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Frequently Asked Questions

What is lung cancer?
What are the symptoms of lung cancer?
What are the different types of lung cancer?
What is a pulmonologist
What is a bronchoscopy?
What is a mediastinoscopy?

What is lung cancer?
Cancer is a group of diseases caused by rapidly dividing cells. As these cell divide they change and can no longer do the job they were intended. Lung cancer is a disease that begins in the cells of the lungs.

It is currently believed that lung cancer may slowly develop over ten or more years before it seen on x-ray or some other radiological scan. However, lung cancer can spread quickly to other parts of the body, because it starts out in an organ through which the blood in the body flows through.

When cancer cells spread from one place to another in the body; it is said that it has metastasized. Metastatic cancer is the same cancer as the original cancer but it has traveled through the bloodstream to another area and started to grow there as well. When a patient is first seen by a physician it is necessary to determine the “stage” of the lung cancer. Based on what stage lung cancer is when first found determines what treatments are available. This may include additional testing before a treatment plan can be developed.

What are the symptoms of lung cancer?
Many people do not have symptoms, or they have only vague symptoms. When lung cancer causes symptoms, they may include: coughing, shortness of breath, tiredness (fatigue), pain in the chest or upper body, frequent upper respiratory infections, blood tinged sputum, weight loss, loss of appetite, or hoarseness.

Diagnosing lung cancer is a process that requires more than one test and/or procedure. A physician will meet with you to talk about your symptoms, lifestyle and family history. A physical exam will help to determine the extent of your health. Based on your history and physical, the physician will order some tests.

A chest x-ray is a two-dimensional picture that will give a general idea of overall lung and heart health. It is not able to show tumors hiding behind the ribs or the heart. It may show a large tumor but may not show smaller tumors. It is also impossible to tell from a chest x-ray if a “spot” or “mass” is a cancer.

A CT scan is a three-dimensional picture that will show the size, shape, and exact location of a tumor. It also gives a better picture of the overall health of the lungs. Enlarged lymph nodes may be seen on a CT scan; this will help to determine if further testing is needed.

A PET scan is different than a CT scan because it looks at the cells in the body. A sugar solution is given intravenously and pictures of the entire body are taken. The pictures will show areas of high metabolic activity like cancer cells have. From these pictures; physicians will be able begin to formulate a treatment plan.

What are the different types of lung cancer?
The two main types of lung cancer are nonsmall cell lung cancer and small cell lung cancer. Nonsmall cell lung cancer makes up about 80% of the lung cancers diagnosed. There are three types of nonsmall cell lung cancers: Adenocarcinoma, Squamous cell carcinoma, and large cell carcinoma.

Of the nonsmall cell lung cancers, adenocarcinoma is the most common. About 40% of all lung cancers diagnosed are adenocarcinoma. It is the most common lung cancer in women and usually starts near the outer edges of the lungs. Squamous cell carcinoma is present is about 35% of all lung cancers. This is usually found in men and older patients. It usually starts in one of the larger breathing tubes and is more likely to cause ulceration, bleeding in the breathing tube, and obstruction of the breathing tube. Squamous cell carcinomas are strongly associated with smoking. Large cell carcinoma, the last of the three nonsmall cell carcinomas, is only present in about 5% of all lung cancers. It usually starts in the smaller breathing tubes but can occur in any part of the lung. Most of these tumors are fairly large when found.

Small cell lung cancer is a more aggressive type of cancer. It tends to develop in smokers or former smokers. It is known to grown and spread quickly but it is more responsive to chemotherapy and radiation than nonsmall cell cancer. It has usually spread to other organs by the time of diagnosis and it is likely to recur following treatment.

There are two other types of cancer that occur in the lungs. These start in other parts of the body and travel (metastasize) to the lungs. Carcinoid tumors are tumors from the endocrine system. These come from hormone producing organs like the thyroid, hypothalamus, and pituitary gland. This type of cancer is very rare. Malignant mesothelioma is another rare form of cancer that can start in several areas of the body but most commonly in the lungs. Exposure to asbestos is the most common cause of mesothelioma. Symptoms may not appear for 35 to 40 years after the cancer begins. Most patients can not be cured with surgery alone and there are high rates of recurrence.

What is a pulmonologist?
Pulmonologists are medical doctors who specialize in evaluating and treating lung disease. Pulmonary physicians evaluate patients with lung nodules or masses that are suspicious for lung cancer and commonly decide which patients need a lung biopsy. Routine tests that Pulmonary physicians order for patients suspected of having lung cancer include blood tests, chest CT scans, PET/CT scans and pulmonary function tests (PFTs). They may perform bronchoscopy or refer a patient to Radiology for a CT or ultra-sound guided needle biopsy of a lung lesion. After the diagnosis of lung cancer has been established, Pulmonary physicians participate in the staging evaluation to determine the anatomic extend of the patient’s lung cancer. The patient's disease stage, which is generally determined by a head MRI or CT scan and a whole body PET/CT scan, will determine the patient’s treatment options and prognosis. Pulmonary physicians may also see patients during or after their lung cancer treatment for evaluation of breathlessness, cough, pleural effusion (fluid around the lung), etc.

What is a bronchoscopy?

A bronchoscopy involves the use of a lighted scope to look into the large airways. Local anesthetic and mild sedation are used to make the patient comfortable during the procedure. If any abnormal tissue is seen by the physician; a biopsy may be taken of the area. These samples can be sent to the laboratory to determine if they contain cancer cells.

What is a mediastinoscopy?

A mediastinoscopy is a surgical procedure. The surgeon makes a small incision in the neck and uses a special scope to look at the lymph nodes surrounding the breast bone.  Lymph node tissue is sent to the laboratory to determine if cancer is present. This procedure is useful in helping to determine “staging” of cancer.

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