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Lung Cancer Symptoms, Screening, Stages

To understand lung cancer, it’s first important to understand what cancer is: basically, the production of abnormal cells.

The body is programmed to routinely replenish cells in different organs. As normal cells age or get damaged, they die off. New cells take their place. This is what’s supposed to happen.

Abnormal cell growth refers to a buildup of extra cells. This happens when:

  • New cells form even though the body doesn’t need them or
  • Old, damaged cells don’t die off.

These extra cells slowly accumulate to form a tissue mass, lump, or growth called a tumor. These abnormal cells can destroy normal body tissue and spread through the bloodstream and lymphatic system.

Benign means not cancerous.  A benign tumor can get larger but does not spread to other tissues or organs.

Malignant means cancerous. A malignant tumor’s cells can invade nearby tissue and lymph nodes and then spread to other organs. These cells are destructive.

Benign tumors:

  • Can be removed
  • Usually don’t grow back
  • Are rarely fatal
  • Don’t spread to other tissues or body parts

Malignant tumors:

  • Can often be removed
  • Sometimes grow back
  • Can invade other tissues and organs and cause damage
  • Can spread to other body parts
  • Can be fatal

Lung cancer is the leading cause of cancer related death. It occurs in both men and women. It is more common in older adults.

To understand lung cancer, it’s helpful to understand how your lungs work.

When you breathe, you take in air. It goes through your nose, down your trachea (windpipe) and into your lungs. There it spreads through tubes that are called bronchi. Most lung cancer begins in cells that line these tubes.

You don’t have to smoke to get lung cancer. There are many different types of lung cancer.

Non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLS) make up 96% of lung cancers.

Non-small-cell lung cancer (NSCLC) is the most common type of lung cancer. It is very slow growing. NSCLC makes up about 80% of lung cancer diagnoses. Here are the common types of NSCLC:

  • Adenocarcinomas

In Situ Pulmonary Adenocarcinoma (AIS) (previously known as Bronchioloalveolar carcinoma)

  • Squamous cell carcinoma
  • Pancoast/ Pulmonary sulcus tumor
  • Large cell undifferentiated carcinoma

Adenocarcinomas: To better understand what an adenocarcinoma is, consider the word: Adeno means gland; Carcinoma is a malignant tumor. These tumors are usually found in the outer area of the lung. This is the most common type of NSCLC.

Adenocarcinomas are usually slow-growing and are often found before the cancer has spread to areas outside of the lungs.

AIS tumors are “in situ” meaning the cancer is localized or not spread. Patients with this type of lung cancer tend to have a better prognosis, due to the ability to remove this small tumor.

Squamous cell carcinomas: Squamous cells are flat cells that line the airways of the lungs. Squamous cell tumors are usually found in the center of the lung near the air tube (bronchus). These tend to grow more slowly than other types.

Pancoast tumor:A type of lung cancer that begins in the upper part of a lung and spreads to nearby tissues such as the ribs and spine. Surgery for this type of tumor can be very difficult because of its location. Less than 5% of all primary lung cancers are Pancoast tumors.

Large cell carcinomas: Large cell carcinomas can occur in any part of the lung. The cells of large cell carcinomas are actually larger than normal cells. This type of lung cancer often grows quickly, sometimes making it difficult to treat.

Small-cell lung cancer (SCLC) is less common, and is very uncommon among non-smokers. Only about 15-25% of all lung cancers are SCLC. This tends to be a faster growing type of lung cancer. SCLCs are also referred to as oat cell cancers or neuroendocrine cancers.

SCLC usually spreads more rapidly than non-small-cell lung cancer. In most cases, SCLC has metastasized or spread to other parts of the body before it is diagnosed.

Some lung cancer consists of both NSCLC and SCLC. These are referred to as mixed small cell/large cell cancers. This is not common.

There are also rarer types of lung cancer including:

  • Mesothelioma: A tumor found in the lining of the chest of abdomen often linked to asbestos exposure.
  • Carcinoid: A slowing-growing tumor. Carcinoids are most often found in the gastrointestinal system, but they can sometimes appear in the lungs.
  • Sarcoma: Sarcomas are a type of tumor that beings in the soft tissues such as fat, muscle, connective tissue, or blood vessels.

Sometimes cancer starts somewhere else in the body and spreads to the lungs. If that is true, it is called metastatic cancer to the lung, not lung cancer.

With Your Healthcare Team

When going through cancer treatment, your healthcare team is very important. Your healthcare team may include your oncologists, surgeon, nurse navigator, a dietitian, a social worker, or other medical professionals. Every member plays an important role. Use the tips below for talking with your healthcare team:

  • Establish your main point of contact.
    • Your main point of contact will probably be a nurse navigator, but it may be another member of your healthcare team. Who should you contact first with questions?
    • You need to always be open and honest with your healthcare team about your physical and emotional well-being.
  • Do not be afraid to ask questions.
    • Cancer is usually not a medical emergency. There is time to ask your healthcare team any questions you may have and to consider your treatment options.
    • Write your questions down before your appointments. Take a pen and paper to write down the answers.
    • Before beginning treatment, ask your healthcare team the following:
      • What are all my treatment options?
      • What are the long term and short term side effects of treatment, and how can I manage them?
      • Will my fertility or ability to have children be affected?
      • Am I eligible for clinical trials?
      • If you develop any new problems or symptoms during treatment, tell your healthcare team immediately. You are not complaining. This is valuable information for your doctors.
      • Do not change your diet, start an exercise program, or take any new medications, including vitamins and supplements, during treatment without talking to your healthcare team first.

With Your Caregiver

Your primary caregiver may be with you when you receive your diagnosis. Your primary caregiver may be your spouse, partner, adult child, parent, or friend. Your primary caregiver is the person who may come with you to appointments, take care of you after surgery or treatment, and support you throughout your cancer journey.

  • Everyone reacts to the news of cancer differently. You may feel upset, shocked, or angry. It may take you some time to process the information. Your caregiver may react the same way you do, or your caregiver may not. Even if your caregiver does not react the same way you do, it does not mean that he or she does not care deeply.
  • Establish your role and your caregiver’s role early. For example, will your caregiver be the one scheduling most of your appointments, or do you prefer to take an active role? Find what works best for you and your caregiver.
  • Be open and honest with each other about how you both feel. Overly positive attitudes may hinder honest communication. It’s okay to be upset.
  • Encourage your caregiver to take time to care for his or her own physical and emotional well-being. Being a caregiver comes with its own hardships.
  • If your primary caregiver is your spouse or partner, your intimate and physical relationship may change.

With Your Children

Children are very perceptive, no matter their age. While you may wish to protect your children by not telling them about your diagnosis, even young children may be able to tell that something is wrong. Not knowing what is wrong may cause them more stress and anxiety.

Here are some tips to talk to your children and teens about your cancer diagnosis:

  • Wait until your emotions are under control and decide what to say ahead of time.
  • Tell the truth and answer questions honestly. Depending on your children’s ages, it may not be appropriate to give them all the details, but do be truthful.
  • Let them know what to expect. For example, let them know that after surgery you will need a lot of rest and may need to stay in the hospital. If your chemotherapy may cause you to lose your hair, let them know. Keep your children in the loop as much as possible.
  • Explain to your children, especially younger children, that they cannot “catch” cancer.
  • Let your children know that it is okay to cry or be upset. This may be especially important for your teens to hear.
  • Tell teachers, babysitters, and others with responsibilities with and around your kids about your diagnosis in case they see behavior changes you may need to know about.
  • Maintain normal schedules as much as possible.
  • Let your kids help. Allow them to help with chores, and let them know that their help is important. Teens may want to take an active caregiver role. Let them do so, at appropriate levels.
  • Look for support groups in your area. Many places offer support groups for children and teens whose parents have a cancer diagnosis.
  • Know when to seek professional help. If your child begins to demonstrate unusual behavior such as angry outbursts, nightmares, or poor grades in school, ask your healthcare team for a recommendation for a counselor.

With Family and Friends

You may choose to keep your cancer journey private, or you may choose to share your story with others. The choice is yours. Remember when family, friends, coworkers, or other acquaintances ask about your diagnosis, they are genuinely concerned about your well-being. You can share with them as much or as little information as you like. These suggestions may help you talk about your diagnosis:

  • Decide how much information you want to share before you start telling people about your diagnosis.
  • If you chose to keep your journey private, make sure to let people know that you appreciate their concern, but you hope they respect your privacy.
  • Choose someone close to you, like your caregiver, to spread the word about updates and treatment progress. After a long day of treatment, you may not feel like calling and texting people, but your friends and family will probably want to know how you are.
  • If you want to share your story, consider starting an email chain or a Facebook group. This way you can update everyone with one message instead of needing to answer a lot of emails and phone calls.
  • You can also create your own private website at MyLifeLine.org.
  • When people offer to help with things, let them. Your family and friends could cook dinner, drive you to an appointment, or babysit.
  • If you lose your hair due to treatment or have visible surgical scars, strangers may ask about your diagnosis. Have a response prepared. Again, you may share as little or as much as you like.

The following increase your risk for lung cancer:

  • Smoking
  • Second-hand smoke
  • Expose to carcinogens, cancer causing agents, such as:
    • Radon
    • Asbestos
    • Coal smoke
    • Diesel fumes
    • Personal history of cancer
      • Radiation of chest
      • Some treatments for Hodgkin lymphoma
      • Family history of lung cancer
      • Personal history of lung diseases such as:
      • Chronic Obstructive Pulmonary Disease (COPD)

Early stage lung cancer is usually asymptomatic, meaning the person has no symptoms. Some common symptoms of lung cancer include:

  • A persistent cough
  • Coughing up blood
  • Chest pains
  • Difficulty breathing or swallowing
  • Fatigue
  • Shortness of breath
  • Pneumonia
  • Wheezing
  • Hoarseness
  • Weight loss or loss of appetite

These symptoms could also be signs of other medical issues. Tell your doctor if you experience any of these symptoms.

The following guidelines are from the National Comprehensive Cancer Network’s 2015 guidelines for patients. To learn more, visit www.nccn.org.

Lung cancer screening is recommended for people who meet the following criteria:

  • 55 years of age or older
  • Smoked for 30 or more pack years*
  • Stopped smoking less than15 years ago
  • 50 years of age of older
  • Smoked for 20 or more pack years*
  • An additional risk factor, such as:

Family history of lung cancer, personal history of chronic lung disease (COPD, emphysema, bronchitis, pulmonary fibrosis), personal history of cancer, or jobs that expose you to arsenic, nickel, asbestos, beryllium, soot, cadmium, diesel fumes, chromium, or coal dust.

*Pack years are equal to number of packs smoked a day multiplied by number of years smoking.

Lung cancer screenings are not recommended for people who do not fit the above criteria. Lung cancer screenings are also not recommended for people in poor health who are not well enough to undergo curative treatment for lung cancer, such as lung surgery.

Low-dose computed tomography (LDCT) scans are used to screen for lung cancer. These scans are similar to CT scans but use a lower dose of radiation to create the images of the lungs.

The first LDCT scan is used as a baseline to determine a screening schedule. Follow up scans will depend on the patient’s other risk factors.

Always follow your doctor’s recommendations. The earlier lung cancer is discovered the easier it is to treat.

The TNM staging system is used for all types of cancer, not just lung cancer. The letters TNM describe the tumor size and if the cancer has spread to other areas:

  • T: indicates how big the tumor is
  • N: indicates number of lymph nodes with cancer cells in them
  • M: indicates metastasis, which means that cancer has spread to other body parts.

Using TNM, your doctor will diagnose your cancer according to one of the following stages:

Occult Stage- Lung cancer cells are found in sputum or in a sample of fluid collected during bronchoscopy, but a tumor cannot be seen in the lung.

Stage 0

Cancer cells are found only in the innermost lining of the lung or airway. A Stage 0 tumor is also called carcinoma in situ. The tumor is not invasive.

Stage 1

This is an invasive cancer. It has grown through the innermost lining of the lung. There are two categories: IA (£ 2cm) and IB (>2cm, £ 3cm). The difference is in the size of the tumor.

Stage 2

Stage 2 is more invasive than Stage 1. Cancer cells are in nearby lymph nodes. Or, the lung tumor has invaded the chest wall, diaphragm, pleura, or main bronchus. There are two categories, IIA and IIB. The main difference is where the cancer has spread and how large the tumor is.

Stage 3A

The tumor is large (>7cm) or invades surrounding structures or has spread to the lymph nodes in the neck, above the clavicle, or near the other lung.

Stage 3B

The tumor may be any size and has invaded nearby organs such as the heart, esophagus, or trachea.

Stage 4

Malignant growths may be found in the other lung. Cancer cells may also exist in other parts of your body, like the brain, liver or bone. This is the most advanced stage of lung cancer.

Terms and Definitions

Angliolymphatic: means cancer has spread to the lymph nodes

Antibody: a protein produced by the immune system to fight foreign substances

Atypia: an abnormal cellular structure

Benign: not cancerous

Cell Density: the number of cells in a single sample Cytology: the study of a single cell or a small group of cells Differentiation: how close the cells look to normal cells Dysplasia: the presence of abnormal cells

Florescence In Situ Hybridization (FISH): a test used to find genetic mutations

Granulomas: inflammation of the tissue, often from infection

Grade: how abnormal the cells look and how quickly the tumor is likely to grow

Histology: the way the cells look under a microscope

Hyperplasia: increased cell production

Inconclusive: with the current sample and tests, it cannot be determined if cancer is present

Invasive: the cancer has spread to surrounding tissues

In Situ: abnormal cells have not spread; the abnormal cells are only where they started

Malignant: cancerous

Metastasis: cancer that has spread to other parts of the body

Necrosis: cell death

Neoplasm: a growth made up of abnormal cells

Pleomorphic: able to change shape

Stage: how advanced the cancer is

Stains: used to color the tissues and cells so the pathologist can see them better

Tissue Block: the sample of tissue removed during a biopsy or surgery

How Lung Cancer Spreads

Before you can understand how lung cancer cells can spread, it's important to have a clear picture of the anatomy of your lungs.

Lung Cancer Diagram