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Lung Cancer

  • Lung Cancer is a leading cause of mortality.
  • Smoking is a major risk factor for developing Lung Cancer.
  • Early detection is important.
  • Holy Name Medical Center offers an early lung cancer screening program.
  • Would you like to be screened?
Information About Lung Cancer

Lung cancer is the leading cause of cancer deaths in both men and women. It results in more deaths than all other cancers combined. Smoking tobacco, whether cigarettes, cigars or pipes, is the leading causes of lung cancer. The number of cigarettes smoked and the number of years smoked, increases one's risk of developing lung cancer. Not smoking, is the most effective way to prevent lung cancer, but stopping at any time can decrease this risk. Other risk factors include: a personal or family history of lung cancer, occupational or environmental exposures to asbestos, radon or arsenic, radiation exposure, environmental tobacco smoke, and lung diseases such as chronic obstructive pulmonary disease (COPD), or emphysema.

Lung cancer is difficult to detect early because symptoms may not appear until the disease is advanced. Symptoms depend on the location of the tumor and can include persistent cough, hoarseness or wheezing, shortness of breath, sputum streaked with blood, recurring bronchitis or pneumonia, loss of appetite accompanied by weight loss, and chest pain.

The Lung Cancer Detection Program at Holy Name Medical Center

Holy Name Medical Center is dedicated to providing appropriate screening for the early detection of lung cancer using low dose computed tomography (CT scan). CT scans can detect a tumor before it appears on a chest X-Ray. Lung cancers are most curable when found in the earliest stages. The screening CT is quick, non invasive and painless. Two radiologists with specialized training interpret the test.

Other lung abnormalities may be found on CT scan and referrals for appropriate care are available.
Lung cancers are generally divided into two types:
  • Non-small cell lung cancer is much more common than small cell lung cancer. The three main kinds of non-small cell lung cancer are named for the type of cells in the tumor:

    • Squamous cell carcinoma is also called epidermoid carcinoma. It often begins in the bronchi near the middle of the lungs.
    • Adenocarcinoma usually begins along the outer edges of the lungs and under the lining of the bronchi. It is the most common type of lung cancer in people who have never smoked.
    • Large cell carcinomas are a group of cancers with large, abnormal-looking cells. These tumors may begin anywhere in the lungs.

  • Small cell lung cancer, sometimes called oat cell cancer because the cancer cells may look like oats when viewed under a microscope, grows rapidly and quickly spreads to other organs. There are two stages of small cell lung cancer:

    • Limited - cancer is generally found only in one lung. There may also be cancer in nearby lymph nodes on the same side of the chest.
    • Extensive - cancer has spread beyond the primary tumor in the lung into other parts of the body.
It is important to find out the kind of lung cancer a person has. The different types of carcinomas, involving different regions of the lung, may cause different symptoms and are treated differently.
What are the symptoms of lung cancer?

The following are the most common symptoms for lung cancer. However, each individual may have a unique presentation.

Lung cancer may not cause any symptoms until the cancer begins to grow. A cough is the most common presenting symptom of lung cancer.

Other symptoms include:
  • Constant chest pain
  • Shortness of breath
  • Wheezing
  • Recurring lung infections, such as pneumonia or bronchitis
  • Bloody or rust colored sputum
  • Hoarseness
  • A tumor that presses on large blood vessels near the lung can cause swelling of the neck and face
  • A tumor that presses on certain nerves near the lung causing pain and weakness in the shoulder, arm, or hand
  • Fever for unknown reason
Like all cancers, lung cancer can cause:
  • Fatigue
  • Loss of appetite
  • Loss of weight
  • Headache
  • Pain in other parts of the body not affected by the cancer
  • Bone fractures
  • Paraneoplastic Syndrome - Symptoms caused by substances produced by cancer cells
How is lung cancer diagnosed?

  1. Complete medical history
  2. Physical examination to find signs of lung cancer and other health problems
  3. Diagnostic procedures
  • Chest X-ray - to look for any mass or spot on the lungs.
  • Computed tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • CT and MRI scans of the brain, liver, bone, and adrenal glands - to determine if the cancer has spread from where it started into other areas of the body.
  • PET Scan - Positron emission tomography (PET) is a type of nuclear medicine procedure that measures metabolic activity of the cells of body tissues. PET may also be used in conjunction with other diagnostic tests such as computed tomography (CT) or magnetic resonance imaging (MRI) to provide more definitive information about malignant (cancerous) tumors and other lesions.
  • Sputum cytology - a study of mucus cells under a microscope to evaluate for cancer cells.
  • Needle biopsy - a thin, hollow needle is guided into the mass while the lungs are being viewed under X-Ray or CT scan, and a sample of the mass is obtained and evaluated by a pathologist for cancer cells.
  • Bronchoscopy - the examination of the bronchi (the main airways of the lungs) using a flexible tube (bronchoscope) passed through the mouth or nose. Bronchoscopy allows for evaluation of the bronchial tree and to obtain specimens for cytologic and pathologic analysis.
  • Mediastinoscopy - a process in which a small cut is made in the neck so that a tissue sample can be taken from the lymph nodes (mediastinal nodes) along the windpipe and evaluated by a pathologist.
  • Thoracoscopy - a procedure in which a small cut is made in the side of the chest wall through which a small tube with a video camera is inserted. This allows the doctor to look at the outer part of the lungs and chest wall and to sample any abnormal areas for evaluation by a pathologist.
Other tests and procedures may be used as well.
Treatment for lung cancer

Specific treatment for lung cancer will be determined by your physician based on:
  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Your opinion or preference
Lung cancer may be treated with surgery, chemotherapy or other medications, radiation therapy, laser therapy, or a combination of treatments. "Combination treatment" or "multimodality treatment" refers to having more than one type of treatment.

Treatment for lung cancer includes one or more of the following:
  • Surgery: Surgery is part of the treatment for early stage lung cancers. The type of surgery depends on the size and location of the tumor in the lung, the extent of the cancer, the general health of the patient, and other factors. Many surgeries are done with a long incision in the side of the chest, known as a thoracotomy. Some early stage tumors may be treated with video assisted thoracic surgery (VATS), which uses several small incisions (instead of one large one).

    Types of surgery include:

    • Segmental or wedge resection - removal of only a small part of the lung.
    • Lobectomy - removal of an entire lobe of the lung.
    • Pneumonectomy - removal of an entire lung.
    • Sleeve resection - removal of a piece of bronchus, after which the lung is reattached to the remaining part of the bronchus.
  • Radiation therapy: Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. Radiation may also be used with chemotherapy to treat lung cancer.

    There are two ways to deliver radiation therapy, including the following:

    • External radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
    • Internal radiation (brachytherapy, implant radiation) - radiation is given inside the body as close to the cancer as possible. Substances that produce radiation, called radioisotopes, may be swallowed, injected, or implanted directly into the tumor. Some of the radioactive implants are called "seeds" or "capsules." Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Other internal treatments stay in the body permanently, though the radioactive substance loses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.
  • Chemotherapy: The use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Chemotherapy may be given before other treatments, after other treatments, or alone for lung cancer.
  • Photodynamic therapy (PDT): A type of laser treatment that involves injecting photosensitizing chemicals into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells, than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser can be focused directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells. For lung cancer, the light is delivered through a bronchoscope (a small, flexible tube with a light on the end) that is inserted through the mouth or nose.
  • Targeted therapy: As cancers grow, they form new blood vessels which nourish them. Research aimed at blocking the growth of these blood vessels has led to the development of medications called antiangiogenesis medications. Bevacizumab (Avastin) is one of these medications. It has been found to be helpful in prolonging the survival of patients with advanced lung cancer. It is used with the standard chemotherapy regimen. Medications with other specific targets, such as erlotinib (Tarceva) and cetuximab (Erbitux), may also be useful.
There are specific names for the order in which treatment is given. Neoadjuvant treatment refers to having radiation or chemotherapy before surgery. Having one or both of these before surgery may help shrink the tumor - a smaller tumor is easier to remove surgically.

Chemotherapy or radiation soon after surgery is called adjuvant treatment. The goal of adjuvant treatment is to kill any cancer cells that may be left after the surgery. Even if there is no sign of cancer cells, your physician may suggest adjuvant treatment, as it lowers the risk that the cancer may come back or spread.

Clinical trials are being conducted on prevention and treatment options for lung cancer, including photodynamic therapy and chemoprevention.