More than 87 percent of lung cancers are related to smoking. Some smokers will never develop lung cancer and if a person quits smoking, it will significantly reduce their risk of this disease. Exposure to other carcinogens such as asbestos and radon gas also increase the risk of lung cancer, especially when combined with cigarette or cigar smoking.

Symptoms of Lung Cancer
The signs and symptoms of lung cancer can take years to appear, and can be confused with symptoms of less serious conditions. Signs of lung cancer may not become clear until the disease has reached an advanced stage. For this reason, and because no specific screening tools have been developed for the early detection of lung cancer, it is essential to be aware of the symptoms and to consult your healthcare provider if you have any doubt as to the cause of symptoms you are experiencing.

Respiratory Symptoms:

• Persistent or intensified smoker’s cough
• Cough that persists for more than two weeks in a non-smoker
• Persistent chest, shoulder, or back pain unrelated to pain from coughing
• Change in color of sputum
• Increase in volume of sputum
• Blood in sputum
• Wheezing
• Recurrent pneumonia or bronchitis

Non-Respiratory Symptoms:

• Fatigue
• Loss of appetite
• Headache, bone pain, or aching joints
• Bone fractures not related to accidental injury
• Neurologic symptoms (e.g., unsteady gait and/or episodic memory loss)
• Neck and facial swelling
• Unexplained weight loss

Diagnosis
Detecting lung cancer as early as possible is critical to improving chances of survival. There are a number of tests physicians use to detect and diagnose this disease, which allow physicians to determine the type and stage of the cancer as well as the best options for treatment. At Oakwood Hospital & Medical Center, we provide the following services, under the direction of your physician:

• Chest X-ray – are “flat” pictures of the lungs, which help doctors to identify abnormal growths.
• CT Scan – Computed Tomography also known as CAT scan is a sophisticated instrument that uses a computer to create a two-dimensional scan from a series of X-ray images; the newest version of the CT is called a helical (or spiral) scan. CT scans reveal much more detail than x-rays.
• MRI – Magnetic Resonance Imaging is similar to a CT scan except it uses a magnetic field in place of X-rays to create an image.
• PET/CT Scan – is the most advanced medical imaging technique available today, combining Positron Emission Tomography with Computed Tomography.
• Sputum Cytology – coughed-up phlegm from the lungs which is examined under a microscope to check for abnormal or cancerous cells.
• Bronchoscopy – Viewing of the lungs through a hollow, flexible tube (bronchoscope) that is passed through the nose and throat into the main airway of the lungs. If abnormal areas or tumors are seen, biopsies can be obtained through the bronchoscope.
• Biopsy – is the removal of a lung tissue sample for examination under a microscope. Biopsies are obtained in different ways depending on the location of the tumor:
  - through a bronchoscopy
  - by inserting a needle through the chest into the lung
  - by removal and examination of an enlarged lymph node in the neck
  - through a small surgery on the lung

Treatments
There are several new treatment options for lung cancer that have been developed over the last few decades. To assure quality patient care, Oakwood offers a thoracic multidisciplinary program. This program, which includes team members such as radiation oncologists, medical oncologists and thoracic surgeons, meets on a weekly basis at tumor board to discuss patient cases and treatment options. These tumor boards provide the patient and referring physician with recommendations from several disciplines of care. Three areas of treatment that are commonly used for lung cancer are provided at Oakwood, by experienced staff and physicians:

• Surgery – an operation is performed to remove any tumors as well as surrounding tissue. This can mean the removal of a section of the lung or an entire lung, depending on the individual’s stage and progression of lung cancer.
• Chemotherapy – a systemic therapy that uses anti-cancer drugs to shrink or destroy tumor cells.
• Radiation Therapy – a treatment that uses high-energy rays (x-rays, radium, neutrons) targeted on cancerous tumors.

Lung Cancer Screening:

• No organizations currently recommend routine screening with either chest radiographs or sputum cytology.
• All patients should be counseled against tobacco use.
• Lung cancer is the leading cause of cancer deaths in men and women. Most striking is the rising incidence and mortality among women in the last decade.
• Over 80 percent of cancers of the lung are smoking-related.
• Only 10 to 12 percent of all new lung cancer patients survive five years.
• Surgical resection is the most important treatment modality from the perspective of cure. Survival is best at earlier disease stages.
• Only 20 to 30 percent of patients with lung cancer are candidates for potentially curative operations.
• Thus, early diagnosis should be beneficial.
• Unfortunately, studies of screening for lung cancer with chest radiographs and sputum cytology have not proven beneficial.

The da Vinci S surgical system dramatically enhances the precision, control and dexterity of surgeons, enabling them to perform complex surgeries in a manner never before possible. Powered by state-of-the-art robotic technology, the hand movements of your surgeon are translated into precise movements.

General and specialized surgeons throughout the Oakwood contribute greatly to the success of the cancer programs.

Most often, the surgeon, through surgical exploration and biopsies makes the diagnosis of cancer. Their expertise is essential as the first line of treatment. Many of the surgeons actively participate in the multidisciplinary discussions with the medical oncologists, radiation oncologists, radiologists and pathologists.

Throughout Oakwood there are specialized nursing units which provide care to the inpatients requiring post-operative care. These nursing units have specialized nurses and nursing assistants for the care of a particular surgery site, such as colon/rectum, breast, thoracic and more. The surgeons and nurses work closely to assure a speedy and complication free post-operative experience.

Surgical expertise in the area of cancer care provided at Oakwood includes the following and others:

• Breast cancer (including breast conservation and reconstruction)
• Gastrointestinal cancers (stomach, liver, pancreas, gallbladder, small intestines, colon, rectum, anus)
• Genitourinary cancers (bladder, kidney, prostate, testis)
• Gynecologic cancers (ovarian, uterine, cervical)
• Head and Neck cancers (larynx, throat, oral, nose, neck, sinus, eye)
• Neurologic cancers (brain, central nervous system)
• Skin cancers (melanoma)
• Thoracic cancers (esophagus, lung)

At first, leukemia cells function almost normally. Overtime, they may crowd out other cells in the circulation, making it hard for the normal cell to do their job.

 There are different types of leukemia. Sometimes it is a chronic, or slow growing disease, and other times it is acute, or fast growing. It can also affect different types of white blood cells such as lymphoid cells or myeloid cells.

Risk factors related to leukemia:

• High-levels of radiation exposure
• Exposure to certain chemicals such as benzene and formaldehyde
• Chemotherapy used to treat other cancers can sometimes result in leukemia
• Down’s syndrome
• Human T-cell leukemia virus 1(HTLV1)
• Myelodysplastic syndrome

Symptoms:

• Feeling tired or weak
• Fever or night sweats
• Frequent infections
• Headache
• Bleeding and bruising easily
• Pain in bone or joints
• Pain or discomfort in abdomen
• Swollen lymph nodes
• Weight loss

• Personal history of breast cancer – Women who have had breast cancer are more likely to develop breast cancer again.
• Family history – A woman’s chance of developing breast cancer increases if her mother, sister, and/or daughter have a history of breast cancer (especially if they were diagnosed before age 50).
• Certain breast changes on biopsy – Having a diagnosis of atypical hyperplasia (a non-cancerous condition in which cells have abnormal features and are increased in number) or lobular carcinoma in situ (LCIS) (abnormal cells found in the lobules of the breast) increases a woman’s risk of breast cancer. Women who have had two or more breast biopsies for other benign conditions also have an increased chance of developing breast cancer. This increase is due to the condition that led to the biopsy, and not the biopsy itself.
• Genetic alterations – Specific alterations in certain genes (BRCA1, BRCA2, and others) increase the risk of breast cancer. These alterations are rare; they are estimated to account for no more than 10 percent of all breast cancers.

• Reproductive and menstrual history – Evidence indicates that:

• - The older a woman is when she has her first child, the greater her chance of developing breast cancer.
• - Women who started menstruating at an early age (age 11 or younger), experienced menopause late (after age 55), or never had children are also at an increased risk of developing breast cancer.
• - Women who take hormone replacement therapy for a long time also appear to have an increased chance of developing breast cancer.

• Breast density – Breasts appear dense on a mammogram if they contain many glands and ligaments (called dense tissue), and do not have much fatty tissue. Because breast cancers nearly always develop in the dense tissue of the breast (not in the fatty tissue), older women who have mostly dense tissue on a mammogram are at an increased risk of breast cancer. Abnormalities in dense breasts can be more difficult to detect on a mammogram.
• Radiation therapy (“x-ray therapy”) – Women who had radiation therapy to the chest (including the breasts) before age 30 are at an increased risk of developing breast cancer throughout their lives. This includes women treated for Hodgkin’s disease. Studies show that the younger a woman was when she received her treatment, the higher her risk of developing breast cancer later in life.
• Diet and lifestyle factors – Diet is thought to play a role in breast cancer risk, although researchers have not yet identified specific dietary factors that affect risk. Differences in diet may explain the lower risk of breast cancer among Asian women compared with American women. Studies have found that obesity and weight gain in postmenopausal women increase breast cancer risk. A number of studies suggest that moderate alcohol consumption may also increase a woman’s chance of developing breast cancer.

What happens if mammography leads to the detection of ductal carcinoma in situ (DCIS)?
Over the past 30 years, improvements in mammography have resulted in an ability to detect a higher number of tissue abnormalities called DCIS. DCIS contains abnormal cells that are confined to the milk ducts of the breast. The cells have not invaded the surrounding breast tissue. Eighty percent of cases of DCIS are found by mammography because DCIS usually does not cause a lump that can be felt. Some of these cases later become invasive cancers.

Today, it is not possible to predict which cases of DCIS will progress to invasive cancer. Therefore, DCIS is usually removed surgically. Until recently, DCIS was often treated with mastectomy, but breast-conserving surgery is now an option for many women with DCIS. Radiation therapy, with or without tamoxifen, may also be an option. Women who have been diagnosed with DCIS should talk with their doctor to make an informed decision about treatment.

What are the chances a woman in the United States might get breast cancer?
Age is the most important risk factor for breast cancer. The older a woman is, the greater her chance of developing breast cancer. A woman’s chance of being diagnosed with breast cancer is:

• from age 20 to age 30. . . 1 out of 2,000
• from age 30 to age 40. . . 1 out of 250
• from age 40 to age 50. . . 1 out of 67
• from age 50 to age 60. . . 1 out of 35
• from age 60 to age 70. . . 1 out of 28
• Ever . . . . . . . . . . . . . . . . 1 out of 8

Most breast cancers occur in women over the age of 50; the number of cases is especially high for women over age 60. Breast cancer is relatively uncommon in women under age 40.

What should women with breast implants do about screening mammograms?
Women with breast implants should continue to have mammograms. (A woman who had an implant following breast cancer surgery should ask her doctor whether a mammogram of the reconstructed breast is necessary). It is important to inform the facility about breast implants when scheduling a mammogram. The technician and radiologist must be experienced in x-raying patients with breast implants. Implants can hide some breast tissue, making it more difficult for the radiologist to detect an abnormality on the mammogram. If the technologist performing the procedure is aware a woman has breast implants, steps can be taken to make sure that as much breast tissue as possible can be seen on the mammogram.

If I change facilities or need a second opinion, do I need my mammograms?
Good question! The answer is yes, but be sure they are originals–not copies. By law, you are entitled to your original mammograms. A doctor needs to compare past mammograms with current ones to see if there have been any changes, and original mammograms are needed for this comparison. Ask your facility for your original mammograms and for a copy of the medical version of your report. You will probably be asked to fill out a form to release your medical records. You can ask the facility to send your records to another medical facility, to your doctor, or to you. Your facility may charge a fee for this service. If they do, the fee must not be more than the cost of providing this service to you.