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Lung Cancer Care

Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. The two major types of lung cancer are:

  • Non-small cell lung cancer (the most common)
  • Small cell lung cancer

There are also less common types of lung cancer. One example is mesothelioma, which affects the lining of several organs in the body, but most commonly the lungs. Another less common cancer is a carcinoid tumor, which grows slowly and is generally cured by surgery.

Diagnosis

Lung cancer screening allows us to identify lung cancer at an earlier stage than previously possible. If you need additional testing after screening, or if you are experiencing symptoms associated with lung cancer, you will likely meet with a doctor called an interventional pulmonologist.

GPS Tracks Down Lung Cancer

Natalie Barnhill was diagnosed with lung cancer. Dr. Samir Makani at UC San Diego Health used electromagnetic navigation bronchoscopy to biopsy the lesion. Traditional biopsy of lung cancer involves using a needle through the chest and into the lung which can cause bleeding and collapse of the lung. The new GPS-like biopsy method enables doctors to definitively diagnose lung cancer in areas of the lung that are hard to diagnose so that treatment can be started earlier.

They will ask about your personal and family health history, conduct a physical exam, and may order a procedure such as endobronchial ultrasound bronchoscopy (EBUS) or electromagnetic navigation bronchoscopy (ENB). Both are non-surgical alternatives to conventional mediastinoscopy, which requires a small incision in the upper part of the chest, and can be used to diagnose and stage lung cancer. For more about diagnostic methods, see Interventional Pulmonology

Staging

A process called staging is used to determine how much your cancer has spread and what treatment options will be considered.

Generally, physicians consider the cancer to be:

  • Early stage
  • Locally advanced
  • Advanced

Treatment

The mainstay of early stage lung cancer treatment is surgical removal, sometimes augmented by chemotherapy and radiation. Locally advanced cancer may involve a combination of chemotherapy, radiation and surgery, in different treatment sequences. In advanced cases, chemotherapy is the main treatment, with radiation or ablation sometimes used to control symptoms. Clinical trials could be offered for patients in all stages of the disease.

Surgery

Our lung surgery team has more than 20 years of experience with thousands of lung cancer patients. Many studies have shown that the best surgical outcomes occur in medical centers with a high volume of cases.

If your lung tumor has not spread beyond the lung, surgery is frequently the first choice of treatment to remove all the cancer. A variety of techniques may be used, depending on the size of the tumor, its location and your overall health. One option is video-assisted thoracic surgery (VATS), in which the surgeon uses a video camera to help visualize and operate upon the lung, resulting in surgical incisions that are much smaller than those required for other forms of surgery.

The surgical team also works closely with your medical oncologist and radiation oncologist to ensure that your therapy is ideal for your specific case. For example, in some cases, radiation or chemotherapy will shrink the tumor to assist in its removal by the surgeon. Read more about Lung Surgery at UC San Diego Health.

Radiation Therapy

While surgery is often the primary treatment for lung cancer, radiation therapy may also be beneficial:

  • After surgery, to destroy any remaining cancer cells
  • Before surgery, to shrink the tumor for a safer, easier surgery
  • As the main treatment for individuals who are not candidates for surgery
  • In cases of cancer recurrence
  • As palliative care to decrease pain and improve quality of life.

A multi-step process, radiation therapy begins with your consultation, followed by a “simulation” visit, where your radiation oncologist precisely outlines the area in your body that needs to be treated, and, together with the medical physicist and dosimetrist, generates your treatment plan. Once your treatment plan is finalized, you will begin therapy. UC San Diego Health offers among the most advanced radiation therapies available, including stereotactic radiotherapy, proton therapy and brachytherapy. Your radiation oncology team will advise you on which technique is most suited to your particular cancer. For more information, see Radiation Therapy.

Chemotherapy

Chemotherapy is an outpatient treatment using drugs to kill cancer cells. The decision about chemotherapy is made with your input and heavily relies on your acceptance of aggressive vs non-aggressive management of your disease.

Chemotherapy can be used to increase the chance of cure after the surgery, to increase survival in advanced lung cancer, and to help reduce pain and other problems caused by lung cancer. Side effects depend mainly on the type of drug, how much of it is used, how often it is given and for how long.

Targeted therapy

Targeted therapy, also called molecularly guided therapy, involves genetic analyses of tumor specimens to determine if there is a specific cancer mutation or aberration that can be targeted by a specific drug. (Examples of targetable mutations include EGFR, ALK, and ROS1, among others.) Treatments for cancers with "driver mutations" involve targeted therapies, which are often in the form of pills that can be taken at home. UC San Diego is involved in many clinical trials studying more advanced genetic analysis of tumors (tumor sequencing) to look for new mutations that can be targeted with newly developed medications.

Immunotherapy

Immunotherapy involves treatments that stimulate and re-educate your body's immune system to kill cancer cells. These therapies are in the form of oral medications, infusions of therapeutic antibodies, or re-infusion of cells modified to target your specific tumor. UC San Diego Health is developing and studying many of these treatments through our clinical trials. For more information, see Immunotherapy.

Palliative care

Palliative care can help improve a patient's quality of life by treating symptoms and side effects such as pain, fatigue, anemia, hair loss, nausea, and depression. For more information, see Palliative Care.

Clinical Trials

In recent years, remarkable progress has been made in the battle against all types of cancer. Researchers believe they are getting closer to techniques for earlier diagnosis, new therapies to stop the cancer’s spread, and possible curative treatments. 

At UC San Diego, scientific studies in lung cancer are particularly exciting, ranging from cancer genetics to basic biological insights. Our investigators are also exploring cancer prevention, the reduction of cancer disparities, tumor growth and metastasis, and control of symptoms. Some examples:

  • UC San Diego medical oncologists are working to find new mutations in tumors that can be treated with targeted therapy. In addition, we are working on ways to find tumor mutations using blood tests rather than biopsies.  
  • Our medical oncologists are also studying new targeted therapies that overcome resistance to widely available medications such as erlotinib, afatinib, or crizotinib.
  • Our medical oncologists are studying immunotherapies that stimulate and reprogram the immune system to fight cancer.
  • UC San Diego radiation oncologists are working on new ways to focus radiation and minimize toxicity and side effects.

Through UC San Diego Health, you have access to clinical trials from the Cancer and Leukemia Group B (CALGB), the Eastern Cooperative Oncology Group (ECOG), and Southwestern Oncology Group (SWOG), as well as trials initiated by UC San Diego researchers and pharmaceutical companies.

For more information see Moores Cancer Center Clinical Trials.

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