I.

INTRODUCTION

Cancerous Human Lung Cancerous Human Lung This dissection of human lung tissue shows light-colored cancerous tissue in the center of the photograph. At bottom center lies the heart. While normal lung tissue is light pink in color, the tissue surrounding the cancer is black and airless, the result of a tarlike residue left by cigarette smoke. Most lung cancer begins in the cells lining the main air passages, or bronchi. In their cancerous state, these cells lack the cilia that normally catch and eliminate foreign particles inhaled into the lung. Mucous ordinarily cleared by bronchial cilia becomes trapped, blocking air passages. Lung cancer accounts for the largest percentage of cancer deaths in the United States, and cigarette smoking is directly responsible for the majority of these cases. Encarta Encyclopedia Martin Rotker/Phototake NYC Full Size

Lung Cancer, malignancy of the lungs that is the leading cause of cancer deaths for both men and women in the United States and Canada. Nearly 90 percent of lung cancers occur in current or former smokers. The American Cancer Society (ACS) estimates that about 175,000 new cases of lung cancer are diagnosed annually in the United States and that more than 160,000 Americans die from the disease each year. The Canadian Cancer Society estimates that nearly 23,000 new cases of lung cancer are diagnosed in Canada annually and that the disease causes nearly 20,000 deaths a year. The likelihood of developing lung cancer increases with age. According to the ACS, nearly 70 percent of people diagnosed with lung cancer are age 65 or older. Smoking or exposure to tobacco smoke contributes to the overwhelming majority of lung cancer cases. The longer someone smokes and the more the person smokes each day, the greater the risk of developing lung cancer. Microsoft Encarta 2009. 1993-2008 Microsoft Corporation. All rights reserved.

TYPES OF LUNG CANCER Cancer experts divide lung cancer into two major types: nonsmall cell and small cell. These types differ in the appearance of the cancerous cells, their rate of growth, and the method of their treatment. Nonsmall-cell cancers are far more common and account for between 85 and 90 percent of all lung cancers. Small-cell cancers make up most of the remainder. There are three main types of nonsmall-cell lung cancers, grouped according to the cells the cancer develops in: squamous cell carcinoma, adenocarcinoma, and large-cell carcinoma. The diagnosis of cancer types can be made by looking at the cells under a microscope. Squamous cell carcinomaaccounts for 25 to 30 percent of all lung cancer. It frequently begins toward the central part of the lung in the bronchial tubes, which are the major airways that lead into the lungs. About 40 percent of lung cancers are adenocarcinomas, cancers that originate on the outer edges of the lungs and under the lining of the bronchial tubes. From 10 to 15 percent of lung cancers are large-cell carcinomas, cancers characterized by large, abnormal cells that can appear in any part of the lung. Small-cell carcinoma accounts for about 20 percent of lung cancers. It is characterized by small cells shaped like either oat grains or rods. Small-cell carcinoma, sometimes called oat-cell carcinoma, grows more rapidly and is more likely to spread than any other kind of lung cancer. Lung cancer often spreads, or metastasizes, through the bloodstream or lymphatic system to other tissues. More than 50 percent of people newly diagnosed for lung cancer already show signs of cancer elsewhere in the body. Conversely, some cancers detected in the lung are actually cancers that have metastasized from other parts of the body to the lungs. These are not considered lung cancers. For example, if breast cancer spreads to the lung, it is still considered breast cancer. It does not look or behave like a cancer that starts in the lung. III. RISK FACTORS

Smoking cigarettes is the single greatest cause of lung cancer. Smoking cigars or a pipe also increases the risk of lung cancer. Tobacco smoking causes as many as 90 percent of lung cancers in men and about 78 percent of those in women. Exposure to secondhand smokethat is, inhaling the tobacco smoke of smokershas occurred in most of the remaining cases. Substances in tobacco damage the cells in lungs, and over time the damaged cells can become cancerous. The great majority of lung cancer cases could be prevented and thousands of lives could be saved each year if people quit smoking. Other environmental factors that have been linked to lung cancer include prolonged exposure to certain workplace substances, such as arsenic; asbestos; and high doses of ionizing radiation, for example, that emitted by uranium (see Radiation Effects, Biological). Long-term exposure to air pollution, which is largely composed of the remains of burned petroleum and coal, may also

increase the risk of lung cancer. One constituent of indoor air pollution, naturally occurring radon gas, poses a special danger to cigarette smokers. This colorless, odorless gas silently seeps from the soil into the air in some regions of the world. Not all heavy smokers develop lung cancer, however, suggesting that heredity may also play a role in the development of the disease. Some people seem to inherit an inability to break down certain types of cancer-causing chemicals, making them more susceptible to the disease. Exposure to tobacco smoke, for example, may cause key cancer-prevention genes to malfunction in these people. For instance, a tumor suppressor gene called FHIT prevents the growth and spread of cancerous tumors. Many people with lung cancer inherit a mutated form of the gene that fails to perform this job. The tumor suppressor gene p53 also prevents tumor growth, and researchers have learned that a mutated form of the p53 gene fails to block the growth of cancerous tumors. Cancer researchers have found that a genetic abnormality on chromosome six makes people more susceptible than others to developing lung cancer. Some studies indicate that women are twice as likely as men to develop lung cancer. Researchers have found a gene called GRPR that causes abnormal cell growth in people exposed to cigarette smoke. The gene is more active in women than in men and it may explain why females are more susceptible to lung cancer. IV. SYMPTOMS AND DIAGNOSIS

The symptoms of lung cancer are not usually apparent during early stages of the disease. The first symptoms to appear are often similar to those of other, nonmalignant respiratory ailments. The patient may develop a persistent cough, or find that a chronic smokers cough is worsening. Other symptoms include chest pain, shortness of breath, hoarseness, bloody sputum (fluid coughed up from the respiratory tract), and frequent bouts of bronchitis or pneumonia. Sometimes, the first symptoms of lung cancer are bone pain, headaches, dizziness, or other signs that the disease has metastasized. A physician who suspects lung cancer may use a chest X ray or CT scan (see Computed Tomography) to view the lungs and locate any tumors. A CT scan, a series of X-ray images combined by a computer, can also pinpoint the tumors approximate size and location. To further evaluate cancerous cells, the physician must examine them under a microscope. In a procedure known as a biopsy, the physician removes a small tissue sample from the tumor. A microscopic analysis of cells contained in the sputum can also help confirm a diagnosis. A diagnostic technique called bronchoscopy enables the physician to visually examine the patients bronchial tubes. In this procedure, the physician feeds a bronchoscope, a thin, fiber optic tool equipped with a light and magnifying device, through the patients mouth and down into the trachea and bronchial tubes to view the lungs. The bronchoscope can be fitted with a tiny cutting tool, enabling the physician to obtain samples of cells for later microscopic examination.

Symptoms of lung cancer rarely appear until the disease has reached an advanced stage and become more difficult to treat. A study reported in 2006 concluded that many lung cancers could be detected at earlier stages through wider use of low-dose CT scans. But the scans also turn up many abnormalities, including slow-growing cancers, that are unlikely to cause problems. Widespread scanning thus may lead to much unnecessary treatment. V. TREATMENT

The course of treatment depends on the type of lung cancer, the size and location of the tumor, the stage of disease, and the age and general health of the patient. The tumor can be removed from the lung using one of several surgical procedures. In a resection, the surgeon removes only a small part of the lung. In a lobectomy, an entire lobe is removed. The left lung is composed of two lobes, the right lung of three. Removal of an entire lung is called a pneumonectomy. Other treatments are called for if the tumor cannot be removed surgically or, following surgery, if cancer cells have spread beyond the tumor. Radiation treatment (see Radiology) and chemotherapy (anticancer drugs) can be used to kill cancer cells. Radiation treatment directs high-energy radiation at a specific area of the body. It can also be used to shrink a tumor before surgery. Through chemotherapy, anticancer drugs travel through the bloodstream and kill cancer cells throughout the body. Patients may receive a combination of both chemotherapy and radiation, depending on the severity of the illness. Lung cancer patients must be monitored regularly following treatment, even if no signs of cancer persist. Second lung cancers develop in a significant number of survivors. Cancer researchers are conducting clinical trials (research studies on patients) to develop new treatments. One promising strategy involves the use of vaccines that engage the bodys immune system in attacking cancer cells. Gene therapythe use of genes to replace defective genes or supersede their actionsis another emerging treatment for lung cancer and other diseases with genetic components. Some preliminary experiments have found that replacing defective p53 tumor suppressor genes with normal p53 genes shrank or stopped the growth of some lung tumors. Gene therapy may someday boost the immune systems response to cancer. VI. PROGNOSIS

According to the American Cancer Society, 41 percent of people diagnosed with lung cancer survive one year after diagnosis; only about 15 percent survive five years. If the cancer is discovered while still localized, the five-year relative survival rate is about 50 percent, but only 15 percent of lung cancers are discovered at this stage. Microsoft Encarta 2009. 1993-2008 Microsoft Corporation. All rights reserved.