Lung Cancer

How do you know if you are at risk of developing lung cancer?
Many things are associated with an increased risk of developing lung cancer.

The National Cancer Institute expected nearly 215,000 people to be diagnosed with lung cancer in 2008, and nearly 162,000 people to die of lung cancer in 2008!

Smoking is the most common cause of lung cancer, and is the best established preventable risk factor for lung cancer (as well as bladder and other cancers). According to the National Cancer Institute, cigarette smoke contains over 4,000 chemical agents and at least 60 known carcinogens (cancer-causing agents)! Few of us would be willing to live or work in an environment that contains that many risky chemicals?!

Other risks include environmental exposures to known carcinogens. A few of them have received significant attention in the media.

Environmental tobacco smoke (aka "second hand smoke") is perhaps the most frequently encountered environmental risk factor known to cause lung cancer. The inhaled smoke is not filtered, and many environments are associated with highly concentrated second hand smoke (i.e., public restaurants, nightclubs, taverns, etc.).

The Environmental Protection Agency estimates that as many as 3,000 people die each year as a result of environmental tobacco smoke exposure. That is 10 times the number of Americans killed in armed conflict in Iraq in 2008, according to globalsecurity.org, and nearly the same number of people who died, directly or indirectly, as a result of the September 11, 2001 attacks on the World Trade Center (according to http://nymag.com/news/articles/wtc/1year/numbers.htm).

While not a common cause of lung cancer, asbestos causes mesothelioma, and has received a great deal of attention from the media, legal system, and Congress. In 1999 nearly 2500 people died in the United States from mesothelioma (Center for Disease Control, National Institute for Occupational Safety and Health). Plumbers, pipefitters and steamfitters are the occupations at greatest risk. For additional occupations associated with exposure to asbestos, please refer to the presentation "Malignant Pleural Mesothelioma". Smoking does not increase the likelihood of developing mesothelioma, however, smoking and exposure to asbestos increases your chance of developing other types of lung cancer by 50 fold!

The second most common cause of lung cancer is radon. According to the National Cancer Institute, it is thought that radon is responsible for as many as 15,000-22,000 deaths from lung cancer each year. Radon is a naturally occurring odorless gas created by the decay of uranium, found in many rocks and soils. Granite counter tops have recently been found to emit radon gas. While in low concentrations outdoors, it can reach concentrated levels indoors in basements and underground mines or shelters. There are radon detectors, like carbon monoxide detectors, that can alert people to dangerous levels of radon gas. Fortunately, the risk of dangerously high radon gas levels can be decreased by improving ventilation systems. For more information about radon gas, visit the Environmental Protection Agency.

What are symptoms concerning for lung cancer?
Symptoms of lung cancer can be nonspecific and can be similar to symptoms of other illnesses, such as congestive heart failure, pneumonia and pulmonary fibrosis. Symptoms of lung cancer can include: chest pain, unexplained weight loss, unexplained fever or chills, new or prolonged cough, bloody cough, new or worsened shortness of breath, decreased appetite. If you have any of these symptoms, you should see your doctor to discuss the possible causes.

What will your doctor do to determine if you have lung cancer?
First, your doctor will ask you questions relating to your past medical health, your family risk factors, and your current symptoms. Your doctor will also perform a thorough physical exam. He or she may also opt to order tests to further evaluate your symptoms, such as blood work, breathing function tests, chest x-rays, CT of the chest, PET scan, etc. Should there be any suspicious looking areas on your chest x-ray, CT of the chest, or PET scan, your doctor may refer you to a pulmonologist (lung doctor) or a cardiothoracic surgeon.

A pulmonologist, a doctor specializing in problems and diseases affecting breathing, will listen to your medical history, perform a physical exam, order tests, and possibly perform a bronchoscopy to obtain tissue samples of your lungs to look for cancer or other causes of apparent lung masses. Bronchoscopy is a means of looking inside the lungs with a tube-shaped camera. Through the camera, the pulmonologist can obtain liquid and tissue samples to be reviewed by a pathologist.

A cardiothoracic surgeon, a surgeon specializing in surgeries involving the heart, lungs, vessels and other organs in the chest cavity, in addition to taking a thorough medical history and performing a medical exam may choose to perform an operative procedure to obtain tissue samples of lungs and lymph nodes in the chest.

What can you expect once you have been diagnosed with lung cancer?
Your doctor will discuss with you
a. the type of cancer you have (based on pathology reports)
b. whether it has spread to other places in your body, like organs or lymph nodes (based on radiologic studies: x-rays, CT scans, PET scans OR based on surgical pathology)
c. what your options are for treatment or palliation (palliation refers to treatment that is NOT designed to cure, but rather to improve the quality of your remaining life)
d. what you would like to do

Your doctor will also likely consult a surgeon, an oncologist or a radiation oncologist to help you understand all of the options available to you. An oncologist is a doctor who specializes in the evaluation and treatment of cancer.

You may want to have a loved one or trusted friend with you when you talk to your doctor about your diagnosis. There will be so much information, and the diagnosis of cancer is very frightening, that you may not be able to remember everything that is said to you. Another person may be able to help you remember information after your appointment, and may also help prompt additional questions for your physician.

While receiving a diagnosis like cancer is stressful, to be forewarned is to be forearmed!

Now is the time to say the things that need to be said, and to do the things that need to be done! Tell your family and friends important things like how much they have meant to you. Say "I love you" to everyone you love. Forgive people, AND TELL THEM THAT YOU FORGIVE THEM! You will feel at peace with yourself, and others will have the joy of knowing how much you care about them! Far too often, family members who have not spoken for years arrive too late, only to find that they missed their last chance to say "I'm sorry" or "I love you". Many people live with the guilt and sadness for the rest of their lives.

Think about what kind of medical treatment you would like to have. Are you someone who wants to fight with all your might, struggling to the bitter end to live every moment, no matter the cost to you? Are you someone who wants to enjoy the last weeks, months or years of your life loving family and friends and taking care of your private affairs? Or, are you somewhere between the two?

Thoughtful, sincere discussions with family members and friends about the kind and extent of medical treatment you would like to receive is very important. From these family and friends you may want to choose a special "spokesperson" to express your desires in the event that you are unable to do so. Just as you will need a Durable Power of Attorney to take care of your private business matters, you will need a Durable Power of Attorney for Health Care to assist with medical decision making when you are unable to do so. You will need someone you can trust to make decisions that you would otherwise make for yourself.

One thing to remember is that YOU are the captain of your ship! Only YOU can make decisions that are best for you!