Diseases & Conditions
The care of patients with lung cancer is a collaborative, multidisciplinary process. In a highly supportive and patient-focused environment, the Center for Thoracic Oncology organizes services around each patient, bringing together the expertise of diverse physician specialists to manage care from the first consultation through treatment and follow-up visits. BMC is the primary teaching affiliate of the Boston University School of Medicine, combining state-of-the-art expertise with the technological advances of a major teaching hospital that is at the forefront of clinical practice, surgical expertise, and research in oncology.
Lung cancer is highly treatable and often curable, even when a patient has severely damaged lungs and advanced disease. The Cancer Care Center's goal is to provide treatment that is effective and innovative in curing and controlling cancer. The Center's doctors are pioneering advances in effective, minimally invasive techniques that lower patients' risk, pain, and recovery time, and enable even very ill patients to improve their quality of life.
What Is Lung Cancer?
The lungs are the organs responsible for delivering oxygen from the air we breathe to our blood and eliminating carbon dioxide. We have two lungs, which are divided into lobes. The right lung has three lobes: upper, middle and lower. Because the heart is located on the left side of the body, the left lung has only two lobes—upper and lower—to accommodate the heart.
Normal, healthy cells grow and divide to form new cells as the body needs them. They die when they grow old or become damaged, and they are replaced with new cells. Sometimes, new cells form when the body does not need them, and old or damaged cells do not die when they should. The buildup of extra cells often forms a mass of tissue called a growth, or tumor. Tumor cells can be malignant (meaning cancerous) or benign (meaning non-cancerous).
Lung cancer is the abnormal growth of cells in the lungs.
There are different types of lung cancers based on the types of cells from which the cancer begins. A physician determines the type of cancer by examining the cells under a microscope.
The two main types of lung cancer are:
- Small cell
- Non-small cell
There are several types of non-small cell lung cancers, including:
- Squamous cell carcinoma, also called epidermoid carcinoma, is a form of cancer that begins in squamous cells, which are in the lining of the lungs.
- Adenocarcinoma begins in cells that have glandular properties.
- Bronchoalveolar carcinoma, a form of adenocarcinoma, may be spread more throughout the lungs than other cancers, and is more common in women and people who do not smoke than other forms of lung cancer.
- Large cell carcinoma is a type of lung cancer in which the cancer cells are large and look abnormal.
In its earliest stages, a patient may not experience symptoms from lung cancer. As the condition advances, however, the patient may develop symptoms that include:
- A new cough that does not go away
- Changes in a chronic cough
- Coughing up blood (even a small amount)
- Shortness of breath
Smoking causes the majority of lung cancer cases by damaging the cells that line the lungs. The risk increases with the frequency and duration of an individual's exposure to tobacco—whether through smoking or by secondhand contact. Tobacco smoke damages the cells that line the lungs. Cigarette smoke contains cancer-causing substances (carcinogens) that alter lung tissue. The damage worsens with repeated exposure. Over time, the injured cells become abnormal, multiply, and form tumors.
Lung cancer can also occur in nonsmokers and people who have never had prolonged exposure to secondhand smoke. There are a number of additional factors that increase lung cancer risk, including:
- Exposure to secondhand smoke
- Exposure to radon gas
- Exposure to asbestos and other chemicals
- Family history
- Excessive alcohol use
- A combination of the above
The multidisciplinary medical team will work with the patient and his or her primary care physician to diagnose lung cancer and determine its severity.
In collaboration with other specialists, the physician will likely order a number of diagnostic tests and review the results at a weekly multidisciplinary Thoracic Tumor Board meeting. This interdepartmental review process guides the recommendations for treatment. In consultation with the patient and primary care physician, the team will plan the best course of treatment for the patient based on the type and extent of cancer, and overall health.
For suspected or confirmed diagnoses of lung cancer, physicians will use a variety of diagnostic procedures to stage the disease and determine its severity and spread. Your doctor may request several tests and diagnostic procedures, including:
- Blood Tests
- CT Scan
- Magnetic Resonance Imaging (MRI)
- Brain MRI
- PET Scan
- Pulmonary Function Tests
- Stress Test
- Ventilation and Perfusion Scans
- Endobronchial Ultrasound (EBUS)
- Endoscopic Ultrasound (EUS)
- Mediastinotomy and Mediastinoscopy
- Needle Biopsy
- Video-Assisted Thoracoscopic Surgery (VATS)
- Lung Cancer Staging
Specialists from thoracic surgery, medical oncology, radiation oncology, radiology, and other medical disciplines combine their expertise to provide each patient with an integrated, individualized treatment plan. The plan may include surgery, radiation, chemotherapy, or a combination of these treatments. A patient may be offered the opportunity to participate in clinical trials if an investigational lung cancer therapy is appropriate.
With their depth and range of expertise, the specialists apply a wide array of state-of-the-art techniques to cure patients by removing and killing cancerous tissue. The surgeons also use the most advanced techniques to relieve the symptoms of patients with advanced disease so they may improve their quality of life.
Learn more about the treatments available for lung cancer.
Cancer Clinical Trials
Promising new techniques in the diagnosis, treatment, and care of patients with cancer are tested in research studies called clinical trials. Patients who may benefit from a new practice or drug may be invited by their doctor to take part in appropriate clinical trials.
BMC thoracic surgeons lead or take part in a number of national studies advancing new treatments for patients with all stages of lung cancer. These trials include minimally invasive surgical techniques for stage l lung cancer; novel use of radioactive seeds and radiofrequency ablation to reduce the risk of cancer recurrence in high-risk cases; and a stage III study that combines high-dosage radiation with chemotherapy. The number and types of clinical trials available for lung cancer patients are constantly changing. View an up-to-date list of ongoing trials here. Those interested in participating in any clinical trials at BMC, should talk with their physician.