World Lung Cancer Day: Shining a Light on a (Still) Overlooked Disease

How does lung cancer, a disease that accounts for the third most non-skin cancer cases and most cancer deaths in the U.S., according to the American Cancer Society, struggle to attract attention? 

“Lung cancer research funding is definitely lower than funding for other types of cancer,” says Ashish Saxena, M.D., PhD, hematologist and medical oncologist specializing in lung cancer and thoracic oncology at Weill Cornell Medicine and NewYork-Presbyterian Hospital. “I think stigma plays a big part in that. In many cases, patients are ashamed or feel like, ‘Oh, I did this to myself. I was a smoker,’ when they shouldn’t feel that way. First of all, many patients who never smoked get lung cancer. In addition, nicotine is an addictive substance, and it’s not easy to just say, ‘I’m going to stop smoking.’” 

In honor of World Lung Cancer Day on August 1, let’s look past the stigma and explore some key facts about lung cancer to help raise awareness. 

Two Main Types of Lung Cancer 

The vast majority of lung cancer cases, around 8 or 9 in 10, are non-small cell lung cancer. Capable of forming anywhere in the lung, non-small cell lung cancer has several subtypes. The most common is adenocarcinoma, which starts in mucus-producing cells in the lining of the lung. 

The second main type of lung cancer is small cell lung cancer, which accounts for around 1 in 10 cases. Small cell lung cancer begins in the lung’s nerve cells. 

Both types can grow and spread to nearby lymph nodes or other organs or bones. Small cell lung cancer, however, tends to be more aggressive, often having spread to other parts of the body by the time physicians diagnose it.  

Along with lung cancer type, the stage of the disease—its size and whether it has spread—helps the cancer care team determine what type of treatment to recommend. 

Smoking: Lung Cancer’s Primary Risk Factor (But Not the Only One) 

It’s well-known that, among lung cancer risk factors, smoking is the runaway leader of the pack. Smoking cigarettes can increase the chance of developing or dying from lung cancer by as much as 30 times, according to the Centers for Disease Control and Prevention. What’s surprising to some people, however, is that many patients with lung cancer never smoked. Dr. Saxena was inspired to care for people with lung cancer after his mother, who had no history of smoking, died from the disease in her late 50s. 

“You don’t have to have smoked to get lung cancer,” Dr. Saxena says. “Patients who develop lung cancer and never smoked often have specific genetic alterations in their tumors, many of which we can target with new forms of treatment. 

“In addition to smoking, other lung cancer risk factors can be environmental, such as secondhand smoke,” he continues. “If you don’t smoke but have been around tobacco smoke a lot, it can increase your risk. Some general sources of pollution, such as indoor coal and wood cooking, are related to a higher risk of lung cancer.” 

You may also have a higher risk of lung cancer if a parent or sibling had it or if you had radiation therapy to the chest to treat a different form of cancer.  

Silence, Symptoms and the Importance of Screening 

Lung cancer is often a silent disease, at least at first. In most cases, it doesn’t cause symptoms and reveal its presence until its later stages, when treating it is more difficult. When symptoms appear, they may include: 

  • Chest pain 
  • Difficulty breathing 
  • Hoarseness 
  • Loss of appetite 
  • Persistent coughing, sometimes with blood 
  • Tiredness 
  • Unexplained weight loss 

The absence of symptoms in most early cases of lung cancer underscores the importance of screening for the disease in high-risk patients. A low-dose CT scan of the lungs can detect nodules, which are small masses that may be cancerous (most aren’t). With early detection, lung cancer is easier to treat, and patients may have a better chance of living longer. 

Who should have a low-dose CT scan? You may qualify if you’re 50 to 80 years old, currently smoke or quit within the past 15 years, and have at least a 20 pack-year smoking history. Smoking an average of one pack of cigarettes daily for 20 years or two packs per day for 10 years qualifies as a 20 pack-year smoking history. 

Diagnosing and Treating Lung Cancer 

If a nodule or another suspicious mass shows up during an imaging scan, the next step is, typically, to take a sample to determine whether lung cancer is present, and if so, what type it is. If cancer is confirmed, physicians then need to determine whether it has spread, often with CT scans, PET/CT scans and MRI scans. 

For early-stage non-small cell lung cancer that hasn’t spread beyond the lungs or to lymph nodes, surgery to remove the tumor may be the only treatment necessary, according to Dr. Saxena. If the patient can’t have surgery, physicians treat the tumor with radiation. 

“If the cancer has spread to certain lymph nodes in the chest, we can, often, perform surgery, but we also usually recommend an additional form of treatment, a systemic treatment that goes throughout the body,” Dr. Saxena says. “That’s generally chemotherapy, either before or after the surgery.” 

Radiation and chemotherapy may be appropriate when non-small cell lung cancer is advanced enough to rule out surgery but hasn’t spread to other organs, Dr. Saxena says. For advanced non-small cell lung cancer that has spread elsewhere in the body, systemic therapies, such as chemotherapy, targeted therapy or immunotherapy, are the go-to treatments. 

Some of the most exciting advances in lung cancer treatment have occurred in the areas of targeted therapy and immunotherapy. Targeted therapies act against tumors with specific mutations. Immunotherapies help the immune system attack cancer cells.  

Immunotherapy, in particular, is a promising form of treatment for advanced lung cancer and, potentially, early-stage disease, according to Dr. Saxena. Physicians at Weill Cornell Medicine and elsewhere are exploring combining immunotherapy with other forms of treatment to improve survival rates in patients with lung cancer—more signs of hope in the effort to reduce the impact of this disease. 

Wondering whether a low-dose CT lung cancer screening makes sense for you? Find a primary care physician at Weill Cornell Medicine who can help you decide.