Lung Cancer

A big misconception is that only smokers can get lung cancer, but smoking is one of the major risk factors associated with lung cancer. You can also develop lung cancer from breathing second hand smoke or from exposure to cancer-causing substances. If you do smoke, we’ve listed some ways to help you stop:

Trying to kick a smoking habit? Try these 3 tips:

1. Don’t Go Alone: There are online, virtual, and in-person smoking- cessation groups. All have proven beneficial to help patients quit smoking.
2. Pay Attention to Your Smoking Triggers and Try to Avoid Them: Are you most likely to smoke while having a glass of wine with friends? Meet for a walk instead. Or maybe you smoke at work when you’re stressed. Instead of heading outside, try a meditation app. Once you pinpoint your smoking triggers, replace them with new habits to make quitting easier.
3. Hit the Gym: Exercise has been shown to help stave off nicotine cravings—and it can help reduce weight gain, which can sometimes be an unwanted side effect of quitting smoking. Win-win!

A big misconception is that only smokers can get lung cancer, but smoking is one of the major risk factors associated with lung cancer. Smoking cigarettes, pipes, or cigars, now or in the past causes 80% of lung cancer

You can also develop lung cancer from breathing second-hand smoke or from exposure to cancer-causing substances such as:

• Radon, which naturally occurs outdoors in harmless amounts, but sometimes becomes concentrated in homes built on soil with natural uranium deposits.
• Asbestos
• Chromium
• Nickel
• Radioactive ores, such as uranium and plutonium
• Arsenic
• Vinyl chloride
• Silica
• Coal products
• Mustard gas
• Chloromethyl ethers
• Diesel exhaust
• Soot
• Tar

Other risk factors include:

• A family history of lung cancer: You have a higher risk of developing lung cancer if a family member also had lung cancer.
• History of radiation therapy to the chest: If you are a cancer survivor, there is a risk that you can develop another lung cancer due to having radiation therapy in the past. We have now operated on 53 women who developed lung cancer after radiation treatment for breast cancer. Patients with a history of radiation to the chest should consider screening chest CT scans.
• Air pollution: Both indoor and outdoor air pollutants can contribute to lung cancer. The World Health Organization (WHO) classifies outdoor air pollution as a carcinogen. On an average day in Beijing, the SMOB is 20 times the safe limits for SMOG levels. Some estimate this will increase the rate of new lung cancers in China to 800,000 cases per year.

Blood and urine test for cancer

The Saint John’s Cancer Institute is a leader in liquid biopsies (checking a patient’s blood to look for cancer cells). We are studying the use of these tests for diagnosis, staging, and follow up.

Sputum cytology

Looks for cancer in sputum tests.

Thoracentesis

A needle passes between the ribs into the chest cavity to drain fluid which can be checked for cancer cells.

Biopsy to obtain a sample of a tumor to make a diagnosis:

Needle biopsy

A needle guided by CT scan passes between the ribs into a  lung mass. Tissue is evaluated under a microscope.

Surgical biopsy

Often performed by video-assisted thoracic surgery (VATS) under general anesthesia, is obtained through a small incision in the chest. A video camera is inserted so the surgeon can see what to biopsy. The patient usually stays in the hospital for 1-2 days. Sometimes the procedure is expanded to remove the whole mass for a cure.

Bronchoscopy:

A flexible tube (bronchoscope) passes into the trachea to look for narrowed windpipes or tumors, and to get biopsies.

Navigational bronchoscopy

Uses a computer as a GPS guidance system to direct the bronchoscope where to get a biopsy

Transbronchial biopsy

Uses fluoroscopy to direct the bronchoscope where to get a biopsy

Biopsy and Staging of Mediastinum (middle of the chest):

Endobronchial ultrasound (EBUS)

Uses ultrasound to direct the bronchoscopy where to get a biopsy of lymph nodes or lung masses.

Mediastinoscopy

Under general anesthesia, an instrument, called a mediastinoscope, passes into the mediastinum to obtain biopsies of mediastinal lymph nodes.

Treatment is determined by the type and stage of lung cancer. Treatment may be surgery, chemotherapy, radiation therapy, immunotherapy, targeted drug therapy, or a combination of treatments.

Chest X-ray

Chest x-ray to look for a mass in the lungs.

Computerized tomography scan

CT-scan combines X-ray and computer technology to create very detailed images of the inside of the chest.

PET scan

Positron emission tomography is an x-ray that is usually used to evaluate and stage patients with a lung mass. The PET scan provides the following information:

Lung Mass

If a lung mass does not light up on the PET, there is about a 5% chance it is cancer. If the mass does light up on the PET, there is an 80% chance it is cancer. The OPET does not prove that a mass is or is not a cancer

Lymph Nodes

If nodes light up on the PET, they usually contain cancer (Table 1), but we see a 20% false-positive rate (20% of nodes that light up have no cancer in the node) so a biopsy is usually performed to determine if cancer is really present in nodes that light up on PET.

Distant Metastases

The PET is often used to determine if a cancer has spread from the lung to other parts of the body.

MR

MR and CT scans can both image all parts of the body. They have many similarities and differences, as seen in the Table: