Smoking, or exposure to tobacco products in any form, is the major risk factor for lung cancer. Nonsmokers who breathe the smoke of others, often called secondhand smoke, are also at increased risk for lung cancer.

If you smoke, you can reduce your risk for lung cancer — and the risk for those around you — by stopping now. If you’ve been diagnosed with lung cancer or are in treatment, it’s not too late to quit. Research shows that quitting smoking can make chemotherapy work more effectively.

Sometimes, there’s no clear reason why a person develops lung cancer. In fact, up to 20 percent of people with non-small cell lung cancer have never smoked.

That said, people who have smoked but recently quit and those who continue to smoke are at ten to 20 times the risk of people who have never smoked. If you’re a current or former smoker, you may want to consider screening for lung cancer. We offer an online tool that can help you better understand your risk as well as screening services for those who are at high risk.

Other risk factors include exposure to asbestos or radon. These toxic substances can cause damage to the lungs, leading to cancer.

Even if you’ve smoked for a long time, quitting today will help lower your chances of getting diseases caused by smoking.

We recommend screening if you:

• currently smoke or quit smoking within the past 15 years
• are between the ages of 50 and 80
• have smoked an average of one pack per day for at least 20 years, or the equivalent (for example, two packs a day for 10 years)

Research shows that screening with low-dose CT scans can reduce the risk of death from lung cancer for people at high risk of getting the disease. All CTs deliver a dose of radiation in order to get an accurate scan. The low-dose CT delivers the lowest possible dose while still getting a highly accurate image. The CT scan takes about 5 minutes to complete and does not require any dyes or contrast.

Lung cancer screening is not a substitute for quitting smoking. We know it can be hard to quit and not start smoking again. But you can do it with the right advice and help. Our Tobacco Treatment Program can help.

Lung Cancer Screening Guidelines

Recommend lung cancer screening for people based on their age and the number of years they’ve smoked.

We recommend screening if you:

• currently smoke or quit smoking within the past 15 years
• are between the ages of 50 and 80
• have smoked an average of one pack per day for at least 20 years, or the equivalent (for example, two packs a day for 10 years)

For many people, the first sign that they may have lung cancer is the appearance of a suspicious spot on a chest x-ray or a CT scan. But an image alone is not enough to tell you whether you have cancer and, if so, what type of cancer it is.

Most people who come to us for a lung cancer diagnosis first meet with a surgeon. He or she will work with pathologists, radiologists, and other lung cancer specialists to determine the specific type of lung cancer you have and how advanced it is. These findings help your disease management team develop the most successful treatment plan for you.

The first step is for your doctor to get a tissue sample using one of several biopsy methods. Then a pathologist — a type of doctor who specializes in diagnosing disease —who focuses on lung cancer studies the tissue under a microscope to determine whether you have lung cancer and, if so, what type. He or she will be able to tell this by looking closely at the cancer cells’ shape and other features.

Knowing which type of lung cancer, you have will help your doctors to stage the tumor accurately and to begin identifying the best treatment approach. Understanding what type of cancer, you have is also important because each type responds differently to certain chemotherapy drugs.

Lung Biopsy

If your doctor suspects that you have lung cancer, he or she will perform a biopsy to remove tissue from the possibly cancerous growth in your chest. It’s the only way to tell whether you have lung cancer, and if so, what type of lung cancer.

In a lung biopsy, a pathologist examines the tissue removed from the suspicious growth under a microscope. He or she is able to use this information to help make a diagnosis of non-small cell lung cancer or small cell lung cancer.

There are a few ways that your doctor can do a biopsy. The most common is called a bronchoscopy. Other methods your doctor might use to get a biopsy include:

• Needle biopsy
• Endoscopic ultrasound
• Surgery

Transthoracic Needle Biopsy

If the suspicious growth cannot be reached by a bronchoscopy, your physician may recommend a needle biopsy through the chest wall. In this procedure, also called transthoracic needle biopsy, you’ll receive anesthesia and a needle will be inserted through the skin directly into the suspicious spot to remove a small sample of tissue for analysis. Physicians called interventional radiologists, who use x-rays or a CT scanner to guide the needle, perform most needle biopsies.

Other Methods for Biopsy

Occasionally, a biopsy is performed using a device with a light attached to it called an endoscope that’s placed through the mouth into the esophagus, the tube that leads from the mouth to the stomach. This approach is called endoscopic ultrasound. At other times, because of the location or size of the suspicious mass, a surgical operation may be necessary to perform the biopsy

After your doctor knows which type of lung cancer you have — small cell or non-small cell — the next step is to identify how far the cancer has spread, called the stage. To determine this, you may need to have one or more imaging tests, including:

• CT scans of the chest and possibly the abdomen and pelvis
• an MRI scan of the head
• a PET/CT scan of the body between the neck and thighs

You may need other tests or procedures depending on your symptoms and the location of the cancer.

After your doctors know how far the cancer has spread, they will determine the stage of the disease. Staging takes into account:

• the size and location of the original tumor (also called the primary tumor)
• whether the cancer has spread to nearby lymph nodes
• whether the cancer has spread (metastasized) to other organs in the body

Staging is a critical step in choosing the best treatment for you. The stage of your cancer stays the same throughout your course of treatment.

4 Stages of Lung Cancer

• Stage I: The cancer developed in and is confined to one lung.
• Stages II and III: The cancer developed in one lung but has spread to nearby chest structures or lymph glands.
• Stage IV: The cancer has spread from one lung to the other or to another organ like the bones, brain, liver, or adrenal gland (a hormone-releasing organ that sits on top of the kidney).

Lung cancer is treated in several ways, depending on the type of lung cancer and how far it has spread. People with non-small cell lung cancer can be treated with surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these treatments. People with small cell lung cancer are usually treated with radiation therapy and chemotherapy.

• Surgery. An operation where doctors cut out cancer tissue.
• Chemotherapy. Using special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both.
• Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer.
• Targeted therapy. Using drugs to block the growth and spread of cancer cells. The drugs can be pills you take or medicines given in your veins. You will get tests to see if targeted therapy is right for your cancer type before this treatment is used.

Doctors from different specialties often work together to treat lung cancer. Pulmonologists are doctors who are experts in diseases of the lungs. Surgeons are doctors who perform operations. Thoracic surgeons specialize in chest, heart, and lung surgery. Medical oncologists are doctors who treat cancer with medicines. Radiation oncologists are doctors who treat cancers with radiation.

The goal of surgery for lung cancer is to remove all of the cancer. surgeon’s top priority is to keep you safe and make sure you have a good quality of life after the procedure.

Successful surgery requires removing the portion of the lung containing the cancer and the adjacent lymph nodes (also called lymph glands). Lymph nodes in the chest trap cancer cells as they leave the lungs and are frequently the first site to which lung cancer spreads.

How much of the lung is removed depends on many factors, including the size and location of the tumor, whether the cancer has been found in the surrounding lymph nodes, and your overall health and

Surgeons offer lung-sparing surgery to remove the cancer and preserve remaining lung tissue whenever possible. We also recommend less-invasive techniques whenever we can, including something called thoracoscopy, which can allow you to recover more quickly than traditional open surgery.

How much tissue our surgeons need to remove will depend on the type of lung cancer you have and how far it has advanced.

Approach for Non-Small Cell Lung Cancer

If you have non-small cell lung cancer that has not spread beyond one lung, surgery to remove the tumor completely provides the best chance for a cure. Lobectomy is the most common type of operation for people with this kind of lung cancer. People with early-stage non-small cell lung cancer who are not candidates for surgery are typically treated with stereotactic body radiation therapy, a treatment that offers excellent long-term chances to eliminate small lung lesions.

If you have advanced non-small cell lung cancer that has spread to your lymph nodes but is still confined to your chest, and you cannot be treated surgically either because of your tumor’s location or because of your health, we may recommend radiation therapy. It’s ideally given with chemotherapy either at the same time or before or after radiation therapy.

Approach for Small Cell Lung Cancer

Surgery is rarely part of the treatment plan for small cell lung cancer because the disease tends to spread quickly and responds well to chemotherapy and radiation therapy. In certain cases, however, particularly if the cancer is identified at an early stage, surgery to remove small cell tumors can be an option. Surgeons are skilled in removing small tumors, including those that are located near the exterior of the lung and those that have not spread beyond the lung.

Patients who are able to have surgery for small cell lung cancer typically receive adjuvant chemotherapy (chemotherapy given after surgery). This approach has been shown to improve cure rates when compared with surgery alone.

Types of Lung Cancer Surgery

These surgical procedures are commonly used to treat lung cancer. Which operation is performed depends on how large the tumor is and where it has spread within the lungs.

• Sublobar operations include surgery to remove parts of the lung within one of the lobes. (There are three lobes in the right lung and two in the left lung.) This approach may involve removing a small section of the lung (called wedge resection), or removing one or more anatomic sections within a lobe (called segmentectomy). These operations are performed either when the tumor is very small or when a larger lung removal would be too physically stressful for the patient.
• A lobectomy is the removal of a complete lobe of the lung. (There are three lobes in the right lung and two in the left lung.) This is the most common operation performed for non-small cell lung cancer and is the best treatment for an isolated lung cancer in an otherwise healthy patient.
• A bilobectomy involves the removal of two lobes of the right lung (the upper and middle lobes or the middle and lower lobes).
• A pneumonectomy is the removal of an entire lung. It is performed when the cancer is located in the center of the lung and cannot be removed using a more localized operation. A pneumonectomy is only performed in patients who have good lung function and could recover and live without the need for supplemental oxygen. Fortunately, our surgeons rarely need to perform a pneumonectomy to remove lung cancer.

Chemotherapy is a drug or a combination of drugs that travel throughout the body to kill cancer cells wherever they are. It is the primary treatment for small cell lung cancer. For non-small cell lung cancer, your doctor may recommend chemotherapy either before or after surgery.

Medical oncologists use the most sophisticated approaches to treating lung cancer, including clinical trials of new therapies and drug combinations.

In 2015, the FDA approved two new immunotherapy drugs, nivolumab (Opdivo®) and pembrolizumab (Keytruda®), for the treatment of non-small cell lung cancer that has stopped responding to standard chemotherapy — in other words, as second-line therapy.

Both of these medications block a protein called PD-1 found on immune cells. PD-1 acts like a brake on the immune system, tamping down immune responses. Nivolumab and pembrolizumab release this brake, allowing the immune system to mount a stronger attack against cancer.

In addition to these FDA-approved drugs, several experimental immunotherapy drugs are being tested in clinical trials for patients with lung cancer.

Clinical trials are testing immunotherapy drugs in all settings: before and after surgery for early stage lung cancers, as first-line therapy in patients with advanced lung cancers, and in patients who have previously received chemotherapy. There are trials available for multiple forms of lung cancer, including non-small cell lung cancer and small cell lung cancer. patients may be eligible to enroll in these and other clinical trials of promising new lung cancer treatments.

Radiation therapy for lung cancer uses high-energy beams called x-rays to destroy cancer cells by damaging their DNA. It’s very effective at controlling or eliminating tumors at specific sites in the body.

The treatment can be given to cure patients whose lung cancers are confined to the chest but cannot be removed surgically. Using the most-advanced technologies, we can now deliver powerful doses of radiation directly to your tumor with exquisite precision. The approaches we use can reduce the number of sessions required for radiation treatment in comparison with more conventional approaches, while also limiting the risk of side effects.

Radiation therapy can also be used as a palliative measure to improve quality of life among patients whose disease does not respond to surgery or chemotherapy.