Lung cancer is the second most common cancer in men, behind prostate cancer, and the second most common cancer in women, behind breast cancer. Lung cancer is the most common cause of cancer death in the United States, killing more people per year than breast cancer, prostate cancer and colon cancer combined.

Tobacco use, environmental exposure to second-hand smoke, asbestos and radon, and a history of lung diseases such as tuberculosis and pneumonia can increase the risk of developing lung cancer. There are no characteristic symptoms to give an early warning of the presence of lung cancer, and there are no useful screening tests for lung cancer. Some patients may experience a persistent cough that worsens over time, cough up blood, have pain in the chest cavity or ribs, or experience shortness of breath, wheezing or hoarseness.

Lung cancer is believed to develop over a period of many years, remaining undetectable for much of that time. Only about a third of patients are able to benefit from surgery when lung cancer is diagnosed; for the majority of patients, the cancer has usually invaded vital structures within the chest or metastasized to other sites via the blood stream or lymphatics.

Cancers that begin in the lungs are divided into two major types, small cell lung cancer and non-small cell lung cancer. Tumor tissue is frequently obtained during broncoscopy, performed by a pulmonologist, or by trans-thoracic needle aspiration, performed by an interventional radiologist. Newer forms of broncoscopy, available at SVCMC, include electromagnetic guided bronchoscopy and endobronchial ultrasound. These newer bronchoscopic technologies facilitate treatment planning by more accurately sampling small tumors and allowing better evaluation of spread of cancer to lymph nodes or other structures within the chest.

Optimal treatment of lung cancer often includes a combination of surgery, chemotherapy and radiation treatments; therefore, it is best to be treated by a coordinated team of specialists like the multidisciplinary team at St. Vincent’s.

Improvements in surgical techniques, including video assistance (VATS), allow shorter hospitalizations and faster recovery after lung surgery. Some patients who have surgery have better survival if they receive post-operative (adjuvant) chemotherapy.

Patients are commonly found to have locally invasive cancers which are best treated by concurrent chemotherapy and radiation. Some patients with localized tumors who are medically unable to have lung surgery can also benefit from radiation. Technology advances over the past decade have improved the accuracy of radiation therapy so physicians are better able to target the tumor cells and spare as much healthy tissue as possible. This is especially relevant to patients with lung cancer since lung tissue moves with each breadth the patient takes making accuracy more challenging.

“When a patient breathes, their internal organs move by as much as several centimeters, causing cancer cells to move in and out of the radiation treatment field,” said John Rescigno, M.D., Acting Chief of Radiation Oncology. “With Computer-guided imaging, simulation, planning and Respiratory Gating we can pinpoint the tumor, determine the optimal arrangement and dose of radiation beams, and accurately target the tumor cells.” Respiratory Gating is a process where the radiation beam is turned on and off based on the patient’s breathing cycle. It is used to target the tumor only when it is in the optimum range. This provides the security of protecting healthy tissue so physicians can target the tumor with signifi cantly higher doses of radiation and ensure a better result. Respiratory Gating can be used in combination with Stereotactic Body Radiosurgery (also called Stereotactic Body Radiation Therapy). This non-surgical procedure uses a large dose of radiation to destroy tumor tissue.

There are also chemotherapy treatments for patients with advanced lung cancer, including targeted agents like bevacizumab and erlotinib and cytoxic agents like pemetrexed.