"I've got to tell you guys something. I have cancer. I'm about to go into surgery to have half of my left lung removed. Yes, I have lung cancer even though I've never smoked!" the 60-year-old comedian wrote on Twitter and Instagram. "The doctors are very optimistic as it is stage one and contained to my left lung. Hopefully no chemo or radiation after this and I should have normal function with my breathing. I should be up and running around as usual in a month or less."
In an interview with Nightline, which is set to air on ABC Monday night, Griffin revealed she was diagnosed after a doctor noticed a mass on her lung that had doubled in size. "I've had it for a long time," she said, regarding the mass. "And it gets X-rayed every three years and hasn't grown. So she said, 'Well, this time, it grew."
Griffin said she was in shock after hearing the news—especially since she doesn't have a history of smoking. "I'm still a little bit in shock. Not denial, but … once a day, I'll just turn to, like, nobody next to me and go, 'Can you believe this s–t? Is this a bitch or what,'" she told Nightline. "It's stage 1. It's nowhere else in my body. So I need to focus on that."
Kathy Griffin Lung Cancer can be affected by the disease.
What is lung cancer?
Lung cancer is cancer that starts in the lungs. It happens when cells in the lung mutate, grow uncontrollably, and cluster together to form a tumor, according to the American Lung Association (ALA). As those cancer cells grow out of control, they destroy the healthy lung tissue around them.
There are two main types of lung cancer: small cell lung cancer and non-small cell lung cancer, the ALA says. Non-small cell lung cancer makes up about 80% of all lung cancer cases, and grows and spreads more slowly than small cell lung cancer, which is "almost always" associated with smoking, per the ALA. Griffith didn't share the type of lung cancer she has.
RELATED: The Stages of Lung Cancer, Explained
What is stage 1 lung cancer?
Lung cancer staging tells where the lung cancer cells are located, the size of the lung cancer tumor, and if (and where) the lung cancer has spread, the ALA says. It also can help doctors recommend that best type of treatment and give some information about prognosis.
Stage 1 lung cancer means that the cancer has not spread to the lymph nodes or other parts of the body.
What are the symptoms of lung cancer?
Lung cancer doesn't usually cause symptoms at its earliest stages, and symptoms usually show up when the cancer is advanced, the Mayo Clinic says. Those can include:
- A new cough that doesn't go away
- Coughing up blood
- Shortness of breath
- Chest pain
- Hoarseness
- Losing weight without trying
- Bone pain
- Headache
RELATED: What Is Lung Cancer?
What causes lung cancer?
Smoking is one of the largest causes of lung cancer, but people who have never smoked can also develop the disease, the Mayo Clinic points out.
Up to 20% of people in the U.S. who die from lung cancer have never smoked or used any type of tobacco, the American Cancer Society (ACS) says. These are the other factors that can increase your risk of lung cancer, aside from smoking:
- Exposure to radon gas
- Exposure to secondhand smoke
- Being around cancer-causing agents, like asbestos, arsenic gas, and diesel exhaust
- Air pollution
- Genetic changes
How is lung cancer treated?
Treatment for lung cancer can include surgery to remove a portion of the impacted lung or removal of an entire lung, radiation therapy, chemotherapy, targeted drug therapy, and immunotherapy, the Mayo Clinic says. The best type of treatment often depends on the form of lung cancer a person has and the stage of their disease.
At the end of her Instagram and Twitter posts, Griffin reassured fans and followers that she will be "just fine." She also added that she's fully vaccinated against COVID-19—which, if she hadn't been, would have complicated her situation even more. She ended with some advice for readers: "Please stay up to date on your medical checkups. It'll save your life."
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]]> 
35-Year-Old-Mom-Mistakes-Lung-Cancer-For-Pregnancy-Pain-GettyImages-544285039-74855234-3 that had spread all over her body.
"Once I had my daughter and the medication wore off, I still had pain," 35-year-old Sherrie, who lives in Glendora, California, told TODAY, recalling when she first realized something serious might be going on.
jessica sherrie
Sherrie said she was "pretty freaked out" by the diagnosis. She'd never smoked, which made her lung cancer diagnosis even more surprising. According to the National Cancer Institute (NCI), women who smoke are 13 times more likely to develop lung cancer than those who have never smoked. Another risk factor, though, is exposure to secondhand smoke. The Centers for Disease Control and Prevention (CDC) estimates that about 7,300 people who have never smoked die of lung cancer caused by secondhand smoke each year.
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According to the American Cancer Society (ACS), symptoms of lung cancer include a persistent cough, wheezing, coughing up blood, shortness of breath, and infections like bronchitis and pneumonia that don't go away or keep returning. If lung cancer has spread to other parts of the body, it may cause bone pain (such as in the back, as Sherrie experienced), swelling of lymph nodes, and nervous system changes like headache, dizziness, weakness, or numbness of an arm or leg.
jessica sherrie
"I hope that people are not scared to go to the doctor and find out if they have cancer, because that could save their lives," said Sherrie. "I hope I can inspire people to take action right away when they experience symptoms."
After a tumultuous year, she's had some good news—the tumors in her brain have shrunk so much, they're now microscopic, and all but one of the tumors in her lungs have disappeared. New tumors have appeared in her liver and hip, though, and Sherrie is on a new drug regimen to treat them. In the meantime, one-year-old Regina is keeping her spirits up.
"I wasn't able to like carry her and walk around the house. I'd have to be sitting down… that was a hard time for me," Sherrie said of her postpartum months, after she was diagnosed. "I just want to hold my daughter. But it's OK now, I can hold her all the time."
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]]>After being diagnosed with cancer last month, Diamond's health had deteriorated over the last week, revealed TMZ. He was taken off a ventilator to try to get him to a hospice, and his father was with him when he died.
RELATED: Dustin Diamond Was Reportedly Diagnosed With Stage 4 Cancer—What to Know About Small Cell Carcinoma
On January 14, Diamond's rep, Roger Paul, confirmed the actor's cancer diagnosis to NBC News. The same day, his team shared a statement on Diamond's Facebook page, saying, "We ask everyone to respect Dustin's privacy during this difficult time. All positivity and prayers are appreciated."
Dustin-Diamond-Has-Died-GettyImages-531812704 .
According to the National Cancer Institute, stage 4 cancer means the cancer has spread from where it first formed to distant parts of the body, such as from the lungs to the bones, brain, and liver. This is known as metastasis. The new tumor is the same type of cancer as the primary tumor—for instance, if lung cancer spreads to the brain, the cancer cells in the brain are lung cancer cells, not brain cancer cells. TMZ reported that Diamond's cancer was "throughout his body."
RELATED: The Difference Between Small Cell and Non-Small Cell Lung Cancer
MedlinePlus says almost all cases of small cell lung cancer are a result of smoking, and only very rarely diagnosed in someone who has never smoked. "If we see it in a non-smoker, we ask 'are you sure?' and recheck the pathology reports," Gregory Kalemberian, MD, clinical professor of medicine in hematology/oncology at The University of Michigan in Ann Arbor, previously told Health. A person has a higher risk of small cell lung cancer the more "pack years" they have from smoking (i.e. the number of packs smoked per day per year).
Unfortunately, Diamond was one of the rare cases—he had never smoked. His rep told TMZ on January 23 that this was making it difficult for the actor to come to terms with having small cell lung cancer. However, he did have a history of cancer in his family—his mother died of breast cancer.
RELATED: The Stages of Lung Cancer, Explained
Symptoms of lung cancer may include chest pain, a persistent cough, coughing up blood, fatigue, shortness of breath, and hoarseness, Health previously reported. However, early lung cancer may not cause any symptoms. Treatment for small cell lung cancer typically includes chemotherapy and radiation to help lessen symptoms and prolong the patient's life. The prognosis depends on how much the cancer has spread at the time of diagnosis, as well as the patient's age, sex, and general health.
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]]>Diamond's health came into the spotlight last week after his team shared shared a statement on the actor's Facebook page on January 14, reading: "At this time we can confirm that Dustin does have cancer. Dustin Will disclose more information once it is available and a plan moving forward is made… We ask everyone to respect Dustin's privacy during this difficult time. All positivity and prayers are appreciated."
Diamond is currently awaiting his next round of chemotherapy, and will soon begin physical therapy as well, Paul told NBC News. "Dustin is looking forward to spending more time with his girlfriend, playing his bass guitar/video games, as well as making videos for his fans on social media," he added.
RELATED: The Stages of Lung Cancer, Explained
What is small cell carcinoma?
Small cell carcinoma (sometimes referred to as oat cell cancer) is a type of small cell lung cancer—one of two types of lung cancer in general. The other, non-small cell lung cancer, is the most common type of lung cancer, according to the US National Library of Medicine's MedlinePlus resource. Small cell lung cancer is less common, and makes up about 20% of all lung cancer cases.
Lung cancer in general is already the deadliest type of cancer for both men and women, and small cell lung cancer is a faster-growing, more aggressive type of lung cancer than non-small cell lung cancer. This type of cancer usually starts in the breathing tubes, or bronchi, in the center of the chest, per MedlinePlus. "We often see masses in the mid-chest," Nicholas Rohs, MD, attending physician in hematology and oncology at Mount Sinai Downtown-Chelsea Center in New York City previously told Health.
Though the cancer cells are small, they can grow quickly and create large tumors, sometimes spreading rapidly (aka, metastasizing) to other parts of the body, like the liver, brain, and bones. Diamond's stage 4 diagnosis means that his cancer has begun to metastasize, or spread.
According to MedlinePlus, almost all cases of small cell lung cancer are a result of smoking, and only vary rarely diagnosed in someone who has never smoked. "If we see it in a non-smoker, we ask 'are you sure?' and recheck the pathology reports," Gregory Kalemberian, MD, clinical professor of medicine in hematology/oncology at The University of Michigan in Ann Arbor, previously told Health. The more "pack years" you smoke (defined as the number of packs smoked per day per year), the greater the risk of small cell, added Dr. Rohs.
Dustin Diamond stage 4 lung cancer , UNIVERSAL CITY, CA – MAY 16: Dustin Diamond visits "Extra" at Universal Studios Hollywood on May 16, 2016 in Universal City, California. (Photo by Noel Vasquez/Getty Images)
What are the symptoms of small cell lung cancer?
Lung cancer typically won't show any symptoms until later stages of the disease and are largely similar between men and women. Common symptoms of small cell lung cancer specifically, per MedlinePlus, include:
- Coughing
- Chest pain
- Coughing up blood (aka, bloody sputum)
- Shortness of breath
- Weight loss
- Wheezing
- Facial swelling
- Fever
- Hoarseness or changing voice
- Difficulty swallowing
- Weakness
TMZ reported that Diamond was hospitalized following "feeling pain all over his body and a general sense of unease."
RELATED: 7 Causes of Lung Cancer in Non-Smokers
How is small cell lung cancer diagnosed?
Lung cancers are usually caught after they've already spread but regular lung cancer screenings can help detect the disease in its earlier stages, previously reported by Health. A large clinical trial revealed that a low-dose CT scan (LDCT), was shown to lower the chances of dying from lung cancer in people at high risk for the disease by about 20% compared to chest X-rays. If you are over the age of 55, are in fairly good health, have smoked at least a pack of cigarettes a day for 30 years or two packs a day for 15 years, and are either still smoking or have quit within the last 15 years, you may be a candidate for lung cancer screening, according to the American Cancer Society.
Unfortunately, in cases of small cell lung cancer, the cancer has already spread to other parts of the body by the time it gets diagnosed. Some of the tests that may be performed, per MedlinePlus, include: a bone scan, chest X-ray, CT scan, and MRI scan, among others. Past that, doctors will also perform a biopsy (removing a piece of tissue from the lungs and examining it under a microscope), and then, if the biopsy shows cancer, more tests to determine the cancer's staging and spreading.
RELATED: These 3 Women Were Each Diagnosed With Advanced Lung Cancer—Even Though They Never Smoked
How is small cell lung cancer treated?
For those with small cell lung cancer, or more specifically, small cell carcinoma, treatment often includes chemotherapy and radiation, though this treatment regimen is only used to lessen symptoms and help the patient live longer, as the cancer almost always returns in the future according to the American Cancer Society.
Regarding the overall prognosis of small cell lung cancer, MedlinePlus says it really depends on how much the cancer has spread by the time of diagnosis. Most people will not survive past five years with the disease, though treatment can help prolong life for six to 12 months. In some very rare cases, and if its diagnosed extremely early, treatment of small cell lung cancer can be enough for a long-term cure. Overall though, the best way to avoid small cell lung cancer is to avoid smoking at all costs, and quit now if you still currently smoke.
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]]>Gina Hollenbeck, 43, made it her professional mission as a nurse to help women get the best health care. And even as the working mom of two young boys, she always took good care of her health. So when she developed a cough in June 2015, she took notice.
“I was eating organic, I had recently gone vegan, and I was playing competitive tennis and running half marathons,” she tells Health. “I kept thinking it was kind of strange, I’d cough up gunk but then get better. However, I had run a couple of 5Ks, and my time wasn’t as good as usual. I started to question what was wrong with me."
Toward the end of July, with her cough still lingering, she noticed she was losing weight. Already fit, she didn’t have weight to lose. “The first thing that came to my mind from my medical experience was when you start to lose weight inexplicably, it could be cancer," she recalls.
RELATED: When This Woman Went to Her Doctor With Lyme Disease Symptoms, She Was Told to 'Try Meditation'
Since she didn't have a regular primary care physician, she made an appointment with her ob-gyn. “I told him I thought something was wrong, and could I get a chest X-ray? But he just said, ‘Oh Gina, you’re 38, you’re an athlete, you do everything right. I don’t want to expose you to the radiation. I think this is seasonal allergies.’”
At the time, she thought it made sense. So she started taking allergy medicine and waited two weeks to see if her symptoms improved. But they only got worse. “My cough was becoming a lot more intense,” she says. “Every time I laughed, I would have to cough.”
Certain she didn't have seasonal allergies, she thought it could be pneumonia. So she called an ear, nose, and throat doctor and explained her situation, and that her cough was more intense and her energy levels were down. She was hoping to get a chest X-ray.
“He told me to come into his office, and he looked down my throat and said, ‘You have gastric reflux.’ He gave me acid reflux medication and said to give him a call in two weeks." Frustrated, she followed her doctor’s orders. But a new symptom presented itself in August: a terrible pain in her left shoulder.
“It was really, really bad, but I was still working out and thought it was from that. I thought I must have pulled a muscle,” she says.
She went to an orthopedic doctor, who did an X-ray to investigate her shoulder pain. “I was told they didn’t see anything wrong with my shoulder, and was sent home with a muscle relaxer,” she says. (Bone pain from the pressure of a growing tumor in the lung can affect the spine, which may have been the actual source of her back pain.)
At this point, Hollenbeck continued to lose weight and was feeling more desperate than ever.
“I felt like I was aggravating the nurses at the doctors' offices. My cough wasn’t going away, and I just wanted somebody to give me a chest X-ray,” she says. “I felt like I had exhausted everything, and that they thought I was a hypochondriac. As a nurse, I knew those kinds of patients. So I backed off.”
RELATED: Doctors Kept Dismissing My Back Pain—Until I Was Finally Diagnosed With Terminal Cancer
Defeated, she didn’t seek any medical attention for her progressing symptoms for two more months.
“It was a Friday in October, and I just needed to figure out what was going on with me. I called out of work (she was working as a nurse at a nonprofit that helps women access prenatal care) and got in touch with a friend who worked at a diagnostic imaging center. I asked her if she could work me in for a chest X-ray, even though I didn’t have a doctor’s order. She got me in, and I paid out of pocket, about $75.”
Immediately after the chest X-ray, the radiologist was alarmed. “I was told something was really wrong: In the upper left lobe of my lung was a mass, and I needed to see a pulmonologist today. They weren’t sure if it was a blood clot or something else.”
After calling the pulmonologist’s office, she was told they didn't have an opening for two months. Scared and worried, “I told them I don’t think I can wait for two months. I have a chest X-ray that shows something is seriously wrong. All they could offer me was that if I thought it was an emergency, that I should go to the emergency room. So I did.”
At the emergency room, “I had my chest X-ray in hand, and it made the ER doctor take me seriously.” She was given a CT scan, and the doctor who treated her said he had a friend who was a pulmonologist and could get her an appointment.
“I asked to the ER doctor, do you think it’s lung cancer? And he said ‘No, you’ve never smoked, you’re a runner.' He thought it was either pneumonia or a fungus in the lungs, but that I’d need to see the pulmonologist and have a biopsy."
In the pulmonologist's office, Hollenbeck really started feeling sick. She was experiencing fatigue and it was difficult to sit up and talk to the physician. “I wasn’t myself. Things just weren’t adding up. I said, ‘Do you think this could be lung cancer?’ And even he said it’s unlikely, but that I needed a biopsy to know for sure."
The biopsy involved a long scope that would take a tissue sample from Gina's lung, and when she woke up from the procedure, the first thing she asked was, “Do you think it’s cancer?” The pulmonologist again told her he really didn’t think it was, but pathologists would know for sure. A week later, her results were in.
“My family and friends knew how sick I was—I'd taken a medical leave of absence from work—and we were all waiting for the results. We were really anxious,” she says. “They called me and told me that I had tumor cells, and that I had a type of lung cancer called non-small cell lung cancer. I was in complete shock. I just thought, I don't even know how to smoke! I wasn't exposed to secondhand smoke. I couldn’t believe this was happening.” Non-small cell lung cancer accounts for 80-85% of all lung cancers, according to the American Cancer Society.
Later, she and her husband, Greg, told their sons, ages 12 and 7, the news. “We’re a really close family, and we let them know what was going on with each step at my doctor’s appointments, including the night we found out I had cancer. We told them that we’re not really telling anybody at this point, but if you want to tell a friend it was okay. We wanted them to have channels to talk to. We eventually started getting family therapy because it was really stressful on my kids.”
RELATED: For 6 Years, Doctors Kept Telling Me I Had PMS—but It Turned Out to Be Brain Cancer
“Somehow I was able to sleep that night. The oncology nurse was so calm and assured me my doctor would go over all my scans tomorrow and that we’ll figure out a plan,” she says.
Hollenbeck's next doctor was a thoracic oncologist (a doctor who treats lung cancer), who gave her more information about her cancer.
“I had three tumors in the left upper lobe of the lung, and the cancer was in my lymph nodes in the middle of my chest, also wrapping around my trachea and blocking my pulmonary artery,” she says. “I was looking at it on the scans and understanding the severity, I didn't feel that bad.”
The doctor informed her that lung cancer "likes to go to the brain," so she was sent for a brain MRI immediately. Cancer was found there as well. She was diagnosed with stage 4 lung cancer and given a bleak outlook: she’d never be cured.
While the traditional treatment of surgery, chemotherapy, and radiation were discussed, she was also encouraged to get genomic testing (also known as biomarker testing). This process tests the DNA of the tumor, and knowing this could help doctors match her with a targeted therapy to stop the cancer from growing.
RELATED: When I Told My Doctor I Thought I Had Endometriosis, He Said, 'Stop Practicing Google Medicine'
In 2015, the technology was new, and her insurance didn’t cover it. But she and Greg agreed it was worth it to pay for themselves. The test would use tissue from her biopsy, and in the meantime she went for a second opinion. The second opinion, however, were less than encouraging.
“They saw it was in my brain, and the head of the thoracic department told me I had 10 months to live. I had the best of the best telling me that,” she says.
Just as she did when she found a way to get a chest X-ray none of her doctors would order, Gina took charge of her cancer treatment and began researching young non-smokers with lung cancer. “I found case studies of young women who had lung cancer linked to genetic alterations, specifically once called ALK. There were two therapies to treat it at the time, and I was just hoping my biomarker testing came back showing I had that.”
It did. “The nurse at my first doctor's office called me and said I’m ALK positive, and I was jumping up and down! I had just won the lung cancer lottery,” she says.
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Since finding out she was ALK positive, Hollenbeck has undergone an exhausting regimen of treatments, testing, and targeted therapy. In January 2016 she had brain surgery to remove a large tumor, and six weeks later underwent another procedure using Cyberknife concentrated radiation. Between that and her targeted therapy, the tumors in her chest were gone after six weeks.
She also had the upper left lobe of her lung removed, something she says her doctor had to convince a thoracic surgeon to do. “Typically with Stage IV cancer, they won’t do surgery on your lungs because it always comes back. You’re never cured. But I was going to be the first ALK positive patient to get cured,” she says.
About six months after her lobe removal, however, doctors found a recurrence of cancer in her brain. “Devastated is an understatement. I had tears. I realized then that I wasn’t going to be cured,” she says. She tried a new targeted therapy that had just been FDA-approved, which kept her cancer-free for three years.
RELATED: This Woman Refused to Leave the Hospital Until Doctors Properly Diagnosed Her Terrible Pelvic Pain
In March 2019, Hollenbeck had a setback. “I started developing fluid around my heart, and we weren’t really sure why. I went to ER three times in three months with severe abdominal pain. After a number of scans, nothing was showing up. Then my doctor found cancer had come back all around my heart and pancreas. I was pretty sure I was going to die,” she says.
Another targeted therapy that had been recently approved by the FDA, lorlatinib, worked for her. After two days on it, she was “up and exercising.”
Today, Hollenbeck is cancer-free with no evidence of disease, but she will have to continue taking therapies the rest of her life. For now, her lorlatinib treatment is working. “My quality of life is back to normal and I’m doing all of the things I love,” she says.
Instead of returning to work as a nurse, she’s using her experience to advocate for ALK positive patients and those with lung cancer. She now serves as president of the nonprofit ALK Positive, a support and advocacy group that helps extend the lives and quality of care for people living with lung cancer.
She encourages everyone to trust their gut if they think something is wrong with their health. “Don’t give up if people tell you you’re a hypochondriac,” she says. She also encourages those with a cancer diagnosis to seek genomic testing. “My husband and I had to advocate for biomarker testing,” she says. “The truth is, not all doctors understand all treatments and drugs."
Another goal is to change the face of lung cancer. “Anytime somebody knows I have lung cancer, the first question they ask is if I smoked, which I never did. But it doesn't matter how we got the disease. We have to figure out how to treat it,” she says. “Nobody deserves this disease, and I wish the doctors that misdiagnosed me had known to look for it. Maybe we could have caught it at an earlier stage.”
If you have a story to share about being misdiagnosed, email us at misdiagnosed@health.com and join our Misdiagnosed Facebook community to talk to women who share the same struggle.
]]>In some cases, when lung cancer is diagnosed early, doctors can surgically remove the tumor or tumors, and cure patients of the disease. In more advanced cases, they can often shrink existing tumors, prevent the cancer from spreading further, or help manage symptoms and improve life expectancy. Here’s a look at some of the ways lung cancer is treated at various stages.
RELATED: The Difference Between Small Cell and Non-Small Cell Lung Cancer
Surgery
Tumors in the lungs can be very difficult to remove, says Prasad Adusumilli, MD, deputy chief of thoracic service at Memorial Sloan Kettering Cancer Center—especially if they’re not diagnosed until they’ve grown quite large or spread to other organs, which is often the case. But if a cancer is caught early enough, doctors may be able to remove it surgically.
The goal of lung cancer surgery is to cut out the tumor as well as a margin of healthy cells around it. This margin reduces the risk of cancer cells being left behind and continuing to spread.
In the early stages of lung cancer, a minimally invasive surgery technique, such as video-assisted or robot-assisted thoracoscopic surgery (known as VATS and RATS), may be used. For these procedures, doctors don’t cut the chest open all the way. Instead, they make a few small incisions through which they insert surgical tools and a camera that helps them see what’s going on beneath the surface of the skin.
“A decade ago, we used to do minimally invasive surgery on maybe four out of 10 lung cancer patients,” says Dr. Adusumilli. “Now, we’ve gotten a lot better at it and almost eight or nine out of 10 patients who need surgery get the minimally invasive kind.”
Removing just a small section of lung tissue is called a wedge resection, while removing a larger portion (but not an entire lobe) is called a segmental resection. The removal of an entire lobe (which can still be done with minimally invasive surgery) is called a lobectomy. Sometimes, patients will need an entire lung removed. This procedure is called a pneumonectomy.
For larger or harder-to-access tumors, an open surgery—with a six- to eight-inch incision between two ribs—may be needed. No matter what type of surgery a lung cancer patient has, says Dr. Adusumilli, it usually takes at least a month for them to feel “back to normal.”
RELATED: The Stages of Lung Cancer, Explained
Chemotherapy and/or radiation
While surgery is the most common way to treat early-stage lung cancer, doctors may also recommend chemotherapy or radiation to shrink a tumor before a patient is operated on. Chemotherapy or radiation may also be used after surgery to kill any rogue cancer cells that may have been left behind.
If a person’s lung cancer is inoperable—because it takes up too much of the lungs, for example, or it’s spread to other parts of the body—radiation may help control pain and keep the tumor (or tumors) from growing larger and spreading farther.
Chemotherapy and radiation are also the primary treatment for small cell lung cancer—a type of lung cancer that makes up about 15% of cases. Because this cancer tends to grow quickly and spread faster than non-small cell lung cancer (the most common type), surgery is usually not recommended.
Chemotherapy for lung cancer is usually administered intravenously, in a doctor’s office or clinic. Radiation is also delivered in an office or clinic, with a device similar to an X-ray machine.
RELATED: What Is Lung Cancer’s Survival Rate?
Immunotherapy
Immunotherapy is a newer type of lung cancer treatment, and one that’s shown promise in treating advanced forms of disease. Immunotherapy drugs manipulate the body’s own immune system to fight cancer. For example, one class of drugs—known as checkpoint inhibitors—provide fuel to white blood cells so they can go on to kill tumor cells.
“Mother Nature gives our immune system breaks so that it doesn’t work too hard,” says Dr. Adusumilli. “What these drugs do is take off those breaks, so the immune cells can keep going and keep attacking the cancer.
Immunotherapy drugs, which are usually administered intravenously, can be a good option for patients whose cancers have stopped responding to chemotherapy, according to the American Cancer Society.
In a small 2018 study published in The Lancet Oncology, researchers found that combining a checkpoint inhibitor with a new immune-stimulation drug, called ALT-803, was even more effective at controlling the spread of cancer than using a checkpoint inhibitor alone. Together, researchers say, the drugs give patients new hope at a longer life.
"People don't talk about 'curing' patients with metastatic lung cancer,” said co-author John Wrangle, MD, an immunologist with the Hollings Cancer Center at the Medical University of South Carolina in a press release. “We now get to flirt with the idea for certain patients using immunotherapy. And at the very least we have a significant proportion of patients enjoying prolonged survival even if we can't call them ‘cured.’"
RELATED: How to Know If You Should Get Screened for Lung Cancer
Targeted therapy
Targeted therapy is a term used for drugs that attack and kill cancer cells, without harming nearby healthy cells. This makes targeted therapy an appealing option for patients with late-stage lung cancer, with fewer side effects than treatments that damage both unhealthy and healthy cells, like chemotherapy and radiation.
In order to develop these drugs, which are taken as pills or capsules, scientist have had to find specific things about cancer cells that make them different from other cells. Certain types cancer cells, for example, have genetic mutations that healthy cells do not.
If doctors are able to identify one of these mutations, they can prescribe a drug that will act directly on those molecular pathways. “Right now it’s only about 15% to 20% of patients that have some type of mutation that we have a drug for,” says Dr. Adusumilli. “But with more research, we hope there will be a lot more in the future.”
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]]>Although smoking has been tied to myriad health problems—including heart disease, fertility issues, and early mortality—the most famous one by far is lung cancer. If you were paying attention during health class or just tuning into TV commercials, you got the message: Smoke and you risk getting lung cancer. Naturally, most people assumed that the reverse—don't smoke and you won't get lung cancer—was also true. It's not.
RELATED: The Stages of Lung Cancer, Explained
While cigarette smoking is by far the leading cause of lung cancer, an alarming number of non-smokers get lung cancer each year. In 2018, as many as 20% of people who died from lung cancer had never smoked.
Meanwhile, women younger than 55 (whether they ever smoked or not) are now more likely than young men to develop lung cancer. And no matter their age, more women die from lung cancer than breast cancer or any other type of cancer.
What's going on?
"We don't know why never-smokers get lung cancer," Jorge Gomez, MD, medical director of the Thoracic Oncology Program at Mount Sinai Hospital in New York City and a volunteer spokesperson for the American Lung Association, tells Health. The most likely theories focus on other risk factors—including exposure to radon, second-hand smoke, and air pollution. Genetic factors also play an important role.
Dr. Gomez is quick to point out that avoiding cigarettes is still the best way to protect yourself. "The vast majority of never-smokers will never get lung cancer," he says. Unfortunately, there's still a sizeable minority who do, including the following three women.
RELATED: 7 Causes of Lung Cancer in Nonsmokers
Gina Hollenbeck, diagnosed at 38
In 2015, Gina Hollenbeck was at the peak of her physical health—or so she thought. When she wasn't busy working as a nurse in a surgery center or directing a nonprofit, she was running half-marathons or playing competitive tennis. Yet when she developed a cough that wouldn't quit, she started to get suspicious.
"My doctor told me it was seasonal allergies and put me on Allegra, which made sense at first," Hollenbeck, who lives in Memphis, tells Health. But she kept coughing, so she saw an ENT and was diagnosed with acid reflux. Again, that seemed plausible, but medication designed to control acid didn't help, either. Around the same time, Hollenbeck—who was already slim—started losing weight.
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"Finally my cough got so bad, I called a friend who worked at an imaging center and asked her to get me in for a chest X-ray. I didn't know if I had pneumonia or what, but something was clearly wrong and no one was doing anything about it," she says. Almost immediately, the radiologist told her she needed to get to a pulmonologist. When she called to make that appointment, she was told there was a two-month wait for new patients. When Hollenbeck insisted it was an emergency, the receptionist told her to go to the emergency room. So she did.
With a copy of her chest X-ray in hand, Hollenbeck headed to the ER. "Fortunately the ER doctor took me seriously. He ordered a CT scan, which showed that I had tumors in my lungs," she says.
Hollenbeck was stunned by her diagnosis of stage 4 lung cancer. "I remember telling the doctor that I had heard of people getting lung cancer who don't smoke, but I ate organic!"
Although Hollenbeck will never be cured, targeted therapy and brain surgery (to remove cancer that had spread to her brain) have kept her faring well most of the time. She still plays tennis, and she now serves as the president of ALK Positive, a support and advocacy group aimed at spreading the word and raising money to conduct research on people whose lung cancer is connected to an ALK-positive gene mutation.
"We want to spread the word about early detection, and we want biomarker testing for all patients who are diagnosed with lung cancer so that they can get the right treatment," she says.
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Felicia Gilchrist, diagnosed at 48
Felicia Gilchrist was at her job as a customer service manager in Denver when she started feeling like a bad cold was coming on. She stuck it out until lunchtime and then decided to pop in to the urgent care facility across the street. The nurse checked her vitals and was shocked to see that Gilchrist's oxygen level was only 30%. (Normal is 95-100%.) The nurse called for an ambulance, and Gilchrist spent three days in the ICU.
In the hospital, Gilchrist was diagnosed with high blood pressure and pulmonary edema; doctors drained fluid from her lungs and sent her home with an oxygen tank that she was told she'd need for a few weeks. Yet months went by—during which she saw a doctor several times—and she wasn't improving. "I would feel short of breath when doing something simple like trying to put my shoes on," she tells Health.
Finally, in February 2017, she marched into her doctor's office and demanded some answers. The doctor ordered a CT scan and found a tumor and lesions on both lungs. She had stage 4 lung cancer.
Gilchrist, who had never smoked and whose genetic tests didn't reveal any abnormalities, is mystified as to why she got lung cancer. She even has an identical twin sister who's perfectly healthy.
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Her doctor prescribed aggressive chemotherapy plus radiation, and Gilchrist's journey hasn't been an easy one. She's landed back in the hospital several times with rhinovirus, a blood infection, and several bouts of pneumonia. She also lost much of her hearing in one ear (a chemotherapy side effect); she now wears a hearing aid.
Recently, she learned that the cancer spread to her brain. She's currently participating in a clinical trial of an oral medication and is hoping to qualify for a second study.
Despite her ordeal, Gilchrist remains positive. "I'm very blessed and very thankful," she says, noting that she has a great support system of friends, family, and co-workers. She went back to work full-time last spring. "Work keeps my mind off things," she says. "Sometimes, they have to make me go home!"
Gilchrist has also become active in her local chapter of the Lung Cancer Research Foundation. She especially enjoys walkathons, because she thinks it's important to remind people that "cancer isn't always pink," she says. "My motto is, 'Can't stop, won't stop. You can let the fear take over but I won't. I didn't come this far for it to knock me down."
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Courtney Cox Cole, diagnosed at 42
Courtney Cox Cole was an athlete most of her life: In college she played basketball and golf, and in her 30s and early 40s she ran several mini marathons and mini triathlons. In January 2014, when she was 42, she ran her first full marathon. A few months later, she found out that she had stage 3 lung cancer.
Cole, who lived in Indiana, didn't experience any breathing trouble; it was severe pain in her shoulder that initially prompted her to visit the ER.
"Courtney never smoked, and we didn't grow up with smokers in the house," her sister, Monica Peck, tells Health. "We did a radon check in her house and office after she was diagnosed, and nothing came back high. It was a shock to all of us." Cole later tested positive for a mutation to the EGFR gene.
After completing chemotherapy, radiation, and surgery to remove a portion of her lung, Cole continued taking daily medication and poured herself into lung cancer awareness and fundraising efforts. She managed to raise more than $20,000 for the American Lung Association. In May 2018, the Indiana chapter recognized her achievement by giving her the first-ever LUNG FORCE Impact Award.
Cole especially enjoyed participating in the Fight for Air Climb, one of the American Lung Association's signature fundraising events, during which she climbed 47 flights of stairs in one of the tallest buildings in downtown Indianapolis.
That was before the cancer returned: It spread to Cole's bones and right bicep, and she was diagnosed with stage 4. She passed away earlier this year in September.
Last year, toward the end of Courtney's life, Peck joined a team of Courtney's supporters who banded together to raise money and complete the 2018 Fight for Air Climb in her honor. "She was always very positive and trying to change things," says Peck.
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]]>The story comes from a new case study published in the The New England Journal of Medicine, which follows a 73-year-old woman, who first presented to a dermatology clinic with "pruritic (itchy) and painful lesions" on the palms of her hands. The woman also revealed to the doctors her smoking history of "30-pack years" and that she had had a persistent cough for the last year and lost 11 pounds in just four months—all red flags.
When examining her hands, doctors noted “sharp demarcation of the folds in the lines of her hands,” in addition to “a velvety appearance of palmar surfaces and ridging of the skin.” She was soon diagnosed with tripe palms, a condition closely associated with cancer—usually lung and gastric.
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Doctors conducted more tests, including a computer tomography of her chest, abdomen, and pelvis, and found an irregular nodule in the left upper lobe of her lungs and enlarged mediastinal lymph nodes (glands between the sternum and the spinal column). She was diagnosed with adenocarcinoma, a cancer that forms in the glandular cells of the body—most often found in the breast, pancreas, lung, prostate, and colon.
Hold on, what exactly are “tripe palms” and how are they linked to cancer?
The term “tripe palms” or acanthosis nigricans of the palm was first coined in 1977 by Jacqueline Clarke, MD, a dermatologist in London, according to the journal Clinical and Experimental Dermatology. The name describes the visual appearance of the condition. Tripe—the edible stomach lining of a farm animal—which has a thick and moss-like appearance. Other descriptions of it include “thickened velvety palms with pronounced dermatoglyphics,"
The condition is extremely rare, so there's very little research on it, but, according to another case report published in 2014 in the journal BMJ Case Reports, it usually occurs in association with an underlying malignancy, gastric and lung being the most common. One review of cases, published in the Journal of Clinical Oncology, found that the majority (94%) occurred in patients with cancer, with only five patients showing no apparent evidence of malignancy.
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Because it can often be the first manifestation of a pulmonary or gastric tumor—as was the case with the 73-year-old woman in this most recent case study—patients with tripe palms are generally evaluated with a full diagnostic work-up for possible malignancies.
There is no specific treatment for tripe palms. However, some cases—about 30 percent, according to an article published in the Journal of Investigative Dermatology—resolve via treatment of the underlying malignancy. However, even with treatment, TP may persist for several years after the malignancy has been resolved.
As for the patient in the most recent case study, she underwent a round of chemotherapy, but her tripe palms were still present and her cancer had progressed. She is currently undergoing another round of chemotherapy.
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]]>The disease is expected to kill more than 140,000 people in 2019—that’s about 27% of all cancer deaths in the United States, according to the Lung Cancer Foundation of America. But the good news, says Rafael Santana-Davila, MD, a medical oncologist at Seattle Cancer Care Alliance and associate professor at the University of Washington School of Medicine, is that when lung cancers are discovered earlier, survival rates are much improved.
One reason for lung cancer’s high death rate is that it can be very aggressive, and spread to other organs before symptoms become noticeable. Because of that, most cases of lung cancer are only diagnosed in the later stages of the disease, when surgery is no longer a realistic option.
But scientists are working hard to find new ways to identify lung cancer earlier, when it’s still curable. And in recent years, new treatments have made life after a lung cancer diagnosis a realistic goal for many patients—even those in later stages of the disease. Here’s a look at the numbers, and what else affects lung cancer prognosis.
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Cancer Stage Matters
Overall, only 19.4% of people who have been diagnosed with lung cancer are still alive five years later, according to National Cancer Institute (NCI) data from 2009 through 2015. That percentage varies greatly, though, depending on when people’s cancers are diagnosed.
When a lung cancer tumor is discovered in Stage 1, it is still very small and easy to remove via surgery, since it has not invaded any major parts of the lungs or other organs. “In Stage 1, the majority of patients are cured—somewhere between 60% and 80% of patients go into remission,” says Dr. Santana-Davila.
Tumors in Stage 2 are slightly larger or have spread to parts of the lungs that are slightly harder to operate on. But even in Stage 2, says Dr. Santana-Davila, between 50% and 60% of patients are cured.
Cancers that have not spread to nearby lymph nodes are also known as “localized.” The estimated 5-year survival rate for localized cancers is 57.4%, according to the NCI. Unfortunately, because localized lung cancer rarely has symptoms, only 16% of cases are diagnosed at these early stages.
When lung cancer spreads to nearby lymph nodes, this is known as “regional.” This often correlates with Stage 3 cancer, and it makes up about 22% of lung cancer diagnoses. The estimated 5-year survival rate for regional lung cancer is 30.8%.
Then there’s metastatic lung cancer, also known as “distant” or Stage 4 cancer. This is when the majority of lung cancer cases—57%, according to the NCI—are diagnosed. It also has the worst survival rate: Only 5.2% of patients diagnosed at this stage are still alive five years later.
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That’s slowly starting to shift, however, says Dr. Santana-Davila. “With the advent of new treatments like immunotherapy, we’re seeing more patients with long-term survival,” he says. “The goal of treatment isn’t to cure them—because we know that’s impossible in the majority of Stage 4 cases—but it’s to manage their symptoms and help them live as long as possible and as comfortably as possible.”
When faced with a lung cancer diagnosis and aggressive treatment options such as surgery, chemotherapy, and radiation, patients may wonder what their likelihood of survival is without any type of intervention. In a 2013 study of prior studies, researchers from the University of South Florida looked into this question and found that “mortality is very high” for non-small cell lung cancer without treatment. Overall, untreated lung cancer patients in their analysis lived for an average of just over 7 months.
What else affects lung cancer prognosis?
Statistics like 5-year survival rates can help patients and their loved ones better understand the disease they’re facing, their expectations for the future, and their options for treatment. But it’s important to remember that every lung cancer case is different, says Dr. Santana-Davila, and that these numbers can’t be used to predict how individual patients will fare, or whether they will die from their disease.
The type of lung cancer can also make a difference in prognosis: Of the two main types of lung cancer, small cell carcinoma is less common; it only makes up about 15% of all lung cancer cases. But it also grows much faster and spreads more quickly than the more common non-small cell lung cancer.
While most lung cancers are smoking-related, some have a genetic component. In these cases, says Dr. Santana-Davila, doctors can use medications to target specific gene abnormalities. “It’s not that one type is more treatable than the another,” he says, “but at least in this case we have an additional pathway that may be able to stop the cancer cells from proliferating.”
Age matters, too. Most people who die of lung cancer are middle-age and older, and the percentage of lung-cancer deaths is highest among people 65 to 74. Overall health can also make a difference: Staying physically active and avoiding tobacco smoke after lung cancer treatment can lower the risk of getting cancer again, according to the CDC.
Improving lung cancer survival rates
Until a few years ago, there were no criteria in place for screening people who were at risk for lung cancer—which is one reason why, historically, so few cases have been diagnosed in early stages. But in 2013, the US Preventive Services Task Force recommended annual low-dose CT screenings for adults with certain lung-cancer risk factors.
The screening guidelines apply to adults ages 55 to 80 who smoked a pack of cigarettes a day for 30 years, or the equivalent in pack-years. The Task Force’s research found that deaths from lung cancer decreased up to 20% among high-risk individuals who were screened with CT scans, compared to those who received chest X-rays only.
The results of better screening practices—and better treatments—seem to be paying off. Death rates for lung cancer have been falling nearly 3% on average each year between 2007 and 2016, NCI reports, and five-year survival rates have been slowly increasing.
“No matter what stage a cancer is diagnosed, I want people to know that we have a lot of options,” says Dr. Santana-Davila. “There’s a lot of hope that the patient in front of me will do well, despite the ugliness of the disease.”
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]]>But those numbers don’t tell the whole story. When it comes to prognosis and life expectancy after a lung cancer diagnosis, the stage of the disease makes a big difference. Patients diagnosed when a tumor is still very small, for example, have a much better chance of beating their cancer and living for many years after a diagnosis.
“Receiving a cancer diagnosis is a life-changing event, and it’s always a difficult conversation to have with patients,” says Rafael Santana-Davila, MD, a medical oncologist at Seattle Cancer Care Alliance and associate professor at the University of Washington School of Medicine. “That being said, the conversation can really vary depending on the stage of the disease.”
Here is what patients and their loved ones should know about the stages of lung cancer, as defined by the American Cancer Society and the American Joint Committee on Cancer (AJCC), and how each stage is diagnosed and treated.
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Non-Small Cell Lung Cancer: Stages 0 to 4
About 85% of lung cancers are classified as a type called non-small cell—a name that dates back to the early days of lung cancer research, when scientists noted that some types of lung cancer cells were bigger than others.
Once non-small cell lung cancer is diagnosed, doctors then have to determine what stage the disease is in—or, in other words, how large the tumor has grown and how far it has spread. Based on the tumor’s size and location, it is defined as one of the following.
Stage 0: This stage is also called carcinoma in situ, which means cancer “in place.” This is used to describe a tumor that is only found in the very top layer of cells lining the lung’s air passages; it hasn’t yet invaded any deeper tissue, and it hasn’t yet spread anywhere else in the body. Because of this, it can usually be removed easily via a minimally invasive surgery.
Stage 0 can also be used to describe a “hidden” cancer, in which cancer cells are found in coughed-up mucus or other lung fluids, but a tumor can’t actually be found in the lung tissue itself. Because doctors can’t find the actual location of the tumor, it’s assumed that it has not yet spread or grown very large.
Stage 1: A diagnosis of Stage 1 lung cancer means that a tumor is discovered, but it is still localized within the lungs. “It hasn’t yet spread to any lymph nodes or to other areas, and the cancer is small enough that it can be taken out surgically,” says Dr. Santana-Davila.
This stage is further divided into 1A and 1B, depending on how large it is and where it is found. Stage 1A is generally used to describe a tumor that is less than 3 centimeters and does not affect the main branches of the bronchi, the central structures of the lungs.
Stage 1B is used to describe larger tumors (between 3 and 4 centimeters); those that have started to grow into main sections of the lungs; or those that are partially blocking the airways but still have not spread to lymph nodes or other parts of the body.
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Stage 2: Tumors that are slightly larger or in more dangerous parts of the lungs are considered Stage 2. This stage is also divided up into substages: Stage 2A describes a tumor that is between 4 and 5 centimeters across, while Stage 2B may describe a smaller tumor that has spread to nearby lymph nodes.
Stage 2B can also be used to describe a tumor that has grown into parts of the cardiovascular system that are harder to operate on—like the chest wall, phrenic nerve (which passes from neck to the diaphragm), or membranes surrounding the heart. It can also describe a situation in which two or more tumors are found in the same lobe of a lung.
Stage 3: A diagnosis of Stage 3 lung cancer means that the tumor has spread to nearby lymph nodes. “The cancer is now in the center part of the chest,” says Dr. Santana-Davila, “or it’s big enough that it’s touching some very important structures in which surgery cannot be easily done.” Instead, chemotherapy and radiation are usually used to shrink the tumor or tumors.
Stage 3 is divided into Stage 3A and 3B depending on the tumor’s size and the location of the affected lymph nodes. For example, a tumor that has spread to lymph nodes around the mediastinum—the space between the lungs—is classified as Stage 3A, while a tumor that has spread to lymph nodes near the collarbone is classified as Stage 3B.
There is also a Stage 3C, which describes a larger or more invasive tumor that has spread to distant lymph nodes or has grown into the heart, windpipe, esophagus, spine, or diaphragm.
Stage 4A means the tumor has either spread to both lungs; cancer cells have been found in fluid around the lung or heart; or the tumor has spread outside the chest to either a distant lymph node or another organ—commonly the liver, bones, or brain, says Dr. Santana-Davila.
Stage 4B also means the cancer has spread outside the chest but has also been detected as more than one tumor. In other words, it has appeared in multiple places throughout the body.
Unfortunately, most lung cancer patients are not diagnosed until Stage 4. “This is a very aggressive disease, so it can progress very rapidly from Stage 1 all the way to metastasis,” says Dr. Santana-Davila.
In addition, the lungs are very adaptable—and they’re good at hiding tumors. “You can have a big mass growing within the lungs, and the rest of the lungs will take over and you’ll never know it’s there,” says Dr. Santana-Davila. “In contrast, when a woman has a pea-sized mass growing in her breast, she might feel it right away.”
Small-cell lung cancer: Limited- and extensive-stage disease
The other major type of lung cancer, known as small-cell lung cancer, does not follow the same staging classification. Instead, it’s divided into limited-stage and extensive-stage disease.
Limited-stage disease is used to describe lung cancer that’s only found within one lung, and may be found in the mediastinum between the lungs. Limited-stage disease generally correlates with Stage 1, 2, or 3 of the traditional cancer staging classification.
Extensive-stage disease correlates with Stage 4, or metastatic cancer. This means that the cancer has spread to the other side of the chest or to distant organs and can only be managed with chemotherapy or radiation—not cured or removed via surgery.
At this point in the disease, curing the cancer is not an option. But it can be managed so that symptoms are lessened and life expectancy is extended, he adds. “People are living longer than ever before with metastatic lung cancer,” says Dr. Santana-Davila. “It may not be curable, but it certainly is treatable—and it’s no longer an immediate death sentence the way it used to be.”
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