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Lung cancer is the most common type of cancer in both men and women in this country. According to the American Cancer Society, almost 220,000 people are diagnosed with it each year. Most cases are linked to tobacco smoking.
The lungs, which help you breathe, are two sponge-like, cone-shaped organs in the chest. When you breathe in, oxygen comes through your mouth and nose. It then travels through the windpipe (trachea), which divides into two tubes called bronchi. These take the oxygen to the left and right lungs. The inside of the lungs includes smaller branches called bronchioles and alveoli, which are tiny air sacs.
Each lung is divided into sections called lobes. The right lung has three lobes. The left lung, which has two lobes, is smaller than the right lung because the heart is also on the left side of the body.
The pleura is a thin membrane that covers the outside of each lung and lines the inside wall of the chest. It usually contains a small amount of fluid and forms a protective lining around the lungs that allows them to move smoothly during breathing.
Cancer Grows in Lungs, May Spread
Lung cancer forms in the tissues of the lungs, most often in the cells that line air passages. It occurs when cells in your lungs grow and multiply uncontrollably, damaging surrounding tissue and interfering with the lungs’ normal function.
Lung cancer may spread through your lymph system. Lymph is a clear fluid that contains tissue waste and cells that help fight infection. It travels through your body in vessels that are similar to veins. Lymph nodes are small, bean-shaped organs that link lymph vessels.
Cancer cells can spread, or metastasize, to other parts of your body through the bloodstream as well. When lung cancer spreads to other organs, it still is called lung cancer.
Lung Cancer Types
Lung cancer is classified by the type of cells within the tumor. Each type of lung cancer grows and is treated in a different way. Lung cancers are divided into two main groups.
Non-small cell lung cancer (NSCLC): This is the most common type of lung cancer. The categories of non-small cell lung cancer are named for the type of cells in the cancer:
Adenocarcinoma begins in cells that line the alveoli and make mucus. It is found more often in nonsmokers, women and younger people.
Squamous cell carcinoma (cancer) begins in thin, flat cells in the lungs, and tobacco smoking most often causes it. It also is called epidermoid carcinoma.
Large cell carcinoma (cancer) begins in certain types of large cells in the lungs.
Small cell lung cancer: Also known as oat-cell cancer, this type of lung cancer makes up less than 20% of lung cancers and almost always is caused by tobacco smoking. It often starts in the bronchi, then quickly grows and spreads to other parts of the body, including the lymph nodes.
Other types of lung cancer
Less common types of lung cancer include:
- Carcinoid tumors
- Salivary gland carcinoma
- Some sarcomas
- Cancer of unknown primary
Lung metastases
Cancer found in the lungs is sometimes another type of cancer that started somewhere else in the body and spread, or metastasized, to the lungs. These tumors are called lung metastases, and they are not the same as lung cancer. They usually are the primary, or original, type of cancer.
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.
Lung Cancer Risk Factors
Anything that increases your chance of getting lung cancer is a risk factor. Smoking is the main risk factor for lung cancer.
- Smoking tobacco in cigarettes, cigars or pipes is responsible for 87% of lung cancer cases in the United States.
- The more years you smoke and the greater amount you smoke, the higher your risk of lung cancer.
- If you stop smoking, your risk of lung cancer becomes lower as time goes by.
- If you smoke and have other risk factors, your chance of getting lung cancer is higher.
- Read more about MD Anderson’s smoking cessation clinical trials
Other risk factors for lung cancer include:
- Family history of lung cancer
- Previous lung cancer
- Exposure to certain materials including radiation, arsenic, radon, chromium, nickel, soot, tar or asbestos
- Radiation therapy to the breast or chest
- Air pollution
- Secondhand smoke
- Lung diseases such as tuberculosis (TB)
Not everyone with risk factors develops lung cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.
Lung Cancer Symptoms
Lung cancer symptoms vary from person to person, and sometimes people with lung cancer don’t have symptoms. If you have symptoms, 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 spit
- Shortness of breath, wheezing or hoarseness
- Repeated episodes of pneumonia or bronchitis
- Swelling of the neck and face
- Loss of appetite and/or weight loss
- Feeling weak or tired
- Clubbing of fingers
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
- 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?
Lung Cancer Diagnosis
If you have lung cancer, it is important to get an accurate diagnosis as early as possible and find out if the cancer has spread. This will help your doctors choose the best type of treatment.
MD Anderson has the most advanced and accurate equipment available to diagnose lung cancer and find out precisely the extent of the disease. This helps increase the likelihood that your treatment will be successful. Our staff includes pathologists, diagnostic radiologists and specially trained technicians who are highly skilled in diagnosing lung cancer.
If you have symptoms that may 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.
Lung Cancer Diagnosis
If you have symptoms that may signal lung cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking habits; your family history; and whether you have been around certain chemicals or substances.
One or more of the following tests may be used to find out if you have lung cancer and if it has spread. These tests also may be used to find out if treatment is working.
The two main tests to find out if you have lung cancer are:
- Chest X-rays: Photographs of the lungs to look for abnormal areas.
- Sputum cytology: A sample of mucus or phlegm brought up by coughing is looked at under a microscope.
If chest X-rays show an abnormal area, one or more of these tests may be used to find out if you have lung cancer:
Bronchoscopy: A thin flexible tube with a tiny camera is inserted through the nose or mouth and down into the lungs. A bronchoscope also can be used to take a small tissue sample for biopsy.
Fine needle aspiration (FNA): A very small needle is placed into the tumor. Suction is used to remove a small amount of tissue, which is then looked at under a microscope.
Thoracentesis: Fluid from around the lungs is drawn out with a needle and looked at under a microscope.
Endobronchial Ultrasound (EBUS): Guided biopsy to check for lung cancer and find out if cancer has spread to nearby lymph nodes.
Video-Assisted thoracoscopic surgery (VATS)
Imaging tests, which may include:
- CT or CAT (computed axial tomography)
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
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.
Lung cancer staging
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.
Stages of lung cancer
(source: National Cancer Institute)
Small-cell lung cancer stages
Limited stage: Cancer is in one lung and possibly in lymph nodes on the same side of the chest.
Extensive stage: Cancer has spread to the other lung, to lymph nodes on the other side of the chest, to the fluid around the lung or to other parts of the body.
Non-small cell lung cancer stages
Stage 0 through stage IB tumors in which cancer has not spread to the lymph nodes are considered early stage lung cancer.
Occult stage: Lung cancer cells are found in spit or in a sample of mucus (phlegm) taken during bronchoscopy, but a tumor cannot be seen in the lung by imaging or bronchoscopy, or a tumor is present but is too small to be biopsied.
Stage 0: Abnormal cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A stage 0 tumor is also called carcinoma in situ. The tumor is not an invasive cancer.
Stage 1A: The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no more than 3 centimeters across. It is surrounded by normal tissue and does not invade the bronchus. Lung cancer cells are not found in nearby lymph nodes.
Stage 1B: The tumor is larger or has grown deeper, but lung cancer cells are not found in nearby lymph nodes. The lung tumor is one of the following:
- More than 3 centimeters across
- Grown into the main bronchus
- Grown through the lung into the pleura
Stage 2A: The lung tumor is no more than 3 centimeters across. Lung cancer cells are found in nearby lymph nodes.
Stage 2B: The lung cancer is one of the following:
- Not found in nearby lymph nodes but has invaded the chest wall, diaphragm, pleura, main bronchus or tissue that surrounds the heart
- Cancer cells are found in nearby lymph nodes and the tumor in the lung is one of the following:
- More than 3 centimeters across
- Grown into the main bronchus
- Grown through the lung into the pleura
Stage 3A: The tumor may be any size. Lung cancer cells are found in the lymph nodes near the lungs and bronchi and in the lymph nodes between the lungs on the same side of the chest as the lung tumor.
Stage 3B: The tumor may be any size. Lung cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumor may have invaded nearby organs, such as the heart, esophagus or trachea. More than one malignant growth may be found within the same lobe of the lung. Cancer cells may be found in the pleural fluid.
Stage 4: Tumors may be found in more than one lobe of the same lung or in the other lung. Lung cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver or bone.
Lung Cancer Treatment
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, 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.
MD Anderson offers the most advanced lung cancer treatments, many available at only a few locations in the United States. Your lung cancer therapy may include:
- Proton therapy
- Targeted therapies
- Gene therapy and use of nanoparticles to deliver chemotherapy
- Minimally invasive operations
- Treatment for lung cancers that elsewhere might be considered inoperable
- Special techniques for treating cancers that invade the spinal column
And we’re constantly researching newer, safer, more-effective treatment 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 translates to a wide variety of clinical trials for new treatments.
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
- Possible side effects of treatment
- Your general health
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 or help relieve symptoms.
Lung Cancer Surgery
Like all surgeries, lung cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure.
MD Anderson lung surgeons are among the most skilled and recognized in the world. They perform a large number of lung surgeries each year, using the least invasive and most effective techniques.
Lung cancer may be treated with surgery alone or combined with other treatments. Chemotherapy or radiation may be given:
- Before surgery to shrink tumors. This is called induction or neoadjuvant therapy.
- After surgery to help destroy cancer cells that may remain in the body. This is called adjuvant therapy.
- Surgery is used less often for small cell lung cancer because this type of cancer spreads more quickly through the body and is not often found in the early stages when it is confined to the lungs.
The most common types of surgery for lung cancer are:
- Wedge resection: Removal of the tumor and a pie- or wedge-shaped piece of the lung around the tumor
- Lobectomy: Removal of the lobe of the lung with cancer
- Segmentectomy or segmental resection: Removal of a segment, or part, of the lobe where the cancer is located
- Pneumonectomy: Removal of the entire lung
- Sleeve resection: Removal of part of the bronchus
In addition, lymph nodes in the chest will be removed and looked at under a microscope to find out if the lung cancer has spread. This will help doctors decide if you need further treatment after surgery.
Video-assisted thoracic surgery (VATS): MD Anderson surgeons are specially trained and highly skilled at performing this minimally invasive surgery, and they use the latest equipment available.
Other types of surgery
Sometimes surgery is needed to help problems caused by lung cancer or its treatment. This may include:
- Laser surgery to open a blocked airway
- Placement of small tubes (stents) to keep airways open
- Cryosurgery to freeze and destroy cancer tissue
- Placement of a Pleurx-Denver catheter to drain fluid that may accumulate in the pleural cavity (the layer of tissue that surrounds the lungs)
Lung Cancer Chemotherapy
MD Anderson offers the most up-to-date and effective chemotherapy options for lung cancer. Chemotherapy is often the main treatment for small cell lung cancer or if the cancer has spread (metastasized). MD Anderson offers techniques to help make chemotherapy more effective, including delivery by nanoparticles. If surgery is not an option for you, your doctor may suggest chemotherapy and radiation.
Lung Cancer Targeted Therapies
MD Anderson is among just a few cancer centers in the nation that are able to offer you targeted therapies for some types of lung cancer. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.
Lung Cancer Radiation Therapy
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target lung cancer more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. Radiation therapy may be used with chemotherapy and/or surgery.
The Thoracic Center provides the very latest radiation treatments for lung cancer, including:
- Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
- 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
- Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor
Lung Cancer Proton Therapy
The Proton Therapy Center at MD Anderson is one of the world’s largest and most advanced centers. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in better cancer control with fewer side effects.
Lung Cancer Photodynamic Therapy (PDT)
In photodynamic therapy, a light-sensitive chemical is injected into the body, where it remains longer in cancer cells than it does in normal cells. The chemical is activated with a laser that initiates the destruction of cancer cells. PDT often is used on very small tumors or to reduce certain symptoms of lung cancer.
Why choose MD Anderson for your lung cancer treatment?
From diagnosis through treatment and follow-up, MD Anderson's Thoracic Center gives you comprehensive lung cancer care every step of the way.
Some of the nation's top lung cancer experts focus their extraordinary expertise on you. They work together closely to ensure you receive the most advanced personalized care with the least impact on your body.
And our experts have at their fingertips the latest cutting-edge technology and techniques to treat lung cancer, including:
- Minimally invasive surgery
- Innovative radiotherapy planning and delivery techniques
- One of the few proton therapy centers in the country with experience treating lung cancer
- A wide range of clinical trials for all stages and types of lung cancer
Because your peace of mind is important to us, we specialize in techniques and therapies that can help preserve lung function.
We're often able to offer hope for lung cancer that elsewhere might be considered inoperable, and we've developed special techniques for treating cancers that have invaded the spinal column.
Leading-edge Research
MD Anderson is 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. As one of the world's largest cancer research centers, MD Anderson is leading the investigation into new methods of lung cancer diagnosis and treatment. Each patient benefits from the most advanced
MD Anderson has helped advance the treatment of lung cancer in many areas. Our research has helped:
- Demonstrate the effectiveness of paclitaxel (Taxol) for certain types of lung cancer
- Pioneer neoadjuvant (before surgery) chemotherapy
- Identify gene variants that influence lung cancer risk
- Discover nanoparticles that deliver drugs to lung cancer that is resistant to treatment
- Establish activity of novel biologic therapies that target specific types of tumors
- Develop four-dimensional simulation techniques to target lung cancer
- Pioneer ways to reduce damage to normal tissue during proton therapy and IMRT
- Discover a way to combine chemotherapy and radiotherapy to treat lung cancer
Everything changes after cancer. I just live in the moment. I just live for the special times.
It was a 5.5-cm tumor wrapped around Jason McFarland’s pulmonary artery that threatened to end his 20-year career as a police officer and, possibly, his life.
He’d sought medical attention after coughing up blood. But at age 42, he never suspected cancer.
The doctors near his hometown of Effingham, Illinois, weren’t optimistic about the diagnosis the X-rays and CT scans revealed: stage IIIA non-small cell lung cancer.
“It’s going to take a Herculean effort to survive this cancer,” his doctor told him.
Jason would need surgery, and because of the tumor’s location, it wouldn’t be easy. The doctor told him it was unlikely he’d get to go back to work and there was a 30% chance he might not make it off the operating table at all.
Jason thought of his wife and three children. He thought of the career he loved. He decided to look for other odds.
Finding hope at MD Anderson
It was a friend who worked in an emergency room that recommended MD Anderson.
“If I were you, I’d be in Texas,” he told Jason.
A week later, Jason and his wife flew to Houston for an appointment. He met with his care team, which recommended four rounds of chemotherapy, and then a lobectomy, followed by radiation therapy.
Jason loved the comradery and compassion among MD Anderson staff and the other patients. But most of all he loved the hope his doctors gave him.
Remembering the odds his doctor back in Illinois had given him, he asked his new surgeon, David Rice, M.D., what the chances were that he wouldn’t survive the surgery. Rice told him 3%.
“Look, you’ve got a difficult case, but it’s just another Monday for us,” Rice told Jason.
“That’s when I thought, I really like this guy,” Jason says.
Jason’s lung cancer treatment: chemotherapy and a lobectomy
Jason completed four cycles of chemotherapy at home in Illinois. This shrunk the tumor down to half its original size. Then, he returned to MD Anderson for surgery: a left lower lobectomy, in which they removed the tumor, along with a portion of his lung.
The surgery was successful, and Jason’s recovery was smooth.
“My pain was very well managed while I was in the hospital. On a scale, of one to ten, ten being very painful, I don’t think it ever got over a three,” he says.
He was discharged from the hospital five days later.
Jason’s radiation therapy
Given the location of Jason’s cancer, his radiation oncologist, Michael O’Reilly, M.D., told him it was best that he come to MD Anderson for his radiation therapy, so he returned in early November. This was going to be a longer stay than any of his previous visits, so he and his dad rented an RV and made the trip together.
Jason had heard stories about the difficult side effects that often accompany radiation, but he said he was fortunate that he didn’t experience any of them.
He finished his last round of radiation on New Year’s Eve 2014. His scans showed no evidence of disease.
Moving forward after lung cancer treatment
So far, Jason’s scans have all been clear. His doctors believe it’s very unlikely that the cancer will return. And while he could do his annual scans closer to home, Jason still returns to MD Anderson simply because he likes to visit.
As for going back to work, Jason returned Jan. 15, 2014 – just a few weeks after finishing up treatment. He can’t do everything he once did, but he’s grateful to continue serving.
“When you’re snatched from the jaws of death, some teeth marks are expected,” he says.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
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