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What is lung cancer?

Lung cancer usually starts in the lining of the bronchi (the main airways of the lungs) but can also begin in other areas of the respiratory system, including the trachea, bronchioles or alveoli.

There are two main types:

  • Non-small cell lung cancer (NSCLC) is the most common type and makes up about 85 percent of all cases. It usually grows and spreads more slowly than the small cell type. Smoking causes most cases, but NSCLC risks increase due to exposure to secondhand smoke and substances such as asbestos, radon, certain chemicals, and products using chloride and formaldehyde.
  • Small cell lung cancer (SCLC) is a fast-growing type. It spreads much more quickly than the non-small cell type. Almost all cases of SCLC are due to cigarette smoking.
  • Mesothelioma, an otherwise rare cancer of the chest lining, is caused by asbestos exposure. The American Lung Association estimates that 2,000 to 3,000 individuals are diagnosed with mesothelioma each year in the U.S.

Our approach

At Northwell Health Cancer Institute, our physicians don't just treat cancer–they treat the whole patient. Our doctors and surgeons work together as a team to create a unique care plan for each patient depending on his or her specific needs, preferences and health history. With full access to the comprehensive clinical resources of Northwell Health–and over 30 years of clinical trial experience, the most on Long Island–we ensure that your care is anything but one-size-fits-all when you're with us.

We'll guide you through every step of your treatment journey. Our specialists are here to answer questions, coordinate integrative care and support services, and make every effort to treat you in one convenient location. Within the first several days of your visit, the team will conduct comprehensive tests and develop a personalized cancer treatment program tailored specifically to you and your needs.

This includes the latest technologies and expertise for treating lung cancer, such as:

  • Minimally invasive surgical techniques performed by specially trained, highly-experienced thoracic surgeons that allow patients quicker recovery, less pain and less scarring
  • State of the art diagnostic procedures including advanced imaging techniques, and molecular profiling of tumors
  • Access to a multidisciplinary team consisting of medical oncologists, radiation oncologists, thoracic surgeons, pulmonologists, interventional pulmonologists, thoracic radiologists, interventional radiologists, pathologists, palliative care specialists, nutritionists, social workers, nurse-navigators, nurses, and advance care practitioners.
  • Aggressive and innovative treatments such as intensity-modulated radiotherapy (IMRT) and stereotactic radiotherapy 
  • Personalized treatment approaches based on tumor and/or blood-based molecular and immunological biomarkers
  • Access to clinical trials

If you have been diagnosed with lung cancer, your oncologist will explain all your treatment options and create a treatment plan tailored to your specific needs and goals. Throughout your treatment, you will work closely with a dedicated team of specialists in medical oncology, surgical oncology and radiation oncology who collaborate to ensure seamless coordination of your care. Because every lung cancer diagnosis is unique, our physicians meet once a week to share ideas and review every step each patient's care. Our prime focus is to treat your cancer effectively and conveniently while preserving your quality of life.

Research at Northwell

As part of your lung cancer treatment plan, you may have the opportunity to participate in clinical trials. These trials study new chemotherapy drugs, radiation technologies and surgical approaches. While not every patient is a candidate for clinical trials, your care team will work with you to determine eligibility. Learn more about clinical trials at Northwell Health.

Symptoms

Lung cancer is normally discovered in patients experiencing specific symptom, such as:

  • Persistent cough (the most common symptom)
  • Shortness of breath or wheezing
  • Recurring lung infections, such as pneumonia or bronchitis

Be aware that these symptoms could be due to conditions other than cancer, so it’s best to see a doctor right away.

Causes

More than 8 out of 10 lung cancers are caused by smoking. Cigarette smoke has carcinogens, or substances that cause cancer, that damage lung cells. The damaged cells can turn into lung cancer over time.

Sometimes lung cancer develops in people who have never smoked. A few people get lung cancer after being exposed to other harmful substances, including asbestos, radioactive dust, radon, or radiation such as X-rays. Cancer also may be caused by gene changes (mutations) that occur as you get older.

Risk factors

The following five risk factors may increase your chances of lung cancer:

  • Smoking tobacco
  • Exposure to radon
  • Exposure to asbestos
  • Substances such as chemicals and gases
  • Genetics

Individuals with certain genetic mutations are at an increased risk of developing lung cancer. When planning treatment, it may be beneficial to talk with a genetic counselor to determine if the tumor is associated with any specific syndrome. Learn more about genetic counseling at Northwell Health.

Diagnosis

Every patient diagnosed with lung cancer is unique. This is why we carefully look at the molecular level of tumors to see how different they are to create a targeted approach – whether it’s stage 1 or stage 4. Many patients are surprised with a diagnosis, and lung cancer is often incidentally detected. This is why serial screening tests are recommended to individuals with significant smoking exposure.

The first step to a diagnosis is usually a physical. Your doctor will also consider medical history, risk factors and any related medical or precancerous conditions. If lung cancer is suspected, the next step is testing.

A number of procedures and tests are used to deliver an accurate diagnosis as well as to determine how far the cancer has spread, known as the stage of the cancer:

  • Chest x-ray — This test can identify any large mass or spot on the lungs.
  • Lung cancer screening uses a combination of X-rays and low-dose computerized tomography (CT) or CAT (computerized axial tomography) scans with reduced radiation to identify lung nodules. These scans are more likely than routine chest X-rays to show lung tumors.
  • CT or CAT (computerized axial tomography) scan — More detailed than an X-ray, this procedure uses a combination of x-rays and computer technology to produce detailed cross-sectional images.
  • MRI (magnetic resonance imaging) — A powerful magnet, radio waves and computer imaging combine to create a series of highly detailed pictures of areas inside the body
  • PET (positron emission tomography) scan — This scan uses a small amount of radioactive sugar to highlight the presence and stage of the cancer
  • Bronchoscopy — A thin viewing instrument (bronchoscope) looks at the airways in the lungs or the bronchi
  • Endobrachial ultrasound (EBUS) — A small camera and sound waves show the airway and structures through the airway walls. Tissue can be extracted for biopsy, cancer staging and treatment planning
  • Biopsy — A piece of tissue is extracted from a node or tumor to determine the type, stage and genetic signature of the tumor
  • Mediastinoscopy — This surgical procedure examines with biopsies of the organs and tissues between the lungs and nearby areas for abnormalities
  • Bone scan — This procedure uses a small dose of radioactive substance to determine if the cancer has spread to the bone

Treatment types

Northwell Health Cancer Institute takes a comprehensive approach to treating lung cancer. The multidisciplinary team of specialists has unparalleled experience diagnosing and treating lung cancer at one of the largest cancer centers in the New York metro area. We offer specialized therapies available at only a few cancer centers in the nation.

There are different types of treatment for lung cancer. Five types of standard treatment are:

Surgery – Lung 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. It 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. This may involve removing the cancer, the affected lobe of lung or the entire lung. Early stage lung cancer is commonly treated with robotic surgery with minimal incisions. Lymph nodes are selectively removed.

Chemotherapy – Chemotherapy is the most effective treatment 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. It also may be used to treat more advanced stages of non-small cell lung cancer.

Targeted therapy – Targeted therapy is the use of medicines such as tyrosine kinase inhibitors or monoclonal antibodies to block cancer growth.

Radiation therapy – Radiation treatment is the use of high-energy X-rays to kill cancer cells and shrink tumors. Most radiation for lung cancer is given externally, which means that the radiation comes from a machine outside the body. It is often used in combination with surgery or chemotherapy or both. But, it may be used alone if surgery is not possible.

Living with lung cancer

  • Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
  • Follow your doctor’s instructions to relieve pain. Use pain medicine when you first feel pain, before it becomes severe. Taking pain medicines regularly is often the best way to keep pain under control.
  • Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early. Eating smaller portions more often may help as well.
  • Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows.
  • Do not smoke. Smoking can make your cancer symptoms worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
  • If you use oxygen, do not smoke, light a cigarette, or use a flame while your oxygen is on. Smoking while using oxygen can lead to fire and even explosion.
  • If you have nausea, try to eat several small meals a day. When you feel better, eat clear soups and mild foods until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
  • If you are vomiting or have diarrhea:
    • Drink plenty of fluids (enough so that your urine is light yellow or clear like water) to prevent dehydration. Choose water and other caffeine-free clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
    • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
  • Take steps to control your stress and workload. Learn relaxation techniques.
    • Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them.
    • Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress.
    • Express yourself with art. Try writing, crafts, dance, or art to relieve stress. Some dance, writing, or art groups may be available just for people who have cancer.
    • Be kind to your body and mind. Getting enough sleep, eating a healthy diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and help reduce stress.
    • Get help if you need it. Discuss your concerns with your doctor or counselor.
  • If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.
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