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How Do I Know If I Have Lung Cancer?

If a routine physical examination reveals swollen lymph nodes above the collarbone, a mass in the abdomen, weak breathing, abnormal sounds in the lungs, or dullness when the chest is tapped, your doctor may suspect a lung tumor. Some lung cancers produce abnormally high blood levels of certain hormones or substances such as calcium. If a person shows such evidence and no other cause is apparent, a doctor should consider lung cancer.

Once a malignant tumor begins to cause symptoms, it is usually visible on an X-ray. Occasionally a tumor that has not yet begun to cause symptoms is spotted on a chest X-ray taken for another purpose. A CT scan of the chest may be ordered for a more detailed examination.

Though examinations of mucus or lung fluid may reveal fully developed cancer cells, diagnosis is usually confirmed through a biopsy. With the patient lightly anesthetized, the doctor guides a thin, lighted tube through the nose and down the air passages to the site of the tumor, where a tiny tissue sample can be removed. If the biopsy confirms cancer, other tests will determine the type of cancer and how far it has spread. Nearby lymph nodes can be tested for cancer cells, while imaging techniques such as CT scans and bone scans can detect tumors elsewhere in the body.

Because sputum examinations and chest X-rays have not proved particularly effective in detecting small tumors characteristic of early lung cancer, annual chest X-rays for lung cancer screening are not recommended by the American Cancer Society, the National Cancer Institute, or the American College of Radiology.

What Are the Treatments?

If the cancer can be successfully removed surgically, the patient has an excellent chance of surviving at least one year, and usually a better than 50% chance of living at five years or more. The challenge comes in detecting lung cancer early enough to make surgery possible.

Surgery

The decision to perform surgery is based not only on the type of lung cancer and how far it has spread but also on the patient's overall health. Many patients with lung cancer — especially smokers — have existing lung or heart problems that make surgery difficult. Cancer that has spread to lymph nodes between the lungs was once considered inoperable, but combining surgery with chemotherapy — before or after surgery — and radiation therapy has improved cure rates.

When feasible, the preferred treatment for non-small-cell lung cancer is surgery. Before the procedure, an effort is made to reduce the size of the tumor with radiation therapy or chemotherapy. During the operation, the surgeon removes the tumor along with surrounding lung tissue and lymph nodes; often the entire lung must be taken out.

After surgery, patients stay in the hospital for several days and receive pain relievers to control pain after surgery.

Radiation

Radiation therapy may be necessary to kill remaining cancer cells, but it is usually delayed for at least a month while the surgical wound heals. Non-small-cell lung cancers that cannot be treated surgically are usually treated with radiation therapy.

Chemotherapy and Combination Therapy

Because of its tendency to spread extensively, small-cell lung cancer is typically treated with combination chemotherapy — the use of more than one drug — often in conjunction with radiation therapy. Surgery is occasionally used if the cancer if felt to be at a very early stage.

Patients whose cancers have metastasized, or spread to distant sites, may be treated with either chemotherapy or radiation therapy. Since metastatic lung cancer is very difficult to cure, the main goals of treatment are to provide comfort and prolong life. Current treatments can shrink tumors, which may lessen pain and other symptoms. Patients with advanced lung cancer commonly take medication to control pain. Morphine and its various derivatives are widely used and extremely effective in the management of cancer pain.

Recent data suggests that chemotherapy may help prevent reoccurence of lung cancer in patients with in early stage of the disease. 

Treatment on the Horizon

Researchers are constantly looking for better ways to treat lung cancer, to relieve symptoms, and to improve patients' quality of life. New combinations of chemotherapy, new forms of radiation, and the use of drugs that make cancer cells more sensitive to radiation are under study. Experimental laser surgery has successfully reduced or eliminated tumors obstructing bronchi, thereby improving breathing.

New drugs that target growth factor receptors and the tumor blood supply have shown encouraging activity in helping to control advanced lung cancer.

At-Home Care

f you've had lung surgery, your nurse or doctor can show you special exercises to improve your breathing and strengthen your chest muscles. You can relieve skin irritation associated with radiation therapy by wearing loose clothes and keeping your chest protected from the sun. Avoid using skin lotions unless approved by your doctor.

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