GENERAL BACKGROUND
Lung cancer is the number one cause of cancer death in the United States. The American Cancer Society estimated approximately 157,000 deaths in the year 2001 from lung cancer alone. These rates far exceed death rates from any other type of cancer, including breast cancer, prostate cancer, or colorectal cancer.

Approximately 85 percent of all lung cancer deaths can be directly attributed to tobacco use. There are more than 40 known cancer causing agents (carcinogens) in tobacco smoke and varying amounts of tar. The development of lung cancer generally takes years before it becomes clinically detectable.

The patient with lung cancer can present with varying problems, which can include shortness of breath, cough, hemoptysis (coughing up blood); the symptoms can be caused by the cancer invading structures in the chest and/or compressing airways.

The development of lung cancer can often be silent until it is quite large or has metastasized (spread outside its site of origin); in fact, the majority of patients diagnosed with lung cancer have more advanced disease.

Generally, lung cancer is divided into two groups: one is small cell lung cancer; the other is non-small cell lung cancer. The reason for this division is that each group has a different natural history and is treated differently. In the non-small cell group, the most common cancers include squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. The small cell group consists of only small cell carcinoma. Small cell lung cancer tends to be a very aggressive tumor and often spreads elsewhere early in its course. It is the type of lung cancer that has the strongest correlation with tobacco use.

TREATMENT | Back to Top
Whenever someone is diagnosed with cancer of any type, it is important the cancer be staged. This refers to the process of determining whether the cancer is localized where it is seen or felt, or has spread to other sites in the body. This process often includes physical examination, x-rays, biopsies, and blood tests. Early stage cancer generally means localized disease without any evidence of metastases. More advanced stage disease indicates the cancer has invaded nearby structures in the body and/or spread elsewhere in the body.

Early stage disease generally can be treated very successfully with surgery; however, it is very important the surgeon be able to remove all of the known disease without leaving any behind. Surgery is of minimal benefit if cancer is left. If the disease is of a more advanced stage, then surgery will likely not be recommended and a treatment, such as radiation and/or chemotherapy will be used. Again, the actual extent of the cancer will determine how the radiation and chemotherapy are combined. Surgery is rarely used for small cell lung cancer. Because of the likelihood of distant spread of this disease, chemotherapy is a vital component in the treatment of small cell lung cancer.

When this disease is found to be localized to the chest, referred to as "limited stage" disease, radiotherapy is often added to the chemotherapy.

Radiotherapy is a localized treatment and affects only the immediate area being treated. In other words, if the patient is receiving radiation treatments to his lung cancer in the chest, any potential benefits and potential side effects will be limited to that area. Therefore, radiation therapy to the chest would not cause the patient's hair to fall out or nausea and vomiting.

Radiation kills the cancer cells by damaging the DNA in those cells. DNA is the substance in each cell which controls its activities. Radiation damages the cancer cells with each treatment, so when they attempt to divide and grow they are unable to, and they die. Radiation treatments do indeed treat normal tissue along with the cancers; however, the normal tissue is able to repair the potential radiation damage each day and carry on as normal. As the cancer cells are killed during the treatment, the tumor will often be seen to slowly shrink and hopefully disappear with time.

Radiation therapy is also delivered differently than the chemotherapy as it is a daily treatment. Generally, the therapy is given one treatment per day, five days a week for up to 6-7 weeks. Again, the extent of the cancer will strongly influence the number of treatments. The daily treatments, however, are delivered quite quickly. The time involved to be set up on the treatment table and receive the treatment is approximately 15-20 minutes per day.

Patients are treated with high-energy x-rays which are generated in machines called linear accelerators. These x-rays are exactly the same type one is exposed to when he receives a chest x-ray or a CT scan; however, they are much more focused and more powerful.

SIDE EFFECTS | Back to Top
Potential side effects which can go along with chest radiation treatments include esophagitis, which is a temporary irritation of the swallowing tube (esophagus). This can develop if a portion of the esophagus is being treated. It presents itself as a heartburn-type feeling or possibly discomfort or pain when the patient swallows.

Again, this is a temporary side effect and responds well to certain medications and subsides once the treatments are completed. It is also possible to develop a mild cough during the treatments; however, that again is usually a temporary side effect and subsides once the treatment is completed. The above side effects do not occur in every patient and can vary in their severity.

The radiation therapy is often given along with the chemotherapy because studies have indicated that oftentimes the combination of the two works much better than either one alone. But again, how they are delivered will strongly depend on the stage of the patient's disease.

FUTURE | Back to Top
With the advent of new and ever changing technology, new techniques are constantly being developed to allow us to deliver radiation treatments more accurately and significantly reduce the treatment of normal tissues.

A recent development now available at our center is intensity modulated radiation therapy (IMRT). This is a very sophisticated way of delivering the radiation so the cancer still receives the same high dose of cancer killing radiation, but the surrounding normal structures can be largely spared from the effects of the radiation.

In the treatment of lung cancer, this means the side effects of cough and esophagitis can oftentimes be significantly reduced. This will allow the patient to tolerate the therapy much more easily, especially when it is combined with chemotherapy.

No matter what treatment you receive at our center, however, you will be followed extremely closely and be cared for by a knowledgeable and caring staff.