VoxHealth
Medical Conditions

Lung cancer

Synonyms: Bronchogenic carcinoma, Carcinoma of the lung, Pulmonary carcinoma

Overview

Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the United States. Cigarette smoking causes most lung cancers. The more cigarettes you smoke per day and the earlier you started smoking, the greater your risk of lung cancer. High levels of pollution, radiation and asbestos exposure may also increase risk.

Doctors diagnose lung cancer using a physical exam, imaging, and lab tests. Treatment depends on the type, stage, and how advanced it is. Treatments include surgery, chemotherapy, radiation therapy, and targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells.

NIH: National Cancer Institute

www.nlm.nih.gov/medlineplus

Symptoms

Symptom
Frequency
Shortness of breath
Cough
Fatigue
General weakness
General pain
Chest pain
Difficulty breathing
Nausea
Back pain
Vomiting
Show more symptoms
Fever
Reduced appetite
Coughing up blood
Anemia
Dizziness
Abdominal pain
Drainage in throat
Headache
Diarrhea
Weight loss
Difficulty swallowing
Edema

Demographics

Age Distribution

The average age of someone with Lung cancer is 66.

Gender Distribution

Lung cancer is significantly more common among males.

Geographic Distribution

Prevalence is higher in the Northeast.
Prevalence is also higher in the South.

Note that above data is by region (Northeast, South, Midwest, West) and not by state.

Prognosis

The average prognosis for someone diagnosed with Lung cancer is poor. The average five-year survival rate is 17%, meaning that only 17% of people are still alive five years after their diagnosis.

Prognosis by Stage

Localized
Regional
Distant

If caught early (in the localized stage), the average five-year survival rate is 54%. Once the cancer has metastasized (the distant stage), the five-year survival rate drops to 4%.

Medications

Prescription

Medication Name
Substance
Drug Class
Carboplatin
carboplatin
Alkylating Agents
Cisplatin
cisplatin
Alkylating Agents
Taxol
paclitaxel
Mitotic Inhibitors
Gemzar
gemcitabine
Antimetabolites
Camptosar
irinotecan
Topoisomerase I Inhibitors
Avastin
bevacizumab
Angiogenesis Inhibitors
Cyramza
ramacirumab
Angiogenesis Inhibitors
Tarceva
erlotinib
Protein Kinase Inhibitors
Gilotrif
afatinib
Protein Kinase Inhibitors
Iressa
gefitinib
Protein Kinase Inhibitors
Xalkori
crizotinib
Protein Kinase Inhibitors
Zykadia
ceritinib
Protein Kinase Inhibitors
Opdivo
nivolumab
Immunomodulators
Zofran
ondansetron
Antiemetic/antivertigo Agents

Risk Factors

Racial/Ethnic Distribution

Prevalence is significantly higher among Caucasians.

Tobacco Use

Tobacco use is a significant risk factor for Lung cancer. Someone who smokes is roughly 2 times more likely to be affected.

Stories

In order to know a condition, you have to know the stories of the people living with it. That's why we asked people, “What is it like?” This is what they had to say.

Karen

Karen Loss is no stranger to cancer. In her thirties, she successfully battled ovarian and uterine tumors, so when she was diagnosed with cancer again at 53, the surprise was blunted. It was a blow, however, to learn though the tumors were small, it was a Stage IV cancer, metastasized from her right lung into her liver.

Read Karen's Story

Yet a deeper frustration came from the assumptions people made about the lung cancer.

Karen lives a clean, meticulous life. She exercises regularly, and her home, in a bustling suburb of Washington, D.C., is neat and tidy. Though small and lined with shelves of books and mementoes of her charity work in Haiti and Ethiopia, the apartment doesn’t feel cluttered. And upon walking in, what’s most striking is the smell: there isn’t one. No grease, no scented candles, no reek of stale nicotine. Karen is a lifelong non-smoker.

People assume that cigarettes must be a part of your life if you develop lung cancer; indeed, a 2003 study stated that around 90 percent of lung cancers are caused by smoking, though more recent studies suggest it’s closer to about 85 percent. Still, it’s no surprise people draw that conclusion; it’s what we’re told. But Karen takes umbrage at the insinuations, when they invariably come.

“No one says to diabetics, ‘Did you overeat?’ The unspoken implication is that we’ve brought this upon ourselves somehow,” she says. “We try to tell people, do you have lungs? Then you can get lung cancer.”

Two and a half years after her diagnosis, Karen still lives with her cancer. The tumor in her lung, shrunken from chemotherapy, is relatively unchanged; the one in her liver, slowly growing. She has a full head of hair again, but is braced for more eventual chemotherapy. She has resumed her active lifestyle—her cancer is not advanced enough to slow her down. She is basically healthy, she says, but happens to have a couple of extra growths.

During her initial treatment, she preferred to rotate through a deep collection of hats and scarves rather than wear itchy wigs; she wrote regular e-mail updates to friends and family that became a book, Trekking Through Cancerland. She’s impassioned by the desire to change the perception that lung cancer is scourge only of smokers, to educate others about what she’s realized is a greatly misunderstood disease.

Having surpassed breast cancer as the most lethal cancer among women in 1987, lung cancer kills 160,000 Americans every year—more than prostate, breast and colorectal cancers combined. Men are more affected than women; African Americans more than other ethnicities. The five-year survival rate for lung cancer is lower than many other cancers: only 17 percent for lung cancer, compared with 65 percent for colon cancer, 90 percent for breast cancer, and 99 percent for prostate cancer. If caught early, when tumors are still localized in the lungs, the survival rate is much better, at 54 percent.

But that’s rare, and more than half of newly diagnosed patients die within one year.

“ Living with cancer has plenty of peaks and valleys, but the operative word to me is ‘living’. This photo represents someone with spirit and spunk. I try to be that person, even in the midst of my circumstances. ”

Karen’s cancer was caught by accident, when she sought treatment for what she calls chest attacks, recurrent spasms of severe tightening at the base of her sternum. Extremely painful and striking at random, a particularly bad one sent Karen to a local urgent care clinic, thinking she might be having a heart attack. Doctors thought it might be gall bladder attacks. Just days before Thanksgiving, an investigative scan revealed masses in her lung and liver, pressing against her heart.

When the call came that confirmed it was indeed cancer, Karen was at work. Her reaction was to calmly walk down the hall to where her supervisor sat to tell him that she’d probably be needing some time off soon for chemotherapy. Though everyone in her company was supportive, she ended up continuing to work as much as possible, day in and day out, staving off the possibility of boredom and self-pity.

Karen’s written missives to her circle of friends and family are often playful, belying the stress and uncertainty she sometimes felt during the early days of her diagnosis and difficult weeks of chemotherapy. “I will soon (it turns out probably within 2-3 weeks, I believe) be losing my hair,” she writes in the early pages of her book. “This will save me blow drying time in the mornings and allow that little bit of extra sleep. Woohoo!! And, I’m planning to wear a Nationals’ baseball helmet as my head covering of choice.”

She attributes her upbeat attitude to two things: her strong faith, and her belief that positivity is a healing factor.

“What helped was to write, to educate others about it,” Karen says. “It’s important to spread the message that lung cancer doesn’t just happen to smokers, and that every cancer patient deserves the same care and compassion as any other.”

She’s a regular on the speaker beat, giving the lead-in to a keynote speech at the 2014 BIO International convention; she helps raise funds at events and participates in walks and stair climbs for lung cancer awareness. She said that as backwards as it sounds, lung cancer has been a sort of blessing, because it’s given her life greater focus.

“I’ve spent my entire adult life trying to figure out where I fit in the world,” she says. “I may have been placed on this earth to help inspire and educate others about this disease and what it can do. Doctors, for the most part, do not and cannot speak from a first-hand perspective. We patients have a lot to offer that only we can offer.”

By Michelle Z. Donahue

Louise

Louise was a wonderful mother, wife and homemaker. In April of 2004, she was diagnosed with lung cancer. She was 71, and her husband and three children were shocked. The doctors told them that the mass they found in her esophagus was a ticking time bomb.

Read Louise's Story

Louise spent much of her life at home. Before she had children, she worked at an office as a secretary and became a nurse’s aid after her husband crushed two vertebrae, leaving him on disability. Her husband, a war veteran and lumberjack, took care of the cooking and cleaning while he was unable to work. When Louise was diagnosed with cancer, not much changed in her husband’s behavior. He was right there to take care of her every step of the way.

At first, Louise just had a bad cold and cough. It didn’t go away, so she saw her family physician. He gave her some prescription medications for the cold, but when those didn’t help, he was more concerned. Her son John tells her story, “At this point, mom was progressively getting more and more ill, and the family physician referred her to another doctor with more expertise. We’re from a rural town, so the technology at our hospitals weren’t state-of-the-art. My sister Debbie went with my mom to her next appointment. When Debbie saw mom that day, she noticed a dramatic difference in her appearance. She looked very ill and had a gray pallor.”

At this appointment, Louise was evaluated by a respiratory specialist who ordered an X-ray. “When the results came back, they told my sister that the x-ray showed a large mass near mom’s esophagus and needed to proceed with emergency surgery. The doctors claimed she was hours away from death and that they did not know if her body would be able to handle the procedure. They asked what to do if mom coded during surgery. Do we want them to try and resuscitate her? Luckily, this was not necessary,” John reports.

“I live halfway across the country in another state. When my sisters called me about the news, I had to book an emergency flight. I remember getting off of the plane, and walking up to the rental car stand. All I remember thinking was, ‘I just need directions to the hospital.’ The person behind the counter asked me if it was the east or west side, and I almost lost it. I didn’t know if I would get to see my mom alive again. ‘I don’t know,’ I replied. ‘Tell me which one is closest and I’ll go there first,’ I said to him. Luckily, that was the right one. At that point I was walking down the hallway, and I didn’t know how she was. The moment I walked in the door, she was aware enough to hear the news they were giving her,” he remembers.

Louise made it through the surgery, and felt much better once they removed some of the mass. However, once the doctors saw how large the mass had grown, they reported that the cancer was malignant and inoperable. She only had a couple of months to live. They gave her the option of aggressive treatment, but the results were unlikely to change and the process would be very wearing on her.

“When she got the news, she was oddly calm. She took it well. However, for my family, our initial reaction was shock. Whether we did it in front of anyone or not, we were very upset and definitely cried about it. We’re a stoic family. We cracked for a minute or two, then it was all about how to proceed. We needed information on hospice and how to take care of her during her last few months.”

Louise elected to go home with the assistance of hospice and no treatment. She only remained in the hospital one day after surgery before returning home, escorted by an ambulance. The nurses, palliative care and medications were very helpful, but she never saw a doctor’s office again. A hospital bed and oxygen equipment were delivered to her house just before she arrived.

“My dad built that house. My mom loved nature, and he wanted her to be able to see it. So, he put huge picture windows in the front of the house by the living room. We set up her bed there so she had a beautiful view to enjoy. I remember, we hung these tacky, glass angel wind chimes from the curtain rods. It’s funny because we aren’t a religious family, but there was something comforting about them being there,” John said.

The most comforting part of this time for John was knowing his mother was in good hands. “The nurses and hospice home care were just outstanding. There was really no way my dad, my sisters and I could have kept mom home without their help. She had regular nurse’s visits, and all of them were very helpful in so many ways. I can’t say enough good things about the hospice care mom had,” John recollects. 

“ I’m solitary now, without the anchor of my parents. I’m a long way from home in Colorado where beautiful mountains and the wilderness are oblivious to our cares and short lives. ”

Louise’s husband and children took turns looking out for her over the following six months. Her two daughters were there 24/7, taking shifts with their mother while working full-time jobs. John flew out to see her every vacation day that he got. “She was pretty much bedridden at that point. She wasn’t too active before anyway. She would stay up to read and watch TV, and often times she’d be up all night. She loved television almost as much as she loved books. She was the first to have satellite TV before anyone in my neighborhood. We had a lot of channels to choose from that you wouldn’t normally have in a rural setting.”

Some people came to visit her, but when they did, they didn’t stay as often as usual. Six months after her diagnosis, Louise passed away in October of 2004.

“My mom was an amazing woman. Everyone loved her. She had a few close friends that we used to visit when we were kids. She kept up with the news, and was a veracious reader. Ever since I was a kid, every time we went to town for groceries, we went to the library. We left with 10-15 books every time, and they would be gone in a week or two,” John remembers.

Before his mother was diagnosed, John – as do most people - assumed lung cancer was something that only affected heavy smokers. Although his mother did smoke, she was a light smoker. She would have about a carton a week. He was worried about her intake of cigarettes, but knew that there were other variables that cause lung cancer.

“When people were growing up in her era, there weren’t surgeon general warnings printed on the cartons. By the time this was mandated, she was addicted and it was part of her routine. Back then, smoking companies weren’t as regulated. They included ingredients that were making them more addictive. Mom didn’t know. We were very poor, and mom struggled with depression in an era when people were not open to talking about it. She also struggled with her weight and self-esteem. It was a way for her to deal with stress,” John recalls.

John never tells people that his mother died of lung cancer. Everyone just assumes it was her fault. “It’s not anyone’s fault that they got cancer,” John says. “There are so many other reasons that they could have gotten cancer. My mom didn’t start smoking thinking ‘I want to die from cancer one day.’ Not everyone who smokes dies of lung cancer, yet it’s the only type of cancer where we blame the victim.”

Since his mother’s death, John has cut back on alcohol, enhanced his exercise, and decided to live healthier. “I rarely drink beer. I try to be very healthy and make good choices. I want to live a full life. I want to do and experience the years I have left. Life is about what you do, the friends you have, and how you spend your time. After mom died, I started to evaluate my life. I was a corporate accountant for years, and I decided that it wasn’t for me. I wanted to help people. I’m currently studying to be an EMT. I don’t see any reason why I should spend the rest of my days any other way,” John concludes.

To anyone struggling to cope with a loved one’s cancer, John says: “Make sure you take care of yourself. You have to make time for you. There will be a very difficult time after you lose someone to cancer that you feel both grief for losing them but also guilt for the relief that the caregiving is over. You don’t have to empty the bed pans anymore or worry about their every need. It’s a very difficult emotion. Part of my family’s sadness after mom’s passing was the guilt. Being a caretaker is such a huge responsibility. You don’t get any sleep. You need to be there at their beck and call … but that’s normal. You feel guilty because you lost your temper a couple times due to stress. Those moments are going to happen though. Everyone feels it. Figure out a way to forgive yourself.”

By Ashley Spencer, Writer’s Ink

legend

All the data above are calculated from anonymized medical records.

Bars in this color represent statistically significant associations.