Researchers have discovered several causes of lung cancer -- most are related to the use of tobacco.

Cigarettes. Smoking cigarettes causes lung cancer. Harmful substances, called carcinogens, in tobacco damage the cells in the lungs. Over time, the damaged cells may become cancerous. The likelihood that a smoker will develop lung cancer is affected by the age at which smoking began, how long the person has smoked, the number of cigarettes smoked per day, and how deeply the smoker inhales. Stopping smoking greatly reduces a person's risk for developing lung cancer.

Cigars and Pipes. Cigar and pipe smokers have a higher risk of lung cancer than nonsmokers. The number of years a person smokes, the number of pipes or cigars smoked per day, and how deeply the person inhales all affect the risk of developing lung cancer. Even cigar and pipe smokers who do not inhale are at increased risk for lung, mouth, and other types of cancer.

Environmental Tobacco Smoke. The chance of developing lung cancer is increased by exposure to environmental tobacco smoke (ETS) -- the smoke in the air when someone else smokes. Exposure to ETS, or secondhand smoke, is called involuntary or passive smoking.

Radon. Radon is an invisible, odorless, and tasteless radioactive gas that occurs naturally in soil and rocks. It can cause damage to the lungs that may lead to lung cancer. People who work in mines may be exposed to radon and, in some parts of the country, radon is found in houses. Smoking increases the risk of lung cancer even more for those already at risk because of exposure to radon. A kit available at most hardware stores allows homeowners to measure radon levels in their homes. The home radon test is relatively easy to use and inexpensive. Once a radon problem is corrected, the hazard is gone for good.

Asbestos. Asbestos is the name of a group of minerals that occur naturally as fibers and are used in certain industries. Asbestos fibers tend to break easily into particles that can float in the air and stick to clothes. When the particles are inhaled, they can lodge in the lungs, damaging cells and increasing the risk for lung cancer. Studies have shown that workers who have been exposed to large amounts of asbestos have a risk of developing lung cancer that is 3 to 4 times greater than that for workers who have not been exposed to asbestos. This exposure has been observed in such industries as shipbuilding, asbestos mining and manufacturing, insulation work, and brake repair. The risk of lung cancer is even higher among asbestos workers who also smoke. Asbestos workers should use the protective equipment provided by their employers and follow recommended work practices and safety procedures.

Pollution. Researchers have found a link between lung cancer and exposure to certain air pollutants, such as by-products of the combustion of diesel and other fossil fuels. However, this relationship has not been clearly defined, and more research is being done.

Lung Diseases. Certain lung diseases, such as tuberculosis (TB), increase a person's chance of developing lung cancer. Lung cancer tends to develop in areas of the lung that are scarred from TB.

Personal History. A person who has had lung cancer once is more likely to develop a second lung cancer compared with a person who has never had lung cancer. Quitting smoking after lung cancer is diagnosed may prevent the development of a second lung cancer.

Researchers continue to study the causes of lung cancer and to search for ways to prevent it. We already know that the best way to prevent lung cancer is to quit (or never start) smoking. The sooner a person quits smoking the better. Even if you have been smoking for many years, it's never too late to benefit from quitting.

Common signs and symptoms of lung cancer include: A cough that doesn't go away and gets worse over time

Constant chest pain

Coughing up blood

Shortness of breath, wheezing, or hoarseness

Repeated problems with pneumonia or bronchitis

Swelling of the neck and face Loss of appetite or weight loss

Fatigue

These symptoms may be caused by lung cancer or by other conditions. It is important to check with a doctor.

To help find the cause of symptoms, the doctor evaluates a person's medical history, smoking history, exposure to environmental and occupational substances, and family history of cancer. The doctor also performs a physical exam and may order a chest x-ray and other tests. If lung cancer is suspected, sputum cytology (the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs) is a simple test that may be useful in detecting lung cancer. To confirm the presence of lung cancer, the doctor must examine tissue from the lung. A biopsy -- the removal of a small sample of tissue for examination under a microscope by a pathologist -- can show whether a person has cancer. A number of procedures may be used to obtain this tissue:

Bronchoscopy. The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue.

Needle aspiration. A needle is inserted through the chest into the tumor to remove a sample of tissue.

Thoracentesis. Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells.

Thoracotomy. Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital.

If the diagnosis is cancer, the doctor will want to learn the stage (or extent) of the disease. Staging is done to find out whether the cancer has spread and, if so, to what parts of the body. Lung cancer often spreads to the brain or bones. Knowing the stage of the disease helps the doctor plan treatment. Some tests used to determine whether the cancer has spread include:

CAT (or CT) scan (computed tomography). A computer linked to an x-ray machine creates a series of detailed pictures of areas inside the body.

MRI (magnetic resonance imaging). A powerful magnet linked to a computer makes detailed pictures of areas inside the body.

Radionuclide scanning. Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.

Bone scan. A bone scan, one type of radionuclide scanning, can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into a vein. It travels through the bloodstream and collects in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas and records them on x-ray film.

Mediastinoscopy/Mediastinotomy. A mediastinoscopy can help show whether the cancer has spread to the lymph nodes in the chest. Using a lighted viewing instrument, called a scope, the doctor examines the center of the chest (mediastinum) and nearby lymph nodes. In mediastinoscopy, the scope is inserted through a small incision in the neck; in mediastinotomy, the incision is made in the chest. In either procedure, the scope is also used to remove a tissue sample. The patient receives a general anesthetic.

Treatment depends on a number of factors, including the type of lung cancer (non-small or small cell lung cancer), the size, location, and extent of the tumor, and the general health of the patient. Many different treatments and combinations of treatments may be used to control lung cancer, and/or to improve quality of life by reducing symptoms.

Surgery is an operation to remove the cancer. The type of surgery a doctor performs depends on the location of the tumor in the lung. An operation to remove only a small part of the lung is called a segmental or wedge resection. When the surgeon removes an entire lobe of the lung, the procedure is called a lobectomy. Pneumonectomy is the removal of an entire lung. Some tumors are inoperable (cannot be removed by surgery) because of the size or location, and some patients cannot have surgery for other medical reasons.

Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Even after cancer has been removed from the lung, cancer cells may still be present in nearby tissue or elsewhere in the body. Chemotherapy may be used to control cancer growth or to relieve symptoms. Most anticancer drugs are given by injection directly into a vein (IV) or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are given in the form of a pill.

Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells. Radiation therapy is directed to a limited area and affects the cancer cells only in that area. Radiation therapy may be used before surgery to shrink a tumor, or after surgery to destroy any cancer cells that remain in the treated area. Doctors also use radiation therapy, often combined with chemotherapy, as primary treatment instead of surgery. Radiation therapy may also be used to relieve symptoms such as shortness of breath. Radiation for the treatment of lung cancer most often comes from a machine (external radiation). The radiation can also come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation).

Photodynamic therapy (PDT), a type of laser therapy, involves the use of a special chemical that is injected into the bloodstream and absorbed by cells all over the body. The chemical rapidly leaves normal cells but remains in cancer cells for a longer time. A laser light aimed at the cancer activates the chemical, which then kills the cancer cells that have absorbed it. Photodynamic therapy may be used to reduce symptoms of lung cancer -- for example, to control bleeding or to relieve breathing problems due to blocked airways when the cancer cannot be removed through surgery. Photodynamic therapy may also be used to treat very small tumors in patients for whom the usual treatments for lung cancer are not appropriate.
Clinical trials (research studies) to evaluate new ways to treat cancer are an option for many lung cancer patients. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the usual (standard) therapy to another group. Through research, doctors are exploring new and possibly more effective ways to treat lung cancer. More information about treatment studies can be found in the NCI publication Taking Part in Clinical Trials: What Cancer Patients Need To Know.PDQ®, NCI's cancer information database, contains detailed information about ongoing studies for lung cancer. NCI's Web site includes a section on clinical trials at http://cancer.gov/clinical_trials. This section provides detailed information about ongoing studies for lung cancer for patients, health professionals, and the public.

Treating Nonsmall Cell Lung Cancer

Patients with non-small cell lung cancer may be treated in several ways. The choice of treatment depends mainly on the size, location, and extent of the tumor. Surgery is the most common way to treat this type of lung cancer. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of non-small cell lung cancer. Radiation therapy and chemotherapy may also be used to slow the progress of the disease and to manage symptoms.

Treating Small Cell Lung Cancer

Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy. Treatment may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body (such as in the brain). Some patients have radiation therapy to the brain even though no cancer is found there. This treatment, called prophylactic cranial irradiation (PCI), is given to prevent tumors from forming in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.

Side Effects

The side effects of cancer treatment depend on the type of treatment and may be different for each person. Side effects are often only temporary. Doctors and nurses can explain the possible side effects of treatment, and they can suggest ways to help relieve symptoms that may occur during and after treatment.

Surgery for lung cancer is a major operation. After lung surgery, air and fluid tend to collect in the chest. Patients often need help turning over, coughing, and breathing deeply. These activities are important for recovery because they help expand the remaining lung tissue and get rid of excess air and fluid. Pain or weakness in the chest and the arm and shortness of breath are common side effects of lung cancer surgery. Patients may need several weeks or months to regain their energy and strength.

Chemotherapy affects normal as well as cancerous cells. Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores, and fatigue.

Radiation therapy, like chemotherapy, affects normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the part of the body that is treated and the treatment dose. Common side effects of radiation therapy are a dry, sore throat; difficulty swallowing; fatigue; skin changes at the site of treatment; and loss of appetite. Patients receiving radiation to the brain may have headaches, skin changes, fatigue, nausea and vomiting, hair loss, or problems with memory and thought processes.

Photodynamic therapy makes the skin and eyes sensitive to light for 6 weeks or more after treatment. Patients are advised to avoid direct sunlight and bright indoor light for at least 6 weeks. If patients must go outdoors, they need to wear protective clothing, including sunglasses. Other temporary side effects of PDT may include coughing, trouble swallowing, and painful breathing or shortness of breath. Patients should talk with their doctor about what to do if the skin becomes blistered, red, or swollen.

Today, because of what has been learned in clinical trials, doctors are able to control, lessen, or avoid many of the side effects of treatment. Several useful NCI booklets, including Chemotherapy and You, Radiation Therapy and You, and Eating Hints for Cancer Patients, suggest ways to cope with the side effects of cancer treatment.
Doctors and nurses can explain the possible side effects of treatment, and they can suggest ways to help relieve symptoms that may occur during and after treatment.

Followup care after treatment for lung cancer is very important. Regular checkups ensure that changes in health are noticed, and if the cancer returns or a new cancer develops, it can be treated as soon as possible. Checkups may include physical exams, chest x-rays, or lab tests. Between scheduled appointments, people who have had lung cancer should report any health problems to their doctor as soon as they appear.

Living with a serious disease, such as cancer, is challenging. Apart from having to cope with the physical and medical challenges, people with cancer face many worries, feelings, and concerns that can make life difficult. They may find they need help coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional and psychological burden of having cancer is often part of a patient's treatment plan. The support of the health care team (doctors, nurses, social workers, and others), support groups, and patient-to-patient networks can help people feel less alone and upset, and improve the quality of their lives. Cancer support groups provide a safe environment where cancer patients can talk about living with cancer with others who may be having similar experiences. Patients may want to speak to a member of their health care team about finding a support group. Many also find useful information in NCI fact sheets and booklets, including Taking Time and Facing Forward.

You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.

Telephone

Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Common signs and symptoms of lung cancer include:

These symptoms may be caused by lung cancer or by other conditions. It is important to check with a doctor.