ONCOLOGYLung Cancer

Lung cancer is among the most common cancers worldwide. Additionally, it is the leading cause of deaths due to any cancer. Smoking has been identified to be the leading cause of lung cancer. Despite advances in treatment, the outcome of patients with advanced lung cancer remains poor. In addition to exploring new avenues of research, strategies to reduce smoking may be helpful in improving outcomes.

Lilly Oncology is committed to providing answers to the complexities of cancer care by investigating therapies and support services that can make a meaningful difference for patients. We're working to help take cancer care beyond today's standards.

In this section, patients can find useful information on lung cancer and answers to some common questions on lung cancer. Please use the menu on the right to access all the relevant information.

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Causes of Lung Cancer

Lung cancer develops for a number of reasons, and in some cases the cause of the cancer is not clear. However, about 80% of lung cancer cases are due to smoking- smokers are at least 10 times more likely to develop lung cancer than non-smokers. In addition, exposure to asbestos, radiation and radon gas are also believed to increase the risk. People who have long-term lung problems and those who are exposed to passive cigarette smoke may also be at greater risk of lung cancer.

  • Cigarette smoking is the most important risk factor for NSCLC
  • It contains more than 300 chemicals, 40 of which are known to be potent carcinogens (cancer causing agents)
  • The N-nitrosamine and polycyclic aromatic hydrocarbons (PAH) are the two main classes of tobacco-related inhaled carcinogens
  • Changes in the composition and makeup of cigarettes have resulted in low-tar low- yield filter cigarettes. As a result smokers compensate by smoking more cigarettes, puffing more vigorously, and inhaling deeper
  • The risk of lung cancer is related to the duration as well as intensity of smoking
  • Lung cancer risk in smokers can be significantly diminished in a time-dependent manner following smoking cessation
  • Environmental tobacco smoke (ETS) exposure (passive smoking) contributes to 25% of all lung cancers in nonsmokers

There are two main types of lung cancer, depending upon how the cancer cells look under a microscope. Non-small cell lung cancers (NSCLC) account for about 80% of lung cancers and develop mainly from the cells which line the lungs. Small-cell lung cancer (SCLC) accounts for about 20% of cases; they are believed to develop from nerve or gland cells. Once a tumor begins to grow, it starts filling up the space in the lungs and can lead to shortness of breath or coughing. If it keeps spreading, it destroys lung tissue and may affect nearby structures called lymph nodes. It may eventually grow into the ribs or across to the other lung. Lung cancer has often spread a great deal before it is diagnosed. If the cancer enters the bloodstream and becomes metastatic, it may spread to other organs throughout the body.

  • Cough
  • Shortness of breath
  • Weight loss
  • Coughing up blood
  • Loss of appetite
  • Weakness
  • Chest pain
  • Hoarseness of voice
  • Persistent lung infection

The first test that doctors usually request in a person with suspected lung cancer is a Chest x-ray. Most lung cancers will show up on an x-ray, and sometimes people find out they have lung cancer while having an x-ray for a different reason. A sample of sputum (spit) may also be taken and sent to a laboratory to check for cancer cells. To check how large the tumor is and how far it has spread, a CT, MRI, or PET scan may be done. A viewing tube called a bronchoscope may be passed through mouth or nose into the lungs to view the tumor and take a sample for pathology testing. Alternatively, a needle may be inserted through the chest wall (under CT scan guidance) to take a sample of the suspected cancer for pathology testing. Blood tests, bone scan and lung function tests may also be undertaken to help guide treatment.

Before beginning treatment, doctors make an overall assessment of how big the cancer is and how far it has spread. This is called staging the tumor: doctors use staging and other factors such as age and general health to determine the best treatment.

Surgery may be considered, especially if the tumor is small and the person has good lung function. Surgery will usually only be considered if doctors are certain that all of the tumor can be removed. Only about 10% of people diagnosed with lung cancer are suitable for surgery. The operation is done under general anesthesia, and the chest is opened so that part or the entire affected lung can be removed (resected).

Radiotherapy uses a beam of x-rays to kill or shrink cancer cells. It is usually used for people who are not able to have surgery, and will often involve receiving radiation treatment over several days or weeks. If the tumor is large, radiotherapy may be used to shrink it to relieve pain or other symptoms, without attempting to cure the cancer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy is mainly used in the later stages of lung cancer, because once injected it can attack cancer cells throughout the body and help stop the cancer from spreading. Because many people with lung cancer are diagnosed with advanced disease, chemotherapy is a common treatment option to help prolong life and reduce symptoms. Sometimes a combination of surgery, radiotherapy and chemotherapy may be given to achieve the best results.

The possible benefits of treatment for lung cancer depend on how big the tumor is and how far it has spread. In some cases it is possible to achieve cure by removing the tumor. Otherwise, the aim of treatment is to slow down the growth and spread of the tumor to reduce symptoms and improve quality of life.

If the tumor is small, surgery may be able to remove it completely. Surgery will also generally relieve any symptoms of the cancer.

For a person whose tumor cannot be resected, radiotherapy can shrink the cancer and may relieve some symptoms. A cure is less likely than with surgery. However radiation can reduce coughing, pain and breathlessness and therefore make life easier.

For people in whom the cancer has grown beyond the lung, chemotherapy can slow the spread to other organs and can reduce the symptoms such as pain. It may also help people live longer, but a complete cure is unlikely one the cancer has spread to other organs. Other drugs such as painkillers may also be used to make life as comfortable as possible.

One of the most important things you can do when you find out that you have cancer is to learn about it and feel reassured that you understand what is happening. You can do this by consulting your healthcare team or by reading or searching the internet. You may also find it useful to talk to a counselor or a support group if you are having problems coping with thoughts about cancer. Sometimes too much information, often given by well-meaning people, can be confusing. Speak to a trusted member of your healthcare team if you have any concerns.

To make sure you understand your cancer and feel comfortable about how it is treated, you should talk to your healthcare team and express any concerns you may have. The following list may help you think about what you would like to ask.

  • How far has my cancer spread?
  • What treatment do you recommend for my cancer?
  • What is the aim of treating my cancer?
  • Are there other choices?
  • What are the possible benefits and risks of treatment?
  • Will I be treated in hospital or at home?
  • How often will I need to be treated, and for how long?
  • What else can I do to help fight cancer?
  • Do I need to change my diet and lifestyle?

Most people are concerned about whether they will have side effects and if so, what they will be like. Once treatment begins, people who have side effects want to know the best ways to cope with it.

Every person doesn't get every side effect, and some people get few, if any. In addition, the severity of side effects varies greatly from person to person. Whether you have a particular side effect and how severe it will be, depends on the kind of chemotherapy you get and how your body reacts.

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