Types of Lung Cancer
There are three main types of lung cancer: Non-small-cell lung cancer (NSCLC), small cell lung cancer (SCLC), and lung carcinoid tumors.
Non-small-cell lung cancer (NSCLC)
The most common type of lung cancer is NSCLC, which accounts for about 83% of lung cancers. It is named non-small-cell lung cancer because, under a microscope, the cells are larger than small-cell lung cancer. While there are many types of NSCLC, the two most common types are adenocarcinoma and squamous cell carcinoma.
Small-cell lung cancer (SCLC)
About 13% of lung cancers are SCLC, named for the size of the cancer cells when seen under a microscope. This type of cancer is less common than non-small-cell lung cancer and is diagnosed almost exclusively in heavy smokers. It is usually treated with chemotherapy and radiation; however, surgery may be an option for small tumors that have not spread to the lymph nodes.
SCLC often starts in the bronchus (the airways of the lung), near the center of the chest. It tends to spread quickly to the lymph nodes and other areas of the body.
Lung carcinoid tumor
Carcinoid tumors of the lung account for fewer than 5% of lung tumors. They are made up of special kinds of cells, called neuroendocrine cells, that help regulate your body’s breathing. Most are slow-growing tumors and usually can be cured by surgery.
Cancers that spread to the lungs
Cancers that start in other organs of your body (like the colon or kidney) can sometimes spread (metastasize) to the lungs, but these are not lung cancers. For example, cancer that starts in the colon and spreads to the lungs is still colon cancer; it has just spread to your lungs. Treatment for metastatic cancer to the lungs is based on where it started (the primary cancer site), the involvement of other areas of the body (such as the liver or brain), and the size, number, and location of the nodules. Metastatic tumors from certain cancers, like colon and kidney cancers, can be limited to the lung and removal can improve outcomes, whereas other cancers tend to spread widely throughout the body and should be treated with chemotherapy rather than surgery.
Diagnosis and Treatment Options
Most lung cancers are now found during radiology scans performed for other reasons. Several imaging tests are available to help confirm or rule out the diagnosis. These tests include chest x-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET scan).
Chest x-ray shows signs of lung cancer
PET scan showing mass in left upper lobe
If you are at high risk for lung cancer, talk with your doctor about undergoing a screening test using low-dose CT scan. People at the highest risk for lung cancer include current and former smokers, people who have been exposed to high levels of radon, and those who have a family history of lung cancer.
For more information on these tests, visit our common diagnostic tests page.
Stages of Lung Cancer
Once you have been diagnosed with cancer, imaging studies such as a CT scan or a PET scan will be performed to determine the extent, or stage, of the tumor. The stage of your lung cancer will help you understand how advanced the disease is, whether the cancer has spread to other parts of your body, and what treatments to consider.
A higher stage tumor means that the cancer is more advanced and has a worse prognosis.
The stages of SCLC differ from those for non-small cell lung cancer. SCLC stages include:
- Limited – Cancer is limited to one lung
- Extensive – Cancer has spread beyond the one lung
If you and your cardiothoracic surgeon decide to move forward with surgery, you likely would undergo one of the following:
- Segmentectomy/wedge resection
For all three operations, cardiothoracic surgeons can use either an incision between two ribs in your back that requires a rib spreader (posterolateral thoracotomy) or a muscle-sparing incision (a thoracotomy that avoids dividing some of the chest wall muscles).
If you are about to undergo surgery for lung cancer, it is important to ask your surgeon about these approaches to determine what is best for you.
To determine whether you are a good candidate for surgery, you will need to undergo pulmonary function testing. Depending on your symptoms and risk factors, cardiac testing to evaluate your heart also may be performed.
In early stage cancer, surgery generally is the standard treatment, removing the primary tumor as well as surrounding lymph nodes to accurately stage the lung cancer. For patients with inadequate pulmonary function or significant shortness of breath, resection of smaller portions of the lung (segmentectomy) or stereotactic radiation are considered as second line treatments.
You can print these sample questions to use as a basis for discussion with your doctor.
Procedure to remove the portion of the lung (lobe) that contains the cancer and is the standard treatment for early stage lung cancers.
Procedure to remove only the cancerous part of the lobe, rather than the entire lobe; may be recommended for carcinoid tumors, metastatic nodules that have spread from other cancers, certain subtypes of slow-growing NSCLC, or if your lung function is not adequate for resection of the entire lobe.
Both segmentectomy, and wedge resections can be performed using minimally invasive techniques by surgeons with expertise in video-assisted thoracoscopic surgery (VATS) or robotic surgery.
Procedure to remove the entire lung and is performed for tumors that are located centrally in the lung, involving the main airway or blood vessels. When possible, lung-sparing procedures resecting only the involved portion of the airway or blood vessels and reattaching the normal structures (sleeve resection) should be considered by surgeons experienced in these techniques and can preserve a lobe or sometimes even the entire lung depending on the tumor’s location.
As with any surgery or operation, risks are involved. Possible complications depend on the extent of the surgery and your overall health. Serious complications can include excess bleeding, infections, and pneumonia.
After most surgical procedures, you will have one or two tubes inserted into your chest to help air and fluid drain out of the area. Once the drainage has decreased and any air leak has stopped, the chest tubes will be removed.
You can expect to go home from the hospital 2-5 days after surgery. While in the hospital, it is important that you work on deep breathing and coughing to keep your lungs functioning.
Following surgery, if your lungs are in good condition, you can usually return to normal activities after a period of recovery, even if a lobe or an entire lung has been removed. Total time for recovery will be different for every patient and depends on the condition of your lungs prior to surgery and any complications experienced following surgery.
If you previously have been diagnosed with a non-cancerous lung disease such as emphysema or chronic bronchitis (which are common among heavy smokers), you likely will still experience shortness of breath with certain levels of activity, even after surgery.
Reviewed by: Rishindra Reddy, MD and Jules Lin, MD