Understanding Lung Cancer
Lung cancer is the nation's third most common major cancer, after breast cancer in women and prostate cancer in men. Though lung cancer remains challenging to treat, doctors and researchers are making steady advances in finding it earlier. Some important things to know:
- Lung cancer has two main types: non-small cell and small cell.
- Most lung cancers are non-small cell, which has more treatment options.
- Smoking remains the leading cause of lung cancer.
What is lung cancer?
Lung cancer occurs when abnormal cells develop in one or both lungs and then grow so quickly that the body's immune system cannot keep up. The abnormal cells can form tumors that keep your lungs from working. Left untreated, the cancer can spread to nearby lymph nodes and other parts of your body.
Who gets lung cancer?
Just over 12% of new cancers in the United States are lung cancers. In 2022, an estimated 236,740 people in the U.S. are expected to be diagnosed with lung cancer.
Smoking: Smoking accounts for as much as 90% of lung cancers. It brings substances into the body that damage cells lining the lungs. Stopping smoking can significantly reduce the risk of many cancers and other diseases. Still, nearly 60% of lung cancers are diagnosed in people who have quit.
Secondhand smoke: Exposure to secondhand smoke causes thousands of lung cancer cases in the U.S. each year.
Gender: Overall, lung cancer in the U.S. is more common in men, with about 59 cases per 100,000 among men and about 47 per 100,000 among women. For white and Latino people ages 30 to 54, however, rates are higher among women. The reasons are not fully understood. Rates have fallen for both genders in this group since 1995, but they've fallen faster for men.
Race and Ethnicity: Black men are more likely than other men to develop lung cancer. Asian Americans, Pacific Islanders, and people of Hispanic origin are significantly less likely than other groups to develop lung cancer.
Age: In the U.S., more than two-thirds of patients are 65 or older when diagnosed.
Environment: Exposure to pollutants such as fuel exhaust and chemical vapors can increase risk. Exposure to radon gas, which can build up in homes and other buildings from the natural breakdown of uranium in soil, also increases risk.
Family history: Inherited genes can increase risk among smokers and nonsmokers. If you have a family history of lung cancer or worry that you’re at high risk, we offer expert genetic counseling and risk assessment to help you learn about and manage your risk.
Lung cancer outcomes
Lung cancer remains difficult to treat, especially because many patients are diagnosed in later stages. This means that overall survival rates remain discouraging. It’s important to know, though, that survival rates are only averages and can’t predict the outcome for any one patient.
Signs of hope: Survival rates have risen substantially over the past decade. Among patients whose cancer is caught before it has spread, 61% survive five years or longer. Researchers at the Knight Cancer Institute are working on new ways to treat lung cancer. Depending on your condition, you may qualify for one of our clinical trials.
Quality of life: While lung cancer sometimes cannot be cured, treatment can keep you comfortable and give you time to do things you want to do. You might set goals such as taking a special trip. Maybe you hope to see a child or a grandchild marry or graduate.
At the Knight Cancer Institute, your goals become our goals. We are devoted to extending and improving your life regardless of your long-term outlook.
Lung cancer types
Lung cancer has two main types, each with several subtypes.
Non-small cell lung cancer: This covers several types in which cancer cells form in lung tissue. Each is named for the type of cell it develops in. This group of lung cancers makes up about 85% to 90% of cases.
- Squamous cell carcinoma: This type begins in squamous cells. These thin, flat cells form the surface of the skin, the lining of hollow organs and the lining of respiratory and digestive tracts. Also called epidermoid carcinoma, this cancer most often develops in smokers.
- Large cell carcinoma: This cancer may begin anywhere in lung tissue. It tends to grow more rapidly than other non-small cell cancers.
- Adenocarcinoma: This slow-growing cancer type usually appears in the areas around the lungs. It occurs most often in smokers but is the most common type of lung cancer in nonsmokers.
- Other: Less common types include pleomorphic, carcinoid tumor, salivary gland carcinoma and unclassified carcinoma.
Small cell lung cancer: This aggressive cancer forms in lung tissue and can spread to other parts of the body. It occurs almost exclusively in heavy smokers and represents about 10% to 15% of lung cancers. Subtypes include small cell carcinoma, also called oat cell cancer, and combined small cell carcinoma.
Symptoms of lung cancer
Lung cancer typically doesn't cause symptoms in early stages, and some symptoms can be caused by other conditions. Lung cancer is sometimes discovered after a chest X-ray for another condition. Talk with your doctor if you're concerned about:
- Chest discomfort or pain
- Bone pain
- A cough that doesn't go away or worsens
- Shortness of breath
- Blood coughed up from the lungs
- Loss of appetite
- Weight loss for no known reason
- Severe fatigue
- Trouble swallowing
- Swelling in the face and/or neck veins
Lung cancer screening
Cancer is easiest to treat when it's found early. Lung cancer can be difficult to detect in early stages, and there is no routine screening.
In response to a National Lung Screening Trial completed in 2010, the government approved annual screening for some high-risk patients covered by Medicare Part B. Those eligible for an LDCT (low dose computed tomography) scan must:
- Get a doctor's approval
- Be 55 to 77 years old
- Have no sign of lung cancer
- Be a smoker, or have quit in the last 15 years
- Have a smoking history of at least one pack a day for 30 years
Researchers and providers are working to win government approval to expand screening to more people at risk.
Lung cancer staging
Staging helps doctors see whether and how far lung cancer has spread. This helps guide treatment options. Your care team will determine the stage of your cancer based on:
- The size of the main tumor and whether it has grown into nearby areas
- Whether the cancer has spread to lymph nodes
- Whether the cancer has spread to other organs or body parts
Non-small cell lung cancer:
The tumor is less than 3 centimeters at its largest dimension (with one rare exception) and has not spread to the membranes surrounding the lungs.
Stage IIA: The tumor is bigger than 4 centimeters but no bigger than 5 centimeters, and cancer has not spread to lymph nodes. Cancer has spread to the bronchus (airway connecting the lung to the windpipe) and/or to a membrane around the lung (pleura) and/or is linked to atelectasis (lung collapse) or obstructive pneumonitis (inflammation).
Stage IIB: One of these applies:
- The tumor is no larger than 5 centimeters, and cancer has spread to nearby lymph nodes on the same side as the tumor. Cancer affects the bronchus and/or a membrane around the lung and/or is linked to atelectasis or obstructive pneumonitis.
- Cancer has not spread to lymph nodes. The tumor is bigger than 5 centimeters but no bigger than 7 centimeters, or cancer has spread to any of these: a chest membrane, chest wall, a nerve between the lung and heart (phrenic nerve), or tissue around the heart; or a tumor(s) has developed in the same lobe as the main tumor.
Stage IIIA: One of these applies:
- The tumor is no bigger than 5 centimeters, and cancer has spread to nearby lymph nodes on the same side as the tumor or to nodes under where the windpipe branches (carina) into each bronchus (airway connecting the lung to the windpipe). Cancer also may affect the bronchus and/or a membrane around the lung and/or is linked to atelectasis (lung collapse) or obstructive pneumonitis (inflammation).
- The tumor is bigger than 5 centimeters but no bigger than 7 centimeters, or cancer has spread to any of these: A chest membrane, chest wall, a nerve between the lung and heart (phrenic nerve) or to tissue around the heart; or a tumor(s) has developed in the same lobe as the main tumor.
- Cancer has not spread to the lymph nodes, or it has to spread to nearby lymph nodes on the same side as the tumor. The tumor is bigger than 7 centimeters and has spread to at least one other nearby organ such as the heart or windpipe.
Stage IIIB: One of these applies:
- Cancer has spread to lymph nodes on both sides or above the collarbone. The tumor is no bigger than 5 centimeters, and cancer also may affect the bronchus and/or a membrane around the lung and/or is linked to atelectasis or obstructive pneumonitis.
- The tumor is bigger than 5 centimeters and has spread as far as to nearby organs such as the heart or windpipe. Cancer has spread to lymph nodes only on the same side or to nodes under where the windpipe branches into each bronchus.
The tumor is any size, and lymph nodes may or may not be affected, plus:
Stage IVA: Tumor(s) have developed in the other lung, and complications have arisen such as fluid buildup around the heart or lung.
Stage IVB: A tumor has developed in one organ outside the chest.
Stage IVC: Tumors have developed in one organ outside the chest or cancer has spread to more than one organ outside the chest.
Lung cancer information
- Lung Cancer, National Cancer Institute
- What is Lung Cancer? Centers for Disease Control and Prevention
- Lung Cancer, American Cancer Society
- American Lung Association
- GO2 for Lung Cancer
- Lung Cancer Action Network
- Lung Cancer Research Foundation
- Secondhand Smoke and Cancer, National Cancer Institute
- OHSU Tobacco Cessation Treatment Program
- OHSU smoking cessation handout
- Oregon Tobacco Quit Line, Oregon Health Authority
- Tobacco: Health Benefits of Smoking Cessation, World Health Organization
Call 503-494-7999 to:
- Request an appointment
- Seek a second opinion
- Ask questions
Knight Cancer Institute, South Waterfront
Center for Health & Healing, Building 2
3485 S. Bond Ave.
Portland, OR 97239
Free parking for patients and visitors
Refer a patient
- Refer your patient to OHSU.
- Call 503-494-4567 to seek provider-to-provider advice
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