A National Cancer Institute-designated Comprehensive Cancer Center

Make an appointment: 800-826-HOPE

Lung Cancer

Lung Cancer
City of Hope's world-class, multidisciplinary team of experts is dedicated to delivering the highest-quality, personalized treatment to lung cancer patients for the best outcomes and the fewest negative side effects.
 
We offer the latest innovations in lung cancer detection and treatment, including molecular mapping that enables physicians to personalize care based on a patient’s genetic makeup.
 
Our innovative lung cancer treatments including immune-based therapies; minimally invasive surgical techniques, including use of the robotic da Vinci Surgical System; and novel chemotherapy agents, with some promising new drugs being tested in clinical trials available to some patients.
 
We employ leading-edge radiotherapy approaches like stereotactic radiotherapy and intensity-modulated radiotherapy (IMRT). Helical TomoTherapy uses hundreds of pencil beams of radiation spirally rotating around the tumor, focusing in from all directions. The radiation can be sculpted to fit the exact shape of the tumor, meaning less damage to normal tissue and fewer complications.
 
As one of the world’s most renowned cancer research programs, City of Hope can offer its patients the opportunity to participate in a wide range of groundbreaking clinical trials to test new drugs and treatment approaches. Our physicians and researchers collaborate across all facets in the field of lung cancer, from basic biological research to developing and testing new patient therapies. This collaborative effort allows us to translate discoveries made in the lab into new treatments. This is part of our commitment to reducing lung cancer deaths and to improving treatments and quality of life for patients everywhere.
 
Getting a Second Opinion at City of Hope

City of Hope’s pathologists are expert in diagnosing and staging lung cancer of every type. We have advanced expertise in developing personalized plans to target genetic changes that affect lung cancer, including cancers involving epidermal growth factor (EGFR), Anaplastic Lymphoma Kinase (ALK) and other gene mutations. We welcome the opportunity to provide second opinions for lung cancer.
 
City of Hope is here to help. We are committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the  online appointment form.
 
About Lung Cancer
 
Lung Cancer Facts
 
  • Each year, some 220,000 people in the United States are diagnosed with lung cancer, making it one of the most common types of cancer. More people die of lung cancer than any other type of cancer.
  • Most people who get lung cancer are or were smokers, but the rate of lung cancer is rising among non-smokers, particularly women who’ve never smoked. If you’re a smoker, the best way to reduce your risk of developing lung cancer is to quit smoking -- even if you’ve been smoking for years.
  • Lung cancer forms in lung tissue, usually in the cells lining air passages, when abnormal cells start to grow and reproduce themselves and gather together to form a tumor. The malignant cells destroy the healthy lung tissue around them.
  • Lung cancer can spread by cancerous cells carried through the blood or lymphatic vessels, which carry a clear fluid called lymph away from the lungs. The most common areas to which lung cancer spreads are the lymph nodes, bones, liver, brain and adrenal glands.

Types of Lung Cancer
 
The two main types of lung cancer – non-small cell and small cell – are classified by their different cell structures when examined under a microscope.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, representing approximately 85 to 90 percent of lung cancers.   Non-small cell lung cancer has three main subtypes:

  • Adenocarcinoma – Adenocarcinoma, which begins in cells that line the alveoli, is the most common type of lung cancer. While this type of lung cancer occurs mainly in current or former smokers, it also is the most common type of lung cancer seen in non-smokers. It is more prevalent in women than in men and is more likely than other types of cancer to occur in younger people
  • Squamous cell (epidermoid) carcinoma – Representing approximately 25 to 30 percent of all lung cancers, squamous cell carcinoma begins in thin, flat cells that line the bronchial tubes in the center of the lungs, near a bronchus. It is most often caused by tobacco smoking.
  • Large cell (undifferentiated) carcinoma –Large cell carcinoma, which can start anywhere in the lungs, is almost always associated with smoking.•Other subtypes –Other forms of non-small cell lung cancer are rarer, and include adenosquamous carcinoma, carcinoid (well-differentiated neuroendocrine tumor),  and sarcomatoid carcinoma.
 
Small Cell Lung Cancer
 
Also known as oat cell cancer, oat cell carcinoma and small cell undifferentiated carcinoma, this type of lung cancer makes up less than 20% of lung cancers and almost always is caused by tobacco smoking. It tends to grow quickly and spread widely to other parts of the body fairly early in the course of the disease, but often responds well to chemotherapy.

Lung Metastases
 
Sometimes cancer found in the lungs is not lung cancer at all. It can also be another type of cancer that started elsewhere in the body and spread (metastasized) to the lungs. Lung metastases are identified as the primary, or original, type of cancer.

Each type of lung cancer grows and is treated in different ways. Your City of Hope team of lung cancer experts will carefully study your individual case and work with you to determine the best treatment plan for you. Learn more about our approach to diagnosis and staging.
 
 
Lung Cancer Risk Factors
 
Smoking
Tobacco smoking is by far the most important risk factor for lung cancer, causing 90 percent of cases in men and about 80 percent of cases in women. Cigarette, pipe and cigar smoking all add to the risk of lung cancer. Low tar or nicotine cigarettes do not lower that risk.
 
Secondhand smoke
People exposed to secondhand tobacco smoke are also at a higher risk of developing lung cancer. People who breathe in the smoke exhaled by smokers are exposed to cancer-causing agents.
 
Radon exposure
Exposure to radon, a radioactive gas, can increase the risk of lung cancer. Radon, from the breakdown of uranium in rocks, can come up through the ground and leak into buildings. Of nonsmokers killed by lung cancer, about 30 percent had been exposed to radon.
 
Family history
A person with a family member who has had lung cancer may be at an increased risk of developing the disease.
 
Other risk factors
Other risk factors for lung cancer include air pollution, and exposure to asbestos, nickel, chromium, arsenic and tar.

Lung Cancer Symptoms
 
Lung cancer symptoms vary from person to person – and early lung cancer sometimes does not cause symptoms. Common symptoms may include:
 
 
  • a cough that worsens or does not go away
  • breathing trouble, such as shortness of breath
  • constant chest pain, worsened by deep breathing, coughing or laughing
  • coughing up blood or rust-colored spit
  • persistent hoarseness
  • frequent lung infections, such as pneumonia or bronchitis
  • swelling of the neck and face
  • arm or shoulder pain
  • ongoing fatigue
  • loss of appetite or unexplained weight loss
 
Having one or more of these symptoms does not necessarily mean you have lung cancer. Nonetheless, early detection and treatment is critical with any illness – especially cancer, so it’s important to see a doctor right away if you experience any of the above symptoms.

For learn more about lung cancer, watch this Ask the Experts video with City of Hope’s lung cancer team members Dan Raz, M.D., and Jae Kim, M.D.
 

Lung Cancer Screening

Why Screen for Lung Cancer ?

Screening increases the chance of diagnosing lung cancer at an early stage when it is more likely to be cured. Screening can also lead to identification of other treatable tobacco-related disease such as emphysema and heart disease.

How is Lung Cancer Screening Performed?
The only screening test proven to effectively reduce death from lung cancer is a high resolution computed tomography (CT) scan of the chest. The scan captures images of the entire chest cavity during a single breath.

What are the Risks of Radiation?
The ultra low-dose CT scan used at City of Hope for lung cancer screening uses far less radiation than standard CT scans, and is slightly higher than the radiation dose used in a standard mammogram. We use some of the most advanced equipment and techniques to enable the lowest radiation dose for your CT scan. For those at high risk for lung cancer, the value of screening far outweighs the minimal risks of radiation.
 
Who is Eligible for Screening?
 
  • Individuals aged 50 and over who are current or former smokers with a history of at least 30 pack years of smoking.
  • Other high risk individuals with a history of smoking may be eligible.
 
What if Screening is Positive?
Approximately 25 percent of all lung cancer screens will identify a lung nodule, but 96 percent of those will be benign and will not require treatment. If the screen is positive, an appointment will be made with the program nurse practitioner, under the supervision of a thoracic or pulmonary physician, to discuss the findings and any additional testing that may be necessary.
 
 
What if Screening is Negative?
If the screen is negative, a repeat scan should be repeated in one year.
 
Is Lung Cancer Screening Covered by Insurance?
Currently, most insurance companies do not cover lung cancer screening. Our team of financial services specialists will work with you to identify your coverage and discuss payment plans.
 
Current patients should ask their primary physician for a referral to the Lung Cancer Screening Program, or call 626-218-9410 to speak with someone from the Lung Cancer Screening Program.
 
To become a patient at City of Hope, please call 800-826-HOPE.
 
 

Diagnosing Lung Cancer


Diagnosis

If you have lung cancer, it is important to get an accurate diagnosis as early as possible. It’s also important to determine if the disease has spread – information key to helping your medical team develop the best treatment options for you.

The process starts with a thorough physical examination, during which your doctor will ask about your general health, symptoms, family history, lifestyle – including smoking habits, and possible exposure to cancer-causing substances.
 
If lung cancer is suspected following the physical exam, your doctor will order additional tests to determine definitively if you have the disease and if it has spread. (These tests also may be used with cancer patients to find out if treatment is working.)

Our team of highly skilled pathologists, diagnostic radiologists and specially trained technicians use the most advanced and accurate equipment available to diagnose and determine the extent (stage) of lung cancer. Diagnosing lung cancer requires examine of cancerous tissue. 

Diagnostic tests for lung cancer include:

Needle biopsy: CT scan images guide a needle through the skin into the lung tissue to collect cells. A biopsy sample may also be taken from lymph nodes or other areas in the body where cancer has spread.

Endobronchial Ultrasound (EBUS): This minimally invasive technique uses a thin, flexible camera with an ultrasound probe to examine and biopsy structures near the windpipe and its branches. At City of Hope, this has largely replaced mediastinoscopy, which is a procedure that gives the same information but requires an incision in the neck and passage of surgical tools to take tissue samples from lymph nodes.

Navigational Bronchoscopy: A special computer creates a three-dimensional map of the lungs and helps guide a thin, flexible tube down the mouth, through the windpipe, and directly to the tumor. This allows the doctor to take biopsies or place markers for other treatments much more accurately than with traditional methods. 
Thoracentesis: Fluid from around the lungs is drawn out with a needle and looked at under a microscope.

Imaging tests:
 
  • CT or CAT (computed axial tomography)
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans

Genomic Testing

Genomic testing for the diagnosis and treatment of lung cancer is one of the most significant breakthroughs in recent medical history. City of Hope is at the forefront of this still-evolving, revolutionary diagnostic tool that represents a major shift from methods based solely on physical and histological findings to protocols that assess and treat tumors based on the presence of distinct, targetable genetic alterations.
 
A disease long viewed as monolithic, with few treatment options, lung cancer now is known to have many molecular subtypes and genetic tests that can match patients with those subtypes to treatments. Our early adoption of genomic testing is another example of how City of Hope is committed to staying at the forefront of significant medical advancements to deliver the best standard of care possible to our patients.
 
Staging

If you are diagnosed with lung cancer, your doctor will determine the stage (or extent) of the disease. This is a way to classify the cancer by how far and to which parts of the body it has spread. Staging helps your medical team plan the best treatment for you.

Staging tests may include imaging procedures that reveal whether the cancer has spread beyond your lungs. These tests include CT scans, magnetic resonance imaging (MRI), positron emission tomography (PET), bone scans, and endobronchial ultrasound (EBUS). Not every test is appropriate for every person, so talk with your doctor about which procedures are right for you.
 
Getting a Second Opinion at City of Hope

City of Hope’s pathologists are expert in diagnosing and staging lung cancer of every type. We have advanced expertise in developing personalized plans to target genetic changes that affect lung cancer, including cancers involving epidermal growth factor (EGFR), Anaplastic Lymphoma Kinase (ALK) and other gene mutations. We welcome the opportunity to provide second opinions for lung cancer.
 
City of Hope is here to help. We are committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the online appointment form.
 
 

Treatments

 
Our multidisciplinary lung cancer team provides compassionate, leading-edge, personalized care. Treatment options include surgery, radiation therapy, systemic therapies or a combination of these treatments.  Treatment is based on the stage of lung cancer at diagnosis.

Early Stage Lung Cancers

Surgery – In cases of early stage lung cancer, when the disease has not spread to lymph nodes or elsewhere, surgical removal can often be the only treatment needed. In most patients, we recommend a lobectomy, or removal of the entire lobe of the lung. In patients with poor lung function or very small tumors, we sometimes recommend more limited surgery, such as segmentectomy or wedge resection of the lung, where a part of the lobe is removed. City of Hope has been offering robotic lung surgery using the da Vinci Surgical System for longer than any other institution in Southern California. Robotic lobectomy is done through small incisions and is associated with less pain and quicker recovery compared with more traditional forms of lung surgery. Most patients stay in the hospital only two days after a robotic lobectomy.

Radiation - Stereotactic Body Radiation Therapy (SBRT), also known as Stereotactic Ablative Radiotherapy, is “sharpshooting” radiation therapy used to treat early stage lung cancer. SBRT is used primarily in patients who cannot undergo surgery because of poor lung function or other medical conditions. It is usually given over five treatment sessions.

Chemotherapy - Many patients with locally advanced lung cancers will be recommended to undergo chemotherapy before or after surgery. In these cases, chemotherapy can increase the chances of a cure and can sometimes shrink the tumor to make surgery safer. Members of our lung cancer team have developed testing to help determine which patients would benefit from post-surgical chemotherapy. We offer such genetic analysis to our patients.
 
Locally Advanced Lung Cancers

Surgery - When lung cancer has spread to lymph nodes or surrounding structures within the chest, surgery is often still an option when combined with other treatments, such as chemotherapy and radiation therapy. We offer complex procedures including airway surgery, chest wall resection, spine resection, and blood vessel resection. Our surgeons have helped patients overcome lung cancer that others professionals had considered inoperable.

Radiation - Radiation and chemotherapy are often used together as the primary treatment for locally advanced lung cancers. In these cases, the radiation therapy is spread out over a number of weeks. Radiation can also be used in combination with both surgery and chemotherapy for some locally advanced lung cancers.

Chemotherapy - For many patients with locally advanced lung cancers, chemotherapy is recommended before or after surgery.  It chemotherapy can increase the chances of a cure, and sometimes can shrink the tumor to make surgery safer.

Metastatic Lung Cancer

Systemic therapy - Treatment for metastatic lung cancer can include conventional chemotherapy agents, targeted therapies, and immune-based therapies and combinations of these. Targeted therapy uses drugs or other agents to find and attack cancer cells, causing less harm to normal cells. We offer clinical trials for a number of new and promising targeted therapies.

Radiation - Radiation therapy can be used to treat pain and other symptoms as part of palliative care for metastatic lung cancer.
 
To learn more about radiation therapy, including Stereotactic Body Radiation Therapy, watch this Ask the Experts video from City of Hope.
 
 
 
 
 

Research

Since its founding in 1913, City of Hope has achieved numerous scientific breakthroughs and pioneered many lifesaving procedures that have benefited patients worldwide. Today, we are recognized as a leading research and treatment center dedicated to the prevention, treatment and cure of cancer and other life-threatening diseases. Our mission is to shorten the time from initial research idea to new treatment in order to quickly bring cures to patients. For more information about current lung cancer clinical trials at City of Hope, visit our Clinical Trials page. 

Some of our recent Lung Cancer Research Program studies: 
  
 
  • We are striving to understand how lung cancer spreads so that we can work to prevent metastasis. Some patients will develop lung cancer spread due to microscopic disease at the time of surgery. We are studying markers of metastatic potential within lymph nodes of patients with completely resected non-small cell lung cancer (NSCLC). We now better understand how the area outside the tumor and the immune system can contribute to cancer spread and are working to find targeted molecules to block tumor metastasis, with the goal of improving survival.
  • Treatment options for advanced stage NSCLC have increased in the last several years and biologic targets have been identified. We continue to evaluate novel therapies through multiple trials of new chemotherapeutic and targeted-therapy agents and novel combinations. As we gain knowledge into the biology of lung cancer, we have also incorporated the evaluation of biomarkers into our trials to better tailor therapies to our patients.
  • Studies with targeted therapies have demonstrated promising results. We seek to improve tumor shrinkage to targeted epidermal growth factor receptor (EGFR) therapy in advanced NSCLC. To this end, we investigated a cyclooxygenase-2 (COX-2) inhibitor, celecoxib, in combination with erlotinib, an EGFR inhibitor. The COX-2 pathway plays a key role in tumor growth, angiogenesis and resistance to therapy. We have completed a randomized trial evaluating the combination, and continue to investigate biomarkers to better understand how to select patients who will receive the greatest benefit from this therapy.
  • We are interested in the investigation of novel agents that target immune modulation through natural products. Patients with advanced lung cancer frequently have abnormalities in the immune system, especially depletion of certain T cells and B cells, which are important to the body's defense. Clinical research has shown that beta-glucans found in certain medicinal mushrooms can exert immune- enhancing activity. We have evaluated MM-IO-001, a solution produced from shiitake mushrooms containing beta-glucans, in patients with advanced non-small cell lung cancer. The study will determine whether the treatment can improve patients' immune system. Future work will evaluate components of the immune system that may inhibit lung cancer growth.
  • The Quality of Life component of our Lung Cancer and Thoracic Oncology Program conducts research to improve quality of life for lung cancer patients and to design effective interdisciplinary interventions to support lung cancer patients and their families. Because lung cancer patients often present with advanced disease, approaches to care are focused on maximizing quality of life through supportive and palliative care.

Resources

 
City of Hope is committed to providing the highest standard of care for the whole person, not just his or her disease. Through the Sheri & Les Biller Patient and Family Resource Center , we offer a wide array of support and educational services. Patients and their loved ones have access to a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers.

The center also offers a variety of programs designed to better prepare patients and caregivers for treatment, including education classes, healing arts workshops, peer support groups and much more.

Additional resources for lung cancer patients include:
 
 
Focusing on Patients’ Quality of Life

We understand that a lung cancer diagnosis is scary. Patients and their loved ones are concerned about their chances of survival and quality of life. These are our concerns, too. Our dedicated team of specialists will work to help you and your family confront both the immediate and long-term effects of the disease.

We recognize that these are personal issues that each patient views differently. Therefore, we respect our patients’ rights to be fully informed about their disease, treatment options and prognosis, so that they can participate fully in critical decisions related to their care.

Lung cancer survival is determined primarily by disease type, stage and treatment modality. Quality of life is an assessment of how a person’s well-being – emotional, social and physical – is impacted by the disease and the side effects resulting from treatment.

While our primary goal is to cure or control the disease, another top priority is relieving pain, suffering and discomfort for patients undergoing cancer treatments. This involves helping patients manage physical symptoms as well as addressing non-physical concerns like depression, anxiety, loss of appetite, nutrition, and establishing or maintaining healthy lifestyle habits.

City of Hope’s team of lung cancer physicians and behind-the-scenes experts is committed to delivering the most effective, individualized treatments based on each patient’s type and stage of disease – always taking into account how the treatments will impact quality of life. Our physicians, nurses and researchers work together to investigate ways to enhance long-term survival and quality of life for patients everywhere.

 

Lung Cancer Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Rick Leonard
Associate Vice President
Direct: 213-241-7218
Email: rleonard@coh.org

 
 
About the Lung Cancer Program


Karen Reckamp, M.D., M.S., co-director of the Lung Cancer and Thoracic Oncology Program, discusses lung cancer treatment and research at City of Hope.
Lung Cancer Education Group
Susan's Story, Lung Cancer Survivor

Already a breast cancer survivor, Susan was shocked to learn she'd been diagnosed with lung cancer, though she had never smoked. But she didn't give up hope.

Watch the video >>
Medical Minute
 
 
 
The Sheri & Les Biller Patient and Family Resource Center embodies the heart and soul of City of Hope’s mission to care for the whole person.
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