There are two primary types of lung cancer. The most common type, called non-small cell lung cancer, accounts for almost 90 percent of lung cancers. Non-small cell lung cancers are further divided into several classifications, depending on which cells they develop in, each with a different treatment and prognosis. The other primary lung cancer, called small cell lung cancer, begins in the bronchi and usually spreads quickly to other parts of the body. Aside from skin cancer, lung cancer is the second most common cancer affecting both men and women. It usually affects people over 65 and is slightly more likely to affect men than women.
At NewYork-Presbyterian, patients with lung cancer are cared for by a multi-disciplinary team of physicians and researchers dedicated to improving the prospects for all patients with this disease. They meet regularly to discuss research, review patients' cases, and plan courses of treatment. Additionally, we have a robust clinical research program aimed at developing novel treatments for lung cancer, and we offer a wide range of clinical trials to patients with lung cancer.
Smoking is the biggest single risk factor for lung cancer in general, although it is not uncommon for non-smokers to develop small cell lung cancer. Exposure to radon gas or asbestos, and to certain workplace ores or chemicals including uranium, arsenic, and diesel exhaust are also known to increase the risk of contracting the disease. Having a family history of lung cancer can be a contributing factor, as can previous radiation therapy to the chest. Air pollution is also believed to contribute to risk for lung cancer.
In its early stages lung cancer may not cause any symptoms. As the disease advances, however, the following symptoms may develop: a persistent or worsening cough; trouble breathing or shortness of breath; constant chest pain; bloody cough; a hoarse voice; frequent lung infections, such as pneumonia; fatigue; and unexplained weight loss. Conditions other than lung cancer can also cause these symptoms, and patients with any symptoms should see a doctor to determine the cause.
Our doctors determine the best treatment approach for each patient with lung cancer by taking into account the type and stage of the disease, its location – particularly its proximity to vital structures such as the heart or the aorta – and the patient's age and physical health. Treatment may include surgery, radiation, chemotherapy, immunotherapy, targeted therapies, or a combination.
Treatment for early-stage, non-small cell lung cancer often involves surgery, during which surgeons remove the tumor and a margin of surrounding tissue. Depending on individual circumstances, surgeons can remove part of a lung (lobectomy) or the entire lung (pneumonectomy).
Our surgeons often use newer, minimally invasive approaches including video-assisted thoracoscopic surgery (VATS) as well as robotic surgery, which is performed through smaller incisions than conventional open surgery, and which results in a shorter hospital stay and faster recovery for patients. We use minimally invasive procedures for more than half of lung cancer surgeries (and more often in patients with early-stage disease). Our thoracic surgeons are experienced in both minimally-invasive and traditional open surgical approaches, and use the procedure that is most likely to be effective for each individual patient. Because of small cell lung cancer's tendency to spread, surgery is not normally an option for that type of lung cancer.
Doctors treat patients who have more advanced forms of lung cancer with chemotherapy, including newer medications that target particular signaling pathways involved in lung cancer growth. Patients may receive chemotherapy after surgery, or if they cannot undergo surgery they may receive chemotherapy alone. Chemotherapy is usually the primary therapy for small cell lung cancer patients.
Many patients with lung cancer receive radiation therapy, either as a primary treatment or in addition to surgery and/or chemotherapy. Radiation and chemotherapy are sometimes used to shrink tumors to make surgery possible, and radiation is often standard treatment to prevent recurrence. Our radiation oncologists use various radiation techniques depending on the patient's situation: conventional external beam radiation therapy, three-dimensional conformal radiation therapy (in which the radiation beams are shaped to the contours of the tumor), or intensity-modulated radiation therapy (a type of 3-D radiation therapy that targets tumors with radiation of various intensities from different angles, sparing healthy tissue from the damaging effects of radiation).
We are also evaluating newer methods of delivering radiation, including stereotactic radiosurgery, which delivers precisely focused, high dose X-rays; radiofrequency ablation, which passes radiofrequency waves through a probe directly to the tumor to destroy it; and a technique called "gating" that account for lungs' movement as patients breathe during treatment.