history, including any history of cancer in your family. This information will help your doctor decide how likely it is that you have lung cancer and whether you need tests to be sure.

Lung cancer is usually first found on a chest X-ray or a CT scan . More tests are done to find out what kind of cancer cells you have and whether they have spread beyond your lung. These tests help your doctor and you find out what stage the cancer is in. The stage is a rating to measure how big the cancer is and how far it has spread.

How is it treated?

Treatment for lung cancer includes surgery, anti-cancer medicines ( chemotherapy ), radiation , or a mix of all three. It depends on what type of cancer you have and how much it has spread.

Few lung cancers are found in the early stages when treatment is most effective.

It can be very scary to learn that you may have lung cancer. Talking with your doctor or joining a support group may help you deal with your feelings. Having support from family and friends can help a lot. And staying as active as possible will also help.

Less than half of people who get lung cancer live 1 more year after the cancer is found. And only about 16 out of 100 people with lung cancer live for 5 or more years. ¹ It’s important to remember that everyone’s case is different and that these numbers may not show what will happen in your case.

Can you prevent lung cancer?

Lung cancer is one of the easiest cancers to prevent because most lung cancer is caused by smoking. So it is important to stop smoking—or to stop being around someone else’s smoke.

Even if you have smoked a long time, quitting can lower your chances of getting cancer. If you already have lung cancer, quitting makes your treatment work better and can help you live longer.

Frequently Asked Questions

Learning about lung cancer:	What is lung cancer? What causes it? Who gets lung cancer? What increases my risk of getting it? How can I avoid getting it? When do I need to see my doctor?
Being diagnosed:	How is lung cancer diagnosed? What types of lung cancer are there? What tests will I need?
Getting treatment:	Will treatment cure my lung cancer? Will I have a choice of treatment? Will I need surgery? Will I need to take medicine? Will I need radiation treatment? Are there other treatments?
Ongoing concerns:	How often will I need to see my doctor? When should I call my doctor?
Living with lung cancer:	How will lung cancer affect my daily life? Is cancer treatment painful? What side effects will treatment cause? How will I feel after treatment?
Care at the end of life issues:	What is care at the end of life? What is hospice care?

Health Tools 

Health Tools help you make wise health decisions or take action to improve your health.

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	Cancer: Controlling nausea and vomiting from chemotherapy

Cause

Most lung cancer is caused by smoking. Over 85% of lung cancers are related to smoking. ² Cancer-causing substances (carcinogens) in tobacco smoke damage lung cells. Over time, these damaged cells may develop into lung cancer.

If you are a smoker, the risk of getting lung cancer is related to how long you have smoked and how many cigarettes you smoke each day. ³ Quitting smoking reduces your risk for getting cancer, and your risk continues to go down as long as you do not smoke. Even cutting down how much you smoke may reduce your risk (but not as much as quitting completely). ⁴

If you live with a smoker, you have 2 to 3 times the risk of developing lung cancer compared with a person who lives in a nonsmoking environment. ⁵ About 25% of nonsmokers who develop lung cancer probably get it from being exposed to secondhand smoke. ³

Studies show that men and women have a similar risk of lung cancer. ⁶ But the chemicals in tobacco smoke may affect men and women differently.

Exposure to other harmful substances, such as asbestos, radioactive dust, or radon, increases the risk for lung cancer. Exposure to radiation such as X-rays may also increase risk. ⁷

Symptoms

You may not have any symptoms of lung cancer , or you may have symptoms such as a cough or shortness of breath that you might think are related to a respiratory illness.

Symptoms of lung cancer may include:

• A new cough or a cough that does not go away. Smokers who have a chronic cough from smoking may have a change in how severe their cough is or how much they cough.
• Chest, shoulder, or back pain that does not go away and often gets worse with deep breathing.
• New wheezing .
• Shortness of breath.
• Hoarseness.
• Coughing up blood or bloody mucus.
• Swelling in the neck and face.
• Difficulty swallowing.
• Weight loss and loss of appetite.
• Increasing fatigue and weakness.
• Recurring respiratory infections, such as pneumonia .
• Clubbing of the fingers and toes. The nails appear to bulge out more than normal.

Lung cancer may spread (metastasize) to other parts of the body. The most common sites are the bones, the brain, the liver, the other lung, the lining of the heart ( pericardium ), the skin, and the adrenal glands . When lung cancer spreads, other symptoms may also occur.

Symptoms of cancer that has spread to the spine or bones may include:

• Bone pain.
• Weakness or numbness of the arms or legs.
• Back pain.

Symptoms of cancer that has spread to the brain may include:

• Seizures.
• Headaches.
• Change in alertness.
• Vision changes, such as double vision or new blind spots.
• Nausea or vomiting.

Symptoms of cancer that has spread to the liver or lymph nodes may include:

• Yellowing of the skin or eyes (jaundice).
• Lumps or bumps under the skin or enlarged lymph nodes .
• Decreased appetite.
• Weight loss.

What Happens

Lung cancer may cause breathing or heart problems such as:

• Pleural effusion , which is the buildup of fluid between the outer lining of the lungs and the chest wall. This is a common condition with lung cancer.
• Coughing up large amounts of bloody sputum.
• Collapse of a lung ( pneumothorax ).
• Blockage of the airway (bronchial obstruction).
• Recurrent infections, such as pneumonia .
• Pericardial effusion , which is the buildup of fluid in the space between the heart and the sac around the heart (pericardium). This condition is not common with lung cancer.

As lung cancer grows, it may spread (metastasize) to other parts of the body. Lung cancer is classified in stages that are determined by the size of the cancer and how far it has spread within the lung, to nearby tissues, or to other organs.

Your doctor determines the stage of your lung cancer by gathering information from a variety of tests, including bone scans , PET scans , CT scans , and X-rays . The stage of your cancer is one of the most important factors in choosing an effective treatment.

The long-term outcome (prognosis) for lung cancer depends on how much the cancer has grown and spread. Experts talk about prognosis in terms of "5-year survival rates." The 5-year survival rate means the percentage of people who are still alive 5 years or longer after their cancer was discovered. Because lung cancer is often diagnosed at an advanced stage, only 16% of people live 5 or more years after being diagnosed. ¹ It is important to remember that these are only averages. Everyone's case is different, and these numbers do not necessarily show what will happen to you.

What Increases Your Risk

Risk factors for lung cancer include:

• Tobacco use. Smoking and chewing tobacco are related to developing lung cancer, as well as to cancer of the mouth and throat. Over 85% of lung cancers are related to smoking. ² More than half of the people who are newly diagnosed with lung cancer are former smokers. Smoking unfiltered, high-tar cigarettes may put you at a higher risk than smoking filtered or low-tar cigarettes, although this has not been proved. The risk of developing lung cancer increases:
  • The longer you smoke.
  • The more cigarettes you smoke each day.
• Exposure to tobacco smoke, such as living with a smoker. If you live with a smoker, you have 2 to 3 times the risk for lung cancer compared with a person who lives in a nonsmoking environment. ⁵ About 25% of nonsmokers who develop lung cancer probably get it from being exposed to secondhand smoke. ³
• Marijuana use. Smoking one marijuana cigarette, or a joint, may affect the lungs as much as smoking a pack of cigarettes. ⁸
• Exposure to certain chemicals, such as arsenic, asbestos, radioactive dust, or radon.
• Radiation exposure from occupational, medical, or environmental sources.

When To Call a Doctor

If you have been diagnosed with lung cancer , be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.

Call 911 or other emergency services immediately if you:

• Have new or sudden onset of chest pain that is crushing or squeezing, is increasing in intensity, or occurs with any other symptoms of a heart attack .
• Have new or sudden difficulty breathing .
• Are coughing up a lot of blood (not just streaks of blood or a small amount of blood mixed with a lot of mucus) from your lungs.
• Have been vomiting and feel that you may pass out when you sit up or stand.

Call your doctor immediately for medical evaluation if you have:

• Labored, shallow, rapid breathing with shortness of breath or wheezing , even when you are resting.
• Swelling of your neck and face.

Call your doctor to determine when an evaluation is needed if you:

• Have new chest pain (more than just discomfort when you cough) that lasts a long time and gets worse when you breathe deeply.
• Develop symptoms of pneumonia , such as shortness of breath, cough, and fever.
• Have a cough that produces a small amount of bloody (bright red or rust-colored) sputum.
• Frequently cough up yellow or green sputum from your lungs (not postnasal drainage) for longer than 2 days.
• Vomit frequently from coughing.
• Have a cough that lasts longer than 4 weeks.
• Breathe normally when you are at rest but are very short of breath after any physical exercise.
• Have increasing fatigue for no apparent reason.
• Have unexplained weight loss.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your condition or symptoms but you do not receive medical treatment. Watchful waiting is not appropriate if you have symptoms that do not go away. If you are concerned about your symptoms and believe you may be at risk for lung cancer, call and make an appointment with your doctor.

It often is difficult to decide when to see a doctor for respiratory symptoms. See the topic Respiratory Problems, Age 12 and Older to determine if and when you need to see your doctor.

Who To See

Health professionals who can evaluate your symptoms and your risk for lung cancer include:

• Family medicine doctor .
• General practitioner .
• Internist .
• Nurse practitioner .
• Physician assistant .
• Pulmonologist .

Health professionals who can evaluate and treat your lung cancer include:

• Pulmonologist .
• Medical oncologist .
• Thoracic surgeon .
• Radiation oncologist .

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

To determine whether lung cancer may be causing your respiratory symptoms, your doctor will evaluate your:

• Medical history, including your smoking history and any symptoms you have now.
• Exposure to environmental and work substances.
• Family history of cancer.

Initial exams and tests for suspected lung cancer include:

• Medical history to determine your risk factors for developing lung cancer.
• Physical examination to find any lung problems or swollen lymph nodes .
• Chest X-ray to look for any abnormalities that may be causing your symptoms, such as pneumonia or a lung mass (tumor).
• Complete blood count (CBC) to see whether you have abnormal values of red blood cells , white blood cells , or platelets .
• Calcium, creatinine, alkaline phosphatase, and lactic acid dehydrogenase to determine electrolyte and liver function. These tests are likely to have abnormal values if cancer is present and has spread to other tissue or body organs.

If your medical history, physical examination, or chest X-ray suggest that lung cancer is present, your doctor may recommend other tests, such as:

• CT scan of the lungs, sometimes with transthoracic needle aspiration biopsy (TNAB) of a lung nodule. A needle biopsy uses a needle inserted through the chest wall to remove a sample of lung tissue ( biopsy ). This usually is done if the abnormal lung tissue is located close to the chest wall. Imaging procedures such as ultrasound or fluoroscopy may also be used to help guide the needle to the right spot.
• Sputum cytology to evaluate the type of any abnormal cells that are present in your mucus.
• Thoracentesis to take a sample of the fluid around your lungs to evaluate the type of any abnormal cells. Thoracentesis is done if you have a large collection of fluid around your lung ( pleural effusion ). Thoracentesis is sometimes used to find out why you have fluid collecting around your lung. Other times it is just to remove the fluid and make it easier for you to breathe.
• Bronchoscopy to take a biopsy of cells from your airway.
• Lung biopsy to evaluate the type of any abnormal cells.
• Video-assisted thoracoscopy (VATS) to take a biopsy of lung tissue through a small incision between two ribs with the aid of a thin, lighted tube (videoscope) and small surgical instruments.
• Positron emission tomography (PET). PET scanning can help determine whether a lung mass (tumor) or enlarged lymph node is cancerous. PET may help determine whether surgery is a treatment option. PET scanning may also be used after treatment to see how well the treatment worked. PET scanning can be used to look for areas of the liver, adrenal gland, or bone that may show where lung cancer has spread.

After the type of lung cancer has been diagnosed, testing is done to determine whether the cancer has spread (metastasized) to other organs in your body and to determine the stage of the cancer. Treatment of lung cancer is based on the stage of the cancer. Tests used to determine whether the cancer has spread may include:

• Mediastinoscopy to take biopsies of lymph nodes to determine whether the cancer has spread to the chest behind the breastbone (mediastinum).
• Endoscopic ultrasound is sometimes done after a mediastinoscopy. In this test, a small ultrasound probe at the end of the endoscope is placed down the throat to the chest area. The ultrasound can help detect cancer behind the breast bone or in lymph nodes in the area. When endoscopic ultrasound and mediastinoscopy are both done, they may be able to determine the stage of lung cancer better than mediastinoscopy alone. ⁹
• CT scan of the brain, neck, abdomen, or pelvis to determine whether the cancer has spread to these areas.
• MRI of the brain to determine whether the cancer has spread to the brain.
• Bone scan to determine whether the cancer has spread to the bones.

An MRI of the spine may be done if there is concern that the lung cancer has already spread to the spine. An MRI of the chest may also be done, but a chest CT scan is used most often to determine whether the cancer has spread in the chest.

Lung function studies, including a lung scan (ventilation and perfusion scans, V/Q scan), may be done if surgery to remove cancer in all or part of a lung is being considered. A person who has very poor lung function may not be a good candidate for surgery.

If small cell lung cancer is diagnosed, additional testing may include a bone marrow aspiration and biopsy.

Early Detection

Several studies have examined the usefulness of chest X-rays, sputum cytologies, or spiral CT to screen for lung cancer in people who do not have symptoms. Although these tests can sometimes diagnose early lung cancer, they have not been proved to affect the long-term outcome (prognosis) of lung cancer. Currently no medical professional organizations recommend routine screening for lung cancer. ^{10, 11} Experts continue to study the benefits of screening tests.

Screening tests may aid in the early diagnosis of lung cancer, but the tests can also show abnormal findings, such as nodules, that are not cancer ( false-positives ). The finding of a solitary pulmonary nodule (SPN) on a chest X-ray does not always mean that cancer is present. Certain tests can help doctors determine whether an SPN is noncancerous (benign) or cancerous (malignant). If cancer is suspected and the tissue is located close to the chest wall, a needle biopsy is recommended to confirm or rule out the presence of cancer. A needle biopsy uses a long needle inserted through the chest wall to remove a sample of lung tissue. Imaging procedures such as CT scan , ultrasound , or fluoroscopy usually are used to help guide the needle to the right spot.

Treatment Overview

Treatment for lung cancer depends on the stage of your cancer and may include surgery to remove the cancer, radiation therapy , or medications ( chemotherapy ). Treatment for non–small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) may be different.

Treatment for lung cancer may include one or more of the following therapies:

• Surgery (taking out the cancer). Surgery may involve removing the cancer (wedge resection), removing the affected lobe of lung (lobectomy), or removing the entire lung (pneumonectomy). Surgery is the most effective treatment for early-stage non–small cell lung cancers (stages I and II). Lung function studies and a lung scan are often done before surgery to predict how much of your lung function you will still have after surgery.
• Radiation therapy (using high-dose X-rays to kill cancer cells). Radiation therapy is often used in combination with surgery or chemotherapy or both. Radiation following surgery for stages IIA, IIB, and IIIA (with lymph node involvement) may reduce the risk of cancer returning in the chest. People who cannot have surgery may have stereotactic body radiation therapy (SBRT). In SBRT, high doses of radiation therapy are targeted to the cancer.
• Chemotherapy (using medicines to kill cancer cells). Chemotherapy is the most effective treatment for small cell lung cancer. It can help control the growth and spread of the cancer, but it is a cure in only a small number of people. Chemotherapy has been shown to improve survival in non–small lung cancer when it is given after surgery for early-stage cancers. ¹² It may also be used to treat more advanced stages (stages III and IV) of non–small cell lung cancer.
• Targeted therapy. Targeted therapies use medicines or antibodies to block growth factors that allow some cancers to grow. At this time, targeted therapies are used for advanced stages of lung cancer.

If you smoke and have lung cancer, quitting smoking will make your treatment more effective and may help you live longer. Smoking delays healing after surgery, so you may have a better recovery from lung cancer surgery if you have quit smoking. People with early-stage lung cancer who continue to smoke during radiation therapy have been shown to have shorter survival times that those who do not smoke. ¹³ It may also make chemotherapy less effective. The nicotine in tobacco seems to help the cancer cells and their blood supply multiply while also protecting the cancer cells from destruction. ¹⁴ For information and help quitting smoking, see the topic Quitting Smoking.

Initial treatment

The kind of treatment and the long-term outcome of lung cancer depends on the type and stage of the cancer. Your age, overall health, and quality of life must also be considered. Many people with lung cancer are diagnosed with the disease when the cancer is already in an advanced stage. Fewer lung cancers are diagnosed in the early stages when lung cancer is likely to be cured by surgery.

Non–small cell lung cancer grows and spreads more slowly. Lung surgery (thoracotomy) is usually the standard treatment for non–small cell stage I to stage IIIA cancers. Treatment for non–small cell lung cancer also includes:

• Treatment with a combination of the three therapies.
  • Lung surgery (thoracotomy) takes out the cancer.
  • Radiation therapy sometimes follows surgery for stages IIA, IIB, and IIIA (with lymph node involvement) and may reduce the risk of cancer returning in the chest.
  • Chemotherapy may be used to treat more advanced stages (stages III and IV). Chemotherapy may also be used after surgery for early stages such as IB, IIA, IIB, and IIIA to reduce the risk of cancer returning.

Small cell lung cancer grows very rapidly in most people and is more likely to spread (metastasize) to other organs. Treatment for small cell lung cancer includes:

• Chemotherapy, which usually is the standard treatment for this type of lung cancer.
• Radiation therapy, which may help shrink a rapidly growing large tumor that is causing symptoms.

Radiation therapy is combined with chemotherapy to treat small cell cancer that is limited to the chest.

Home treatment measures may help relieve some common side effects of your cancer treatment. For more information, see the Home Treatment section of this topic.

If you have been recently diagnosed with lung cancer, you may feel denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. Reactions vary from person to person. You can take steps, though, to manage your emotional reactions to learning that you have lung cancer. You may find that talking with family and friends is comforting, or you may need to spend time alone to understand your feelings about your disease.

If your emotions interfere with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.

What to think about during initial treatment

Your quality of life is critical when considering your treatment choices. Discuss your personal preferences with your oncologist when he or she recommends treatment.

Treatment for advanced-stage lung cancer is intended to control your symptoms and increase your comfort ( palliative care ), but it will not cure your cancer.

You may be interested in participating in research studies called clinical trials. Clinical trials are based on the most up-to-date information and are designed to find better ways to treat people who have cancer. People who do not want standard treatments or are not cured by standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries around the world for all stages of lung cancer.

There are many clinical trials being done to see if combining chemotherapy or radiation treatments either before or after surgery is more effective for the different stages of lung cancer. Other clinical trials are studying different medicine combinations for different stages of lung cancer. Discuss what choices are available for your lung cancer with your oncologist. For more information about specific lung cancer treatments, see the topics:

• Lung Cancer, non–small cell — Health Professional Information [NCI PDQ].
• Lung Cancer, non–small cell — Patient Information [NCI PDQ].
• Lung Cancer, small cell —Health Professional Information [NCI PDQ].
• Lung Cancer, small cell —Patient Information [NCI PDQ].

Ongoing treatment

After initial treatment for lung cancer , it is important to receive follow-up care.

• Your oncologist will schedule regular checkups, usually every 3 to 4 months, depending on the therapies used in initial treatment. After 2 to 3 years, regular checkups will occur less often but more than just once a year, depending on your medical history.
• Checkups include a physical exam, blood tests, chest X-rays, and any other laboratory tests recommended by your oncologist. A CT scan is usually done every 3 to 6 months for the first 2 to 3 years, and then once a year after that.

Radiation therapy may be used to prevent small cell lung cancer from growing in the brain. This is called prophylactic cranial irradiation (PCI). PCI may be most beneficial if you have limited small cell lung cancer and have had successful treatment with chemotherapy and radiation therapy to the chest. But PCI is not advised for older people whose thinking process may be impaired.

Your emotional reactions are likely to vary during your treatment depending on how you feel, your prognosis, the treatment methods used, and your decisions about treatment.

Treatment if the condition gets worse

The long-term outcome (prognosis) for lung cancer that does not respond to treatment as hoped or that comes back after being treated is poor, and treatment focuses on managing your pain and improving your quality of life ( palliative care ).

Treatment to help control your symptoms (such as pain, coughing up blood, shortness of breath, and weakness) may include:

• Radiation therapy. This may be done to shrink cancers that make swallowing or breathing difficult or that are causing pain.
• Chemotherapy.
• Chemotherapy combined with radiation therapy.
• Surgery, if your cancer has spread to your brain.
• Laser surgery or internal radiation therapy (brachytherapy).
• Radiation applied directly to the cancer during surgery.

Other treatments being studied for lung cancer include radiofrequency ablation, microwave ablation, and cryoablation. Each of these is a way of trying to destroy the cancer cells without major surgery. These treatments may be useful for people who are not able to have surgery either because they are in poor health or because their cancer is too advanced. ¹⁵

Additional treatment measures

• Oxygen therapy may relieve your shortness of breath. It is usually used at the end stage of the disease, but it may also be used for pneumonia or other treatable conditions.
• Thoracentesis is used to remove fluid from around your lungs ( pleural effusion ). A large amount of fluid may cause pain and shortness of breath.
• Pleurodesis is used to prevent fluid buildup around your lungs. Pleurodesis is a procedure that is intended to cause inflammation of the lining around your lungs. The irritated tissue reacts by producing scar tissue, which causes the two layers of the lung lining to stick together. This removes the space where fluid can build up around your lungs. Pleurodesis is commonly used to treat fluid buildup around your lungs that returns after repeated thoracentesis.
• Small tubes (pleural catheters) to drain fluid from around the lungs are used to relieve fluid buildup (pleural effusion).
• Treatments that burn (cauterize) selected areas of blocked airways or that place stents—small, coiled, wire-mesh tubes that can be inserted into a blocked airway and expanded to hold it open—are also becoming more common.
• Pain medicines can be taken regularly. These may include prescribed narcotic medicines, such as codeine, or medicines you can buy without a prescription, such as aspirin and similar drugs .

Complementary therapies

In addition to conventional medical treatment, you may wish to try complementary therapies to help you manage pain and improve your quality of life.

• Acupuncture
• Herbs
• Biofeedback
• Meditation
• Yoga
• Guided imagery
• Vitamins and nutritional supplements

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

What To Think About

If surgery is part of your treatment, you also may be given radiation therapy or chemotherapy before surgery or after surgery to try to kill any cancer cells that may remain. Radiation or chemotherapy may be given before or after surgery when only microscopic areas of cancer may still be present. In some studies, people who receive radiation or chemotherapy after they had surgery to remove non–small cell lung cancer have been found to live longer, but other studies have shown little or no increase. ^{16, 17}

Most treatments for lung cancer cause some side effects. Which side effects you experience will depend on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects related to each treatment.

Side effects of chemotherapy

Side effects of radiation therapy

Side effects of surgery

Clinical trials

If standard treatments are not effective or are causing more side effects than desired, you may want to consider being part of a clinical trial. These trials study new or different ways to treat cancer.

Palliative care

As your cancer gets worse, you may want to think about palliative care . Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different than care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body but also in your mind and spirit. Some people combine palliative care with curative care.

Some treatments for advanced-stage lung cancer are considered palliative care. These treatments cannot cure your cancer, but they can control your symptoms, reduce your pain, and make you feel more comfortable. They include:

• Radiation therapy.
• Medicines, including chemotherapy.
• Therapies such as radiofrequency ablation, microwave ablation, or cryoablation that can destroy cancer cells without major surgery.
• Complementary medicine.

In addition to helping your body feel better, palliative care can help you feel better emotionally and spiritually. Talking with a palliative care provider may help you cope with your feelings about living with a long-term illness. It may also help your loved ones better understand your illness and how to support you. Or it could help you make future plans about your health and your medical care.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

If you have advanced-stage cancer, you may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the following topics:

Hospice Care

Care at the End of Life

Prevention

Experts have identified several causes of lung cancer . Most lung cancers are caused by the use of tobacco. Changing your lifestyle can, over time, gradually reduce some of your risk for lung cancer.

Tobacco

Tobacco use is the leading cause of lung cancer. More than 85% of lung cancers are caused by smoking. ² Secondhand smoke is also a risk factor for lung cancer.

To prevent lung and other cancers, do not use tobacco. If you do use tobacco, you can reduce your risk of lung cancer by quitting. Your risk will gradually decrease with time as your lungs recover. Quitting smoking reduces your risk for cancer, and your risk continues to decrease as long as you do not smoke. The benefit of quitting smoking is greater the younger you quit. ³

Even cutting down how much you smoke may reduce your risk (but not as much as quitting completely). In one study, cutting in half the number of cigarettes smoked each day significantly reduced the risk of getting lung cancer during a 5- to 10-year period. ⁴

If you live with a smoker, you have 2 to 3 times the risk of lung cancer compared with a person who lives in a nonsmoking environment. ⁵ About 25% of nonsmokers who develop lung cancer probably get it from being exposed to secondhand smoke. ³

Nicotine gum, medicated nicotine inhalers, nicotine patches, and oral medicines such as varenicline (Chantix) or bupropion are available to help you to quit smoking. For more information, see the topic Quitting Smoking.

Other exposure risk factors

Other things that increase your risk of lung cancer include asbestos and radon exposure. Certain occupations, such as mining and farming, expose people to fumes, radioactive dust, or other chemicals that may be harmful. Taking precautions to reduce your exposure to harmful substances in your environment can reduce your risk of developing lung cancer.

Diet

Recent studies on the connection between diet and lung cancer have shown mixed results. One study shows that eating a diet rich in nutrients called phytoestrogens may help reduce your risk of lung cancer. ¹⁸ Phytoestrogens are found in a wide variety of whole grains, legumes such as chickpeas, vegetables, and soy products. Other research shows that taking supplements of beta-carotene, vitamin E, and retinoids may actually be harmful and increase the risk of lung cancer in people who continue to smoke. ¹⁹

Chemoprevention

Chemoprevention, which is the use of specific medicines to reverse, suppress, or prevent cancer growth, is being studied for lung cancer. Chemoprevention has shown some effectiveness in other types of cancers. The results of several large studies on beta-carotene (a vitamin A derivative) use show that this vitamin supplement may actually increase the risk for lung cancer in smokers. ¹⁹

Researchers and doctors are very interested in vaccines for lung cancer. Vaccines to treat lung cancer have been developed and are being tested in clinical trials.

Home Treatment

During treatment for any stage of lung cancer , you can manage some side effects that may accompany lung cancer or cancer treatment. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet, getting enough sleep, and exercising regularly may help control your symptoms.

Home treatment may help relieve some common side effects of cancer treatment.

• Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration , such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Your doctor also may prescribe medicines to control nausea and vomiting. For more information on how to deal with these side effects, see:

  Cancer: Controlling nausea and vomiting from chemotherapy.

• Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.
• Home treatment for constipation includes gentle exercise along with adequate intake of fluids and a diet that is high in fruits, vegetables, and fiber. Check with your doctor before using a laxative for your constipation.
• Home treatment for fatigue includes making sure you get extra rest while you are receiving chemotherapy or radiation therapy . Let your symptoms be your guide. You may be able to keep your usual routine and just get some extra sleep. Fatigue is often worse at the end of treatment or just after treatment is completed.

Other issues that may arise include:

• Hair loss. You may be concerned about losing your hair from cancer treatment. Not all chemotherapy medicines cause hair loss, and some people have only mild thinning that is noticeable only to them. Talk to your doctor about whether hair loss is an expected side effect of the medicines you will receive.
• Sleep problems. If you find you have trouble sleeping, having a regular bedtime, doing some exercise during the day, avoiding naps, and taking other steps to relieve sleep problems may help you sleep more easily.
• Loss of appetite or difficulty eating. Eating several small meals throughout the day or eating soft, bland foods may help if you do not have an appetite or if certain foods are difficult to eat.
• Mouth sores (stomatitis) can be a side effect of certain chemotherapy drugs. There are ways you can reduce your discomfort:
  • Drink cold liquids, such as water or iced tea, or eat flavored ice treats or frozen juices.
  • Eat foods that are easy to swallow such as gelatin, ice cream, or custard.
  • Drink from a straw.
  • Rinse your mouth several times a day with a warm saltwater solution. You can make the saltwater mixture with 1 tsp (5 g) of salt in 8 fl oz (0.2 L) of warm water.
  • Do not eat or drink acidic foods, such as tomatoes or oranges.
  • See other home treatments for a sore mouth.
• Coughing. You may have an ongoing cough or develop a severe cough. Your doctor can recommend some nonprescription cough medicines or prescribe some medicines to help relieve your symptoms.

Many people with lung cancer face emotional issues as a result of their disease or its treatment. The diagnosis of lung cancer and the need for treatment is very stressful. You may be able to reduce your stress by expressing your feelings to others. Learning relaxation techniques may also help you reduce your stress.

Not all forms of cancer or cancer treatment cause pain. If pain occurs, many treatments are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. You may use home treatment for pain to improve your physical and mental well-being. Be sure to discuss with your doctor any home treatment you use for pain.

If your disease is at an advanced stage, you may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the following topics:

Hospice Care

Care at the End of Life

Medications

Chemotherapy uses powerful medications to kill cancer cells. Chemotherapy is the most effective therapy for small cell lung cancer. It can help control the growth and spread of the cancer, but it cures lung cancer in only a small number of people. Chemotherapy also may be used to treat more advanced stages (stages III and IV) of non–small cell lung cancer.

Medication Choices

Chemotherapy

Chemotherapy is called a systemic treatment because the medicines enter your bloodstream, travel through your body, and kill cancer cells both inside and outside the lung area. Some chemotherapy drugs are taken by mouth (orally), while others are injected into a vein ( intravenous, or IV ).

Extensive research and clinical trials have studied the different chemotherapy medicines used to treat lung cancer. Some medicines are used for most people with lung cancer. Some are used in combination with others to be more effective. Some may be used before surgery or after surgery. Your oncologist will discuss and recommend chemotherapy treatment specific to your condition. Several of the more common chemotherapy medicines include the following:

• Carboplatin
• Cisplatin
• Docetaxel
• Erlotinib
• Etoposide
• Gemcitabine
• Irinotecan
• Paclitaxel
• Pemetrexed
• Topotecan
• Vinorelbine

Gefitinib. This medicine is used for lung cancer but recent studies show it may not improve long-term survival for many people. The United States Food and Drug Administration (FDA) advises people who are using this medicine to continue their treatment and talk with their oncologist. ²⁰

Bevacizumab is an intravenous (IV) drug that helps prevent formation of blood vessels that supply the tumor with nutrients and help the cancer grow and multiply. Studies suggest that bevacizumab used at the same time as some other forms of chemotherapy may help people with advanced lung cancer live longer. Bevacizumab is now approved to be used with the chemotherapy drugs carboplatin and paclitaxel for treating non-small cell lung cancer. ²¹ But because bevacizumab has serious side effects, talk with your doctor about whether you should take this medicine.

What To Think About

Most chemotherapy causes some side effects. Your doctor may prescribe medicines to control nausea or vomiting.

Chemotherapy may be given before surgery (neoadjuvant) or after surgery (adjuvant therapy) to kill cancer cells.

Many clinical trials are studying the different combinations of chemotherapy medicines for the different stages of lung cancer. Discuss with your oncologist what choices are available for your lung cancer.

Radiation therapy may be given in combination with chemotherapy to treat specific tumors.

Clinical trials

If standard treatments are not effective or are causing more side effects than desired, you may want to consider being part of a clinical trial. These trials study new or different ways to treat cancer.

Surgery

Sometimes surgery may be used to help determine exactly which type of lung cancer you have.

Surgery to remove the cancer may be an option when your cancer is in only one lung or present in one lung and in nearby lymph nodes. Surgery usually is done only if your doctor thinks all the cancer can be removed and your general health is good enough for you to handle the surgery. ²² Surgery is the most effective treatment for the early-stage non–small cell lung cancers. And for advanced stages, surgery is often combined with radiation and/or chemotherapy.

Surgery Choices

The type of surgery performed depends on the location and size of your lung cancer. Lung function studies and a lung scan are often done before surgery to predict how much of your lung function you will still have after surgery.

Lung surgery

Lung surgery (thoracotomy)

Surgery to remove lymph nodes in the center of the chest is usually recommended at the time of lung surgery, to determine whether the cancer has spread.

Radiofrequency ablation

Radiofrequency ablation uses a small needle inserted through the skin and into the tumor. Energy passes through the needle into the tumor. This heats and kills cancer cells. It also closes up the little blood vessels in the area so there is less bleeding.

Cryosurgery

Cryosurgery (also called cryoablation) freezes the tumor and kills it. Cryosurgery for lung cancer is experimental and is being used only in certain clinical trials .

Laser therapy

Laser therapy uses a narrow beam of very intense light to destroy cancer cells. Laser therapy usually is used as a palliative care to remove tumors that block the airway. Laser therapy does not cure lung cancer.

Cautery

Cautery is used to burn (cauterize) and remove tumors that block the airway.

What To Think About

You may have side effects from your surgery.

Chemotherapy may be given before (neoadjuvant) or after (adjuvant) surgery to destroy any cancer cells.

Adjuvant chemotherapy for non–small cell lung cancer has been shown to improve long-term survival for stages I, II, and III that have been completely removed with surgery. ¹⁶

Adjuvant radiation therapy does not seem to improve long-term survival but may reduce tumor recurrence in the lungs. ³

Other Treatment

Radiation therapy

Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy, also called brachytherapy). Radiation therapy is often used in combination with surgery or chemotherapy or both.

Radiation following surgery for stages II or III non–small cell lung cancer may reduce the risk of cancer recurrence in the chest, but long-term survival rates are not significantly improved because cancer may have already spread to other areas of the body. ³

Photodynamic therapy

Photodynamic therapy (PDT) uses laser light and a special light-activated substance (Photofrin) to kill cancer cells. It is approved for palliative treatment to destroy tumors that block the airway but it does not cure the lung cancer. Few lung cancers are treated with this therapy. Surgery is still the standard treatment for early-stage lung cancer.

In clinical trials, PDT appears to help relieve coughing, shortness of breath, and coughing up bloody mucus. Additional research is being done.

What to think about

Radiation may cause side effects.

Radiation therapy may be used to prevent small cell lung cancer from growing in your brain. This is called prophylactic cranial irradiation (PCI). PCI can improve survival for people with limited-stage small cell lung cancer whose cancer is in remission from treatment with chemotherapy and with or without radiation to the chest. ²³

Occasionally, radiation therapy may be given during your surgery. In this procedure, radiation is focused directly on the tumor during surgery and affects as little healthy tissue as possible.

Radiation therapy also may be used as palliative care to:

• Shrink tumors that make it hard for you to swallow.
• Reduce tumors that block your airway and make it hard for you to breathe.
• Relieve pain from cancer that has spread to your bones or spinal cord.

Other Treatment Choices

Oxygen therapy

Oxygen therapy may relieve your shortness of breath. It is usually used at the end stage of the disease. Some people who have pulmonary conditions, such as chronic obstructive pulmonary disease (COPD) , may use oxygen as regular therapy.

Thoracentesis

Thoracentesis is used to remove fluid from around your lungs ( pleural effusion ). A large amount of fluid may cause pain and shortness of breath.

Pleurodesis

Pleurodesis is used to prevent fluid buildup around your lungs. Pleurodesis is a procedure that is intended to cause inflammation of the lining around your lungs. The irritated tissue reacts by producing scar tissue, which causes the two layers of the lung lining to stick together. This removes the space where fluid can build up around your lungs. Pleurodesis is commonly used to treat fluid buildup around your lung that returns after repeated thoracentesis.

Complementary therapies

In addition to conventional medical treatment, you may wish to try complementary therapies, such as:

• Acupuncture.
• Biofeedback.
• Herbs.
• Meditation.
• Visualization.
• Vitamins and nutritional supplements.
• Yoga.

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

What To Think About

The combination of conventional medical treatment and complementary medicine is an approach that is sometimes called integrative medicine, in which conventional and complementary therapies are used together for the best outcome.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone:	1-800-ACS-2345 (1-800-227-2345)
TDD:	1-866-228-4327 toll-free
Web Address:	www.cancer.org
The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.
American Lung Association
1301 Pennsylvania Avenue NW
Suite 800
Washington, DC  20004
Phone:	1-800-LUNG-USA (1-800-586-4872) 1-800-548-8252 (to speak with a lung professional) (212) 315-8700
Web Address:	www.lungusa.org
The American Lung Association provides programs of education, community service, and advocacy. Some of the topics available include asthma, tobacco control, emphysema, asbestos, carbon monoxide, radon, and ozone.
Cancer.Net
Phone:	1-888-651-3036 (571) 483-1300
Fax:	(571) 366-9530
E-mail:	foundation@asco.org
Web Address:	www.cancer.net
Cancer.Net is the information Web site of the American Society of Clinical Oncology (ASCO) for people living with cancer and for those who care for them. ASCO is the world's leading professional organization representing physicians of all oncology subspecialties. Cancer.Net provides current oncologist-approved information on living with cancer.
National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD  20892-8322
Phone:	1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:	1-800-332-8615
E-mail:	cancergovstaff@mail.nih.gov
Web Address:	www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people with cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.

Related Information

• Cancer Pain
• Quitting Smoking

References

Citations

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20. U.S. Food and Drug Administration (2004). FDA statement on Iressa. FDA Public Health Web Notification. Available online: http://www.fda.gov/bbs/topics/news/2004/new01145.html.
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Other Works Consulted

• National Comprehensive Cancer Network and American Cancer Society (2004). Lung Cancer Treatment Guidelines for Patients, version II. Available online: http://www.nccn.org/patients/patient_gls/_english/_lung/contents.asp.
• National Comprehensive Cancer Network and American Cancer Society (2005). Non–Small Cell Lung Cancer, version 2.2005. Available online: http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf.
• National Comprehensive Cancer Network and American Cancer Society (2005). Small Cell Lung Cancer, version 1.2006. Available online: http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf.
• Neville A (2004). Lung cancer. Clinical Evidence (13): 1–21.
• Schwartz DA (2007). Occupational and environmental lung disease. In DC Dale, DD Federman, eds., ACP Medicine, section 14, chapter 18. New York: WebMD.

Credits

Author	Bets Davis, MFA
Editor	Maria Essig
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Michael Seth Rabin, MD - Medical Oncology
Last Updated	June 4, 2008