This section contains information to help you understand how lung cancer is diagnosed and treated - and what you might expect along the way.
About your lungs
Your lungs are located in your chest, one on the left and one on the right. They allow you to breathe in (inhale) the oxygen your body needs and breathe out (exhale) the carbon dioxide it doesn’t. Your lungs are made up of:
- Lobes: Main sections of each lung. The right lung has three lobes; the left lung has two
- Bronchi: Tubes that carry air from the windpipe (trachea) to both lungs
- Bronchioles: Very small tubes that carry air inside the lungs
- Alveoli: Air sacs at the ends of the bronchioles. Alveoli have thin walls so that oxygen from the air can be exchanged for carbon dioxide in the blood
- Pleura: Outside covering of your lungs. There is a small amount of fluid between the lungs and the pleura that helps the lungs move smoothly as you breathe
Symptoms of Lung Cancer
There are two main types of lung cancer, small cell (SCLC) and non-small cell (NSCLC). With lung cancer, symptoms may not appear until the cancer is advanced. Always discuss any of the following signs or symptoms with your healthcare team:
Chest discomfort or pain
A cough that doesn’t go away or gets worse over time
Trouble breathing or trouble swallowing
Hoarseness or wheezing
Blood in sputum (mucus coughed up from the lungs)
Feeling very tired or loss of appetite
Weight loss for no known reason
Swelling in the face and/or veins in the neck
How Lung Cancer is Diagnosed
Different tests and procedures are used to detect, diagnose, and evaluate lung cancer and may include:
A general examination is performed to check for unusual lumps and signs of disease and to record overall health, including smoking history.
How Lung Cancer is Staged
The tool used most often to stage NSCLC is the American Joint Committee on Cancer (AJCC) TNM system, which is based on:
- The size of the main (primary) tumor (T) and whether it has grown into nearby areas
- Whether the cancer has spread to nearby (regional) lymph nodes (N). Lymph nodes are small bean-shaped collections of immune system cells to which cancers often spread before going to other parts of the body
- Whether the cancer has spread (metastasized; M) to other organs of the body. The most common sites are the brain, bones, adrenal glands, liver, kidneys, and the other lung
Numbers or letters appear after T, N, and M to provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping, and an overall stage is assigned.
Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage of 0, I, II, III, or IV (4). This process is called stage grouping. Some stages are subdivided into A and B. The stages identify cancers that have a similar outlook (prognosis) and thus are treated in a similar way. Patients with lower stage numbers tend to have a better outlook.
How Lung Cancer is Treated
Though many lung cancer patients may be more than ready to start fighting the cancer, each treatment option comes with special considerations that could impact day-to-day life. That’s why it’s important to discuss treatment options with your doctor, including risks and potential benefits.
After a patient is diagnosed with lung cancer, a treatment plan can be formed based on the type of lung cancer, the stage of the cancer, and overall health of the patient. Depending on your specific diagnosis, your cancer treatment may include one or a combination of the following options:
Chemotherapy (chemo) is treatment with anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer anywhere in the body. Chemotherapy may be used before surgery to shrink a tumor, after surgery to destroy cancer cells that may remain, or to relieve symptoms in patients with advanced cancer. Chemotherapy also may be combined with radiation therapy.
A machine outside the body directs high-powered beams of energy into the tumor to kill the cancer cells. Radiation may be used before surgery to shrink a tumor, after surgery to destroy cancer cells that may remain, or to relieve symptoms in people with advanced cancer. Radiation also may be combined with chemotherapy.
If your doctor believes you’re a good candidate, surgery may be used to diagnose the cancer and may help determine staging. Surgery also may be used to reduce the size of a tumor that is too large to be removed completely to help reduce pain and help you continue with your daily activities.
Plan: What’s Next?
Lung cancer means many aspects of life will have to be carefully planned, starting with treatment. Each treatment option presents different considerations for the patient. Daily schedules will likely change. Priorities may shift. Just know that each person living with lung cancer is different and has different ideas about treatment. Some may want the most aggressive option possible. Others may want to minimize the amount of side effects they might experience. Still others may want a balance of both. As you consider and decide on your treatment options, it's important to:
Work closely with your care team
Involve loved ones
Support for those with Lung Cancer
A lung cancer diagnosis can be difficult to hear, but for some people, it may be even harder. More than 50 years ago, smoking was directly linked to lung cancer. Unfortunately, lung cancer has since become labeled as a “smoker’s disease” and carries with it a very real stigma that may affect people who are fighting it. In addition to the blow of their diagnosis, some people who smoked may experience feelings of fear, guilt, self-blame, and shame that may impact them psychosocially.
According to the American Lung Association, there are several reasons lung cancer has become stigmatized. Unlike other cancers, there is not as strong community support; there is a lack of public knowledge about various causes; and there is a perception of personal responsibility. However, as new advances in treatment and research increase, the number of people who get lung cancer, or pass away because of it, is slowly decreasing. And as more people become aware that smoking isn’t the only cause of lung cancer and recognize how even people who have quit smoking or have never smoked also may develop lung cancer, the more urgent the need to fight it will become.
Coming to terms with a lung cancer diagnosis or any social challenges it may bring isn’t easy. Your healthcare team may know of resources in your area that can help. The organizations listed below are also great resources for learning more and finding support.
New Normal: Life’s Different.
Adjusting to life with lung cancer and all its challenges can bring ongoing cycles of changing emotions and practical needs for everyone involved. Here are some suggestions that might help throughout your cancer treatment:
Lung cancer treatment can consist of multiple phases. If your cancer stays stable or improves with your initial treatment, your doctor may talk to you about staying on medication to help maintain your body’s response for as long as possible. This is called maintenance therapy. Your doctor may keep you on the same medication you had before (continuation maintenance) or use a new medication (switch maintenance). If your cancer comes back after treatment (recurrence), you also may have the option of starting treatment with a different medication. Talk with your doctor to understand treatment and to help you develop a plan of action you and your loved ones are comfortable with from the start.