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Lung cancer risks and diagnosis

With lung cancer, nothing is certain

Like any cancer, being diagnosed with lung cancer is one of those devastating, life-changing events. Some people will never forget the way it just "showed up" on their chest x-ray one day without any warning. Some still wonder why they got lung cancer, while others did not. In many ways, lung cancer seems like a modern day mystery that we still haven't solved. The good news is that we know much more now about lung cancer than we ever did before—and new insights are emerging every day.

Take the causes of lung cancer. Once it was thought only smokers and coal miners got lung cancer. Many decades of research have taught us this is not true.

Even as research continues to give us more understanding about lung cancer, it may still never be possible to predict who will get lung cancer. Through active and ongoing communication with your healthcare team, you can learn about risks, how to be screened, and possible symptoms you should not ignore.

 

IMPORTANT: lung cancer risk factors may not be what you think

Newer information that may help answer, "Why me?"

Truth be told, you may never fully understand why you got lung cancer. Yet, it does help to understand what's been learned over the years about risk patterns in lung cancer and identifying possible causes.

Some lung cancer risk factors are inherited

Researchers are learning there's more to the lung cancer story than smoking. While smoking is still a key risk factor for developing lung cancer, we are learning about additional risk factors. For instance, some people are more likely to get lung cancer because of their biology or inherited genes.

  • Estrogen. You may already know the role estrogen plays in breast cancers, but recent research suggests that estrogen may also help lung cancer cells grow and spread. Estrogen is found in higher levels in women, which could explain why a large number of women who don't smoke get lung cancer.
  • Genes. Some people inherit genes that can reduce their body's ability to get rid of cancer-causing chemicals. Having one of these genes may put you at a high risk for developing lung cancer. The discovery of a gene called UGT2B10 haplotype is one such gene. Researchers have learned that this gene can influence your body’s ability to flush toxic substances, like nicotine and cotinine. (Cotinine is a nicotine byproduct that is thought to promote lung tumor growth.)
  • Mutations. Genetic mutations are also known to play a critical role in the progression of disease and response to treatment. It is now known that some patients with non-small cell lung cancer may test positive for any of the following: mutations in epidermal growth factor receptor (EGFR), KRAS, or anaplastic lymphoma kinase (ALK). Therefore, testing for these mutations may be recommended as part of standard practice.

Our environment affects our lungs—for better or for worse

Depending on where you live, certain environmental factors may increase your risk of cancer.

  • Radon, a radioactive gas, is the second most common cause of lung cancer in the United States and the main cause of lung cancer in non-smokers. Houses built in certain regions of the United States can expose people to radon, especially the basements of those buildings. If you suspect that you live in one of these areas, you should test your house for radon.
  • Studies have shown that a type of air pollution called "particle air pollution" increases the risk of lung cancer. Cities and areas near heavily traveled roads seem to have more of it. If you live in one of those environments, you could have been exposed to particle air pollution and may be at a higher risk of getting lung cancer.
 

Do you know your lung cancer type and subtype?

Lung cancer will fall into one of two categories: non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). What's the difference? The size, shape, and chemical make-up of the cancer cells.

 

NSCLC makes up about 85% of lung cancer cases and includes a few sub-categories:

 

  • Adenocarcinoma: This type of cancer is usually found in the outer lining of the lungs.
  • Squamous cell carcinoma: This type of lung cancer usually starts in the flat cells in the inner lining of the middle area of the lungs.
  • Large cell carcinoma: This type of cancer can show up anywhere in the lungs and is fast growing.

SCLC makes up the other 15% of lung cancer cases

 

Do you know how a lung cancer diagnosis is made?

If you or someone you love has experienced one or more of the following lung cancer symptoms, be sure to discuss them with your physician:

  • persistent or worsening cough
  • chest pain
  • hoarseness
  • coughing up discolored mucus or blood
  • shortness of breath
  • frequent bouts of bronchitis or pneumonia
  • weight loss
  • loss of appetite
  • fatigue
  • wheezing

Are lung cancer symptoms in women different than lung cancer symptoms in men?

Lung cancer symptoms may vary by individual. If you're experiencing different symptoms than someone else with lung cancer, it may be due to the type of lung cancer you have or the size and location of the tumor. Only your doctor would be able to confirm this, so be sure to review your symptoms thoroughly with your healthcare team.

To confirm or rule out lung cancer, your doctor may have ordered some or all of the following tests:

  1. Computed tomography (CT) scan: A CT scan produces three-dimensional images of the inside of the body using x-rays. Those images can be used to see the position and size of lung tumors.
  2. Positron emission tomography (PET) scan: A PET scan creates pictures of the inside of the body to see if the cancer has spread. A PET scan works by detecting energy that's absorbed by different parts of the body from injected radioactive material.
  3. Magnetic resonance imaging (MRI) scan: An MRI scan makes pictures of the inside of the body using magnetic fields. These pictures can be used to see the position and size of lung tumors.
  4. Sputum cytology: Sputum cytology is a test where a mucus sample is looked at under a microscope. A doctor will look for cancer cells in the mucus sample.
  5. Thoracentesis: Thoracentesis is a test where fluid from between the chest and lungs is removed with a needle and studied. A doctor will look for cancer cells in the fluid sample.
  6. Bronchoscopy: A bronchoscopy is a test where a tube is inserted down the throat and into the lungs. The tube lets a doctor see the inside of the lungs and take a tissue or fluid sample. The sample is then checked for cancer cells.
  7. Biomarker testing: When healthcare providers test for biomarkers, they're looking for molecules that signal a normal or abnormal process, condition, or disease. Biomarker testing may help your oncologist know more about your cancer and may be used to help identify appropriate treatment options.

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What are some of the new things scientists are learning about lung cancer?

The renewed energy and attention devoted to lung cancer may be due to innovations in screening and imaging, as well as an ongoing understanding of how tumors form and spread. New research in how the environment and our DNA can influence the development of cancer is also noteworthy. Don't be afraid to ask your healthcare team about what they know and if they have reading suggestions on this topic.

Why are we seeing more lung cancer in women?

There has been an increase in the number of women who smoke since the 1950s. But in 2000, studies showed that only 47% of lung cancers in women were attributed to smoking. What might explain the other 53%? Hormones used in replacement therapy have been cited as one potential reason. Another could be the mutation of epidermal growth factor receptors (EGFR). In healthy cells, EGFR grow and divide. With an EGFR mutation, cancer cells grow and divide out of control.

Should you or someone you love be screened for lung cancer?

Studies show that screening is a valuable tool for detecting lung cancer at its earliest and most treatable stages. The U.S. Preventive Services Task Force—an independent volunteer panel of national health experts—recommends low-dose CT scans for those at "high risk." Talk with your doctor about whether or not a scan is right for you or someone you love.

What are some of the new things scientists are learning about lung cancer?

The renewed energy and attention devoted to lung cancer may be due to innovations in screening and imaging, as well as an ongoing understanding of how tumors form and spread. New research in how the environment and our DNA can influence the development of cancer is also noteworthy. Don't be afraid to ask your healthcare team about what they know and if they have reading suggestions on this topic.

Scans and tests are used often

It's not uncommon for lung cancer to be found by accident as a result of a chest x-ray or chest CT scan that was ordered for bronchitis or pneumonia. In fact, one suspicious scan could trigger a host of additional tests and scans. Each test plays a different role in confirming size, position, or growth of cancerous cell tissue. A lung cancer diagnosis should be made when all your tests work together to tell a complete story.

FACT: most people don't know they have lung cancer until it has already advanced

Because of the size of the lungs, tumors can grow for a while without causing any symptoms. By the time someone with lung cancer does show symptoms, often the cancer has rooted and metastasized (or spread). Therefore, many lung cancer cases are diagnosed when the cancer is already advanced.

 

Could you be helping the ones you love understand how lung cancer is staged?

NEXT: Stages of Lung Cancer

 

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