Lung Cancer

What is Lung Cancer?  
 
The lungs are 2 sponge-like organs found in the chest. The right lung has 3 sections, called lobes. The left lung has 2 lobes. The left lung is smaller because the heart takes up more room on that side of the body. The lungs bring air in and out of the body, taking in oxygen and getting rid of carbon dioxide gas, a waste product.

The lining around the lungs, called the pleura, helps to protect the lungs and allows them to move during breathing. The windpipe (trachea) brings air down into the lungs. It divides into tubes called bronchi (singular, bronchus) which divide into smaller branches called bronchioles. At the end of these small branches are tiny air sacs known as alveoli.

Most lung cancer starts in the lining of the bronchi, although it can also start in other parts of the lung.

Lung cancer often takes many years to develop. First, there may be areas of pre-cancerous changes in the lung. These changes are not a mass or tumor. They can’t be seen on an x-ray and they don’t cause symptoms. But these changes can be found by special tests of cells in the lining of the airways of lungs damaged by smoke.

As these pre-cancerous areas go on to become true cancer, they may make chemicals that cause new blood vessels to form nearby. These new blood vessels nourish the cancer cells and allow a tumor to form. Finally, the tumor becomes large enough to show up on an x-ray.

Non-small cell cancer

Small cell cancer

Types of Lung Cancer

There are 2 main types of lung cancer and they are treated differently.

• Non-small cell lung cancer (NSCLC)
• Small cell lung cancer (SCLC)

If the cancer has features of both types, it is called mixed small cell/large cell cancer. Other types of tumors can grow in the lungs as well. Some of these are not cancer and others are cancerous. Carcinoid tumors, for example, are slow-growing and usually cured by surgery.

Non-Small Cell Lung Cancer (NSCLC)

About 85% of all lung cancers are of the non-small cell type. There are 3 sub-types of NSCLC. The cells in these sub-types differ in size, shape, and chemical make-up.

• Squamous cell carcinoma: about 25% to 30% of all lung cancers are of this kind. They are linked to smoking and tend to be found near the bronchus.
• Adenocarcinoma: this type accounts for about 40% of lung cancers. It is usually found in the outer part of the lung
• Large-cell undifferentiated carcinoma: about 10% to 15% of lung cancers are this type. It can start in any part of the lung. It tends to grow and spread quickly. 

How Many People Get Non-Small Cell Lung Cancer?
 
Lung cancer is the leading cause of cancer death for both men and women. More people die of lung cancer than of colon, breast, and prostate cancers combined. Lung cancer is fairly rare in people under the age of 40.  

In 2008, there will be about 215,020 new cases of lung cancer (both small cell and non-small cell) in the United States and about 161,840 people will die from it. The average lifetime chance that a man will develop lung cancer is 1 in 13. For a woman it is 1 in 16.

About 4 out of 10 people with lung cancer will still be alive 1 year after finding out they have lung cancer.

What Causes Non-small Cell Lung Cancer? 
 
Different cancers have different risk factors. Some risk factors, such as smoking, can be controlled. Others, like a person's age or family history, can't be changed. Several factors can increase the risk of lung cancer.

• Smoking is by far the leading risk factor for lung cancer. Tobacco smoke causes more than 8 out of 10 cases of lung cancer. The longer a person has been smoking and the more packs per day sm oked, the greater the risk. If a person stops smoking before lung cancer develops, the lung tissue slowly returns to normal. Stopping smoking at any age lowers the risk of lung cancer.
• Cigar and pipe smoking are almost as likely to cause lung cancer as is cigarette smoking. There is no evidence that smoking low tar cigarettes reduces the risk of lung cancer.
• Second hand smoke: People who don’t smoke but who breathe the smoke of others also have a higher risk of lung cancer. Non-smoking spouses of smokers, for example, have a 30% greater risk of developing lung cancer than do spouses of nonsmokers. Workers exposed to tobacco smoke in the workplace are also more likely to get lung cancer.
• Hookah smoking has become popular among young people. Although there is less tobacco in the product used for hookahs, it is still dangerous and addictive.
• Arsenic, if found in high levels in drinking water, may increase the risk of lung cancer. The effect is even greater for smokers.
• Asbestos is another risk factor for lung cancer. People who work with asbestos have a higher risk of getting lung cancer. If they smoke as well, the risk is greatly increased. Although asbestos was used for many years, the government has now nearly stopped its use in the workplace and in home products. While it is still present in many buildings, it is not thought to be harmful as long as it is not released into the air. (Another type of cancer linked to asbestos (mesothelioma) can start in the lining of the lung.)
• Radon is a radioactive gas made by the natural breakdown of uranium, which is found at higher than normal levels in the soil in some parts of the United States. Radon can’t be seen, tasted, or smelled. Radon can become concentrated indoors and create a possible risk for cancer. Smokers are especially sensitive to the effects of radon. State and local offices of the EPA (Environmental Protection Agency) can provide information about how to test for radon in the home
• Cancer-causing agents in the workplace include the following:
  • Uranium
  • Beryllium
  • Vinyl chloride
  • Nickel chromates
  • Coal products
  • Mustard gas
  • Chloromethyl ethers
  • Gasoline
  • Diesel exhaust
• Marijuana cigarettes have more tar than regular cigarettes. Many of the cancer-causing substances in tobacco are also found in marijuana. Marijuana is also inhaled very deeply and the smoke is held in the lungs for a long time. Medical reports suggest that marijuana could cause cancers of the mouth and throat. But because marijuana is an illegal substance it is not easy to gather information about its effects on the body. 
• Radiation treatment to the lung: People who have had radiation to the chest to treat cancer are at higher risk for lung cancer, especially if they smoke. But non-smoking women who have radiation to the breast after surgery for breast cancer do not have a higher risk of lung cancer.
• Diseases such as silicosis and berylliosis (caused by breathing in certain minerals) also increase the risk of lung cancer.
• Personal and family history: If you have had lung cancer, you have a higher risk of getting another lung cancer. Brothers, sisters, and children of people who have had lung cancer may have a slightly higher risk themselves.
• Diet: Some reports suggest that a diet low in fruits and vegetables might increase the risk of lung cancer in people who are exposed to tobacco smoke. It may turn out that fruits and vegetables help protect against lung cancer.
• Air pollution: In some cities, air pollution may slightly increase the risk of lung cancer. But the risk is still far less than that caused by smoking.

During the past few years, scientists have made great progress in understanding how risk factors produce certain changes in the DNA of lung cells, causing the cells to become cancerous. DNA is the genetic material that carries the instructions for nearly everything our cells do.

Current research in this field is aimed at developing tests that can find lung cancers at an early stage by spotting DNA changes. But these tests are not yet ready for routine use. Therefore, doctors stress avoiding tobacco smoke and the other risk factors listed above.
 
Can Non-Small Cell Lung Cancer Be Prevented?
 
The best way to prevent lung cancer is not to smoke and to avoid people who do. If you already smoke, you should try to quit. You should also avoid breathing in other people’s smoke.

A good diet with lots of fruits and vegetables may also help prevent lung cancer.

Some people who get lung cancer do not have any known risk factors, so it is not possible to prevent all cases of lung cancer
 
How is Non-small Cell Lung Cancer Found?
 
Since most people with early lung cancer do not have any symptoms, only a small number of lung cancers are found at an early stage. When lung cancer is found early, it is often because of tests that were being done for something else.

Screenings Tests for Lung Cancer

Screening is the use of tests or exams to find a disease (such as cancer) in people who don’t have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a good screening test to find lung cancer early could save many lives.

• Chest x-rays and checking sputum (spit) under a microscope to look for cancer cells have been studied for several years. These studies have shown that this kind of screening does not find many lung cancers early enough to improve a person’s chance for a cure. For this reason, lung cancer screening is not usually advised even for people at higher risk, such as those who smoke.
• Spiral CT scanning has shown some promise in finding early lung cancer in smokers and former smokers. But it has not yet known if this test will lower the chances of dying from lung cancer. One major problem is that it finds a lot of things that turn out not to be cancer. This leads to unnecessary tests and even surgery.

Common Signs and Symptoms of Lung Cancer

Although most lung cancers do not cause symptoms until they have spread, you should report any of the following to your doctor right away. Often these problems are caused by something other than cancer. But if lung cancer is found, getting treatment right away could help you live longer and relieve symptoms. 

The most common symptoms are: 

• A cough that does not go away
• Chest pain, often made worse by deep breathing
• Hoarseness
• Weight loss and loss of appetite
• Bloody or rust-colored sputum (spit or phlegm)
• Shortness of breath
• Infections such as bronchitis and pneumonia that keep coming back
• New onset of wheezing

When lung cancer spreads to distant organs, it may cause:

• Bone pain
• Weakness or numbness of the arms or legs
• Dizziness or seizure
• Yellow coloring of the skin and eyes (jaundice)
• Masses near the surface of the body, caused by cancer spreading to the skin or to lymph nodes in the neck or above the collarbone

If you have any of these problems, you should see a doctor right away.
 
How is Non-small Cell Lung Cancer Treated?  
 
If you have lung cancer, your treatment choices are surgery, radiation therapy, and chemotherapy. More than one kind of treatment may be used, depending on the stage of your cancer.

Your doctor will talk to you about treatment choices. The most important factors to take into account include the stage of the cancer, your overall health, the likely side effects of the treatment, and the chance of curing the cancer or extending your life. Age alone should not be a barrier to treatment. Older people can benefit from treatment as much as younger people as long as their general health is good.

Types of Treatment for Non-Small Cell Lung Cancer Surgery 

Surgery may be used to remove the cancer along with some of the lung tissue around it.

• Removing only part of a lobe (section) of the lung is called a wedge resection.
• If a whole lobe of the lung is removed, the surgery is called a lobectomy.
• If the entire lung is removed, the surgery is called a pneumonectomy.
• Lymph nodes are also removed so the doctor can see if the cancer has spread.

These operations are done with the patient asleep. A hospital stay of 1 or 2 weeks is usually needed. There will be some pain after the surgery because the surgeon has to cut through the ribs to get to the lungs. Other possible problems include bleeding, wound infections, and pneumonia.

There is a new kind of surgery for people with early stage lung cancer. It is called video-assisted chest surgery .

• A tiny camera can be placed through a small hole in the chest to help the surgeon see the tumor.
• Only small incisions are needed, so there is less pain after surgery.
• This approach is most often used for tumors smaller than about one and a half inches.
• The cure rate seems to be the same as for standard surgery.
• The doctor who does this surgery should have experience since it requires a lot of skill.

People whose lungs are in good condition (other than the cancer) can often return to normal activities after a lobe or even an entire lung is removed. But if they also have problems such as emphysema or chronic bronchitis (common among heavy smokers), they may have long-term shortness of breath.

For people who can't have the usual surgery because of lung disease or other medical problems, or because the cancer is widespread, other types of surgery (for example, laser surgery) can be done to relieve symptoms.

Sometimes fluid collects in the chest and interferes with breathing. This fluid can be removed through a small tube placed in the chest. Then either talc or some type of drug is placed into the chest. This will start a reaction that will help seal the space and prevent future fluid buildup.

Radiation Therapy for Non-Small Cell Lung Cancer

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation). External radiation is the type most often used to treat lung cancer. Also, radioactive materials can be placed into or next to the tumor (brachytherapy).

Radiation is sometimes used as the main treatment of lung cancer. It might be used for people who are not healthy enough to have surgery. For other patients, radiation might be used after surgery to kill small areas of cancer that can't be seen and removed during surgery. Or it could be used on the brain to try to prevent the spread of cancer there. Radiation can also be used to relieve symptoms such as pain, bleeding, trouble swallowing, or problems caused by the cancer spreading to the brain.

Side effects of radiation could include:

• Mild skin problems
• Nausea
• Vomiting
• Tiredness
• Chest radiation may cause lung damage and trouble breathing or swallowing

Radiation therapy to the brain usually becomes most serious 1 or 2 years after treatment. These side effects could include memory loss, headaches, trouble with thinking, and less sexual desire. These side effects, though, are minor compared to those caused by a brain tumor.

A special kind of radiation (called the gamma knife ) can be used instead of surgery if the cancer spreads to the brain in only 1 spot. In this method, several beams of radiation are focused on the tumor over the span of a few minutes to hours. The head is held in place with a rigid frame.

Chemotherapy for Non-Small Cell Lung Cancer

Chemotherapy is treatment with anticancer drugs given into a vein or by mouth. These drugs enter the bloodstream and reach throughout the body, making this treatment useful for cancer that has spread (metastasized) to organs beyond the lung. Several drugs may be given at the same time.

Chemotherapy drugs kill cancer cells but they also damage some normal cells, causing side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment.

You could have some of these short-term side effects:

• Loss of appetite
• Hair loss (temporary)
• Mouth sores
• Loose stools (diarrhea)
• A higher risk of infection caused by a shortage of white blood cells
• Bruising or bleeding after minor cuts caused by a shortage of blood platelets
• Fatigue or shortness of breath caused by low red blood cell counts

Some chemotherapy drugs can damage nerves. This can cause numbness in the fingers and toes, and sometimes the arms and legs may feel weak.

Most of these side effects go away when treatment is over. If you have any problems with side effects, be sure to tell your doctor or nurse, as there are often ways to help.

There is a new drug (erlotinib ) that works by keeping cancer cells from growing. It is given, as a pill, to some patients for whom chemotherapy is not working. Side effects can include diarrhea, rashes, eye problems, vomiting, loss of appetite, and tiredness.

For cancer cells to grow, they must form new blood vessels to “feed” the tumor. There is a drug (Avastin) which can keep new blood vessels from forming. It has been shown to help people with advanced lung cancer live longer when it was given along with chemotherapy. But it causes bleeding, so it can’t be used for patients who are coughing up blood or whose cancer has spread to the brain.

Non-Small Cell Lung Cancer Survival by Stage
Stage 5-year Survival Rate 

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is found. Of course, some patients live much longer than 5 years. Five-year relative survival rates means that people who die of other causes are not included, and the rate only includes people who die from lung cancer.

While these numbers provide an overall picture, keep in mind that every person’s situation is unique and the statistics can’t predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your own chances of a cure, or how long you might survive your cancer. They know your situation best. 
 
 
Staging
 
Staging is the process of determining how far the cancer has spread. This process is very important because your treatment and the outlook for your recovery depend on the stage of your cancer. The tests described above are also used to stage lung cancer. There are different staging systems for small cell and non-small cell lung cancer.

Staging of Non-Small Cell Lung Cancer

The system used to stage non-small cell lung cancer is the AJCC system. Stages are described using Roman numerals from 0 to IV (0 to 4). Some stages are further divided into A and B. In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer.

What is Small Cell Lung Cancer(SCLC)? 
 
About 15% of all lung cancers are of the small cell type. This cancer often starts in the bronchi near the center of the chest. Although the cancer cells are small, they can multiply quickly and form large tumors that can spread widely through the body. This means that the treatment must include drugs to kill the widespread disease.

SCLC is almost always caused by smoking. It is very rare for someone who has never smoked to have small cell lung cancer.
 
How Many People Get Small Cell Lung Cancer?
 
Lung cancer is the leading cause of cancer death for both men and women. More people die of lung cancer than of colon, breast, and prostate cancers combined. Lung cancer is fairly rare in people under the age of 40.

In 2008, there will be about 215,020 new cases of lung cancer (both small cell and non-small cell) in the United States and about 161,840 people will die from it. The average lifetime chance that a man will develop lung cancer is 1 in 13. For a woman it is 1 in 16.

About 4 out of 10 people with lung cancer will still be alive 1 year after finding out they have lung cancer.

What Causes Small Cell Lung Cancer?
 
A risk factor is anything that increases a person's chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, such as smoking, can be controlled. Others, like a person's age or family history, can't be changed. Several factors can increase the risk of lung cancer.

Smoking is by far the leading risk factor for lung cancer

• Tobacco smoke causes more than 8 out of 10 cases of lung cancer
• The longer a person has been smoking and the more packs per day smoked, the greater the risk
• If a person stops smoking before lung cancer develops, the lung tissue slowly returns to normal
• Stopping smoking at any age lowers the risk of lung cancer.

Cigar and pipe smoking are almost as likely to cause lung cancer as is cigarette smoking. There is no evidence that smoking low tar cigarettes reduces the risk of lung cancer.

Second Hand Smoke: People who don’t smoke but who breathe the smoke of others also have a higher risk of lung cancer.

• non-smoking spouses of smokers, for example, have a 30% greater risk of developing lung cancer than do spouses of nonsmokers.
• Workers exposed to tobacco smoke in the workplace are also more likely to get lung cancer.

Hookah smoking has become popular among young people. Although there is less tobacco in the product used for hookahs, it is still dangerous and addictive.

Asbestos is another risk factor for lung cancer.

• People who work with asbestos have a higher risk of getting lung cancer
• If they smoke as well, the risk is greatly increased
• Although asbestos was used for many years, the government has now nearly stopped its use in the workplace and in home products
• While it is still present in many buildings, it is not thought to be harmful as long as it is not released into the air.

Another type of cancer linked to asbestos (mesothelioma ) can start in the lining of the lung.

Arsenic, if found in high levels in drinking water, may increase the risk of lung cancer. The effect is even greater for smokers.

Radon is a radioactive gas made by the natural breakdown of uranium, which is found at higher than normal levels in the soil in some parts of the US.

• Radon can’t be seen, tasted, or smelled
• Radon can become concentrated indoors and create a possible risk for cancer
• Smokers are especially sensitive to the effects of radon
• State and local offices of the EPA (Environmental Protection Agency) can provide information about how to test for radon in the home.

Cancer-causing agents in the workplace include the following:

• uranium
• beryllium
• vinyl chloride
• nickel chromates
• coal products
• mustard gas
• chloromethyl ethers
• gasoline
• diesel exhaust

People who work with these substances should be very careful to avoid exposure as much as possible.

Marijuana cigarettes have more tar than regular cigarettes.

• Many of the cancer-causing substances in tobacco are also found in marijuana.
• Marijuana is also inhaled very deeply and the smoke is held in the lungs for a long time.
• Medical reports suggest that marijuana could cause cancers of the mouth and throat. But because marijuana is an illegal substance it is not easy to gather information about its effects on the body.

Radiation treatment to the lung: People who have had radiation to the chest to treat cancer are at higher risk for lung cancer, especially if they smoke. But non-smoking women who have radiation to the chest after surgery for breast cancer do not have a higher risk of lung cancer.

Diseases such as silicosis and berylliosis (caused by breathing in certain minerals) also increase the risk of lung cancer.

Personal and family history: If you have had lung cancer, you have a higher risk of getting another lung cancer. Brothers, sisters, and children of people who have had lung cancer may have a slightly higher risk the mselves.

Diet: Some reports suggest that a diet low in fruits and vegetables might increase the risk of lung cancer in people who are exposed to tobacco smoke. It may turn out that fruits and vegetables help protect against lung cancer.

Air pollution: In some cities, air pollution may slightly increase the risk of lung cancer. But the risk is still far less than that caused by smoking.

During the past few years, scientists have made great progress in understanding how risk factors produce certain changes in the DNA of lung cells, causing the cells to become cancerous. DNA is the genetic material that carries the instructions for nearly everything our cells do.

Current research in this field is aimed at developing tests that can find lung cancers at an early stage by spotting DNA changes. But these tests are not yet ready for routine use. Therefore, doctors stress avoiding tobacco smoke and the other risk factors listed above.

Can Small Cell Lung Cancer Be Prevented?
 
The best way to prevent lung cancer is not to smoke and to avoid people who do. If you already smoke, you should try to quit. You should also avoid breathing in other people’s smoke.

A good diet with lots of fruits and vegetables may also help prevent lung cancer.

Some people who get lung cancer do not have any known risk factors, so it is not possible to prevent all cases of lung cancer
 
How Is Small Cell Lung Cancer Found?
 
Since most people with early lung cancer do not have any symptoms, only a small number of lung cancers are found at an early stage. When lung cancer is found early, it is often because of tests that were being done for something else.

Screenings Tests for Small Cell Lung Cancer

Screening is the use of tests or exams to find a disease (such as cancer) in people who don’t have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a good s creening test to find lung cancer early could save many lives.

• Chest x-rays and checking sputum under a microscope to look for cancer cells have been studied for several years. Studies have shown that this kind of screening does not find many lung cancers early enough to improve a person’s chance for a cure. For this reason, lung cancer screening is not usually advised even for people at higher risk, such as those who smoke.
• Spiral CT scanning has shown some promise in finding early lung cancer in smokers and former smokers. But it has not yet known if this test will lower the chances of dying from lung cancer. One major problem is that it finds a lot of things that turn out not to be cancer. This leads to unnecessary tests and even surgery.

Common Signs and Symptoms of Lung Cancer

Although most lung cancers do not cause symptoms until they have spread, you should report any of the following to your doctor right away. Often these problems are caused by something other than cancer. But if lung cancer is found, getting treatment right away could help you live longer and relieve symptoms.

• a cough that does not go away
• chest pain, often made worse by deep breathing, coughing, or laughing
• hoarseness
• weight loss and loss of appetite
• bloody or rust-colored sputum
• shortness of breath
• infections such as bronchitis and pneumonia that keep coming back
• new onset of wheezing

When lung cancer spreads to distant organs, it may cause:

• bone pain
• weakness or numbness of the arms or legs
• dizziness or seizure
• yellow coloring of the skin and eyes (jaundice)
• masses near the surface of the body, caused by cancer spreading to the skin or to lymph nodes in the neck or above the collarbone

If you have any of these symptoms, you should see a doctor right away. Less often, there are some other clusters of symptoms (called syndromes) that can point to a possible lung cancer.

If Small Cell Lung Cancer Is Suspected

After asking questions about your health and doing a physical exam, your doctor might want to do some of the following:

• Imaging Tests : There are a number of different tests that can produce pictures of the inside of your body. Some of these are used to find lung cancer and to see if it has spread.
  • Chest x-ray: This is the first test your doctor will order to look for any spot on the lungs. It is a plain x-ray of your chest. If the x-ray is normal, you most likely do not have lung cancer. If anything looks suspicious, the doctor may order more tests.
  • CT scan (computed tomography): A CT scan is a special kind of x-ray. Instead of taking just one picture, the CT scanner takes many pictures as it moves around you. A computer then combines these pictures into an image of a slice of your body. Often after the first set of pictures is taken you will get an injectio n of a “dye” that helps to outline structures in your body. Then a second set of pictures is taken. CT scans take longer than normal x-rays, but they are getting faster all the time.

The CT scan will give the doctor precise information about the size, shape, and place of a tumor. It can also help find enlarged lymph nodes that might contain cancer. CT scans are also used to find tumors in other organs that might be affected by the spread of lung cancer.

• MRI scan (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays. MRI scans take longer than x-rays—often up to an hour. Also, you have to be placed inside a tube-like machine, which upsets some people. MRI scans are useful in finding lung cancer that has spread the brain or spinal cord.
• PET scan (positron emission tomography): PET uses a form of sugar that contains a radioactive atom. Cancer cells in the body absorb large amounts of the sugar. A special camera can then detect the radioactivity. This test can show whether the cancer has spread to the lymph nodes. It is also helpful in telling whether a spot on your chest x-ray is cancer. PET scans are also useful when the doctor thinks the cancer has spread, but doesn’t know where. Newer machines combine a CT and a PET scan to even better pinpoint the tumor.
• Bone scan: For a bone scan a small amount of radioactive substance is injected into a vein. The amount used is very low and causes no long-term effects. This substance builds up in areas of bone that may be abnormal because of cancer. But other problems can also cause suspicious results. Bone scans are usually done in patients with small cell lung cancer. They are only done in patients with non-small cell lung cancer when other tests or symptoms suggest that the cancer has spread to the bones.
• Other Tests

The following tests can be used to confirm whether something seen on an imaging test is really lung cancer. These tests are also used to decide the exact type of lung cancer and how far it may have spread.

• Sputum cytology: A sample of phlegm is looked at under a microscope to see if cancer cells are present.
• Needle biopsy: A long, thin needle is placed into the tumor in the lung to remove a piece of ti ssue. The tissue is looked at in the lab to see if cancer cells are present.
• Bronchoscopy : A lighted, flexible tube is passed through the mouth into the bronchi. This test can help find tumors or it can be used to take samples of tissue or fluids to see if cancer cells are present. You will need to be sedated for this exam.
• EUS (endoscopic esophageal ultrasound): In this method, a scope with an ultrasound emitter at the tip is placed into the esophagus. Ultrasound images taken from inside the esophagus can be helpful in finding large lymph nodes in the chest. A thin needle can be used to take a sample of these nodes.
• Thoracentesis and thoracoscopy : These tests are done to check whether fluid around the lungs is caused by cancer or by a condition such as heart failure or an infection. For thoracentesis, the skin is numbed and a needle is placed between the ribs to drain the fluid, which is checked for cancer cells. Thoracoscopy uses a thin, lighted tube connected to a video camera and monitor to look at the space between the lungs and the chest wall.
• Bone marrow biopsy: After the area is numbed, a needle is used to remove a small piece of bone, usually from the back of the hip bone. The sample is checked for cancer cells. This is done mostly to help find if small cell lung cancer has spread to the bones.
• Blood tests: A complete blood count (CBC) shows whether your blood has the correct number of different cell types. This test will be done often if you are treated with chemotherapy because these drugs can affect the blood-forming cells of the bone marrow. Other blood tests can spot problems in different organs such as the liver and bones. 
   

Staging
 
Staging is the process of finding out how far the cancer has spread. The tests described above are also used to stage lung cancer. There are different staging systems for small cell and non-small cell lung cancer.

Staging of Small Cell Lung Cancer

For small cell lung cancer a 2-stage system is most often used. These are limited stage and extensive stage.

• Limited stage usually means that the cancer is only in one lung and in lymph nodes on the same side of the chest.
• If the cancer has spread to the other lung, to lymph nodes on the other side of the chest, or to distant organs, it is called extensive. Many doctors consider cancer that has spread to the fluid around the lung to be extensive stage as well.

Small cell lung cancer is staged in this way because it helps to separate people who have a fair outlook and might be cured from those who do not have as good an outlook. Many people with small cell lung cancer will already have extensive disease when it is found.
 
How Is Small Cell Lung Cancer Treated? 
 
If you have small cell lung cancer, the main treatment will be chemotherapy, either alone or combined with radiation. Very rarely, surgery might be done, depending on the stage of the cancer.

After the cancer is found and staged, your doctor will talk to you about treatment choices. The most important factors to take into account include the stage and type of cancer, your overall health, the likely side effects of the treatment, and the chance of curing the cancer or extending your life. Age alone should not be a barrier to treatment. Older people can benefit from treatment as much as younger people as long as their general health is good.

Types of Treatment for Small Cell Lung Cancer

• Surgery
  • Surgery is rarely used in small cell lung cancer. In about 1 out of 20 cases, the small cell lung cancer is in only one tumor nodule, with no spread to lymph nodes or other organs. In these cases, surgery might be a good idea. It is usually followed by further treatment with chemotherapy or radiation.

Removing only part of a lobe (section) of the lung is called a wedge resection. If a whole lobe of the lung is removed, the surgery is called a lobectomy. If the entire lung is removed, the surgery is called a pneumonectomy.

These operations are done with the patient asleep. A hospital stay of 1 or 2 weeks is usually needed. There will be some pain after the surgery because the surgeon has to cut through the ribs to get to the lungs. Other possible problems include bleeding, wound infections, and pneumonia.

For people who can't have the usual surgery because of lung disease or other medical problems, or because the cancer is widespread, other types of surgery (for example, laser surgery) can be done to relieve symptoms.

Sometimes fluid collects in the chest and interferes with breathing. This fluid can be removed through a small tube placed in the chest. Then either talc or some type of drug is placed into the chest. These will start a reaction that will help seal the space and prevent future fluid buildup.

• Radiation Therapy
  • Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells.
  • The radiation may come from outside the body (external radiation) External radiation is the type most often used to treat lung cancer.
  • radioactive materials placed into or next to the tumor (brachytherapy).
  • Radiation is sometimes used as the main treatment of lung cancer. It might be used for people who are not healthy enough to have surgery. For other patients, radiation might be used after surgery to kill small areas of cancer that can't be seen and removed during surgery. Or it could be used on the brain to try to prevent the spread of cancer there. Radiation can also be used to relieve symptoms such as pain, bleeding, trouble swallowing, or problems caused by the cancer spreading to the brain.

Side effects of radiation could include

• mild skin problems
• nausea, vomiting
• tiredness
• Chest radiation may cause lung damage and trouble breathing or swallowing.
• radiation therapy to the brain usually become most serious 1 or 2 years after treatment. These side effects could include memory loss, headaches, trouble with thinking, and less sexual desire. These side effects, though, are minor compared to those caused by a brain tumor.

A special kind of radiation (called the gamma knife ) can be used instead of surgery if the cancer spreads to the brain in only one spot. In this method, several beams of radiation are focused on the tumor over the span of a few minutes to hours. The head is held in place with a rigid frame.

• Chemotherapy

Chemotherapy is treatment with anticancer drugs given into a vein or by mouth. These drugs enter the bloodstream and reach throughout the body, making this treatment useful for cancer that has spread (metastasized) to organs beyond the lung. Chemotherapy is usually the main treatment for small cell lung cancer. Several drugs may be given at the same time.

Chemotherapy drugs kill cancer cells but they also damage some normal cells, causing side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment. You could have some of these short-term side effects: nausea and vomiting loss of appetite hair loss (temporary) mouth sores loose stools (diarrhea) a higher risk of infection caused by a shortage of white blood cells bruising or bleeding after minor cuts caused by a shortage of blood platelets fatigue or shortness of breath caused by low red blood cell counts

Some chemotherapy drugs can damage nerves. This can cause numbness in the fingers and toes, and sometimes the arms and legs may feel weak.

Most of these side effects go away when treatment is over. If you have any problems with side effects, be sure to tell your doctor or nurse, as there are often ways to help.

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