Diagnosis and Treatment of

Diagnosis and Treatment of Lung Cancer James L. Jones, RRT, CPFT Coordinator, Respiratory Care Services Baptist Regional Medical Center Presented by: Sponsored by: This program has been approved by the Kentucky Board for Respiratory Care for 2 CEUs. Approval Number: 061205002 Primary Objectives: 1) Review of Lung Cancer Statistics 2) Review the types of Lung Cancer and the stages of the disease. 3) Learn the different treatment options available for Lung Cancer Patients Basic Information Lung cancers are cancers that begin in the lungs. Other types of cancers may spread to the lungs from other organs. However, these are not lung cancers because they did not start in the lungs. When cancer cells spread from one organ to another, they are called metastases. Facts Aside from non-melanoma skin cancer, lung cancer is:  The second most common cancer for all men in the United States  The second most common cancer among white and American Indian Alaska Native women Diagnosis and Treatment of Lung Cancer  The third most common cancer among black, Asian/Pacific Islander and Hispanic women In 2002 (the most recent year for which statistics are currently available):  100,099 men and 80,163 women were diagnosed with lung cancer.  90,121 men and 67,509 women died from lung cancer. Lung Cancer Definition Cancer of the lung, like all cancers, results from an abnormality in the body’s basic unit of life, the cell. Normally, the body maintains a system of checks and balances on cell growth so that cells divide to produce new cells only when needed. Disruption of this system of checks and balances on cell growth results in an uncontrolled division and proliferation of cells that eventually forms a mass known as a tumor. Tumors can be benign or malignant; when we speak of "cancer" we refer to those tumors that are considered malignant. Benign tumors can usually be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system, which spread the tumor to other sites in the body. This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastases. Since lung cancer tends to spread, or metastasize, very early in its course, it is a very life-threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain organs – particularly the adrenal glands, liver, brain, and bone - are the most common sites for lung cancer metastasis. The lung is also a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original, or primary, tumor. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer in the lung and is not lung cancer. Lung Cancer Picture The principal function of the lungs is the exchange of gases between the air we breathe and the blood. Through the lung, carbon dioxide Diagnosis and Treatment of Lung Cancer is removed from the body and oxygen from inspired air enters the bloodstream. The right lung has three lobes while the left lung is divided into two lobes and a small structure called the lingula that is the equivalent of the middle lobe. The major airways entering the lungs are the bronchi, which arise from the trachea. The bronchi branch into progressively smaller airways called bronchioles that end in tiny sacs known as alveoli, where gas exchange occurs. The lungs and chest wall are covered with a thin layer of tissue called the pleura. Lung cancers can arise in any part of the lung. Ninety to 95% of cancers of the lung are thought to arise from the epithelial, or lining cells of the larger and smaller airways (bronchi and bronchioles); for this reason lung cancers are sometimes called bronchogenic carcinomas. Cancers can also arise from the pleura (the thin layer of tissue that surrounds the lungs), called mesotheliomas, or rarely from supporting tissues within the lungs, for example, blood vessels. Types of lung cancer Lung cancers, also known as bronchogenic carcinomas ("carcinoma" is another term for cancer), are broadly classified into two types: small cell lung cancers (SCLC) and nonsmall cell lung cancers (NSCLC). This classification is based upon the microscopic appearance of the tumor cells themselves. These two types of cancers grow and spread in different ways, so a distinction between these two types is important. SCLC comprise about 20% of lung cancers and are the most aggressive and rapidly growing of all lung cancers. SCLC are strongly related to cigarette smoking with only 1% of these tumors occurring in non-smokers. SCLC metastasize rapidly to many sites within the body and are most often discovered after they have spread extensively. Referring to a specific cell type often seen in SCLC, these cancers are sometimes called oat cell carcinomas. NSCLC are the most common lung cancers, accounting for about 80% of all lung cancers. NSCLC has three main types that are named based upon the type of cells found in the tumor. They are:  Adenocarcinomas are the most commonly seen type of NSCLC in the U.S. and comprise up to 50% of NSCLC . While adenocarcinomas are associated with smoking like other lung cancers, this type is especially observed as well in non-smokers who develop lung cancer. Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs. Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.  Squamous cell carcinomas were formerly more common than adenocarcinomas; at present they account for about 30% of NSCLC. Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi. Diagnosis and Treatment of Lung Cancer  Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC.  Mixtures of different types of NSCLC are also seen.  Other types of cancers can arise in the lung; these types are much less common than NSCLC and SCLC and together comprise only 5-10% of lung cancers:  Bronchial carcinoids account for up to 5% of lung cancers. These tumors are generally small (3-4 cm or less) when diagnosed and occur most commonly in persons under 40 years of age. Unrelated to cigarette smoking, carcinoid tumors can metastasize, and a small proportion of these tumors secrete hormone-like substances. Carcinoids generally grow and spread more slowly than bronchogenic cancers, and many are detected early enough to be amenable to surgical resection.  Cancers of supporting lung tissue such as smooth muscle, blood vessels, or cells involved in the immune response can rarely occur in the lung.  As discussed previously, metastastatic cancers from other primary tumors in the body are often found in the lung. Tumors from anywhere in the body may spread to the lungs either through the bloodstream, through the lymphatic system, or directly from nearby organs. Metastatic tumors are most often multiple, scattered throughout the lung and concentrated in the peripheral rather than central areas of the organ. Stages of Lung Cancer The stage of a tumor refers to the extent to which a cancer has spread in the body. Staging involves both evaluation of a tumor’s size as well as the presence or absence of metastases in the lymph nodes or in other organs. Staging is important for determining how a particular tumor should be treated, since lung cancer therapies are geared toward specific tumor stages. Staging of a tumor is also critical in estimating the prognosis of a given patient, with higher-stage tumors generally having a worse prognosis than lowerstage tumors. Doctors may use several tests to accurately stage a lung cancer, including laboratory (blood chemistry) tests, x-rays, CT scans, bone scans, and MRI scans. Abnormal blood chemistry tests may signal the presence of metastases in bone or liver, and radiological procedures can document the size of a tumor as well as possible spread to other organs. NSCLC are assigned a stage from I to IV in order of severity.  In stage I, the cancer is confined to the lung.  In stages II and III, the cancer is confined to the chest (with larger and more invasive tumors classified as stage III).  Stage IV cancer has spread away from the chest to other parts of the body. SCLC are staged using a two-tiered system: Diagnosis and Treatment of Lung Cancer  Limited stage (LS) SCLC refers to cancer that is confined to its area of origin in the chest.  In extensive-stage (ES) SCLC, the cancer has spread beyond the chest to other parts of the body. Symptoms Different people have different symptoms for lung cancer. Some people don't have any symptoms at all. About 25% of people with lung cancer do not have symptoms from advanced cancer when their lung cancer is found. Lung cancer symptoms may include:        shortness of breath coughing that doesn't go away wheezing coughing up blood chest pain fever weight loss Other changes that can sometimes occur with lung cancer may include repeated bouts of pneumonia, changes in the shape of the fingertips, and swollen or enlarged lymph nodes (glands) in the upper chest and lower neck. These symptoms can happen with other illnesses, too. People with symptoms should talk to their doctor, especially if they smoke, but even if they don't. Doctors can help find the cause. Diagnosis and Treatment A person’s lung cancer diagnosis depends on the type of lung cancer present. The two main types of lung cancer are small cell lung cancer and non-small cell lung cancer. Nonsmall cell lung cancer is more common than small cell lung cancer. These categories refer to what the cancer cells look like under a microscope. The extent of disease is referred to as the stage. Information about how big a cancer is or how far it has spread is often used to determine the stage. Doctors use information about stage to plan treatment and to monitor progress. There are several ways to treat lung cancer. The treatment depends on the type of lung cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation. People with lung cancer often get more than one kind of treatment. Cancer Treatment Treatment for lung cancer can involve surgical removal of tumor, chemotherapy, or radiation therapy, as well as combinations of these methods. The decision about which treatments will be appropriate for a given individual must take into account the localization and extent of the tumor as well as the overall health status of the patient. Diagnosis and Treatment of Lung Cancer As with other cancers, therapy may be prescribed that is intended to be curative (removal or eradication of a cancer) or palliative (measures that are unable to cure a cancer but can reduce pain and suffering). More than one type of therapy may be prescribed. In such cases, the therapy that is added to enhance the effects of the primary therapy is referred to as adjuvant therapy. An example of adjuvant therapy is chemotherapy or radiotherapy administered after surgical removal of a tumor in order to be certain that all tumor cells are killed. Surgery - Surgical removal of the tumor is generally performed for limited-stage (Stage I or sometimes Stage II) NSCLC and is the treatment of choice for cancer that has not spread beyond the lung. About 10-35% of lung cancers can be removed surgically, but removal does not always result in a cure, since the tumors may already have spread and can recur at a later time. Among people who have an isolated, slow-growing lung cancer removed, 25 to 40% are alive 5 years after diagnosis. Surgery may not be possible if the cancer is too close to the trachea or if the person has other serious conditions (such as severe heart or lung disease) that would limit their ability to tolerate an operation. Surgery is less often performed with SCLC because these tumors are less likely to be localized to one area that can be removed. The surgical procedure chosen depends upon the size and location of the tumor. Surgeons must open the chest wall and may perform a wedge resection of the lung (removal of a portion of one lobe), a lobectomy (removal of one lobe), or a pneumonectomy (removal of an entire lung). Sometimes lymph nodes in the region of the lungs are also removed (lymphadenectomy). Surgery for lung cancer is a major surgical procedure that requires general anesthesia, hospitalization and follow-up care for weeks to months. Following the surgical procedure, patients may experience difficulty breathing, shortness of breath, pain, and weakness. The risks of surgery include complications due to bleeding, infection, and complications of general anesthesia. Radiation - Radiation therapy may be employed as a treatment for both NSCLC and SCLC. Radiation therapy uses high-energy x-rays or other types of radiation to kill dividing cancer cells. Radiation therapy may be given as curative therapy, palliative therapy (using lower doses of radiation than with curative regimens) or as adjuvant therapy to surgery or chemotherapy. The radiation is either delivered externally, by using a machine that directs radiation toward the cancer, or internally through placement of radioactive substances in sealed containers within the area of the body where the tumor is localized. Radiation therapy can be given if a person refuses surgery, if a tumor has spread to areas such as the lymph nodes or trachea making surgical removal impossible, or if a person has other conditions that make them too ill to undergo major surgery. Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy, yet in 10-15% of persons it leads to long-term remission and palliation of the cancer. Combining radiation therapy with chemotherapy can further increase the chances of survival when chemotherapy is administered. External radiation therapy can generally be carried out on an outpatient basis while internal radiation therapy requires a brief hospitalization. A person who has severe lung disease in addition to a lung cancer may not be able to receive radiotherapy to the lung. Diagnosis and Treatment of Lung Cancer For external radiation therapy, a process called simulation is necessary prior to treatment. Using CT scans, computers, and precise measurements, simulation maps out the exact location where the radiation will be delivered, called the treatment field or port. This process usually takes 30 minutes to two hours. The external radiation treatment itself generally is done over four or five days a week for several weeks. Radiation therapy does not carry the risks of major surgery, but it can have unpleasant side effects including tiredness and lack of energy. A reduced white cell count (rendering a person more susceptible to infection) and low blood platelet levels (making blood clotting more difficult) can also occur with radiation therapy. If the digestive organs are in the field exposed to radiation, patients may experience nausea, vomiting, or diarrhea. Radiation therapy can irritate the skin in the area that is treated, but this irritation generally improves with time after treatment has ended. Chemotherapy - Both NSCLC and SCLC may be treated with chemotherapy. Chemotherapy refers to the administration of drugs that stop the growth of cancer cells by killing them or preventing them from dividing. Chemotherapy may be given alone, as an adjuvant to surgical therapy, or in combination with radiotherapy. While a number of chemotherapeutic drugs have been developed, the platinum-based drugs have been the most effective in treatment of lung cancers. Chemotherapy is the treatment of choice for most SCLC, since these tumors are generally widespread in the body when they are diagnosed. Only half of people who have SCLC survive for four months without chemotherapy. With chemotherapy, their survival time is increased up to four- to fivefold. Chemotherapy alone is not particularly effective in treating NSCLC, but when NSCLC have metastasized; it can prolong survival in many cases. Chemotherapy may be given as pills, as an intravenous infusion, or as a combination of the two. Chemotherapy treatments are usually given in an outpatient setting. A combination of drugs is given in a series of treatments, called cycles, over a period of weeks to months, with breaks in between cycles. Unfortunately, the drugs used in chemotherapy also kill normally-dividing cells in the body, resulting in unpleasant side effects. Damage to blood cells can result in increased susceptibility to infections and difficulties with blood clotting (bleeding or bruising easily). Other side effects include fatigue, weight loss, hair loss, nausea, vomiting, diarrhea, and mouth sores. The side effects of chemotherapy vary according to the dosage and combination of drugs used and may also vary from individual to individual. Medications have been developed that can treat or prevent many of the side effects of chemotherapy. The side effects generally disappear during the recovery phase of the treatment or after its completion. Brain prophylactic radiation – SCLC often spreads to the brain. Sometimes people with SCLC that is responding well to treatment are treated with radiation therapy to the head to treat very early spread to the brain (called micrometastasis) that is not yet detectable with CT or MRI scans and has not yet produced symptoms. Brain radiation therapy can cause short-term memory problems, fatigue, nausea and other side effects. Treatment of recurrence – Lung cancer that has returned following treatment with surgery, chemotherapy, and/or radiation therapy is called recurrent or relapsed. If a Diagnosis and Treatment of Lung Cancer recurrent cancer is confined to one site in the lung, it may be treated with surgery. Relapsed tumors generally do not respond to the chemotherapeutic drugs that were previously administered. Since platinum-based drugs are generally used in initial chemotherapy of lung cancers, these agents are not useful in most cases of recurrence. A type of chemotherapy referred to as second-line chemotherapy is used to treat recurrent cancers that have previously been treated with chemotherapy, and a number of secondline chemotherapeutic regimens have been proved effective at prolonging survival. People with recurrent lung cancer who are well enough to tolerate therapy are also good candidates for experimental therapies including clinical trials. Experimental therapies - Since no therapy is currently available that is absolutely effective in treating lung cancer, patients may be offered a number of new therapies that are still in the experimental stage, meaning that doctors do not yet have enough information to decide whether these therapies should become accepted forms of treatment for lung cancer. New drugs or new combinations of drugs are tested in so-called clinical trials, studies that evaluate the effectiveness of new medications in comparison with those treatments already in widespread use. Experimental treatments known as immunotherapies may involve the use of vaccine-related therapies or other therapies that attempt to utilize the body’s immune system to fight cancer cells. One kind of experimental therapy used for recurrent SCLC is photodynamic therapy. This treatment is now being tested in recurrent SCLC that is causing a type of airway obstruction (endobronchial obstruction, or obstruction of a bronchus from within). In photodynamic treatment, a photosynthesizing agent (such as a porphyrin, a naturally-occurring substance in the body) is injected into the bloodstream a few hours prior to surgery. During this time, the agent deposits itself selectively in rapidly growing cells such as cancer cells. A surgical procedure then follows in which the physician applies a certain wavelength of light through a hand held wand directly to the site of the cancer and surrounding tissues. The energy from the light activates the photosensitizing agent, causing the production of a toxin that destroys the tumor cells. Prevention of Lung Cancer Smoking cessation is the most important measure that can prevent lung cancer. Many products, such as nicotine gum, nicotine sprays, or nicotine inhalers, may be helpful to people trying to quit smoking. Minimizing exposure to passive smoking is also an effective preventive measure. Using a home radon test kit can identify and allow correction of increased radon levels in the home, which can also cause lung cancers. Methods that allow early detection of cancers, such as the helical low-dose CT scan, may also be of value in the identification of small cancers that can be cured by surgical resection and prevention of widespread , incurable metastatic cancer. Survivorship Diagnosis and Treatment of Lung Cancer People with lung cancer may experience symptoms caused by the cancer or by cancer treatments side effects. Common symptoms caused by lung cancer include shortness of breath, cough, wheeze, coughing up blood, pain, fever, and weight loss. Side effects vary depending on the type of treatment. People who want information about symptoms and side effects and those that can occur with their treatment plan should talk to their doctors. Also those with symptoms or concerns should discuss them with their doctors. Doctors can help answer questions and make a plan to control symptoms. A recent study suggested that people diagnosed with lung cancer sometimes feel stigmatized by others. That is, that because of the association of smoking with lung cancer, some people felt blamed for causing their illness. Even some people who never smoked had similar feelings. For some, these feelings interfered with relationships or made them not want to talk to others about their cancer. Risk Factors Research has found several risk factors for lung cancer. A "risk factor" is anything that changes risk of getting a disease. Different risk factors change risk by different amounts. The risk factors for lung cancer include:  Smoking and being around others' smoke  Things around us at home or work (such as radon gas)  Personal traits (such as having a family history of lung cancer) Smoking and Secondhand Smoke Cigarette smoking causes lung cancer. In fact, smoking tobacco is the major risk factor for lung cancer. In the United States, about 90% of lung cancer deaths in men and almost 80% of lung cancer deaths in women are due to smoking. People who smoke are 10 to 20 times more likely to get lung cancer or die from lung cancer than people who do not smoke. The longer a person smokes and the more cigarettes smoked each day the more risk goes up. People who quit smoking have a lower risk of lung cancer than if they had continued to smoke, but their risk is higher than people who never smoked. As more people quit smoking, lung cancer rates will continue to fall, the percentage of lung cancers that occur in smokers will decrease, and the percentage of lung cancers that occur in people who have quit will rise. Smoking also causes cancer of the larynx, mouth and throat, esophagus, bladder, kidney, pancreas, cervix, and stomach. Using cigars or pipes also increases risk for lung cancer, but not as much as smoking cigarettes. Smoke from other people's cigarettes ("secondhand" smoke) causes lung cancer as well. There are more than 4,000 chemicals in secondhand smoke. More than 50 of these chemicals cause cancer in people or animals. Every year, about 3,000 nonsmokers die from lung cancer due to secondhand smoke. Things That May Cause Cancer at Home and Work There may be several things that can cause cancer carcinogens in the workplace or even in the home. For example, radon gas causes lung cancer and is sometimes found in Diagnosis and Treatment of Lung Cancer people's homes. Radon is an odorless, colorless gas that comes from rocks and dirt and can get trapped in houses and buildings. Examples of substances found at some workplaces that increase risk include asbestos, arsenic, and some forms of silica and chromium. For many of these substances, risk of getting lung cancer is even higher for those who also smoke. Other substances may increase lung cancer risk as well. Family History Risk of lung cancer may be higher if a person's parents, siblings, or children have had lung cancer. This increased risk could come from one or more things. They may share behaviors, like smoking. They may live in the same place where there are carcinogens such as radon. They may have inherited increased risk in their genes. Diet Scientists are studying many different foods to see how they may change the risk of getting lung cancer. However any effect diet may have on lung cancer risk is small compared with the risk from smoking. Eating a lot of fat and cholesterol might increase risk of lung cancer. Drinking a lot of alcohol may raise risk as well. However it's hard to tell how much of the risk in people who drink is actually due to tobacco smoke, since many people both smoke and drink. Some foods may actually help prevent lung cancer. Diets high in fruits and vegetables likely decrease cancer risk. Diets high in vitamin C, vitamin E, or selenium might also help protect against lung cancer. The effect of eating foods with carotenoids, like beta carotene, on lung cancer risk is currently uncertain. Carotenoids can be found in carrots, sweet potatoes, and some green vegetables. Eating these foods may lower chances of lung cancer. Taking beta-carotene supplements pills is not recommended however, since it may actually increase risk in some smokers. Reducing Risk There may be several ways to reduce the risk of developing lung cancer. Don't Smoke and Avoid Secondhand Smoke Tobacco use is the major cause of lung cancer in the United States. About 90% of lung cancer deaths in men and almost 80% of lung cancer deaths in women in this country are due to smoking. The most important thing a person can do to prevent lung cancer is to not start smoking, or to quit if he or she currently smokes. Quitting smoking will lower risk of lung cancer compared to not quitting. This is true no matter how old one is or how much he or she smokes. The longer a person goes without smoking, the more his or her risk will improve compared to those who continue to smoke. However, the risk in people who have quit is still higher than the risk in people who have never smoked. Diagnosis and Treatment of Lung Cancer Make Your Home and Workplace Safer The Environmental Protection Agency (EPA) recommends that all homes be tested for radon. Radon detectors can be purchased or arrangements can be made for qualified testers to come into the home. Health and safety guidelines in the workplace can help workers avoid things that can cause cancer carcinogens. Eat Lots of Fruits and Vegetables Eating a diet high in fruits and vegetables may help protect against lung cancer. Other Substances that Lower Risk An area of current research is the study of substances to decrease the risk of lung cancer (termed chemoprevention) Screening Screening means testing for a disease when there are no symptoms or history of that disease. Doctors give a screening test to find a disease early on, when treatment may work better. Scientists have studied several types of screening tests for lung cancer. A review of these studies by experts shows that more information is needed It is not known if these tests can help prevent deaths from lung cancer. Examples of screening tests for lung cancer include:  Chest x-rays  Sputum Cytology  CAT scans of the lungs There is fair evidence that low-dose CAT scans, chest x-rays, and sputum cytology can find cancers earlier than they would be found without screening. There is little evidence that these screening tests actually prevent people from dying from lung cancer. Screening also has its downside. Screening tests may find spots in the lungs that are not cancers. However, a screening test does not always show the difference between cancers and other abnormalities that are not cancers. More tests may be needed to find out if the spot is a cancer. These tests might include removing a small piece of lung tissue for more testing (biopsy). This means that some people might have a surgical procedure even though they don't have cancer. These procedures have risks associated with them. They also can cause anxiety and cost money. Experts do not know if the benefits of screening outweigh the potential harms. For these reasons, experts do not currently recommend for or against lung cancer screening. Screening for lung cancer with chest x-rays was once promoted by some experts, but researchers found out that people who were screened did not have a lower death rate than people who were not screened. Studies are underway that will help provide more information about the effectiveness of more modern screening tests. Diagnosis and Treatment of Lung Cancer Statistics More people die from lung cancer than any other type of cancer. This is true for both males and females. In 2002 (the most recent year for which statistics are currently available), lung cancer accounted for more deaths than breast cancer, prostate cancer, and colon cancer combined. In that year:  100,099 males and 80,163 females were diagnosed with lung cancer  90,121 males and 67,509 females died from lung cancer. Aside from non-melanoma skin cancer, lung cancer is the second most common cancer for all males in the United States. Among females, lung cancer is the second most common cancer among white and American Indian/Alaska Native females and the third most common cancer among black, Asian/Pacific Islander, and Hispanic females. Males - of all ages. Ten leading causes of death among males and females, 2002 Females - of all ages. *Note: Incidence counts cover approximately 93% of the U.S. population and death counts cover 100% of the U.S. population. Use caution in comparing incidence and death counts. Trends by Sex, Race, and Ethnicity The graph below shows how the rates of developing lung cancer (incidence) and dying from lung cancer have changed over time for males and females. Diagnosis and Treatment of Lung Cancer Lung and Bronchus Cancer (Invasive) SEER Incidence and U.S. Death Rates by Sex, 1975–2002 Decreases in lung cancer cases and death rates among males stem from reductions in smoking that began several decades ago. Among females, reductions in smoking are more recent, beginning in the late 1970s. Lung cancer death rates for U.S. females are among the highest in the world. Death rates for U.S. males are lower than rates among males in several other countries, although rates among males are still higher than rates among females in the United States. Lung cancer rates differ for different racial and ethnic populations. Differences in lung cancer death rates as of 2002 are shown in the graphs below. For example, black males have higher rates of dying from lung cancer than other males, although rates are decreasing. Asian/Pacific Islander males, American Indian/Alaska Native males, and Hispanic males have the lowest rates. For females, white and black females have the highest rates of dying from lung cancer. Asian/Pacific Islander females and Hispanic females have the lowest rates. Lung and Bronchus Cancer U.S. Death Rates by Sex and Race/Ethnicity 1992–2002 Males Diagnosis and Treatment of Lung Cancer Females Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population. Hispanic and non-Hispanic are not mutually exclusive from white, black, American Indian/Alaska Native (AI/AN), and Asian or Pacific Islander (Asian/PI). Source: National Center for Health Statistics (NCHS) Risk by Age The table below shows the percentage of men or women (how many out of 100) who die from lung cancer over different time periods. The time periods are based on the person's current age. For example, 2.3% of men who are 60 years old will die from lung cancer during the next 10 years, that is, by the age of 70. In other words, if you imagine 100 men who are 60 years old, 2–3 will die from lung cancer within 10 years. The risk of death from lung cancer increases with age and is greater in men than in women. Percent of Men And Women Who Die From Lung Cancer Over 10, 20, and 30 Year Intervals According to Their Current Age Men Current Age 30 40 50 60 70 10 years 0.0 0.2 0.8 2.3 3.8 20 years 0.2 1.0 2.9 5.5 6.0 30 years 1.0 3.0 5.8 7.2 10 years 0.0 0.1 0.5 1.4 2.2 Women 20 years 0.2 0.6 1.8 3.3 3.5 30 years 0.6 1.9 3.7 4.5 - Diagnosis and Treatment of Lung Cancer Risk by State Risks of getting lung cancer vary from state to state in the United States. Kentucky has the highest rate of lung cancer for men. Kentucky also has the highest rate of lung cancer for women. Utah has the lowest rate of lung cancer for both men and women. The maps below show how the states compare on lung cancer rates. The blue states have lung cancer rates in the lowest quartile (75% of states have rates higher than these states). The yellow states have rates in the second quartile (50% of states have rates higher than these states). The orange states have rates in the third quartile (50% of states have rates lower than these states). The red states have lung cancer rates in the highest quartile (75% of states have rates lower than these states). There is not enough information available to accurately estimate the rates in the white states. Rates of Developing Lung Cancer Among Men by State* No Data Arkansas, Mississippi, South Dakota, Tennessee, Virginia, Wyoming 38.1–77.5 Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Minnesota, New Mexico, Utah, Vermont 77.6–83.4 Connecticut, Kansas, Maryland, Nebraska, New Jersey, New York, New Hampshire, North Dakota, Oregon, Washington, Wisconsin 83.5–94.2 Delaware, Florida, Illinois, Iowa, Massachusetts, Michigan, Nevada, North Carolina, Pennsylvania, Texas, District of Columbia 94.3–133.8 Alabama, Georgia, Indiana, Kentucky, Louisiana, Maine, Missouri, Oklahoma, Ohio, Rhode Island, South Carolina, West Virginia *Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population. Source: United States Cancer Statistics: 2002 Incidence and Mortality. Diagnosis and Treatment of Lung Cancer Rates of Developing Lung Cancer Among Women by State No Data Arkansas, Mississippi, South Dakota, Tennessee, Virginia, Wyoming 20.9–47.3 Arizona, Colorado, District of Columbia, Hawaii, Idaho, Nebraska, New Mexico, North Dakota, Utah, Vermont 47.4–53.4 Alaska, Alabama, California, Iowa, Kansas, Montana, Minnesota, New York, North Carolina, South Carolina, Texas, Wisconsin 53.5-58.4 Georgia, Illinois, Louisiana, Maryland, Michigan, Missouri, New Jersey, Ohio, Oregon, Pennsylvania, Washington 58.5–73.0 Connecticut, Delaware, Florida, Indiana, Kentucky, Maine, Massachusetts, Nevada, New Hampshire, Oklahoma, Rhode Island, West Virginia *Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population. Source: United States Cancer Statistics: 2002 Incidence and Mortality Cost of Lung Cancer The financial costs of lung cancer are high. A recent study estimated that the cost of treating lung cancer in the United States in 1996 was about $5 billion per year. This made it one of the most expensive cancers to treat in the country. Prognosis of lung cancer The prognosis of lung cancer refers to the chance for recovery and is dependent upon the localization and size of the tumor, the presence of symptoms, the type of lung cancer, and the overall health status of the patient. SCLC has the most aggressive growth of all lung cancers, with a median survival time of only 2-4 months after diagnosis when untreated. (That is, by 2-4 months, half of all Diagnosis and Treatment of Lung Cancer patients have died.) However, SCLC is also the type of lung cancer most responsive to radiation therapy and chemotherapy. Because SCLC spreads rapidly and is usually disseminated at the time of diagnosis, methods such as surgical removal or localized radiation therapy are less effective in treating this tumor type. However, when chemotherapy is used alone or in combination with other methods, survival time can be prolonged four- to fivefold. Of all patients with SCLC, only 5-10% are alive 5 years after diagnosis. Most of those who survive have limited stage (LS) SCLC. In non-small cell lung cancer (NSCLC), results of standard treatment are generally poor in all but the most localized cancers that can be surgically removed. However, in Stage I cancers that can be completely removed, the 5-year survival rate can approach 75%. Radiation therapy can produce a cure in a small minority of patients with NSCLC and relief of symptoms in most patients. In advanced-stage disease, chemotherapy offers modest improvements in survival time, although overall survival rates are poor. Survival rates for lung cancer are generally lower than those for most cancers, with an overall 5-year survival rate for lung cancer of about 15% compared to 63% for colon cancer 88% for breast cancer, and 99% for prostate cancer. Lung Cancer At A Glance Lung cancer is the number one cause of cancer deaths in both men and women in the U.S. and worldwide.  Cigarette smoking is the principal risk factor for development of lung cancer.  Passive exposure to tobacco smoke can also cause cancer.  The two types of lung cancer, which grow and spread differently, are the small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC).  Staging of lung cancer refers to the extent to which the cancer has spread in the body. Treatment of lung cancer can involve a combination of surgery, chemotherapy, and radiation therapy as well as newer experimental methods.  The general prognosis of lung cancer is poor, with overall survival rates of about 15% at 5 years.  Smoking cessation is the most important measure that can prevent the development of lung cancer. References 1) 2) 3) 4) 5) 6) 7) 8) 9) American Cancer Society. International Agency for Research on Cancer (IARC). 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