Lung Cancer

About this Cancer Lung cancer is the most common type of cancer in both men and women. It is estimated that more than 175,000 new cases will be diagnosed in the United States this year alone. The majority of these cancers are directly linked to cigarette smoking.
Lung cancer has three main classifications:
Non-small cell lung cancer is the most common type of lung cancer, accounting for 75 percent of cases. Non-small cell lung cancer includes squamous cell carcinoma, adenocarcinoma, large cell carinoma, and undifferentiated carcinomas.
Small cell lung cancers grow more rapidly and are more likely to spread to other organs. They account for about 20 percent of lung cancers.

Mesothelioma is a rare tumor of the lining of lungs, often attributed to asbestos exposure, and represents 5 percent of lung cancer cases. Risk Factors
Cigarette smoking is the most important risk factor in the development of lung cancer. It is estimated that as many as 90 percent of lung cancer diagnoses could be prevented if cigarette smoking (see information on screening trial below) were eliminated. Exposure to certain industrial substances such as arsenic, some organic chemicals, radon, asbestos, radiation exposure, air pollution, tuberculosis, and environmental tobacco smoke in non-smokers also increases a person’s risk of developing lung cancer. Diagnostic Tests Lung cancer is usually diagnosed by X-rays and CT scans that provide images of the lung and show if a tumor is present.

Other tests used to diagnose lung cancer are:

examination of cells – cells obtained from sputum are examined under a microscope to see if they contain cancer cells.
fiberoptic examination – under anesthesia, a thin, fiberoptic camera is inserted into the bronchial passages of the lungs to examine the organ for tumors or lesions.
biopsy – a small sample of cells is removed from the tumor and examined for cancer cells under a microscope to see if it contains cancer cells. Cancer Symptoms The most common signs of lung

cancer are:

-- persistent cough-- sputum streaked with blood-- chest pain-- recurring pneumonia or bronchitis Current Treatments
Standard therapies for lung cancer typically include surgery , chemotherapy , and radiation therapy. In recent years, a number of innovative therapies have greatly improved the treatment of lung cancer. New anticancer drugs, better staging and imaging techniques, new surgical procedures, and combined approaches have shown promise in the treatment of these cancers.
At the Johns Hopkins Kimmel Cancer Center, a diverse team of specialists including surgeons, medical oncologists, radiation oncologists, pulmonary experts, radiologists, pathologists, and others come to together to plan and tailor a course of treatment for each patient based on their specific lung cancer diagnosis.

Non-Small Cell Lung Cancer

For non-small cell lung cancers that have not spread beyond the lung, surgery is used to remove the cancer. Surgery may also be used in combination with radiation therapy and chemotherapy in cancers that are more advanced. These treatments can also be given prior to surgery to shrink tumors and prevent the spread of cancer cells through the blood stream. This is called neoadjuvant therapy.

Small Cell Lung Cancer

Surgery is most commonly used in non-small cell lung cancers and less frequently in small cell lung cancer (SCLC), which tends to spread more quickly to other parts of the body. Chemotherapy is the most common treatment for small cell lung cancer, as these medicines circulate throughout the body killing lung cancer cells that may have spread outside of the lung. Radiation therapy is frequently used in combination with chemotherapy when the tumor is confined to the lung and other areas inside of the chest. Radiation therapy may also be used to prevent or treat the development of SCLC that has spread to the brain (metastasis). In radiation therapy, precisely targeted x-rays are used to destroy localized cancer cells. Radiation therapy can be used to prevent tumor recurrence after surgery, to treat tumors in patients who are not candidates for surgery, or to treat tumors causing symptoms in other parts of the body.
Mesothelioma

Chemotherapy, radiation, and surgery can all be part of the treatment for mesothelioma. Combined approaches that utilize these therapies together, particularly using chemotherapy prior to surgery, as well as new drugs that specifically target mesothelioma cells, are currently being tested.

New Treatment Approaches Johns Hopkins is a major center for the development and testing of new anticancer therapies. A number of these agents are now in clinical trials for patients with newly diagnosed and recurrent disease.

Laboratory Research:

Genetic DiscoveriesHopkins researchers have cloned a gene known as hASH1 and found it to be a critical factor in the development of SCLC and certain NSCLC. Our scientists continue to study the mechanisms by which this gene leads to lung cancer in hopes of identifying novel therapeutic strategies. Polyamine pathways are another genetic area of research in lung cancer. Our scientists are developing anticancer agents that target this pathway as an effective therapy for

lung cancer.

Molecular Analysis and ScreeningLung cancer often does not exhibit any symptoms until it has reach an advanced stage. A major objective of Hopkins clincians and scientists is to identify molecular screening markers for lung cancer to allow for earlier dectection. Our research scientists have created a panel of genetic alterations common to lung cancer that can be detected in cells washed from the lining of the lung. In screening selected high-risk populations for these alterations, our clinicians can diagnose cancers in their earliest stage and monitor existing lung cancer patients for recurrence.

Genetic Epidemiology of Lung Cancer ProjectJohns Hopkins Kimmel Cancer Center lung cancer experts are collaborating with colleagues at the University of Maryland and the National Institutes of Health to examine hereditary factors associated with lung cancer. They believe that certain individuals may be predisposed to certain genetic alterations that lead to an increased risk of lung cancer. This project studies DNA repair, p53 gene mutations, and cell death to identify potential culprits of lung cancer susceptibility.

SPORE

The Kimmel Cancer Center at Johns Hopkins is one of a select few cancer centers in the United States to receive the prestigious National Cancer Institute SPORE (specialized programs of research excellence) grant for translational lung cancer research. This grant provides funding for lung cancer research and its rapid transfer from the laboratory to the clinic.