LUNG CANCER EVALUATION CENTER - PATIENT EDUCATION

About The Center

Patient Education

What is Lung Cancer?

Cancer is an out-of-control growth of abnormal cells. Cancer cells have abnormal DNA (deoxyribo-nucleic acid)-the genetic information in all the cells of the body that determines individual hereditary characteristics. DNA can be abnormal from inheriting damaged DNA or from being damaged from environmental exposure. Cancer cells usually form a tumor, which is an abnormal growth of tissue. Some cancers like leukemia involve blood and blood-forming organs. This is a problem because normal tissue is replaced with the cancerous tissue, and the organ does not function properly. Cancer cells can travel to other parts of the body by the lymph system, and begin to grow. This process of spreading in the body is called metastasis.

Types of Lung Cancer

A pathologist is a doctor who studies diseases by looking at tissue and cells under a microscope. The pathologist can tell what type of cancer cells are in the tissue. There are two main types of lung cancer; small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).

About 13% of lung cancers are small cell. The other 87% that are non-small cell are divided into subgroups: squamous cell carcinoma, adenocarcinoma, and large cell undifferentiated carcinoma.

Chest Anatomy and Physiology

In order to understand some things about lung cancer, let's review what organs are in your chest. The chest contains a trachea, commonly called windpipe, which carries air to the lungs. It has two main branches. Each branch of the trachea is called a bronchus. These two branches connect to your lungs. Each bronchus continues to divide into smaller branches and tiny air sacs called alveoli.

We have two lungs, which are divided into sections called lobes. Your right lung is divided into three lobes: upper, middle, and lower. Your left lung is divided into two lobes: upper and lower. You also have a large muscle that divides your chest from the abdomen called the diaphragm. The lungs are surrounded by a tissue lining called the pleura.

The chest also contains your heart and aorta (main artery that carries blood to the heart), as well as other blood vessels and nerves. All these organs are protected by the rib cage and breastbone, also known as the sternum.

Throughout our body we have a lymphatic system, which is part of our circulatory (blood) system. In the chest and other parts of the body, we have lymph nodes-pea-sized "glands" that filter impurities from the body. You may hear different terms used to describe their locations in the chest, such as mediastinal (area between pleural sacs), hilar (area near opening through which bronchus, blood vessels, and nerves pass), or paratracheal(area near trachea).

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What is Staging?

Staging is the process of finding out how far the cancer has spread (metastasized). This information will determine your treatment options and prognosis-the probable course of your disease and the chance of your recovery from it. Numerous tests may be performed to determine the stage

The TNM system is commonly used. Each letter, together with a number after it, gives more details.

• "T" describes the tumor size and whether the cancer has spread to nearby tissues.
• "N" describes if or how far the cancer has spread to the lymph nodes (pea-sized "glands" that filter impurities from the body).
• "M" tells whether the cancer has spread to other organs of the body.

These TNM descriptions are the grouped together into stages 1 (early) through 4 (advanced). In general, the lower the number the better prognosis. For small-cell cancer, a two-stage system is most often used. Limited stage means that the cancer is confined to one area in the chest. Extensive stage means that the cancer has spread beyond the chest.

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Risk Factors

The number one risk factor for lung cancer is smoking. Smoking causes 8 out of every 10 cases. The longer someone has smoked increases the risk of getting lung cancer, as does the number (packs) of cigarettes he or she smokes every day. Quitting at any age lowers the risk.

Second-hand smoke is also a risk factor. Non-smoking spouses of smokers have a 30% greater risk of developing lung cancer than non-smoking spouses of non-smokers.

Smoking alone causes one-third of all cancer deaths. Environmental exposure to certain substances, such as asbestos, is another risk factor for lung cancer. Family history of a mother or father or sibling may have a slightly higher risk.

Not smoking and avoiding those who do, and eating a diet rich in fruits and vegetables could lower one's risk of getting lung cancer.

Many cases of lung cancer are found in their early stages because a test was ordered for something else. The average age of people diagnosed with lung cancer is 70.

Many people with lung cancer do not have any signs or symptoms, but some may include a cough that doesn't go away, hoarseness, unexplained weight-loss, bloody or rust-colored sputum, shortness of breath, wheezing, chest pain, bronchitis, or pneumonia that keeps coming back.

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Smoking Cessation

Making the commitment to quit smoking is one of the best choices that smokers can make for themselves, but also a difficult one. There are various opportunities for support available. Here is an overview of them.

• Anger
• Anxiety
• Cravings
• Depressed mood
• Difficulty concentrating
• Frustration
• Headaches
• Insomnia
• Irritability
• Restlessness
• Weight gain

There are various forms of nicotine replacement therapy available to assist with minimizing these symptoms. They are nicotine gum, nicotine patch, nicotine nasal spray, nicotine inhaler, and nicotine lozenge. Which kind of nicotine replacement therapy will best work for you can be discussed with your doctor or nurse to help you understand the pros and cons of each. Non-nicotine replacement therapy is also available. Bupropion (Wellbutrin, Zyban) is a mild anti-depressant that is also effective in helping people to quit smoking. It can be used alone or with nicotine replacement therapy. Varenicline (Chantix) is another medication that helps people who what to quit. This medication is not a form of nicotine replacement therapy, but it helps with the withdrawal symptoms.

Studies have shown that the best success rates for people trying to quit include counseling and/or support groups.

Nicotine Anonymous is a support group; you can call them at 631-665-0527.

The Suffolk County Department of Health offers an excellent program that involves a series of classes to help people understand the best strategies to help break the smoking habit. Its phone number is 631-853-4017, and its website is www.co.suffolk.ny.us/health.

Both of these resources are free, and assistance is also available through HealthConnect here at Stony Brook University Medical Center (631-444-4000).

New York State offers a hot line, 1-866-NY-QUITS or 1-800-QUIT-NOW, and a website www.nysmokefree.com

Some helpful hints include:

• Avoidance. Stay away from smokers and places where you are tempted to smoke.
• Activities. Exercise or do hobbies that keep your hands busy.
• Alternatives. Use oral substitutes such as sugarless gum, hard candy, and carrot sticks.
• Change of habits. For example, if you usually smoke during a coffee break, then go for a walk instead.
• Deep breathing. When you have the urge to smoke, do a deep breathing exercise and remind yourself why you quit.
• Delay tactic. If you feel that you are about to light up, delay. Tell yourself you must wait 10 minutes. Often this simple trick will allow you to move beyond the urge.
• Discussion. Call a friend for support.
• Drink of water. Use as an oral substitute such as water.

Many people say the reason they smoke is to deal with stress. Unfortunately, stress is a part of all our lives. When quitting, you will need to find new strategies to deal with stress. There are stress-management classes, and self-help books that can help you discover new ways to reduce and deal with stress. The bottom line is: don't just try to go it alone-reach out for support to help you achieve your goal.

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