Lung Cancer

What is lung cancer?

Lung cancer is an abnormal growth of malignant cells arising from the structures in the lung. Left unchecked, these cells often grow in a mass-like fashion, can invade and destroy adjacent structures, and can spread to lymph nodes or other organs outside of the chest.

Types of lung cancer

There are many different subtypes of lung cancer, but perhaps the most basic distinction is between the two following types.

• Small cell carcinoma tends to spread in the lymph system more quickly
• Non-small carcinoma often grows in place with limited initial spread.

Meet Mark

When Mark learned he had lung cancer, the North Memorial Health oncology team utilized minimally invasive robotic technology to set him on a path toward recovery and healing.

Hear his story

Although there is no way to completely prevent lung cancer, there are ways to reduce your risk:

• Quit smoking. Quitting will help reduce your risk. Meet with your healthcare provider for support on ways to stop smoking.
• Eliminate secondhand smoke. Avoid areas where people are smoking and if you live or work with someone that does smoke, encourage them to either quit or smoke in an area that is outside and away from you.
• Eat Healthy. Choose a diet that is rich with fruits and vegetables.
• Exercise. It’s never too late to start exercising. Listen to your body and try to exercise three to five days per week.
• Avoid carcinogens at work. Protect yourself from exposure to toxic chemicals at work. Become familiar with your employee’s safety precautions and follow them.
• Test your home for radon. Have the radon levels in your home checked. For information on radon testing, contact your local department of public health.

Some patients develop symptoms that are concerning for lung cancer, such as:

• Persistent cough
• Unexplained weight loss
• Chest pain
• Blood in the sputum

These symptoms often lead to a chest X-ray or a chest CT scan that shows a mass in the lung. Many patients, however, are entirely without symptoms, and their lung mass is an incidental finding or the result of intentional screening for lung cancer.

Once a suspicious lung mass is detected it is evaluated using several possible approaches:

• Observation – Often a new lung nodule is detected and is small enough that observation is recommended. If the nodule changes over time, then additional diagnostic tests are indicated.
• Robotic-assisted navigational bronchoscopy – This technique allows a pulmonologist to use sophisticated imaging and robotic technology to navigate a biopsy tool for tissue sampling, with accuracy exceeding 90%. Lymph nodes along the airways can also be biopsied using ultrasound guidance during the procedure.
• CT-guided needle biopsy – This technique allows a radiologist to pass a needle from outside the chest directly into a lung nodule, using real-time CT imaging for guidance.
• Surgical biopsy – Minimally invasive surgery may be required to sample a lung nodule if other tests have failed to provide an answer.
• Blood tests – Once lung cancer is diagnosed, there are additional blood tests designed to better understand the genetic features of the cancer, which may be used to guide a patient’s treatment. These “liquid biopsies” are not indicated for all patients but are part of our effort to be as precise and personalized in our care as possible.

Stages

Once lung cancer is diagnosed, additional efforts are made to determine the stage of the cancer. The lung cancer stage depends on the size and behavior of the tumor, the extent of lymph node involvement, and the spread of cancer outside the lung. A PET scan is usually helpful for staging.

• For non-small cell lung cancer, there are four possible stages:
  • Stage I – small size, limited to the lung, not involving lymph nodes
  • Stage II – a larger or more invasive tumor, or one that has spread to lymph nodes within the lung
  • Stage III – a larger or more invasive tumor, or one that has spread to lymph nodes outside the lung
  • Stage IV – tumor has spread from the lung distantly to other organs
• Some Stage I and II cancers are often referred to as “early stage” and Stage III and IV cancers may be called “advanced stage,” but all stages are treatable. Lung cancer staging is critical to planning the best treatment regimen for each patient.

How is lung cancer treated?

Every patient’s clinical treatment is unique as lung cancers vary in size, location, and behavior, and each person has a unique medical history that must be considered when planning treatment. We are committed to you and the best approach for your diagnosis. We anchor our care in the best practices based on current medical literature and our extensive experience while also encouraging questions and discussion to address any concerns that may arise along the way.

In general, lung cancer treatment can be separated into two major categories – local and systemic.

• Local treatment
  • Addresses the primary tumor itself to determine what can be done to either kill the cancer cells or to remove them entirely from the body.
    • Surgery – Surgical removal of the primary tumor is the gold standard of care for early-stage lung cancer. This often yields the best long-term survival benefits. Most lung cancer surgery at North Memorial Health is performed using a minimally invasive, robotic-assisted approach and is led by Dr. Mark Solfelt. This allows for smaller incisions, less trauma to the chest wall, and quicker recovery to full activity. A portion of normal lung surrounding the tumor is also removed to ensure that the margins are clear, and no cancer is left behind in the lung. After surgery, most patients require 3-5 days of hospitalization.
    • Radiation – For some patients with lung cancer, surgery is not the best alternative. Radiation treatment is an outpatient therapy that uses beams of energy to destroy the cancer cells. Radiation can be an excellent option for early-stage lung cancer patients who are medically unable to tolerate surgery, but it is also used for patients with advanced-stage lung cancer to treat areas of tumor spread. Radiation is also used in combination with surgery and other therapies to help prevent cancer recurrence.
• Systemic treatment
  • While surgery and radiation are used to treat the tumor in its primary location, medical therapy uses drugs that circulate through one’s entire system to fight cancer cells wherever they are located. Several types of medical therapy are commonly used:
    • Chemotherapy – Traditional chemotherapy drugs are frequently used to fight lung cancer. These medications are powerful in their effects on all tumor cells, especially when used in multi-drug combinations. Each drug regimen varies in its side-effects, and we are careful to discuss these with patients and monitor them closely as treatment progresses.
    • Targeted therapy – Genomic testing of your tumor may reveal genetic features that can be specifically targeted with newer drugs known as targeted therapy. These medications are specific in their action against particular gene mutations, and so they are carefully selected by your provider based on the features of your tumor.
    • Immunotherapy – This group of medications is designed to stimulate your own immune system to recognize and eliminate cancer cells.

Who are the primary members of the care team?

We believe that every lung cancer patient deserves the benefits of a multi-disciplinary team approach. Our team includes medical oncology, thoracic surgery, radiation oncology, interventional radiology, and pulmonology. We practice in a truly collaborative fashion, so that every patient has access to all that the various specialties have to offer. We try to streamline appointments and coordinate our patient’s care to be as efficient and timely as possible.

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Helpful Cancer Resources

Connect with local organizations who are here to support individuals experiencing cancer and their families.

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