1. PLWC Slide Deck Series: Understanding Lung Cancer Presents 2006

2. What is Cancer? A group of 100 different diseases The uncontrolled, abnormal growth of cells Cancer may spread to other parts of the body

3. What is Lung Cancer? The leading cause of cancer death among men and women Begins when cells in the lung grow out of control and form a tumor There are two main types of lung cancer: non-small cell and small cell

4. What is the Function of the Lungs? The lungs consist of five lobes, three in the right lung and two in the left lung Most cells in the lung are epithelial cells, which line the breathing passages and produce mucus, which lubricates and protects the lungs The main function of the lungs is to allow oxygen from the air to enter the bloodstream for delivery to the rest of the body

5. What Are the Risk Factors for Lung Cancer? Tobacco and second-hand smoke AsbestosRadon Most people who develop lung cancer today have either stopped smoking years earlier or have never smoked

6. Lung Cancer and Early Detection No tests are recommended for screening the general population A low-dose helical computerized tomography (CT or CAT) scan is currently being studied for this purpose Any person who is at increased risk due to smoking or asbestos exposure should discuss the benefits and limitations of a screening CT scan with his or her doctor

7. What Are the Symptoms of Lung Cancer? Fatigue (tiredness) Cough Shortness of breath Chest pain Loss of appetite Coughing up phlegm Hemoptysis (coughing up blood) If cancer has spread, symptoms include bone pain, difficulty breathing, abdominal pain, headache, weakness, and confusion

8. How is Lung Cancer Evaluated? Because almost all patients will have a tumor in the lung, a chest x-ray or CT scan of the chest is performed The diagnosis must be confirmed with a biopsy The location(s) of all sites of cancer is determined by additional CT scans, PET (positron emission tomography) scans, and MRI (magnetic resonance imaging) It is important to find out if cancer started in the lung or somewhere else in the body. Cancer arising in other parts of the body can spread to the lung as well

9. How is Lung Cancer Treated? Treatment depends on the stage and type of lung cancer Surgery Radiation therapy Chemotherapy (options include a combination of drugs) Targeted therapy Lung cancer is usually treated with a combination of therapies

10. Cancer Treatment: Surgery The tumor and the nearby lymph nodes in the chest are typically removed to offer the best chance for cure For non-small cell lung cancer, a lobectomy (removal of the entire lobe where the tumor is located), has shown to be most effective Surgery may not be possible in some patients

11. Cancer Treatment: Chemotherapy Drugs used to kill cancer cells A combination of medications is often used May be prescribed before or after surgery, or before, during, or after radiation therapy Can improve survival and lessen lung cancer symptoms in all patients, even those with widespread lung cancer

12. Cancer Treatment: Radiation Therapy The use of high-energy x-rays or other particles to destroy cancer cells Side effects include fatigue, malaise (feeling unwell), loss of appetite, and skin irritation at the treatment site Radiation pneumonitis is the irritation and inflammation of the lung; occurs in 15% of patients It is important that the radiation treatments avoid the healthy parts of the lung

13. Lung Cancer Staging Staging is a way of describing a cancer, such as the size of the tumor and where it has spread Staging is the most important tool doctors have to determine a patient’s prognosis The type of treatment a person receives depends on the stage of the cancer Staging is different for non-small cell lung cancer and small cell lung cancer

14. Stage I Non-Small Cell Lung Cancer Cancer is found only in the lung Surgical removal recommended Radiation therapy and/or chemotherapy may also be used

15. Stage II Non-Small Cell Lung Cancer The cancer has spread to lymph nodes in the lung Treatment is surgery to remove the tumor and nearby lymph nodes Chemotherapy recommended; radiation therapy sometimes given after chemotherapy

16. Stage III Non-Small Cell Lung Cancer The cancer has spread to the lymph nodes located in the center of the chest, outside the lung Stage IIIA cancer has spread to lymph nodes in the chest, on the same side where the cancer originated Stage IIIB cancer has spread to lymph nodes on the opposite side of the chest, under the collarbone, or the pleura (lining of the chest cavity) Surgery or radiation therapy with chemotherapy recommended for stage IIIA Chemotherapy and sometimes radiation therapy recommended for stage IIIB

17. Stage IV Non-Small Cell Lung Cancer The cancer has spread to different lobes of the lung or to other organs, such as the brain, bones, and liver Stage IV non-small cell lung cancer is treated with chemotherapy

18. Small Cell Lung Cancer–All Stages Patients with limited stage (confined to one area of the chest) small cell lung cancer are treated with simultaneous radiation therapy and chemotherapy Patients with extensive stage (not confined to one area of the chest) small cell lung cancer are treated with chemotherapy only Because small cell lung cancer can spread to the brain, preventative radiation therapy to the brain is routinely recommended to all patients whose tumors disappear following chemotherapy and radiation therapy

19. Living With Lung Cancer Patients with lung cancer face the risk of cancer growing back or the development of a new lung cancer. All patients must follow up with their doctors for regular x-rays, scans, and check-ups Many people with lung cancer feel that they will not receive as much support or help from people around them because they believe others will think that their behavior caused the disease Doctors and other members of the health-care team can help patients and families cope with a diagnosis of lung cancer Patients can take comfort knowing that the advances being made in the diagnosis and treatment of lung cancer will provide more and more patients with a chance for cure

20. The Role of Clinical Trials for the Treatment of Lung Cancer Clinical trials are research studies involving people They test new treatments and prevention methods to determine whether they are better than the best known treatment The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process Clinical trials evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

21. Clinical Trials: Patient Safety Informed consent: Participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks Informed consent is an ongoing process. Participants are constantly updated as new information becomes available Participation is always voluntary, and patients can leave the trial at any time

22. Clinical Trials: Phases Phase I trials determine safety and dose of a new treatment in a small group of people Phase II trials provide more detail about the safety of the new treatment and determine how well it works for treating a given form of cancer Phase III trials take a new treatment that has shown promise when used to treat a small number of patients with cancer and compare it with the best treatment available for that disease; phase III trials involve a large number of patients

23. Clinical Trials Resources Coalition of Cancer Cooperative Groups (www.CancerTrialsHelp.org) CenterWatch (www.centerwatch.com) National Cancer Institute (www.cancer.gov/clinical_trials)

24. Coping With the Side Effects of Cancer and its Treatment Side effects are treatable; talk with the doctor, nurse, and pharmacist Fatigue is a common, treatable side effect Pain is always treatable; non-narcotic pain relievers are available Medications and extra oxygen can improve breathing Radiation therapy or surgery can be used to treat metastases that are causing pain or other symptoms For more information, visit www.plwc.org/sideeffects

25. Follow-Up Care Quitting smoking helps recovery and health. Patients who have developed lung cancer who then stop live longer. It is never too late to stop smoking Your doctor will outline a program of tests and visits to monitor your health

26. Where to Find More Information: PLWC Guide to Lung Cancer (www.plwc.org/lung) Overview Medical Illustrations Risk Factors and Prevention SymptomsDiagnosis Staging With Illustrations Treatment Side Effects of Cancer and Cancer Treatment Living With Lung Cancer Questions to Ask the Doctor Current Research Patient Information Resources Clinical Trials Resources

27. People Living With Cancer (www.plwc.org) PLWC is the cornerstone of ASCO’s patient resources program Visitors to PLWC will find:  PLWC Guides to more than 90 types of cancer  Coping resources  Ask the ASCO Expert Series, including chats, Q&A forums, and event transcripts  Cancer information in Spanish  The latest cancer news For patient information resources, please call 888-651-3038