The following is taken from the American Cancer Society web pages and covers non-small cell cancer - the type I know I have:-
When you breathe in, air enters through your mouth or nose and goes into your lungs through the trachea (windpipe). The trachea divides into tubes called the bronchi (singular, bronchus), which divide into smaller branches called bronchioles. At the end of the bronchioles are tiny air sacs known as alveoli.
Many tiny blood vessels run through the alveoli. They absorb oxygen from the inhaled air into your bloodstream and pass carbon dioxide from the body into the alveoli. This is expelled from the body when you exhale. Taking in oxygen and getting rid of carbon dioxide are your lungs' main functions.
A thin lining layer called the pleura surrounds the lungs. The pleura protects your lungs and helps them slide back and forth against the chest wall as they expand and contract during breathing.
Below the lungs, a dome-shaped muscle called the diaphragm separates the chest from the abdomen. When you breathe, the diaphragm moves up and down, forcing air in and out of the lungs.
Lung cancers are thought to start as areas of pre-cancerous changes in the lung. The first changes happen in the genes of the cells themselves and may cause them to grow faster. The cells may look a bit abnormal if seen under a microscope, but at this point they do not form a mass or tumor. They cannot be seen on an x-ray and they do not cause symptoms.
Over time, these pre-cancerous changes in the cells may progress to true cancer. As a cancer develops, the cancer cells may make chemicals that cause new blood vessels to form nearby. These new blood vessels nourish the cancer cells, which can continue to grow and form a tumor large enough to be seen on imaging tests such as x-rays.
At some point, cells from the cancer may break away from the original tumor and spread (metastasize) to other parts of the body. Lung cancer is often a life-threatening disease because it tends to spread in this way even before it can be detected on an imaging test such as a chest x-ray.
Lymph nodes are small, bean-shaped collections of immune system cells (cells that fight infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the lungs. Lymph contains excess fluid and waste products from body tissues, as well as immune system cells.
Lung cancer cells can enter lymphatic vessels and begin to grow in lymph nodes around the bronchi and in the mediastinum (the area between the 2 lungs). When lung cancer cells have reached the lymph nodes, they are more likely to have spread to other organs of the body as well. The stage (extent) of the cancer and decisions about treatment are based on whether or not the cancer has spread to the nearby lymph nodes in the mediastinum.
These 2 types of lung cancer are treated very differently.
Squamous cell (epidermoid) carcinoma: About 25% to 30% of all lung cancers are squamous cell carcinomas. These cancers start in early versions of squamous cells, which are flat cells that line the inside of the airways in the lungs. They are often linked to a history of smoking and tend to be found in the middle of the lungs, near a bronchus.
Adenocarcinoma: About 40% of lung cancers are adenocarcinomas. These cancers start in early versions of the cells that would normally secrete substances such as mucus. This type of lung cancer occurs mainly in people who smoke (or have smoked), but it is also the most common type of lung cancer seen in non-smokers. It is more common in women than in men, and it is more likely to occur in younger people than other types of lung cancer.
Adenocarcinoma is usually found in the outer region of the lung. It tends to grow slower than other types of lung cancer, and is more likely to be found before it has spread outside of the lung. People with the type of adenocarcinoma called adenocarcinoma in situ (previously called bronchioloalveolar carcinoma) tend to have a better outlook (prognosis) than those with other types of lung cancer.
Large cell (undifferentiated) carcinoma: This type of cancer accounts for about 10% to 15% of lung cancers. It may appear in any part of the lung. It tends to grow and spread quickly, which can make it harder to treat. A subtype of large cell carcinoma, known as large cell neuroendocrine carcinoma, is a fast-growing cancer that is very similar to small cell lung cancer (see below).
Other subtypes: There are also a few other subtypes of non-small cell lung cancer, such as adenosquamous carcinoma and sarcomatoid carcinoma. These are much less common.
The lungs
Your lungs are 2 sponge-like organs found in your chest. Your right lung is divided into 3 sections, called lobes. Your left lung has 2 lobes. The left lung is smaller because the heart takes up more room on that side of the body.Many tiny blood vessels run through the alveoli. They absorb oxygen from the inhaled air into your bloodstream and pass carbon dioxide from the body into the alveoli. This is expelled from the body when you exhale. Taking in oxygen and getting rid of carbon dioxide are your lungs' main functions.
A thin lining layer called the pleura surrounds the lungs. The pleura protects your lungs and helps them slide back and forth against the chest wall as they expand and contract during breathing.
Below the lungs, a dome-shaped muscle called the diaphragm separates the chest from the abdomen. When you breathe, the diaphragm moves up and down, forcing air in and out of the lungs.
Start and spread of lung cancer
Lung cancers can start in the cells lining the bronchi and parts of the lung such as the bronchioles or alveoli.Lung cancers are thought to start as areas of pre-cancerous changes in the lung. The first changes happen in the genes of the cells themselves and may cause them to grow faster. The cells may look a bit abnormal if seen under a microscope, but at this point they do not form a mass or tumor. They cannot be seen on an x-ray and they do not cause symptoms.
Over time, these pre-cancerous changes in the cells may progress to true cancer. As a cancer develops, the cancer cells may make chemicals that cause new blood vessels to form nearby. These new blood vessels nourish the cancer cells, which can continue to grow and form a tumor large enough to be seen on imaging tests such as x-rays.
At some point, cells from the cancer may break away from the original tumor and spread (metastasize) to other parts of the body. Lung cancer is often a life-threatening disease because it tends to spread in this way even before it can be detected on an imaging test such as a chest x-ray.
The lymph (lymphatic) system
The lymph system is important to understand because it is one of the ways in which lung cancers can spread. This system has several parts.Lymph nodes are small, bean-shaped collections of immune system cells (cells that fight infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the lungs. Lymph contains excess fluid and waste products from body tissues, as well as immune system cells.
Lung cancer cells can enter lymphatic vessels and begin to grow in lymph nodes around the bronchi and in the mediastinum (the area between the 2 lungs). When lung cancer cells have reached the lymph nodes, they are more likely to have spread to other organs of the body as well. The stage (extent) of the cancer and decisions about treatment are based on whether or not the cancer has spread to the nearby lymph nodes in the mediastinum.
Types of lung cancer
There are 2 major types of lung cancer:- Small cell lung cancer (SCLC)
- Non-small cell lung cancer (NSCLC)
These 2 types of lung cancer are treated very differently.
Non-small cell lung cancer
About 85% to 90% of lung cancers are non-small cell lung cancer (NSCLC). There are 3 main subtypes of NSCLC. The cells in these subtypes differ in size, shape, and chemical make-up when looked at under a microscope. But they are grouped together because the approach to treatment and prognosis (outlook) are very similar.Squamous cell (epidermoid) carcinoma: About 25% to 30% of all lung cancers are squamous cell carcinomas. These cancers start in early versions of squamous cells, which are flat cells that line the inside of the airways in the lungs. They are often linked to a history of smoking and tend to be found in the middle of the lungs, near a bronchus.
Adenocarcinoma: About 40% of lung cancers are adenocarcinomas. These cancers start in early versions of the cells that would normally secrete substances such as mucus. This type of lung cancer occurs mainly in people who smoke (or have smoked), but it is also the most common type of lung cancer seen in non-smokers. It is more common in women than in men, and it is more likely to occur in younger people than other types of lung cancer.
Adenocarcinoma is usually found in the outer region of the lung. It tends to grow slower than other types of lung cancer, and is more likely to be found before it has spread outside of the lung. People with the type of adenocarcinoma called adenocarcinoma in situ (previously called bronchioloalveolar carcinoma) tend to have a better outlook (prognosis) than those with other types of lung cancer.
Large cell (undifferentiated) carcinoma: This type of cancer accounts for about 10% to 15% of lung cancers. It may appear in any part of the lung. It tends to grow and spread quickly, which can make it harder to treat. A subtype of large cell carcinoma, known as large cell neuroendocrine carcinoma, is a fast-growing cancer that is very similar to small cell lung cancer (see below).
Other subtypes: There are also a few other subtypes of non-small cell lung cancer, such as adenosquamous carcinoma and sarcomatoid carcinoma. These are much less common.
How is non-small cell lung cancer staged?
Staging is the process of finding out how far a cancer has spread. Your treatment and prognosis (outlook) depend, to a large extent, on the cancer's stage. The stage of a cancer does not change over time, even if the cancer progresses. A cancer that comes back or spreads is still referred to by the stage it was given when it was first found and diagnosed, only information about the current extent of the cancer is added. A person keeps the same diagnosis stage, but more information is added to the diagnosis to explain the current disease status.
There are actually 2 types of stages.
Because many patients with non-small cell lung cancer do not have surgery, the clinical stage is often used when describing the extent of this cancer.
There are actually 2 types of stages.
- The clinical stage is based on the results of the physical exam, biopsies, and imaging tests (CT scan, chest x-ray, PET scan, etc.),
- If you have surgery, your doctor can also determine a pathologic stage, which is based on the same factors as the clinical stage, plus what is found as a result of the surgery.
Because many patients with non-small cell lung cancer do not have surgery, the clinical stage is often used when describing the extent of this cancer.
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