Lung cancer forms in the tissues of the lungs, most often in the cells that line air passages. It occurs when these cells start to grow and multiply uncontrollably, usually as a result of exposure to toxins such as tobacco smoke, radiation and asbestos.
Lung cancer is the most common cause of cancer-related deaths and second most common cancer in both men and women in the United States. According to the National Cancer Institute, about 234,000 people in the U.S. are diagnosed with the disease each year. While most cases are linked to tobacco smoking, a growing number of diagnoses are among non-smokers, especially among women. Most lung cancers are diagnosed after the disease has spread. As a result, the five-year survival rate for lung cancers is just 19%.
What are the types of lung cancer?
Lung cancers are classified into two major groups according to the type of cancer cells that make up the tumor. They are divided into two main categories: Small cell lung cancer and Non-small cell lung cancer. There are significant differences in the prognosis and treatment for each category.
Non-small cell lung cancer
This is the most common type of lung cancer and accounts for approximately 85% of lung cancers. It arises from the lungs’ epithelial cells, a type of cell that lines the surface of organs, including the airways. These cancers tend to start as solitary nodules. As they grow they may invade surrounding structures or spread (metastasize) to lymph nodes inside the chest as well as to distant organs.
There are several types of non-small cell lung cancer. The most common ones are:
- Adenocarcinoma: This begins in glandular cells that line the alveoli. When healthy, these cells make mucus. The main cause for development of lung adenocarcinomas is tobacco smoking, although this cancer type can often occur in nonsmokers, women and at younger age. Adenocarcinoma often occurs in the more peripheral parts of the lung.
- Squamous cell carcinoma: This lung cancer begins in thin, flat squamous epithelial cells that line the airways of the lungs. Tobacco smoking is its main cause and it tends to arise in the more central regions of the lungs. Squamous cell carcinoma is also called epidermoid carcinoma.
- Large cell carcinoma: Large cell carcinoma is a less common type of non-small cell lung cancer. It tends to grow rapidly and may spread early. It usually originates from neuroendocrine cells present in the lungs.
Small cell lung cancer
Small cell lung cancer makes up about 15% of lung cancers and almost always is caused by tobacco smoking. It often starts in the more central portions of the chest. They also grow and spread quickly to other parts of the body, including the lymph nodes. Because it is so aggressive, it is usually not found when it is confined to a single area of the lung. Therefore, surgery is used less often for small cell lung cancer than non-small cell lung cancer.
Cancer grows in lungs, may spread
When lung cancer is small and at an early stage, it usually does not cause symptoms. However, once the disease grows, it may damage surrounding tissue, interfering with the lungs’ normal function and causing symptoms such as hemoptysis (coughing up blood), shortness of breath or pain.
Lung cancer frequently spreads, or metastasizes through the lymphatic system. Lymph is a clear fluid that is drained from our tissues and contains immune cells that help fight infection. It travels through your body in lymphatic vessels. Lymph nodes are small, bean-shaped organs that link lymph vessels. They often trap cancer cells that have spread to the lymphatic system.
Cancer cells can spread to other parts of your body through the bloodstream, as well. When lung cancer spreads to other organs such as the liver or bone, it is known as stage IV lung cancer or metastatic lung cancer. Cancer that has spread to another organ is still referred to as lung cancer. Whether or not a lung cancer has spread to lymph nodes or to other organs significantly influences how the tumor is treated.
What are lung metastases?
Sometimes, a tumor starts in another part of the body and then spreads, or metastasizes, to the lungs. These tumors are called lung metastases, and they are not the same as lung cancer. In these cases, they are the type of cancer where they came from. For example, a colon cancer with lung metastases is called metastatic colon cancer.
Lung anatomy
When you breathe in, oxygen comes through your mouth and nose and then travels through the trachea, or windpipe. The trachea divides into two tubes called bronchi, which take the oxygen to the left and right lungs. Inside the lungs are smaller branches called bronchioles and alveoli, tiny air sacks where oxygen is transferred to the blood stream.
Each lung is divided into sections called lobes. The right lung has three lobes and the left lung has two lobes. The left lung is smaller than the right lung because the heart is also located in the left side of the chest. Each lobe can be further divided into bronchopulmonary segments.
The pleura is a thin membrane that covers the outside of each lung and lines the inside wall of the chest. The space between the lungs and the chest wall usually contains a very small amount of fluid that allows the lungs to move smoothly during breathing.
What are the risk factors for lung cancer?
A risk factor is anything that increases the chance that a person will develop a particular disease. The main risk factors for lung cancer are:
- A history of or current tobacco use
- Exposure to second-hand smoke
- Exposure to asbestos, arsenic, chromium or other chemicals
- Radiation exposure, including radiation therapy to the breast or chest and radon exposure.
- Living in an area with air pollution
- A family history of lung cancer
- Infection with the human immunodeficiency virus.
What are the symptoms of lung cancer?
Lung cancer symptoms vary for person to person. Sometimes people with lung cancer don't have any symptoms. Often, symptoms are easily confused with common respiratory illnesses such as bronchitis or pneumonia, delaying an accurate diagnosis.
If you have symptoms of lung cancer, they may include:
- A cough that does not go away and gets worse over time
- Constant chest pain, often made worse by deep breathing, coughing or laughing
- Arm or shoulder pain
- Coughing up blood or rust-colored phlegm
- Shortness of breath, wheezing or hoarseness
- Repeated episodes of pneumonia or bronchitis
- Swelling of the neck and face. This occurs when the tumor compresses a large vein, the superior vena cava, that moves blood to the heart from the head and arms
- Loss of appetite and/or weight loss
- Feeling weak or tired
- Widening of the fingertips and nailbed also known as “clubbing.” This symptom is common in non-small cell lung cancer cases, but rare for small cell lung cancer
If lung cancer spreads to other parts of the body, it may cause:
- Bone pain
- Arm or leg weakness or numbness
- Headache, dizziness or seizure
- Balance problems or an unsteady gait
- Jaundice (yellow coloring) of skin and eyes
- Swollen lymph nodes in the neck or shoulder
These symptoms do not always mean you have lung cancer. However, it is important to discuss any lung cancer symptoms with your doctor, since they may also signal other health problems.In rare cases, lung cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Some people have an elevated risk of developing lung cancer. Review the lung cancer screening guidelines to see if you need to be tested.
Behavioral and lifestyle changes can help prevent lung cancer. Visit our prevention and screening section to learn how to manage your risk.
Did You Know?
How is lung cancer diagnosed?
Early stage lung cancer often does not have symptoms. In addition, when symptoms appear they can easily be mistaken for common respiratory illnesses like bronchitis or pneumonia. Because of this, many cases are diagnosed at an advanced stage.
Patients at high risk for lung cancer, especially those with a history of smoking, should undergo regular screenings in order to catch the disease at its early stages, when there is a better chance of cure.
If you have symptoms that signal lung cancer, your doctor will ask you questions about your medical, smoking and family history and whether you have been around certain chemicals or substances.
You will then undergo an imaging exam, typically a chest X-ray. If the image shows an area of concern, the doctor may order other scans, including a CT scan or PET scan, for additional details regarding the area of concern.
If the findings on the imaging scans indicate cancer, the doctor will request that tissue or fluid be removed from the lung and examined by microscope. The act of obtaining a tissue or fluid sample is called a biopsy. There are several ways doctors can perform biopsies of lung tumors:
- Bronchoscopy: A thin flexible tube with a tiny camera is inserted through the nose or mouth and down into the lungs to obtain a small tissue sample (biopsy). This is usually performed under mild sedation.
- Needle biopsy: A CT-guided biopsy where a needle is inserted through the skin under local anesthesia to acquire a tumor sample.
- Fine needle aspiration (FNA): A very small needle is placed into the tumor. Suction is used to remove a small amount of tissue.
- Thoracentesis: Fluid from around the lungs is drawn out with a needle and tested for cancer cells.
- Endobronchial Ultrasound (EBUS): a bronchoscope with an attached ultrasound device is used to check for lung cancer inside nearby chest lymph nodes. EBUS is often performed at the same time as a bronchoscopy and requires general anesthesia.
- Video-assisted thoracoscopic surgery (VATS): This minimally invasive surgical procedure uses a small camera to help retrieve tumor samples that are otherwise difficult to access. VATS requires a general anesthetic and is performed in the operating room by a thoracic surgeon.
To complete assessment of how advanced the cancer is, which is called staging, the patient will undergo a PET-CT scan and, for most cases, an MRI of the brain to check for signs of cancer spread to other organs. This will guide the treatment decisions for each patients’ lung cancer.
What are the stages of lung cancer?
If you are diagnosed with lung cancer, your doctor will determine the stage (or extent) of the disease. This is a way to classify the cancer by how far and to which parts of the body it has spread. Staging helps the doctor plan the best treatment for you. Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.
Staging is often the most important part of your treatment. If the cancer is staged improperly, you may not receive the right treatment.
The following are the lung cancer staging systems of the National Cancer Institute.
Non-small cell lung cancer stages
Occult (hidden) stage
In the occult (hidden) stage, cancer cannot be seen by imaging or bronchoscopy. Cancer cells are found in sputum or bronchial washings (a sample of cells taken from inside the airways that lead to the lungs). Cancer may have spread to other parts of the body.
Stage 0
In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 may be adenocarcinoma in situ (AIS) or squamous cell carcinoma in situ (SCIS).
Stage I
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
- Stage IA: The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes.
- Stage IB: The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes,
or the tumor is 4 centimeters or smaller and one or more of
the following is found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneumonitis.
- Cancer has not spread to the lymph nodes.
Stage II
Stage II is divided into stages IIA and IIB.
- Stage IIA: The tumor is larger than 4 centimeters but not
larger than 5 centimeters. Cancer has not spread to the lymph
nodes and one or more of the following may be found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneumonitis.
- Stage IIB: The tumor is 5 centimeters or smaller
and cancer has spread to lymph nodes on the same side of the chest
as the primary tumor. The lymph nodes with cancer are in the lung or
near the bronchus. Also, one or more of the following may be
found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneumonitis.
nor cancer has not spread to the lymph nodes and one or more of the following is found:
- The tumor is larger than 5 centimeters but not larger than 7 centimeters.
- There are one or more separate tumors in the same lobe of the lung as the primary tumor.
- Cancer has
spread to any of the following:
- The membrane that lines the inside of the chest wall.
- Chest wall.
- The nerve that controls the diaphragm.
- Outer layer of tissue of the sac around the heart.
Stage III
Stage III is divided into stages IIIA, IIIB, and IIIC.
- Stage IIIA: The tumor is 5 centimeters or smaller
and cancer has spread to lymph nodes on the same side of the chest
as the primary tumor. The lymph nodes with cancer are around
the trachea or where the trachea divides into the bronchi. Also, one
or more of the following may be found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pne
- umonitis.
or cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:
- The tumor is larger than 5 centimeters but not larger than 7 centimeters.
- There are one or more separate tumors in the same lobe of the lung as the primary tumor.
- Cancer has
spread to any of the following:
- The membrane that lines the inside of the chest wall.
- Chest wall.
- The nerve that controls the diaphragm.
- Outer layer of tissue of the sac around the heart.
or cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:
- The tumor is larger than 7 centimeters.
- There are one or more separate tumors in a different lobe of the lung with the primary tumor.
- The tumor is any size and cancer has spread
to any of the following:
- Trachea.
- Carina.
- Esophagus.
- Breastbone or backbone.
- Diaphragm.
- Heart.
- Major blood vessels that lead to or from the heart.
- Nerve that controls the larynx (voice box).
-
Stage IIIB: The tumor is 5 centimeters or smaller
and cancer has spread to lymph nodes above the collarbone on the
same side of the chest as the primary tumor or to any lymph nodes on
the opposite side of the chest as the primary tumor. Also, one or
more of the following may be found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneum
- onitis.
or the tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or where the trachea divides into the bronchi. Also, one or more of the following is found
- There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
- Cancer
has spread to any of the following:
- The membrane that lines the inside of the chest wall.
- Chest wall.
- The nerve that controls the diaphragm.
- Outer layer of tissue of the sac around the heart.
- Trachea.
- Carina.
- Esophagus.
- Breastbone or backbone.
- Diaphragm.
- Heart.
- Major blood vessels that lead to or from the heart.
- Nerve that controls the larynx (voice box).
- Stage IIIC: The tumor may be any size and cancer has spread
to lymph nodes above the collarbone on the same side of the chest as
the primary tumor or to any lymph nodes on the opposite side of the
chest as the primary tumor. Also, one or more of the following is
found:
- There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
- Cancer has spread to any of the following:
- The membrane that lines the inside of the chest wall.
- Chest wall.
- The nerve that controls the diaphragm.
- Outer layer of tissue of the sac around the heart.
- Trachea.
- Carina.
- Esophagus.
- Breastbone or backbone.
- Diaphragm.
- Heart.
- Major blood vessels that lead to or from the heart.
- Nerve that controls the larynx (voice box).
Stage IV
Stage IV is divided into stages IVA and IVB.
- In stage IVA, the tumor may be any size and cancer may have
spread to the lymph nodes. One or more of the following is
found:
- There are one or more tumors in the lung that does not have the primary tumor.
- Cancer is found in fluid around the lungs or the heart.
- Cancer has spread to one place in an organ not near the lung, such as the brain, liver, adrenal gland, kidney, bone, sac around the heart, or to a lymph node that is not near the lung.
- In stage IVB, cancer has spread to multiple places in one or more organs that are not near the lung.
Small cell lung cancer stages
Limited-Stage Small Cell Lung Cancer
In limited-stage, cancer is in the lung where it started and may have spread to the area between the lungs or to the lymph nodes above the collarbone.
Extensive-Stage Small Cell Lung Cancer
In extensive-stage, cancer has spread beyond the lung or the area between the lungs or the lymph nodes above the collarbone to other places in the body.
What are the treatment options for lung cancer?
At MD Anderson, some of the nation’s top lung specialists focus their extraordinary expertise on you. We customize your treatment to deliver the most advanced, effective and least invasive treatments available for lung cancer. And because your peace of mind is important to us, we specialize in techniques and therapies than can help preserve lung function and quality of life
We’re constantly researching safer and more effective treatments for lung cancer with fewer side effects. We are proud to be one of the few cancer centers in the nation to house a prestigious federally funded lung cancer SPORE (Specialized Program of Research Excellence) program. This leads to a large number of active clinical trials at MD Anderson and ensures that our patients have access to some of the most cutting-edge therapy anywhere in the world.
If you are diagnosed with lung cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the stage and type of lung cancer; other lung problems, such as emphysema or chronic bronchitis; other prior or current medical conditions; and possible side effects of treatment.
Your treatment for lung cancer will be customized to your particular needs. It may include one or more of the following therapies to treat the cancer and help relieve symptoms.
Lung Cancer Surgery
Statistically speaking, the more experienced the surgeon, the better the outcomes for lung cancer patients. MD Anderson’s Thoracic Center is home to many of the field’s most highly trained, experienced and respected thoracic surgeons. They operate only on cancers involving the chest and use the most advanced surgical techniques to treat a wide variety of lung cancers, including highly complex cases.
All patients with lung cancer who undergo surgery at the Thoracic Center enroll in a program of enhanced recovery, which aims to minimize pain, surgical stress and downtime. This leads to faster recovery, fewer side effects and better quality of life following surgery.
The most common types of surgery for lung cancer, in order of the amount of lung tissue removed, are:
- Wedge resection: Removal of the tumor and a pie- or wedge-shaped piece of the lung around the tumor. This procedure is typically used to perform a biopsy of a lung nodule.
- Segmentectomy or segmental resection: Removal of a segment, or part, of the lobe where the cancer is located. Both the segmentectomy and wedge resection are typically performed on patients who have limited lung capacity and can’t tolerate the removal of a larger section of the lung. They are also a good option for patients with small early-stage tumors generally measuring less than two centimeters. Both preserve lung capacity and the patient’s quality of life.
- Lobectomy: Removal of the lung lobe where the cancer is located. This is considered the “standard of care” for most lung cancer patients who undergo surgery.
- Sleeve lobectomy: A more complex form of lobectomy that is typically used for centrally located tumors. Though not always possible, sleeve lobectomies are preferable to pneumonectomy (complete removal of the lung) in order to preserve more functioning lung tissue.
- Pneumonectomy: Removal of the entire lung. This surgery is occasionally required due to the location of the tumor. In people with lungs that are otherwise healthy and function normally, pneumonectomy is well tolerated.
During most of these procedures, the surgeon will also remove lymph nodes from the chest. Since cancer often spreads through these nodes, doctors will examine them under a microscope to find out if the lung cancer has moved outside the lungs. This will help doctors decide if you need further treatment after surgery, such as chemotherapy, radiation therapy or targeted therapy. Treatment following surgery is called adjuvant therapy.
Occasionally, patients may receive chemotherapy or radiation before surgery in order to shrink the tumor. This is called neoadjuvant therapy.
Surgical approaches
For some lung cancer surgeries, there are different ways to perform the same procedure. Your surgeon will work with you to choose the best option. These methods include:
- Open surgery: The traditional surgical method. Surgeons perform the procedure through a four- to eight-inch incision between the ribs.
- Minimally invasive surgery: These procedures require several smaller incisions, typically between ¼ and ½ inch, and usually have a shorter recovery time and less pain for the patient. There are two primary methods of minimally invasive surgery for lung cancer patients.
- Video-assisted thoracic surgery (VATS) or thoracoscopy: This technique uses a small camera and instruments that are inserted into the chest allowing the surgeon to perform the surgery through small incisions. It is typically performed on patients with small, early stage lung cancers.
- Robotic-assisted Surgery: This newer method of minimally invasive surgery uses robotic arms remotely controlled by the surgeon. Better images of the surgical site and greater instrument dexterity allow the surgeon to perform more complex surgery than is possible with VATS.
Lung Cancer Radiation Therapy
At most hospitals, radiation oncologists are expected to treat several different types of cancer. MD Anderson’s Thoracic Center has radiation oncologists dedicated exclusively to caring for patients with lung cancer. This gives them incredibly deep experience in designing treatment plans.
Working with these radiation oncologists is a team of radiation therapy specialists, including dosimetrists and medical physicists, that helps MD Anderson deliver the maximum amount of radiation with the least damage to healthy cells. The radiation therapy treatments used for lung cancer patients include:
- 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor. This is primarily used as a palliative treatment and not to cure the disease.
- Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor. Brachytherapy is primarily used to treat metastatic growths in the airway. Since most of these growths can be treated with external beam radiation, brachytherapy is rarely used on lung cancer patients.
- Intensity-modulate radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor. This type of radiation is commonly used to treat cancers that have invaded nearby lymph nodes.
- Volumetric-modulate Arc therapy (VMAT): A type of IMRT, in VMAT therapy, the part of the machine that shoots out the beam of radiation rotates around the patient in an arc. This can irradiate the tumor more precisely and shorten procedure times.
- Stereotactic body radiation therapy (SBRT): High doses of radiation delivered with several beams at various intensities and angles to precisely target the tumor. Learn more about SBRT.
All radiation therapies are used with all lung cancer subtypes. MD Anderson’s lung radiation oncology team develops models for several different treatment types and determines which is best for each patient. Read more about radiation therapy.
Lung cancer proton therapy
A type of radiation therapy, proton therapy delivers a high dose of radiation directly to the tumor, sparing nearby healthy tissue and organs. MD Anderson operates one of the world’s largest and most advanced proton therapy centers. Read more about proton therapy.
Systemic Therapy for Lung Cancer
There have been significant advances in the treatment of lung cancer through the last decades. The medical oncologists at MD Anderson’s Thoracic Center are world renowned in the care of lung cancer patients and have participated in the clinical trials that have led to the development of important new treatments, including targeted and immune therapies.
Targeted therapy for lung cancer
Cancer cells use specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules. Currently there are targeted therapies for many subtypes of adenocarcinoma. Read more about targeted therapies.
Immunotherapy for lung cancer
Immunotherapies recruit the body’s own immune system in the fight against cancer. The current standard of care for non-small cell lung cancer includes the use of checkpoint inhibitor immunotherapies, which take the natural “brakes” off the immune system, allowing it to attack cancer cells. This treatment can lead to durable responses and has revolutionized care for lung cancer patients. Read more about immunotherapy.
Chemotherapy for lung cancer
Chemotherapy uses drugs to directly kill cancer cells by stopping their growth. This form of treatment is commonly combined with immunotherapy. In combination, both drugs become more effective. Learn more about chemotherapy.
Why choose MD Anderson for your lung cancer treatment?
Choosing the right hospital may be the most important decision you can make as a lung cancer patient. At MD Anderson you’ll get treatment from one of the nation’s top-ranked cancer centers. Our expertise starts with the ability to accurately diagnose and stage even extremely rare cancers, then carries on through groundbreaking treatment and into survivorship.
At other hospitals, doctors may be expected to develop treatment plans or perform surgery on patients with several different types of cancer or non-cancerous conditions. At MD Anderson, cancer is all we do. Even better, the surgeons, radiation oncologists and medical oncologists within the Thoracic Center focus exclusively on lung cancers and other types of cancer originating inside the chest. This allows them to develop a tremendous amount of experience and skill in treating lung cancer patients, including those with rare and hard-to-treat forms of the disease.
As a leading cancer hospital that’s focused exclusively on the disease, MD Anderson is also a leader in innovating new and better ways to care for patients. Our lung cancer doctors have helped develop treatments and therapies that offer new hope to lung cancer patients, decreased surgical recovery times and improved patient quality of life.
This treatment is available beyond MD Anderson’s campus in the Texas Medical Center. Through our five Houston-area locations, patients throughout the region can get the same top-ranked care and personalized attention close to home.
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Targeted therapy trial is giving me another chance
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Coping with lung cancer and heart disease
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Survivor is grateful for Cancer Prevention Center
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Lung Cancer Moon Shot
MD Anderson’s Lung Cancer Moon Shot® aims to rapidly and dramatically improve the disease’s survival rates and reduce suffering through prevention, early detection, research and new treatments.
Learn more about the Lung Cancer Moon Shot