Dr. M.J. Bazos, Patient Handout

About Your Diagnosis
Cancer of the lung is the most common cancer among both men and women. Every year more than 170,000 new cases are diagnosed. Nearly 90% of lung cancers originate from the lining of the tubes in the lung called bronchi and bronchioles or from the air sacs called alveoli. Lung cancer is usually divided into two types: non–small-cell lung cancer and small-cell lung cancer. Therapy is different for each type. Nearly 90% of all lung cancers occur among persons who smoke or are former smokers. This makes use of cigarettes, cigars, or pipes the main cause of lung cancer. Other possible causes include asbestos exposure, especially for smokers, radon and radiation exposure, and secondhand smoke. The only sure way to diagnose lung cancer is by means of tissue biopsy. This procedure is performed in different ways depending on the location of the suspected area in the lung. Bronchoscopy (examination with a lighted scope that passes through the mouth into the breathing passages) is the procedure of choice to obtain the biopsy specimen. If this procedure is unsuccessful, needle aspiration (placing a needle through the chest into the tumor to retrieve cells) is performed. Sometimes there is fluid in the space that surrounds the lung. This fluid can be removed with a needle to check for cancer cells (thoracentesis). If none of these procedures leads to a definite diagnosis, an operation can be performed to open the chest (thoracotomy). Some lung cancers can be cured but only if detected very early, before any spread (metastasis) occurs.

Living With Your Diagnosis
The signs and symptoms of lung cancer include a persistent cough, coughing up blood-tinged phlegm, wheezing, shortness of breath, recurrent pneumonia, loss of appetite, and weight loss. Sometimes the tumor can press on a large vessel, which causes swelling of the face and neck. If the tumor is
pressing on nerves near the lung, this can lead to pain in the shoulder, arm, and hand. Lung cancer also can produce hormones that lead to various syndromes.

Once lung cancer has been diagnosed, staging is performed to determine whether the tumor has spread. For non–small-cell lung cancer, staging helps determine whether the tumor can be removed and whether surgical treatment is possible. Computed tomography (CT) of the chest and abdomen is ordered to help detect the spread of lung cancer to the lymph nodes or liver. Mediastinoscopy or mediastinotomy (operations to obtain biopsy specimens of lymph nodes in the chest) is performed, and a bone scan is ordered to look for spread to bone. Breathing tests (pulmonary function tests) help determine whether you can tolerate an operation. For small-cell lung cancer, CT of the head and a bone marrow biopsy are performed to look for spread into the brain or involvement of the marrow. For patients with non–small-cell lung cancer that is localized, an operation is the treatment of choice and provides the best hope for cure. For patients with more advanced disease or those who cannot tolerate an operation, radiation therapy alone or
radiation and chemotherapy are recommended. For patients with small-cell lung cancer, chemotherapy or combined chemotherapy with radiation therapy is recommended according to the findings at staging. The types of treatment and common complications are as follows:
1. Surgical treatment. The main complication is pain, especially with turning, coughing, and deep breathing. Patients may feel short of breath, but this may gradually improve as the remaining lung tissue expands, making it easier to breath.
2. Radiation therapy. Fatigue is a common complication. The skin over the treated area may become red, dry, tender, and itchy. A dry sore throat may occur. Scarring of the lungs may occur, which can lead to shortness of breath.
3. Chemotherapy. Complications depend on the drugs used. Anticancer drugs affect cells that divide rapidly, including blood cells, which fight infection and help the blood to clot. Therefore easy bruising and bleeding may occur. Hair cells and digestive tract cells become affected, leading to nausea, vomiting, and hair loss.

The DOs
• Understand the consequences of smoking.
• Seek the advise of an oncologist (cancer specialist) regarding therapy for lung cancer.
• Understand the importance of nutrition before and after therapy for lung cancer.

The DON’Ts
• Do not be afraid to ask questions.
• Do not smoke.
• Do not be afraid to ask for a second opinion. Therapy for lung cancer is complex, and many decisions have to be made before you feel comfortable with the type of treatment you receive.
• Do not be afraid to ask about support groups.

When to Call Your Doctor
• If you have a persistent cough or are coughing up blood.
• If you are more short of breath.
• If you have no appetite and are losing weight.
• If you have a fever while undergoing chemotherapy.
• If you are having pain.