Treatment

Symptoms, Risk Factors and Diagnosis

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide what treatment is needed. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options for you may be identified.

Symptoms of Lung Cancer

  • Chest discomfort or pain.
  • A cough that doesn’t go away or gets worse over time.
  • Trouble breathing or wheezing.
  • Blood in sputum (mucus coughed up from the lungs).
  • Hoarseness.
  • Loss of appetite.
  • Weight loss for no known reason.
  • Feeling very tired.
  • Trouble swallowing.
  • Swelling in the face and/or veins in the neck.
  • Symptom from spread of cancer
    • Bone pain or breakage from spreading to the bone
    • Seizures from brain metastases

Risk Factors

  • Smoking cigarettes, pipes, or cigars now or in the past.
  • Being exposed to secondhand smoke.
  • Having a family history of lung cancer.
  • Being treated with radiation therapy to the breast or chest.
  • Being exposed to asbestos, chromium, nickel, arsenic, soot or tar in the workplace.
  • Being exposed to radon in the home or workplace.
  • Living where there is air pollution.
  • Being infected with the human immunodeficiency virus (HIV).
  • Using beta carotene supplements and being a heavy smoker.
  • Smoking combined with other risk factors.

Diagnosis

Determining the exact type and stage of lung cancer often takes more than one approach. Patients are scheduled for a diagnostic workup within two days of referral to the Siteman lung cancer program. If you have had X-rays or laboratory tests done, you should bring those with you. The diagnostic evaluation of a chest cancer usually includes a mediastinoscopy, a simple operation to insert a scope to sample lymph nodes below the neck. Depending on the location of the tumor the doctor may do a variety of tests, including examination of the chest, lungs or esophagus with a lighted instrument, and other radiology tests.

The following tests and procedures may be used:

  1. Biopsy of a suspicious area: It can be a needle or surgical core biopsy under image guidance to obtain the cellular characteristics of the sample. Different approaches can be used:
  2. Brain MRI or CT scan: This helps stage the cancer. Small-cell lung cancer metastasizes to the brain 50 percent of the time and is often present at diagnosis.
  3. CT-PET: Washington University researchers at Siteman are pioneers in the development of this new technology that combines two often-used types of scanning – PET and CT. This technology combines high-quality images of body structures from a CT scanner with images showing cancer activities in the cells from a PET scanner. Because the scan gives both anatomical and functional information, it can find the smallest cancer that has spread to other parts of the body. Treatment can then target the cancer with the least amount of damage possible to healthy tissue.
  4. Chest X-ray to examine the lungs and chest cavity
  5. Physical exam and history to examine the patient’s past illnesses and treatments, and any signs of disease, such as lumps, a history of smoking, exposure to smoke or carcinogens, or anything else that seems unusual.-Bronchoscopy: A thin tube is inserted through the nose or mouth into the airway and down into the lungs to look at suspicious areas and retrieve a sample of tissue.
    -Thoracoscopy: This surgical procedure involves a small incision between two ribs to insert a tube with a light to view the chest cavity and take samples of suspicious areas.
    -Thoracentesis: Fluid is suctioned through a needle from the space between the lining of the chest and the lung, to obtain cells for microscopic analysis.
    -Mediastinoscopy: Through an incision at the top of the breastbone, a thin, tube-like instrument is inserted into the chest for viewing and to remove tissue.
  6. Endobronchial ultrasound (EBUS): This new technology allows the radiologist to navigate out to the periphery of the lung and biopsy nodules. The ultrasound allows visualization of areas of the lung that goes beyond the sight obtained with a CT or MRI scan. Siteman has advanced expertise in this technology.

Light microscopy: A sample of tissue is viewed under regular and high-powered microscopes in the laboratory to look for certain changes in the cells.

Immunohistochemistry: This test uses antibodies to check for certain antigens in a sample of tissue to differentiate among different types of cancer.

Tumor genetic mutation analysis: Siteman is a national leader in mutational analysis and sequencing of cancer genes. This test looks for specific molecular alternations in the tumor that predict response to a matched targeted drug.

Staging of Lung Cancer

Staging is different for non-small cell and small-cell lung cancers.

Staging for non-small cell: These cancers are staged differently for extent of disease, and for treatment.
Extent of the disease: Stages 1-4 are given, depending on the size of the tumor, its location and where the cancer might have spread outside the lung. Staging also includes the grade of the cancer (1-3) because grade is a function of how aggressive the tumor cells are and how fast they are likely to spread.

Staging for treatment:

  • Early stage is amenable to surgery with curative intent. You may still need chemotherapy and radiation.
  • Locally advanced is usually treated with chemoradiation, chemotherapy and radiation given together for better effect of each.
  • Metastatic disease is treatable with chemotherapy, targeted or immune therapy and radiation to some areas.

Staging for small-cell lung cancer

These cancers are divided into:

  • Limited-stage receives chemotherapy. Radiation may be added because of the potential for cure.
  • Extensive-stage receives chemotherapy.

Prognosis

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
  • The type of lung cancer.
  • Whether the cancer has mutations (changes) in certain genes, such as the epidermal growth factor receptor (EGFR) gene or the anaplastic lymphoma kinase (ALK) gene.
  • Whether there are signs and symptoms such as coughing or trouble breathing.
  • The patient’s general health.

Finding lung cancer early gives is a better chance of management or recovery. However, it is often in an advanced stage when diagnosed. At later stages, lung cancer can be treated but rarely cured. Clinical trials are a good option for getting the latest treatment.