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Lung cancer

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From MayoClinic.com

Risk factors

Smoking remains the greatest risk factor for lung cancer, accounting for as many as 9 out of every 10 cases of the disease. Your risk increases with the number of cigarettes you smoke each day and the number of years you have smoked. Your risk is also greater if you start smoking early in life — even if you later quit. Smoking filtered, low-tar or low-nicotine tobacco offers no additional protection because most people who smoke these cigarettes inhale more deeply, which also increases the risk. The good news is that it's never too late to quit smoking. Quitting — at any age — can lower your risk of developing lung cancer.

Other risk factors include:

  • Sex. Current or former women smokers are at greater risk of lung cancer than are men who have smoked an equal amount. Although the exact reasons for this are unknown, some experts speculate that women may have a greater susceptibility to the cancer-causing substances found in tobacco. Others believe that estrogen may play a role. Women also are known to inhale more than men do, and they are less likely to quit.

  • Exposure to secondhand smoke. Even if you don't smoke yourself, you're at high risk of lung cancer if you're exposed to the smoke of others. Daily exposure to secondhand smoke may increase your chances of developing lung cancer by as much as 30 percent. The Environmental Protection Agency has determined that secondhand smoke causes at least 3,000 lung cancer deaths a year.

  • Exposure to radon gas. Second only to smoking as a cause of lung cancer, radon comes from the natural (radioactive) breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Although unsafe levels of radon can accumulate in any building, the greatest exposure risk most people face is at home. The Surgeon General and the Environmental Protection Agency recommend that all homeowners check for the presence of radon. The best tests are those that take 3 to 6 months.

  • Exposure to asbestos and other chemicals. Workplace exposure to asbestos and other cancer-causing agents — such as vinyl chloride, nickel chromates and coal products — also can increase your risk of developing lung cancer, especially if you're a smoker.

  • Race. Lung cancer is much more prevalent among African Americans than it is among whites. African American men are two to four times more likely to develop lung cancer than are their white counterparts. They also develop the disease at an earlier age and are less likely to survive. Doctors don't think there's a genetic reason for this disparity. Rather, it is more likely to be related to inequities in health care and to environmental factors.

Screening and diagnosis

Screening for lung cancer is controversial. Some doctors believe that smokers, especially those 50 years or older, should have an annual chest X-ray, although having annual chest X-rays has never been shown to be of particular benefit.


A standard chest X-ray can reveal an abnormal mass or nodule in your lungs. And a CT scan may show very small lesions and whether cancer has spread to other areas. But as with all types of cancer, lung cancer can be definitively diagnosed only by looking at a tissue sample (biopsy) under a microscope. The sample may be removed using one of the following techniques:

  • Bronchoscopy. In this test, a flexible tube called a bronchoscope is passed into your airway. The bronchoscope allows your doctor to look inside your lungs as well as to take a tissue sample for examination in the laboratory.

  • Mediastinoscopy. In this test, an instrument passed through a small incision at the base of your neck allows your doctor to take a biopsy of lymph nodes in your chest. This helps determine how far the cancer has spread and whether surgery is a reasonable option for removing the tumor.

  • Transthoracic needle biopsy. Using an X-ray or CT scan for guidance, your doctor takes a small needle and places it into a mass in your lung, removing a small piece for study.

  • Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.

  • Thoracentesis. If you have fluid in your chest cavity, your doctor can remove a sample by inserting a thin needle into your chest between the ribs. The fluid is then examined in the laboratory for presence of cancer cells. When large amounts of fluid are present, thoracentesis can improve your breathing.

  • Video thoracoscopy. In this procedure, your doctor inserts a tube (endoscope) through a small incision between your ribs and partially collapses one of your lungs. This creates a space through which a pen-sized instrument with a video device is passed between the ribs and through your chest wall. Your doctor then can perform biopsies of nodules or masses while watching the procedure on a video screen. Your lung will expand again after the procedure.


Staging is a system of classifying information about cancer, including where and to what extent the cancer has spread. In many cases, Roman numerals are used to describe stages, with 0 being the least advanced and IV the most advanced. Your doctor uses this information to determine what treatment you need and to evaluate how your cancer might progress.

Non-small cell lung cancer

Non-small cell lung cancer is staged according to the size of the tumor, the level of lymph node involvement and the extent to which the cancer has spread. Stages of non-small cell lung cancer include:

  • Stage 0. At this stage, cancer is limited to the lining of the air passages and hasn't invaded lung tissue. Stage 0 cancers almost always are found during bronchoscopy, which is likely to have been performed to assess an abnormality on a chest X-ray. If found and treated promptly, cancers at this stage usually can be eliminated.

  • Stage I. Cancer at this stage has spread to layers of lung tissue but not to the lymph nodes.

  • Stage II. This stage cancer has invaded neighboring lymph nodes or spread to the chest wall.

  • Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes beyond the lung area.

  • Stage IIIB. The cancer has spread locally to areas such as the heart, blood vessels, trachea and esophagus — all within the chest.

  • Stage IV. The cancer has spread to other parts of the body, such as the liver, bones or brain.

Small cell lung cancer

Small cell lung cancer is staged differently from non-small cell types. Rather than using numbers, it's classified as either limited or extensive:

  • Limited. Cancer is confined to one lung and to its neighboring lymph nodes.

  • Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have invaded both lungs, more remote lymph nodes or other organs.


Your lungs are abundantly supplied with blood and lymph — a fluid that helps return water and proteins from your tissues to your blood. Lung cancer spreads easily to other parts of your body through your bloodstream and lymph system.

Small cell cancer, in particular, is a fast-growing tumor that quickly spreads to other organs. At the time of diagnosis, this type of cancer has already spread in more than two-thirds of people with the condition. Without treatment, the tumor will continue to grow and may prove fatal within a matter of months.

This kind of cancer responds very well to chemotherapy and radiation therapy — better than do non-small cell lung cancers. But even when there is a positive response to treatment, relapses usually occur within two years. Unfortunately, at that point the cancer usually isn't as responsive to further therapy.

In addition, some non-small cell lung cancers — even those identified at any early stage — may spread undetectably (micrometastasis) to lymph nodes and other organs. As a result, cancer can reappear months and even years after treatment.

lung cancer > 1 > 2 > 3 > 4

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