In the US, Lung Cancer Kills More People Than Breast Cancer, Colon Cancer, and Prostate Cancer Combined.

For the last few decades, survival for other cancers have significantly improved, and in just the last few years, screening and new treatments have finally started to improve survival rates for lung cancer.

The American Cancer Society’s estimates for lung cancer in the United States for 2020 are:

  • About 228,820 new cancer cases diagnosed
  • About 135,720 deaths from lung cancer

Overall, the chance that a man will develop lung cancer in his lifetime is about 1 in 15; for a woman, the risk is about 1 in 17. Black men are about 15% more likely to develop lung cancer than white men. The rate is about 14% lower in black women than in white women.

Both black and white women have lower rates than men, but the gap is closing. The lung cancer rate has been dropping among men over the past few decades, but only for about the last decade in women.

At the Saint John’s Cancer Institute, our physicians work closely together as a team to provide all the clinical resources you need during your cancer treatment. Your health care team includes distinguished thoracic surgeons, radiation oncologists, pathologists, pulmonologists and medical oncologists. The appropriate members of the lung cancer screening team or the Thoracic Tumor Board will review the CT scan and make recommendations.

Types of Lung Cancer

Types of Lung Cancer

There are two major types of lung cancer:

Non-Small Cell Lung Cancer

Non-small cell lung cancer accounts for 85 to 90 percent of lung cancers. The main types of non-small cell lung cancer are:

Squamous cell carcinoma

Squamous cell carcinoma (also called epidermoid carcinoma) often begins in the bronchi near the middle of the lungs.


Adenocarcinoma usually begins along the outer edges of the lungs. It is the most common type of lung cancer in people who have never smoked.

Large cell carcinomas

Large cell carcinomas are a group of cancers with large, abnormal-looking cells related to hormone-secreting glands. These tumors may begin anywhere in the lungs and grow quickly.

Small Cell Lung Cancer

Small cell lung cancer is sometimes called oat cell cancer. It grows rapidly and spreads to other organs. There are two types:


Limited cancer is generally found in one lung. There may be cancer in nearby lymph nodes on the same side of the chest.


Extensive cancer has spread beyond the primary tumor in the lung into other parts of the body.



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!

Symptoms of Lung Cancer

Lung cancer may not cause any symptoms and may be found on a routine chest X-ray or low-dose chest CT-scan.

Signs and symptoms of lung cancer may include:

  • Cough that doesn’t go away and worsens over time
  • Trouble breathing
  • Chest pain
  • Wheezing
  • Coughing up blood or rust-colored mucus
  • Hoarseness
  • Loss of appetite
  • Weight loss for no known reason
  • Feeling very tired
  • Pneumonia or bronchitis
  • Shoulder pain
  • Bone pain
  • Yellowing of skin and eyes (jaundice)
  • Headache, seizures, or confusion
  • Enlarged lymph nodes in the neck
Risk Factors

Lung Cancer Risk Factors

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.

Diagnosis of Lung Cancer

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.


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.


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.


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


Treatment for Lung Cancer

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

CT scan MR
Method Radiation

Fast with high resolution

Magnetic field
Slow, noisy, in smaller tunnel
Better test for Lungs, bones, chest, arteries Soft tissue, tendons, spinal cord, brain tumors
Time for test 5 minutes > 30 minutes
Contra-indicated Pregnant women, children, Obesity (>450 lbs)
Allergies kidneys Kidneys, liver
Cost Less More expensive

Stages of Lung Cancer

The staging system for any cancer was created to put cancers into groups that correlate with the prognosis and into categories that determine treatment. A simplified description of the 4 stages of lung cancer is shown below.

Illustration of the four stages of oncological disease - lung cancer

When to See a Provider

Unfortunately, lung cancer doesn’t usually cause symptoms until the cancer has spread, which makes it difficult to treat. Lung cancer screening is recommended for adults age 55-80 years who have smoked at least 1 pack per day for 30 years, current smokers, or former smokers who quit smoking within the last 15 years, if you have had radiation therapy in the past, or a family history of lung cancer.