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NCCN GUIDELINES FOR PATIENTS
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Lung Cancer Screening Version 1.2017 Presented with support from:
Available online at NCCN.org/patients
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Lung Cancer Screening
SHOULD YOU
be screened for lung cancer?
Cancer screening is testing for cancer before signs of cancer appear. This book describes who should be screened and the test used for lung cancer screening. It also has special guides for the screening process recommended by experts in lung cancer. The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 27 of the world’s leading cancer centers. Experts from NCCN have written treatment guidelines for doctors who screen for lung cancer. These treatment guidelines suggest what the best practice is for cancer care. The information in this patient book is based on the guidelines written for doctors. This book focuses on lung cancer screening. Key points of the book are summarized in the NCCN Quick Guide™ series for Lung Cancer Screening. NCCN also offers patient books on non-small cell lung cancer, malignant pleural mesothelioma, and many other cancer types. Visit NCCN.org/patients for the full library of patient books as well as other patient and caregiver resources.
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About
These patient guides for cancer care are produced by the National Comprehensive Cancer Network® (NCCN®).
The mission of NCCN is to improve cancer care so people can live better lives. At the core of NCCN are the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). NCCN Guidelines® contain information to help healthcare workers plan the best cancer care. They list options for cancer care that are most likely to have the best results. The NCCN Guidelines for Patients® present the information from the NCCN Guidelines in an easy-to-learn format. Panels of experts create the NCCN Guidelines. Most of the experts are from NCCN Member Institutions. Panelists may include surgeons, radiation oncologists, medical oncologists, and patient advocates. Recommendations in the NCCN Guidelines are based on clinical trials and the experience of the panelists. The NCCN Guidelines are updated at least once a year. When funded, the patient books are updated to reflect the most recent version of the NCCN Guidelines for doctors. For more information about the NCCN Guidelines, visit NCCN.org/clinical.asp. Dorothy A. Shead, MS Director, Patient and Clinical Information Operations Laura J. Hanisch, PsyD Medical Writer/Patient Information Specialist
Alycia Corrigan Medical Writer Rachael Clarke Guidelines Data and Layout Coordinator
Susan Kidney Graphic Design Specialist Kimberly Williams Graphic Design and Production Specialist
NCCN Foundation was founded by NCCN to raise funds for patient education based on the NCCN Guidelines. NCCN Foundation offers guidance to people with cancer and their caregivers at every step of their cancer journey. This is done by sharing key information from the world’s leading cancer experts. This information can be found in a library of NCCN Guidelines for Patients® and other patient education resources. NCCN Foundation is also committed to advancing cancer treatment by funding the nation’s promising doctors at the center of cancer research, education, and progress of cancer therapies. For more information about NCCN Foundation, visit NCCNFoundation.org.
© 2017 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Guidelines for Patients® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. National Comprehensive Cancer Network (NCCN) • 275 Commerce Drive, Suite 300 • Fort Washington, PA 19034 • 215.690.0300
NCCN Guidelines for Patients®: Lung Cancer Screening, Version 1.2017
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Supporters
Sponsored in part and endorsed by
Lung Cancer Alliance
For over 20 years, Lung Cancer Alliance has focused on saving lives and advancing research by empowering those living with or at risk for lung cancer. LCA is proud to collaborate with NCCN to sponsor and endorse the NCCN Guidelines for Patients: Lung Cancer Screening. www.lungcanceralliance.org
Lung Cancer Research Council
As an organization that seeks to increase public awareness and understanding about lung cancer and support programs for screening and early detection, the Lung Cancer Research Council strongly supports and endorses these NCCN Guidelines for Patients
www.lungcancerresearchcouncil.org
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Lung Cancer Screening
Contents 6 How to use this book 7 Part 1 Why get screened?
Presents the risks of lung cancer.
11 Part 2 Are you at risk?
Describes what increases your chances for lung cancer.
14 Part 3 Should you start now?
Describes who should start screening.
21 Part 4 What happens after the first test?
Presents a guide to care based on screening test results.
33 Part 5 How can you know for sure it’s lung cancer?
Describes removal and testing of lung tissue for cancer.
38 Part 6 How can you learn more about screening? Offers tips for choosing the best care. 45 Glossary Dictionary Acronyms
51 NCCN Panel Members 52 NCCN Member Institutions 54 Index
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How to read this book
Who should read this book?
Help! What do the words mean?
This book is about screening for lung cancer. People who are deciding whether to be screened or not may find this book helpful. It may also help you discuss a screening plan with your doctor.
In this book, many medical words are included. These are words you will likely hear from your medical team. Most of these words may be new to you, and it may be a lot to learn. Don’t be discouraged as you read. Keep reading and review the information. Don’t be shy to ask your medical team to explain a word or phrase that you do not understand.
Does the whole book apply to you? This book includes information for many situations. Your medical team can help. They can point out what parts of the book apply to you. They can also give you more information. As you read through this book, you may find it helpful to make a list of questions to ask your doctors.
Words that you may not know are defined in the text or in the Dictionary. Words in the Dictionary are underlined when first used in the book. Acronyms are also defined when first used and in the Glossary. Acronyms are short words formed from the first letters of several words. One example is LDCT for low-dose computed tomography.
The recommendations in this book are based on science and the experience of NCCN experts. However, these recommendations may not be right for you. Your doctors may suggest another screening program based on your health and other factors. If other suggestions are given, feel free to ask your medical team questions.
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1
Why get screened? 8
The lungs
9
Detect lung cancer early
10 Types of lung cancer 10 Review
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1 Why get screened?
The lungs
The lungs The lungs are a pair of organs in the chest that are vital to life. The lungs move important gases in and out of the blood. You breathe in oxygen and let out carbon dioxide (a toxic gas) from the body.
The two large breathing tubes that go from the windpipe (trachea) to the lungs are called bronchi. A single tube is called a bronchus. Then inside of the lungs are small tubes (bronchioles) and small air sacs (alveoli). See Figure 1.
The lungs have sections called lobes. The left lung has 2 lobes and the right lung has 3 lobes. A thin layer of tissue (membrane) surrounds the lungs called the pleural membrane.
Figure 1. The lungs The lungs have sections called lobes. The left lung has 2 lobes and the right lung has 3 lobes.
Illustration Copyright © 2016 Nucleus Medical Media, All rights reserved. www.nucleusinc.com
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1 Why get screened?
Detect lung cancer early
Detect lung cancer early Lung cancer is a disease that starts in the cells that make up the lungs. Normal cells make new cells when needed, die when old or damaged, and stay in place. Cancer cells don’t do this. They grow out of control and invade other tissue. Without treatment, cancer cells can form a tumor (abnormal mass of cells) and spread to other organs in the body.
Lung cancer causes more deaths than any other cancer in both men and women. See Figure 2. Of all causes of death, lung cancer ranks second behind heart disease. The high number of deaths is due in part to lung cancer being found after it has spread. Screening for lung cancer is done before you have symptoms and the doctor wants to check for disease. Cancer screening can help find lung cancer at an early stage when it can be cured.
Figure 2. Cancer deaths in the U.S. About 27 out of 100 deaths caused by cancer are due to lung cancer.
Source: Cancer Facts & Figures 2016.
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1
Why get screened?
Types of lung cancer | Review
Types of lung cancer
Review
Lung cancer has two main types called non-small cell lung cancer (NSCLC) and small cell lung cancer. The most common type of lung cancer is NSCLC. It accounts for 85 out of 100 of all lung cancers that are diagnosed. NSCLC can be broken down even further into sub-types. The sub-types are found by looking at the cancer cells under a microscope. This is known as histology. The sub-types listed from the most common to least common are:
The lungs are a pair of organs in the chest that are vital to life. Lung cancer causes more deaths than any other cancer in both men and women. Lung cancer has two main types called NSCLC and small cell lung cancer.
Adenocarcinoma is a type of NSCLC that starts in the cells that line the alveoli in the lungs. Squamous cell carcinoma starts in the cells that are flat and thin in the airways of the lungs. Large cell starts in large cells that can grow anywhere in the lungs.
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Are you at risk? 12 Risk factors for lung cancer 13 Review
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2 Are you at risk?
Risk factors for lung cancer
Risk factors for lung cancer Guide 1. Risk Factors
Tobacco smoke has over 7000 chemicals, and more than 50 of them are known to cause cancer. Any smoking increases your risk for lung cancer, but the more you smoke, the higher your risk. If you quit smoking, your risk will decrease. However, the risk for lung cancer is higher for former smokers than people who never smoked. Thus, current or past tobacco smoking is a risk factor for lung cancer.
Risk Factors Tobacco smoking Contact with second-hand smoke Contact with radon
Second-hand smoke
Contact with asbestos or other cancer-causing agents
In 1981, a link between second-hand smoke and lung cancer was first suggested. Since then, many studies have found that second-hand smoke can cause lung cancer in people who don’t smoke. The more contact you have with second-hand smoke, the higher your risk for lung cancer.
History of other cancers History of lung disease Family history of lung cancer
Radon
Uranium is a metallic chemical found in rocks and soil. As it decays, radon is made and gets into the air and water. Miners of uranium have a high risk for developing lung cancer. Some studies of radon in the home have linked radon to lung cancer while other studies have not.
Some people are more likely to develop lung cancer than others. Anything that increases your chances of lung cancer is called a risk factor. Risk factors can be activities that people do, things in the environment, or traits passed down from parents to children through genes. Genes are a set of coded instructions in cells needed to make new cells and control how cells behave. If one or more risk factors applies to you, it doesn’t mean you’ll get lung cancer. Likewise, lung cancer occurs in some people who have no known risk factors. The known risk factors for lung cancer are listed in Guide 1.
What you can do:
üIf you smoke tobacco, ask your doctor about support resources.
üLearn about counseling or drugs
Tobacco smoking
that might help you quit.
Tobacco smoking is the major risk factor for lung cancer. It accounts for 85 out of 100 people dying from lung cancer. The link between smoking and lung cancer was first reported in 1939, and since then it has been firmly proven. Smoking also increases the risk for cancer in many other areas of the body, such as the bladder, esophagus, and head and neck. NCCN Guidelines for Patients®: Lung Cancer Screening, Version 1.2017
üWhen you are ready to quit, reach out to your family and friends for support.
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2 Are you at risk?
Risk factors for lung cancer | Review History of lung disease
Two lung diseases have been linked to lung cancer. A history of COPD (chronic obstructive pulmonary disease) increases your risk for lung cancer. COPD makes breathing hard because the lung tissue is damaged or there’s too much mucus. The second disease linked to lung cancer is pulmonary fibrosis. Pulmonary fibrosis is major scarring of lung tissue that makes it hard to breathe. Pulmonary fibrosis puts someone at higher risk for lung cancer regardless of their age, being male or female, or history of smoking.
1 out of 14 people develop lung cancer
Family history of lung cancer
Your risk is even higher if your relative had cancer at a young age or if multiple relatives have had lung cancer. Lung cancer in families may be due to a shared environment, genes, or both.
The risk for lung cancer may depend on how much radon is in the home. For people who’ve had major contact with radon, such as uranium miners, the risk for lung cancer is higher for those who smoke than for those who don’t smoke.
Review
Other cancer-causing agents
Besides radon, 10 other agents are known to cause lung cancer. Five are metallic chemicals: arsenic, beryllium, cadmium, chromium, and nickel. The others are asbestos, coal smoke, soot, silica, and diesel fumes. Among people who’ve had contact with these agents, the risk for lung cancer is higher for those who’ve smoked than for those who’ve never smoked.
Anything that increases your chances of lung cancer is called a risk factor. Tobacco smoking is the major risk factor for lung cancer. Ask your doctor for support resources that can help you quit smoking.
History of other cancer
Your risk for lung cancer may be increased if you’ve had other cancers. Having had small cell lung cancer increases your risk of developing cancer in other types of lung cells. Likewise, if you’ve had another smoking-related cancer, like head and neck cancer, your risk for lung cancer is increased. The risk for lung cancer increases after receiving radiation therapy in the chest for other cancers, especially if you smoke. Treatment of Hodgkin lymphoma with alkylating agents—a type of cancer drug—increases the risk for lung cancer too. NCCN Guidelines for Patients®: Lung Cancer Screening, Version 1.2017
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Should you start now? 15 Start before you have symptoms 16 Find out your level of risk 17 Get the best screening test 19
The LDCT test
20 Review
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3 Should you start now?
Start before you have symptoms
Start before you have symptoms Guide 2. Symptoms of lung cancer Symptoms of lung cancer Cough that lasts
Tiredness that lasts
Blood in mucus
Pneumonia
Shortness of breath
Hoarse voice
Wheezing
Pain when swallowing
Pain in chest area
Weight loss
Because of this risk, it is important to tell your doctor about your health history and your family’s health history. Let the doctor know if you smoked in the past and how many years it has been since you quit. Also, let the doctor know if you smoke now. Your doctor can then share the level of risk you have for lung cancer. The level of risk can be high, moderate, or low. If you are at high risk, learn about your screening options.
Screening can help find disease early, before symptoms occur. If you find disease early, you can start treatment and have a higher chance of a cure. The goal of lung cancer screening is to find lung cancer when treatments will work best. Treatments usually work best if started at the earliest stage of cancer, before there are symptoms of cancer. However, at this time, most lung cancer is found after symptoms appear. Common symptoms of lung cancer are listed in Guide 2. See your doctor if you have these symptoms. Most often, these symptoms are caused by health problems other than lung cancer. If your doctor thinks your symptoms may be caused by lung cancer, he or she may suggest other types of tests to check for cancer. If you have no symptoms of lung cancer, a screening program may be right for you. Certain people are at risk for lung cancer.
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3 Should you start now?
Find out your level of risk
Find out your level of risk Guide 3. People at risk Level of risk
Screening option
High risk
Screening is an option. Engage in shared decisionmaking with your doctor.
• ≥55–74 years old • ≥30 pack years of smoking • Quit smoking
