Lung cancer

Lung cancer, also called bronchogenic carcinoma, is a type of cancer that forms in lung tissue. It often starts with an overgrowth of the cells that line air passages in your lungs. These passages include the tubes, called bronchi, that branch off from your trachea (windpipe) that move air in and out of your lungs. They also include smaller branches of bronchi called bronchioles, all the way down to the tiny air sacs known as alveoli that are located at the end of bronchioles. 

Alveoli move oxygen from the fresh air you inhale into your bloodstream and draw carbon dioxide out of your bloodstream so it can be expelled from the body when you exhale. The growth of abnormal cells caused by lung cancer can greatly inhibit these vital functions. 

Symptoms of lung cancer may not show up during the early stages. In fact, they may not manifest until cancer cells have grown and spread beyond the lungs (or metastasize), preventing your lungs and other affected organs from working properly. 

The lungs don’t have many nerve endings, so you may not feel pain or discomfort while a tumor grows. Moreover, lung cancer symptoms may differ from person to person. 

These may include:  

• Coughing that persists or worsens 
• Coughing up mucus, phlegm, or blood (even in small amounts) 
• Frequent lung infections such as bronchitis and pneumonia  
• Hoarse voice that sounds raspy, strained, or breathy 
• Persistent chest pain 
• Shortness of breath, wheezing, or stridor (a harsh sound made with each breath) 

You can also have symptoms that don’t seem related to breathing and other lung functions, such as: 

• Blood clots 
• Bone pain or fractures 
• Headaches 
• Loss of appetite  
• Persistent fatigue 
• Swelling in the face or neck veins 
• Trouble swallowing 
• Weight loss for no obvious reason 

The two main types of lung cancer are small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). These are distinguished based on histology, or how they appear when seen under a microscope. Around 85 percent of lung cancers are NSCLC while roughly 15 percent are SCLC.  

Non-small cell lung cancer (NSCLC) 

Non-small lung cancer consists of several subtypes, but the ones most often diagnosed include the following: 

Lung adenocarcinoma 

Lung adenocarcinoma comprises around 40 percent of all lung cancers and 50 percent of all non-small cell lung cancers. It’s the most common lung cancer subtype in people who have never smoked. 

Lung adenocarcinomas usually start forming in gland cells that secrete substances such as mucus. They often grow more slowly than other lung cancer types. Lung adenocarcinoma cells are typically found along the periphery (outer edges) of the lung in smaller airways such as alveoli. In many cases, they’re found in lung areas that are chronically inflamed or have scar tissue. 

Squamous cell lung cancer 

This type of lung cancer starts in squamous cells, which are thin, flat cells that form the lining of the respiratory and digestive tracts, the hollow organs of the body, and the surface of the skin. Under a microscope, they resemble fish scales.  

This NSCLC subtype is also called squamous cell carcinoma (SCC) of the lung or epidermoid carcinoma. It accounts for around 30 percent of all non-small cell lung cancers. 

SCC lung tumors often arise in the central part of the lung or in the main airway, such as the left or right bronchus. The location of these tumors can cause symptoms such as coughing, shortness of breath, chest pain, and bloody sputum (mucus produced from the lungs by coughing). 

Large cell carcinoma 

This NSCLC subtype comprises as few as 2 percent of all lung cancers, a rate that has dropped from around 10 percent due to the emergence of more precise ways of diagnosing lung cancer. 

Large cell carcinomas can be found anywhere in the lung, although they’re usually found in the outer edges. It’s generally a fast-growing cancer that spreads quickly, which makes it difficult to treat. One fast-growing subtype of large cell carcinoma is large cell neuroendocrine carcinoma (LCNEC), a cancer that is similar to small cell lung cancer.  

Pancoast tumors 

Pancoast tumors form in the uppermost portion of the lung called the apex. They can also spread to the thoracic ribs at the top of the chest, the upper part of the back, blood vessels that supply blood to the arms, and the brachial plexus (the nerve bundle that transmits signals from the spinal cord to the shoulder, arm, and hand).  

These rare tumors account for 3 to 5 percent of all lung cancers. Pancoast tumors are of the NSCLC variety about 95 percent of the time, with nearly half being adenocarcinomas and the rest being squamous cell lung cancer. The tumors can also be caused by conditions such as lymphoma and tuberculosis. 

Small cell lung cancer (SCLC) 

Small cell lung cancer consists of two subtypes: small cell carcinoma and combined small cell carcinoma (cSCLC). SCLC manifests as round, oval, or spindle-shaped cells that are smaller than either NSCLC cells or noncancerous lung cells.  

Small cell carcinoma may also be referred to as oat cell carcinoma. That’s because these lung cancer cells can resemble oat grains when they’re assessed under a microscope. 

Combined small cell carcinoma is also known as mixed small cell/large cell lung cancer. As either name suggests, this rare lung cancer subtype has attributes of both SCLC and NSCLC types such as adenocarcinoma and squamous cell lung cancer. 

Small cell lung cancers most often start in the bronchi, though they also start in the lung periphery around 5 percent of the time. This highly aggressive cancer tends to grow and metastasize quickly, forming large tumors in other parts of the body such as the adrenal glands, bones, brain, liver, and lymph nodes (Lymph nodes are small structures located throughout the body that store lymph, a fluid that consists of immune cells that help fight infection.) 

Small cell lung cancer has often metastasized by the time it’s diagnosed.   

Metastatic lung cancer 

Metastatic lung cancer is an advanced form of the disease. It means that cancer cells have broken away from the original tumor and spread to the other lung or to tissues and organs outside of the lung. 

With local metastasis, cancer cells spread to other lung tissue but still stay inside the lungs. Distant metastasis involves lung cancer cells migrating to areas outside of the lungs via the blood or lymph system. They then form new tumors in tissues and organs such as the adrenal glands, bones, brain, and liver. 

Although tumors have formed in other areas of the body, the disease is still considered lung cancer. That’s because these metastatic cancer cells retain the same features as the original lung cancer cells. 

Other types of lung cancer 

There are other types of lung cancer, which tend to occur less often. Examples include: 

Lung carcinoid tumors 

Lung carcinoid tumors account for fewer than 5 percent of all lung tumors. They’re considered a form of neuroendocrine tumor (NET).  

While nerve cells are involved in their development, neuroendocrine tumors mainly arise from endocrine cells, which produce hormones. They can form anywhere endocrine cells are present, including the pancreas, small intestines, and areas of the lungs such as bronchi and bronchioles. 

Lung carcinoid tumors can be: 

• Typical: These comprise around 90 percent of lung carcinoids. They tend to grow slowly and don’t seem to be associated with smoking. 
• Atypical: These grow somewhat faster but are much less common than typical carcinoids. They’re also more likely to metastasize to other organs. 

Mesothelioma 

Mesothelioma is a rare type of cancer that forms in the mesothelium, the thin layer that covers most of the internal organs. The most common type is pleural mesothelioma, which affects the lining of the lungs known as the pleura.  

Mesothelioma can be malignant (cancerous) or benign (noncancerous), although the malignant type is much more common. Benign growths often recur even after being removed, but they rarely transform to the malignant type. 

Smoking tobacco is the leading cause and risk factor for lung cancer, including non-small cell lung cancer and small cell lung cancer. The NCI estimates that smoking tobacco causes 90 percent of lung cancers in people assigned male at birth and 80 percent of lung cancers in people assigned female at birth.  

Toxins in tobacco products can damage DNA, which ordinarily controls the growth and proper functioning of the body’s cells. Damage or mutations to DNA can make it harder for the body to curb the formation and growth of cancer cells. 

Tobacco toxins can also weaken your immune system, impairing its ability to prevent cancer cells from growing and spreading.  

The risk of lung cancer goes up with the number of tobacco products (such as cigarettes, cigars, and pipes) smoked daily, as well as the number of years smoked. People who smoke cigarettes, for example, are 15 to 30 times more likely to get lung cancer or die from it than are people who don’t smoke. Though low-tar or low-nicotine cigarettes may be marketed as lighter alternatives, smoking them doesn’t offer a lower risk of lung cancer. 

Secondhand smoke also contributes to lung cancer. Exposure to secondhand smoke (also known as passive smoking) raises the risk of lung cancer by 20 to 30 percent, according to the CDC. 

There is no safe level of exposure to secondhand or passive tobacco smoke. Even short exposure can cause harmful effects, including raising lung cancer risk. 

Does vaping with e-cigarettes cause lung cancer? 

The American Cancer Society (ACS) cautions that vaping may sound harmless, but the aerosol that comes out of e-cigarettes can contain addictive nicotine as well as harmful substances known to cause cancer. Cancer-causing chemicals, called carcinogens, found in both e-cigarettes and conventional tobacco products include: 

• N‐nitrosonornicotine 
• 4–(methylnitrosamino)‐1–(3–pyridyl)‐1–butanone 
• N‐nitrosoanabasine 
• N‐nitrosoanatabine 

Scientists are still researching e-cigarettes and clinical studies are needed to draw conclusions about their long-term health effects in humans. 

Can you get lung cancer if you don't smoke? 

While smoking is the primary cause, there are other non-smoking risk factors for lung cancer, including: 

• Air pollution 
• Asbestos, arsenic beryllium, chromium, nickel, soot, or tar exposure in the workplace 
• Having a family history of lung cancer 
• Having HIV 
• Exposure to radon in the home or workplace. (Radon is a radioactive gas released by uranium found in soil and rock.) 
• Radiation therapy to the breast or chest 
• Taking beta-carotene supplements (if you smoke heavily or have a history of asbestos exposure) 

Does COPD raise the risk of lung cancer? 

Having chronic obstructive pulmonary disease (COPD) raises your risk of lung cancer. This includes a higher risk of the NSCLC subtype squamous cell carcinoma, as well as SCLC regardless of smoking status, according to a 2023 review of studies published in the International Journal of Molecular Sciences.  

There is also some overlap between the conditions. Around 40 to 70 percent of people with lung cancer have symptoms that point to COPD, such as airflow obstruction, according to the review. COPD causes chronic inflammation of lung tissues, which can raise the risk of lung cancer by two to seven times, no matter what your smoking history may be. 

Patients have better outcomes when lung cancer is detected as early as possible. The disease can be diagnosed in different ways, depending on: 

• Your personal history and family medical history 
• Your symptoms 
• Results of a physical exam to check your general health and signs of disease, such as lumps or other unusual physical findings 

If you have smoked for many years, you should consider being screened for lung cancer every year. This applies if you’re between 50 and 80 years old and you currently smoke or if you quit within the past 15 years and have smoked for at least 20 pack years.  

(“Pack years” are calculated by multiplying the number of packs you smoke per day by the number of years you’ve smoked. For example, if you smoked one pack a day for 20 years or two packs a day for 10 years, you have a 20 pack-year history.) 

Screening for lung cancer is done using low-dose computed tomography (CT), or LDCT. In this test, an X-ray machine scans the body from a variety of angles using low doses of radiation to create detailed images of the lungs. 

Additional tests can help confirm or rule out suspected lung cancer. These include: 

Lab tests for lung cancer 

Your HCP will test samples of your blood, urine, or other substances in the body. These tests can help your HCP diagnose lung cancer, develop a treatment plan, check how well treatments are working, and monitor the disease over time. 

Imaging scans to detect lung cancer 

Using imaging tests for lung cancer might start with a chest X-ray to view the organs and tissues inside your chest. Although this isn’t the most effective method for lung cancer screening, a tumor may show up on an X-ray you have received for another health issue. 

If your HCP suspects lung cancer, they may order more imaging tests to view a suspicious growth in greater detail. This might include a: 

• Computed tomography (CT) scan  
• Positron emission tomography (PET) scan: This test uses a radioactive substance called a tracer that’s injected into your bloodstream and viewed through a special camera to see whether lung cancer cells have spread to lymph nodes or other areas of your body. A PET scan is often used in conjunction with a CT scan to create a 3D image that shows areas of rapid cancer cell growth and distinguishes between benign and malignant masses. 

Once lung cancer is diagnosed, your HCP may advise that you have a bone scan to determine if cancer cells have spread to your bones. In this procedure, a small amount of radioactive material is injected into a vein and then travels through the bloodstream and into the bones. A scanner is then used to detect whether any damage has occurred in the bones. 

Biopsy of cell, tissue, or fluid samples 

Your HCP will remove a small sample of cells, tissue, or fluid from the lung or from nearby tissue. There are many ways to perform a biopsy for lung cancer. Examples include: 

• Bronchoscopy: Your HCP passes a lighted, flexible tube called a bronchoscope through the mouth or nose and into the large airways of the lungs to remove samples. 
• Endobronchial ultrasound (EBUS): EBUS involves passing an ultrasound-equipped bronchoscope into the trachea to view nearby lymph nodes and structures inside the chest. A hollow needle is then passed through the tube to take biopsy samples. 
• Fine needle aspiration (FNA) biopsy: During FNA, a CT scan, ultrasound, or other imaging procedure locates abnormal tissue in the lung. Next, a long, thin needle is used to remove a sample for testing. 
• Mediastinoscopy: This involves passing a thin, tube-like device called a mediastinoscope through a small incision at the top of the breastbone. The device is fitted with a light and lens that helps your HCP view and remove biopsy samples from lymph nodes in the area between the lungs called the mediastinum. 
• Sputum cytology: This involves coughing up sputum or phlegm from the lungs to see whether cancer cells can be seen under a microscope. 
• Thoracentesis: This involves using a hollow needle to remove fluid that has collected between the lungs and chest wall. 
• Thoracoscopy or video-assisted thoracoscopic surgery (VATS) biopsy: This involves passing a thin, tube-like device called a thoracoscope into a small incision between two ribs to view small tumors, remove sample tissue from the lung or lining of the chest wall, or remove part of the affected lung during early stage lung cancer.  

Biomarker testing for lung cancer 

Cancer biomarkers usually refer to genes, proteins, and other molecules that influence how cancer cells grow, multiply, die, and respond to other substances in the body. Biomarker testing is also called genomic, genetic, molecular, or tumor testing. 

Lung cancer biomarker testing looks for changes in the tumor’s DNA. These might involve mutations, insertions, deletions, or rearrangements in DNA that can cause cancer. Biomarker testing can be used to detect these DNA or molecular changes in advanced non-small cell lung cancer.  

After diagnosing lung cancer and determining which type it is, your HCP will figure out how large your tumor has grown and whether cancer cells have spread beyond the original tumor to other lung tissue or other organs outside of the lung.  

This is called lung cancer staging. Staging helps determine which treatment options might work best for your lung cancer type and what the general outlook might be for treatment and recovery.  

Tumor, node, metastasis (TNM) lung cancer classification 

The TNM classification system is the most common method for staging cancer. To stage lung cancer, your HCP evaluates your tests and tissue samples to pinpoint:  

• T: Tumor size and location 
• N: Whether lung cancer cells have spread to nearby lymph nodes 
• M: If and where cancer cells have metastasized 

Non-small cell lung cancer stages 

NSCLC stages range from 0 to 4, often noted in Roman numerals 0 to IV. In general, lower cancer stages indicate: 

• Smaller tumor size 
• Less cancer cell metastasis 
• Greater likelihood of recovery and survival from lung cancer 

Stage 0 non-small cell lung cancer 

In this stage, abnormal cells are found in the top lining of the originally affected lung or bronchus and remain “in situ.” This means these cells remain “in place” and haven’t spread beyond the original tumor site. 

Stage I non-small cell lung cancer 

Cancer cells haven’t spread to nearby lymph nodes or other parts of the body. During stage IA, the original tumor grows no more than 3 centimeters (cm). 

During stage IB, the original tumor grows larger than 3 cm but no more than 4 cm, but part of the affected lung or the entire lung may have collapsed or developed lung inflammation called pneumonitis. Cancer cells may have also spread into either the: 

• Main bronchus but not the carina, which is the ridge at the base of the trachea (windpipe) that separates the openings of the right and left main bronchi 
• Innermost layer of the membrane that covers the lung 

Stage II non-small cell lung cancer 

During stage IIA the tumor is 4 to 5 cm large, but cancer cells haven’t spread to any lymph nodes. During stage IIB lung cancer, the original tumor measures 5 to 7 cm, but cancer cells haven’t spread to nearby lymph nodes, or the tumor measures no more than 5 cm, but cancer cells have spread to lymph nodes within the lung on the same side of the chest as the original tumor. 

Stage III non-small cell lung cancer 

Stage III non-small cell lung cancer is subdivided into stage IIIA, IIIB, or IIIC. During stage IIIA, cancer cells may have spread to lymph nodes on the same side of the chest as the original tumor. These include lymph nodes in the lung or near the bronchus. 

In addition, one or more the following occurs: 

• The original tumor is larger than 5 cm but smaller than 7 cm and cancer cells have spread to lymph nodes on the same side of the chest as the original tumor. 
• One or more separate tumors may be found in the same lung lobe as the original tumor. (Each lung consists of several large sections called lobes. The right lung consists of three lobes and the left lung has two lobes.) 
• Cancer cells may have spread to the chest wall and the membrane that lines the inside of it, to the nerve that controls the diaphragm, or to the outer tissue layer surrounding the heart. 

Or: 

• The original tumor grows larger than 7 cm and one or more tumors form in a different lobe of the lung as the original tumor. 
• The original tumor is any size and has spread to any of these sites: trachea, carina, esophagus, breastbone, backbone, diaphragm, heart and the major blood vessels that run to and from it (for example, the aorta or vena cava), and the nerve that controls the larynx (voice box). 

During stage IIIB, the original tumor is no larger than 5 cm, but lung cancer cells have spread to lymph nodes above the collarbone on the same side of the chest as the original tumor or to any lymph nodes on the opposite side of the chest as the original tumor. In addition, one or more of the following can occur: 

• The cancer has spread to the inner membrane that covers the lung or the main bronchus but not the carina. 
• Part of the lung or the entire affected lung collapses or lung inflammation called pneumonitis sets in. 

During stage IIIC, the tumor can be any size and cancer cells have spread to lymph nodes above the collarbone on the same side of the chest as the original tumor or any lymph nodes on the opposite of the chest as the original tumor. In addition, one or more different tumors form in the same or different lung lobe as the original tumor. Or cancer cells have spread to any of these sites: 

• Backbone 
• Breastbone 
• Carina 
• Chest wall or the membrane that lines it 
• Diaphragm and/or the nerve that controls it 
• Esophagus 
• Heart, major blood vessels to and from it, or the outer layer of tissue surrounding it 
• Nerve that controls the larynx 
• Trachea 

Stage IV non-small cell lung cancer 

The original tumor can be any size during this advanced NSCLC stage. It’s also called metastatic lung cancer since cancer cells spread to lymph nodes as well as distant tissues and organs such as the adrenal gland, bone, brain, kidney, liver, and pancreas. Cancer cells are also found in fluids around the lungs and heart.  

During stage IVA, cancer cells have spread to one distant organ or tissue site. By stage IVB, cancer cells have spread to multiple organs and tissue outside the lung. 

Occult (hidden) stage of non-small cell lung cancer 

NSCLC also includes a stage in which neither cancer cells nor a tumor can be seen by imaging scans or bronchoscopy. The original tumor or cancer cells may be hidden from view due to their small size. 

Instead, lung cancer cells are found in sputum or bronchial washings, a sample of cells taken from inside the airways that lead to the lungs. By the time cancer cells are found, they may have already spread to lymph nodes or distant parts of the body. 

Limited vs. extensive stage of small-cell lung cancer 

Small-cell lung cancer is divided into two stages.  

• In the limited stage of SCLC, cancer cells are in the lung where they first formed and may have spread to the area between the lungs or the lymph nodes above the collarbone. 
• In the extensive stage of SCLC, cancer cells have metastasized to lymph nodes and other tissues and organs outside of the lungs. 

Your lung cancer treatment options will depend on the type and stage of your disease, as well as other health conditions you have and your treatment preferences. These might include: 

Lung cancer surgery 

Lung cancer surgery may be the best option when cancer cells are localized and haven’t spread.  

This includes treating non-small cell lung cancers and carcinoid tumors while they’re in the early stages of the disease. 

In addition to a VATS biopsy, your surgical treatment options might include: 

• Lobectomy: This involves resection (removal) of the affected lung lobe. A bilobectomy resects two adjacent lobes of the right lung. A sleeve lobectomy removes the cancerous lobe and a part of the main bronchus of the affected lung, and then joins the remaining portion of that bronchus with the bronchus of any unaffected lobe. 
• Segmentectomy: This involves removing one to four segments of certain lung lobes and saving unaffected tissue.  
• Wedge resection: This involves resecting a small, wedge-shaped portion of lung tissue around the lung cancer tumor. 
• Pneumonectomy: This involves resecting the entire affected lung. It may be done if lobectomy can’t fully remove the tumor or the tumor sits in the center of the affected lung.  
• Laser therapy: This involves using a narrow beam of focused light to destroy cancer cells, such as those causing blockages in the airways.  

Lung cancer radiation therapy 

Lung cancer radiation therapy uses powerful, high-energy X-rays to destroy cancer cells in affected area of the lung and keep them from growing. 

Radiation therapy techniques include: 

• External beam radiation: Radiation doses are delivered from outside the body. 
• Intensity modulation radiation therapy (IMRT): IMRT shapes the beam to match the shape of the tumor and allows the intensity of treatment to be changed during each radiation session. 
• Brachytherapy: This involves implanting sealed radioactive material into or near the tumor. 
• Stereotactic body radiation therapy (SBRT), also called stereotactic ablative radiotherapy (SABR): A very high dose of radiation is delivered precisely to tumors in the lung or other organs while limiting the dose to the surrounding organs. 
• Stereotactic radiosurgery (SRS): This procedure delivers high-dose radiation precisely to tumors that have spread to the central nervous system (such as the brain and spinal cord). 

Lung cancer chemotherapy 

Chemotherapy (or chemo) can be used to shrink the tumor prior to surgery. This is known as preoperative or neoadjuvant chemotherapy. It can also be used to destroy cancer cells that remain after surgery. In some cases, chemo can be combined with radiation or other types of lung cancer treatment. 

Chemo may also be an option during advanced lung cancer stages when other treatments such as surgery aren’t an option. The treatment helps ease lung cancer symptoms and keep tumors from growing and spreading. 

Lung cancer targeted drug therapy 

Targeted therapies for lung cancer involve the use of cancer medicines that target certain changes to cancer cells based on biomarker testing. They can also block new blood vessel growth in tumors. Because they focus on specific genetic or molecular changes, targeted therapies avoid destroying healthy cells, which can be a side effect of some forms of radiation and chemotherapy. 

Lung cancer immunotherapy 

Immunotherapy helps treat lung cancer by improving your immune system’s ability to identify and destroy cancer cells. These medicines are called immune checkpoint inhibitors. 

Ordinarily, the immune system attacks harmful substances in the body. In addition to cells that attack these invaders, the immune system contains “checkpoint” proteins that help prevent the immune system from damaging otherwise healthy and non-threatening cells.   

Cancer cells use these checkpoints to avoid detection and to prevent your immune system from attacking them. But medicines used for lung cancer immunotherapy help prevent your immune system from getting tricked by cancer cells using checkpoints. These lung cancer medicines unleash your immune cells and allow them to find and eliminate cancer cells more effectively.  

Radiofrequency ablation 

Radiofrequency ablation (RFA) may be used to remove small NSCLC lung tumors close to the outer edge of the lungs, especially if surgery isn’t an option. The procedure uses guided, high-energy radio waves to heat the tumor and destroy cancer cells. 

Although you may not be able to fully prevent the disease, you can take steps to lower your risk of lung cancer. Aim to: 

• Quit or never start smoking. 
• Stay away from secondhand smoke. 
• Test for radon in your home. 
• Follow workplace safety guidelines to avoid or minimize exposure to carcinogens. 

Talk with your HCP about your individual risk factors and how you can lower your chances of getting lung cancer. 

Your HCP can’t predict how your lung cancer will progress, but they can share the general outlook for people with the same type and stage of the disease. They’ll also consider your age, overall health, and risk factors. 

Bear in mind that this information is only an estimate of how the disease may unfold. Your actual prognosis can differ from these estimates or from the experience of other patients. In general, the earlier your lung cancer is detected and treated, the higher your chances of recovery and survival. 

How fast does lung cancer spread? 

It’s hard to predict the speed at which cancer cells grow and spread. Multiple variables have an impact, including your lung cancer type and stage. That said, lung cancer tends to spread early and some types spread faster than others. For instance, small cell lung cancer usually spreads faster than non-small cell lung cancer. 

What is the survival rate for lung cancer? 

A cancer survival rate describes the percentage of people with the same type and stage of cancer who are still alive for a given amount of time following diagnosis compared to people in the overall population. The 5-year survival rate is the most common measure used. 

The 5-year relative survival rates for NSCLC and SCLC are based on whether cancer cells are: 

• Localized: No cancer cells have spread outside the lung. 
• Regional: Cancer cells have spread beyond the lung to nearby lymph nodes and structures. 
• Distant: Cancer cells have spread beyond the lung to distant tissues and organs. 

The 5-year survival rates for NSCLC are: 

• Localized: 65 percent 
• Regional: 37 percent 
• Distant: 9 percent 
• Overall: 28 percent 

The 5-year survival rates for SCLC are: 

• Localized: 30 percent 
• Regional: 18 percent 
• Distant: 3 percent 
• Overall: 7 percent 

It’s worth noting that people being diagnosed with NSCLC or SCLC today may have a better outlook than what these numbers suggest. That’s because these figures are based on people who were diagnosed and treated at least 5 years earlier. Meanwhile, treatments for lung cancer are continually improving. 

Your healthcare team will do as much as they can to support and guide you through your cancer journey, but living with lung cancer also involves being your own advocate. Don’t hesitate to ask questions and speak up if your symptoms are getting worse or you have concerns about sticking with your lung cancer treatment plan. 

Cancer care coordinators and nurse navigators can advocate for you 

If you need advocacy support, ask your HCP if they can refer you to a nurse navigator or oncology (cancer) care coordinator. Think of them as your personal guides during your lung cancer journey.  

Most people who serve in these roles are highly trained and experienced oncology registered nurses or nurse practitioners who work closely with your HCP and other members of your healthcare team. They provide ongoing support and help connect you with medical and mental health resources, including: 

• Information and education to help you decide what and how to get what you need during each stage of your lung cancer journey 
• Mental and emotional support resources, such as referrals to support groups and crisis intervention resources for you, your family, and other caregivers involved in your care at home 
• Help with making referrals to other HCPs, building your lung cancer healthcare team, understanding your health insurance benefits, getting coverage assistance for medical necessities such as prescriptions and treatments, and working with your employer to coordinate a leave of absence from work, if needed 
• Resources to help offset financial challenges and plan for future health needs 
• Wellness strategies to complement your lung cancer treatment plan and help improve your quality of life, such as help with your eating and exercise plans and tips for managing your stress 

How to cope with the stress of living with lung cancer 

Staying positive during your lung cancer journey can be challenging. You may feel a variety of overwhelming emotions. 

To help cope with the stress of having lung cancer, it often helps to: 

• Communicate with people you trust to support you, including close friends, loved ones, and family members. 
• Join an in-person or online support group for people living with lung cancer. 
• Seek professional help and guidance from a licensed mental health provider or spiritual advisor. 
• Consider expressing and processing your thoughts and concerns in a journal or through creative mediums such as art, music, or a personal blog. 

How to maintain strength and energy with lung cancer 

You can also adopt healthy lifestyle habits that help you strengthen and protect your body during and after cancer. This includes: 

• Conserving energy to ease fatigue: Try to get adequate rest, space out your tasks, and ask for help with your daily tasks when needed. 
• Eating nutrient-rich foods: Fill your plate with lean proteins and plant-based whole foods such as fruits, vegetables, beans, and whole grains. 
• Working with a registered dietitian nutritionist: They can help you maintain a healthy weight and manage treatment side effects that affect your appetite or desire to eat.  
• Staying physically active: Light physical activities such as walking and stretching are a great way to start. If needed, consider working with a physical therapist, medical exercise physiologist, or certified personal trainer to come up with activity plans based on your energy level, experience, and activities you enjoy doing. 
• Quitting smoking if you have continued to smoke: Quitting enhances your quality of life and longevity. It also improves your body’s response to chemotherapy and radiation and lowers the risk of complications from those treatments.  

Lung cancer questions to ask your healthcare provider 

Receiving a lung cancer diagnosis can take time to process, and you will likely have questions about what the future holds. The key is to have open, candid conversations with your HCP about what to expect from your treatment and your prognosis. Given the amount of information you are likely receiving, it may feel difficult to know exactly what to ask.  

To help patients make informed decisions over the course of their journey, the ACS has compiled a list of questions to ask about lung cancer. Some of the top questions that may be relevant to you include: 

• Who should be part of my lung cancer team? 
• Are there resources you can recommend to help cover the costs of diagnosis and treatment? 
• What treatment options do I have, and which of these do you recommend and why? 
• What are my treatment goals and what are the chances that my lung cancer will be cured with these treatments? 
• How will I know if my lung cancer treatment is working? 
• How long will each treatment last, what will they be like, and where will they be performed? 
• How will treatment affect my daily activities? 
• What options do I have if treatment doesn’t work or if the cancer comes back after I finish treatment? 
• Should I get a second opinion? If so, can you refer me to the right HCP? 
• Can you refer me to a licensed mental health provider if I start to feel depressed, anxious, or stressed?