Expert Videos

Module: Understanding Non-Small Cell Lung Cancer

Expert Video - What is non-small cell lung cancer (NSCLC)?
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 80% of lung cancers diagnosed every year. NSCLC has several sub categories. The most common sub category is called “adenocarcinoma” which makes up about half of all patients. Another category is called “squamous cell carcinoma” which makes up about a quarter of all patients. There are also other rarer subtypes such as “large cell carcinoma” and other neuroendocrine type of cancers.
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Expert Video - What are the risk factors for non-small cell lung cancer (NSCLC)?
The most common risk factor for non-small cell lung cancer is cigarette smoking (former and current smokers). Other risk factors include second-hand smoke, and prior exposure to asbestos, radon, and radiation. There are also individuals for whom there is no clear identified risk factor - these can be individuals who are “never smokers” and who have not had exposure to any of the traditional factors that can lead to an increased risk of lung cancer.
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Expert Video - What are the symptoms of non-small cell lung cancer (NSCLC)?
There are no specific symptoms for lung cancer. Lung cancer starts in the chest and can be masked by other diseases that begin in the chest, like pneumonia, or bronchitis. Patients often come to the attention of their doctors because they have pulmonary symptoms such as coughing, or wheezing, or shortness of breath and the doctor might order further tests to look for the presence of lung cancer.
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Expert Video - What are my options for treatment and management of non-small cell lung cancer (NSCLC)?
The treatment options for non-small cell lung cancer (NSCLC) depend on the stage or extent of the cancer, and may include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. The earlier the stage of the cancer, the more likely it can be operated on and removed. If the cancer has entered the lymph nodes it can still potentially be operated on, but sometimes requires additional treatments like chemotherapy and/or radiation therapy. If the cancer has spread outside the lungs into other organs of the body, it is typically no longer something that is operated on but treated with either chemotherapy, or targeted therapy, or immune therapy.
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Module: Understanding Small Cell Lung Cancer

Expert Video - What is small cell lung cancer (SCLC)?
Small cell lung cancer (SCLC) accounts for about 15-20% of lung cancers diagnosed every year in the United States. It is rarer than non-small cell lung cancer. The term “small cell” refers to the size and shape of the cancer cells as seen under a microscope. Small cell lung cancer appears as small blue cells, instead of the larger cells associated with more common forms of lung cancer. Small cell lung cancer typically starts in the middle part of the chest in a unique set of cells different to non-small cell lung cancer. Small cell lung cancer is treated differently to non-small cell lung cancer.
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Expert Video - What are the risk factors for small cell lung cancer (SCLC)?
Being a smoker or smoking in the past may raise a person’s risk of developing small cell lung cancer. Small cell lung cancer is almost exclusive to patients who are current or former smokers. It's very rare for someone who has never smoked to have small cell lung cancer, unlike non-small cell lung cancer which can occur in 15-20% of never smokers.
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Expert Video - What are the symptoms of small cell lung cancer (SCLC)?
Small cell lung cancer typically starts in the middle part of the chest and is often associated with breathing difficulties. Sometimes coughing occurs, or coughing up blood. Sometimes the tumor presses on one of the large veins that drain blood from the arms or head, resulting in swelling in the arms or sometimes swelling around the neck or the head.
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Expert Video - What are my options for treatment and management of small cell lung cancer (SCLC)?
Treatment options for small cell lung cancer depend on the stage or extent of the cancer, and may include a combination of chemotherapy and radiation therapy. Surgery is rarely used for patients with small cell lung cancer. If the small cell lung cancer occurs only in the chest, it’s called “limited stage” and treated with chemotherapy and radiation at the same time. If the cancer has spread outside the chest to other parts of the body it’s called “extensive stage”, and treated with chemotherapy. After chemotherapy, additional radiation therapy to the head may be given to lessen the risk that the cancer will spread to the brain.
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Module: Diagnosis and Staging of Lung Cancer

Expert Video - How is non-small cell lung cancer (NSCLC) diagnosed?
Diagnosis of non-small cell lung cancer is “tissue based”. This means that typically if a patient has been given a CAT Scan or X-Ray which identifies an abnormality in the lungs, the next step is to do a biopsy which can done in a variety of ways. It can be done by the radiologist at the time of the CAT scan (or CT scan). A piece of the tissue is looked at by a pathologist under the microscope. Another way is using a “bronchoscopy” which involves a tube being placed through the nose or into the mouth and into the airway. The pulmonologist can use this tool to see the cancer and then take a sample of the tissue for biopsy. In some cases, surgeons can be involved in the diagnosis of small cell lung cancer. In these cases its usually when the cancer is located in places like the lymph nodes which are difficult for the pulmonologist or radiologist to reach.
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Expert Video - How is small cell lung cancer (SCLC) diagnosed?
Small cell lung cancer is typically diagnosed by a pulmonologist. The reason is that the cancer is usually centrally located and easily accessed by the pulmonologist using a bronchoscope. A pulmonologist will use a bronchoscope, which is essentially a tube with a light and a camera on the end of it to try to see the cancer. The bronchoscope can be passed through the nose or mouth and be guided into the lung to try to see the cancer and then biopsy it (take a sample of the tissue). Sometimes this is not feasible and then an interventional radiologist needs to be involved in the diagnosis.
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Expert Video - What is screening for lung cancer?
Screening for lung cancer means looking for lung cancer using a screening technique in individuals that do not currently have lung cancer, but who may be at risk for lung cancer. In the US, screening is approved for patients older than 55 years of age and also have smoked greater than 30 pack years of cigarettes in their lifetime. “Pack years” is defined by the number of packs smoked X(multiplied by) the number of years smoked. For this group, screening is associated with better outcomes. Other individuals might benefit from screening however this is an area still being studied. The technique used for screening involves the use of CAT scans (with Low Dose radiation). These have a much lower amount of radiation exposure than a typical diagnostic CAT scan (or CT scan).
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Expert Video - What is staging for lung cancer and how is it determined?
The treatment of any type of lung cancer depends on the stage of the cancer. The stage is based on how far the cancer has spread - whether the lung cancer is local or has spread outside the lungs to the lymph nodes or to other parts of the body. For non-small cell lung cancer, doctors want to determine the size of the primary cancer and whether it has spread to the lymph nodes or spread to the middle part of the chest, or spread outside those areas. Doctors use different diagnostic tests to determine the cancer’s stage. These tests include CT scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans. If undergoing surgery, a procedure called a “mediastinoscopy” can provide additional information on the stage of the lung cancer. Knowing the lung cancer stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis (outlook).
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Expert Video - What is stage I, II, III or IV lung cancer?
The stage of a cancer describes the extent of the cancer. It is based on the size and location of the tumor, and whether it has spread to the lymph nodes or other parts of the body. A stage 1 lung cancer is located only in the lungs and has not spread to any of the lymph nodes. A stage 2 lung cancer is a bit more advanced, where the cancer has spread to the localized lymph nodes. A stage 3 cancer is one where the lymph nodes in the middle part of the chest are also involved (the area called the mediastinum). A stage 4 lung cancer is one that has spread outside the chest, either to the other lung, or to other parts of the body, such as the bone or brain or liver or adrenal glands.
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Expert Video - If someone with lung cancer has very poor lung function, what should they be aware of?
It’s most important that patients discuss their lung function with their doctor. They need to consider what their lung function is both before surgery and what it might be like after surgery. The decision about surgery can be very much a personal decision. In certain patients, if their lung function is excellent then the standard of care might be surgery and they can discuss this with their physician.
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Expert Video - What does it mean if a patient has “metastatic lung cancer”?
The words “metastatic lung cancer” can mean a lot of different things and it is an important topic to discuss with your doctor as it may relate to your situation. In the past patients with “metastatic lung cancer” were considered untreatable when it came to surgery. Today we have a more hopeful situation. For example, there is a new term that sounds very complex and it is called “Oligometastatic lung cancer”. In these patients surgery can be an option to consider.
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Expert Video - What is “multi-focal lung cancer”?
Some patients might have what is called “multi-focal lung cancer”. They might have a genetic mutation, for example an EGFR mutation, and they might have 2 different types of lung cancers growing in their body. Decisions about surgery in these patients can be complex.
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Expert Video - What is “bronchoscopic ablation”?
Bronchoscopic ablation is when you navigate a camera through the airway and then pass a catheter through the center of the instrument to the part of the lung where a tumor might be. The instrument has the ability to apply an energy source to the center of a tumor. The energy source can be freeze therapy or microwave therapy or other types of therapy. This is somewhat still an experimental procedure and being tested in a number of settings.
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Expert Video - What kind of healthcare team is a lung cancer patient likely to see?
It’s important to think about a team approach if you have lung cancer. It’s important to realize that your family and friends are part of that team approach, as well as your healthcare professionals. In terms of your healthcare team, it’s important to have what’s called a "multidisciplinary" approach where different doctors and healthcare members bring different types of expertise to help you fight your lung cancer.
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Expert Video - What does pulmonary lung function mean and how is it tested?
Pulmonary lung function testing is one of the essential ways that doctors use to decide if you are a candidate for lung cancer surgery. It’s a breathing test and someone on your healthcare team will coach you on how to do this test. Sometimes patients get nervous about this test. It’s important to do it well and to the best of your ability. Some doctors even suggest a second time for the testing to make very sure that it is as accurate as possible.
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Expert Video - What is a lung biopsy?
Take a small needle and pass it through the CAT scan to watch the needle going in towards the center of the nodule. Once there the healthcare member can take a sample. Sometimes they apply suction to the needle or sometimes they will pass what’s called a “needle core”. The different types of biopsies can help your doctor test for genetic mutations in the tumor and help to guide the type of therapy or treatment. For example, it can show that a patient has small cell lung cancer, which is very rarely treated with surgery. You should discuss the different biopsy techniques with your doctor.
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Module: Treatment and Management of Lung Cancer

Expert Video - What kind of surgery is used for Non-Small Cell Lung Cancer (NSCLC)?
Surgery for non-small cell lung cancer is quite varied. There is no “one size fits all” because it depends on multiple factors. First of all, it depends on the location of the cancer. Secondly, it depends on the extent of the cancer, for example, to what extent does it involve the lymph nodes and the middle of the chest. Thirdly, it depends on the “cardiopulmonary reserve” of the patient. That includes factors like the amount of normal lung that can be spared from the surgery to ensure that the patient has sufficient lung function after the surgery is completed. The different types of surgery explained in this video are wedge resection, lobectomy, and pneumonectomy.
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Expert Video - What factors determine the extent of lung cancer surgery?
The extent of lung cancer surgery depends on multiple factors. First, it depends on the location of the cancer and if it can be removed with a simpler kind of surgery or if it requires a more complicated surgery. Second, it depends on the amount of normal lung that the patient would lose as part of the surgery and their existing lung function. If their lung function is already weak, then it’s possible that the amount of surgery a patient can tolerate will be much less and that will impact the choice of surgical procedure as well. Lung cancer patients may be seen by a lung specialist called a pulmonologist, who can evaluate what their lung capacity is by conducting some tests. Surgery can range from limited surgery called wedge resections (also called a segmentectomy), to bigger surgeries, where a lobe of the lung is removed (called a lobectomy) and in some cases an entire lung needs to be removed (called a pneumonectomy).
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Expert Video - Is surgery an option for small cell lung cancer?
Surgery is typically not used in patients who have been diagnosed with small cell lung cancer. The reason is that small cell lung cancer tends to spread much quicker into the blood stream than non-small cell lung cancer. Small cell lung cancer is more often a systemic disease and as such the primary treatment is usually chemotherapy and/or radiation therapy. There may be situations where surgery was used to remove a large mass in someone who was not yet diagnosed with lung cancer, however it’s rare.
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Expert Video - What is chemotherapy? When is it needed?
Chemotherapy is a type of treatment for lung cancer that tries to eradicate the cancer cells. There are different types of chemotherapy drugs. They work by affecting the general process in which cells divide (or make copies of themselves during the normal cell growth cycle). Cancer cells tend to grow much faster than normal cells in the body, and this makes them more sensitive to chemotherapy than the other cells in the body. Chemotherapy is used for lung cancer in patients with advanced lung cancer (in cases which cannot be treated by surgery). It is also sometimes used after surgery in cases where there are risk factors of the cancer that increase the likelihood of it coming back again (“adjuvant” setting). Finally, chemotherapy can be used with someone who has locally advanced lung cancer and is given together with radiation to enhance the effect of the radiation. This can be done prior to another round of surgery.
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Expert Video - What is radiation therapy? When is it needed?
Radiation therapy, unlike chemotherapy, is a focused type of treatment that is used in localized cancers. A radiation beam is directed at a specific area of the lung for example. It’s used as a local therapy when a surgeon cannot remove the cancer in the chest. It is also used in cases where there are no other treatment options, for example if the lung cancer has spread to the brain then chemotherapy has difficulty passing the blood-brain barrier, so radiation therapy will be used. Radiation therapy is also used if the lung cancer has spread to the bone.
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Expert Video - What is targeted therapy? When is it needed?
Targeted therapy is a cancer treatment that uses drugs to target specific features (genes or proteins) of an individual’s cancer. Cancer patients need to have their tumors tested to see if they are candidates for a particular type of “targeted” therapy.
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Expert Video - What is immune therapy? When is it needed?
Immune therapy is very different to chemotherapy and targeted therapy. Instead of targeting the cancer cell, immune therapy boosts the naturally present immune system in your body to fight the cancer. It’s rapidly becoming our “3rd” treatment approach for lung cancer patients and offers a lot of hope for the future.
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Expert Video - What is genomic testing? And why is it needed?
Genomic testing for lung cancer is used to understand the unique characteristics (genomic alterations) of the individual patient’s cancer. Doctors look for genomic alterations that impact the growth and development of the person’s cancer, which helps to determine the best treatment options for the individual. The tests can take days or a few weeks to complete.
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Expert Video - What is a clinical trial?
Clinical trials are research studies that evaluate new ways to improve treatments and quality of life for people with diseases, like lung cancer. Clinical trials take place in various phases, each designed to answer important research questions that lead to the next phase. The earliest phase of a clinical trial is called a Phase 1 trial where the treatment is usually being tested in humans for the first time. Other phases of clinical trials are called Phase 2, Phase 3 and Phase 4.
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Expert Video - Is a “Placebo” always used in a controlled clinical trial?
Not all clinical trials are “Placebo-Controlled Trials”. Most of the time placebo controlled trials are quite rare, because in lung cancer trials the patients almost always get the best standard of care available. It’s very rare that a cancer clinical trial patient would get “no active therapy” as a placebo. Patients need to discuss the details of each clinical trial very carefully with their healthcare provider to make sure they understand the potential benefits and risks involved.
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Expert Video - When would a patient with lung cancer consider “Palliative Care”?
Understanding what “Palliative care” means is very important for lung cancer patients. Palliative care are those options available to lung cancer patients that help them get the best quality of life possible. Every person is unique and needs to consider their treatment options carefully. The goal of palliative care is to minimize suffering in a very respectful and meaningful way.
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Expert Video - What should a patient think when their doctor says: “We do not want to do surgery”?
A lot of patients ask their doctors: “Am I a candidate for surgery”?. The answer to this question is complex and may differ depending on the center of care or the healthcare team that is involved. It is important for patients to get a second opinion or even more opinions to reassure them about the first opinion they received on surgery. There are always a lot more options out there and many patients can benefit from a more extensive search for answers.
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Expert Video - What is a “lobectomy”?
A lobectomy is performed when surgery is used to take out a part of the lung. A “lobe” is a functional unit of the lung. The lungs typically have 3 lobes in the right lung and 2 lobes in the left lung. Each lobe is also divided into smaller parts called "lung segments". A lobectomy is a type of surgery that is done to remove a specific lobe from one of the lungs. It may be part of a minimally invasive surgery or it may be part of a more extensive type of surgery.
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Expert Video - What is a lung ablation?
A lung ablation is when a surgeon uses a special technique to apply an energy source to kill the tumor. Different types of energy sources can be used (cryotherapy, or microwave ablation, or radiofrequency ablation) and the amount of energy applied to the tumor is carefully calculated using different software programs. It’s still considered somewhat experimental however it can help certain patients to spare as much lung tissue as possible.
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Expert Video - Can you have lung ablation after radiation therapy?
Whether you can have lung ablation after radiation therapy is a difficult question to answer and may require a detailed discussion with your physician.
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Expert Video - What is “percutaneous ablation”?
Percutaneous ablation of the lung is a procedure where the doctor takes a needle and passes it through the chest wall and puts it in the center of the tumor. Doctors will use imaging techniques (such as a CAT scan) to guide the needle to the center of the tumor. Once there, they will apply the energy source (cryotherapy, or microwave ablation, or radiofrequency ablation) to kill the tumor.
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Expert Video - What is a “wedge surgery”?
A wedge surgery or wedge resection of the lung is the least amount of lung that a doctor will remove when performing surgery for a cancer or a tumor nodule or a benign nodule.
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Expert Video - What are “lung sparing techniques”?
Lung sparing techniques are very important and are becoming more widespread for lung cancer surgery. Lung sparing techniques include a segmentectomy, a bisegmentectomy, and a trisegmentectomy. Instead of removing the entire lobe of a lung, the surgeon will remove just a segment of the lung.
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Expert Video - What is a segmentectomy?
A segmentectomy is a surgical procedure that removes the basic segment unit of the lung. It is a more difficult type of surgery to perform than a “wedge resection”. The goal is to balance the best possible surgery for the patient with maximizing the lung function after the surgery.
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Expert Video - What is an EGFR mutation for lung cancer?
An EGFR mutation means an “epidermal growth receptor factor” mutation. Some patients may have this mutation and it means that they might be a candidate for targeted therapy. Targeted therapy is a way to treat the individual cancer patient’s unique genetic identifiers.
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This educational activity has been developed by
A Breath of Hope Lung Foundation and Mechanisms in Medicine Inc.

This activity is supported by an independent educational grant from Bristol-Myers Squibb Foundation Inc., and a Celgene Patient Advocacy Sponsorship.

This website is part of the Animated Patient™ series developed by Mechanisms in Medicine Inc., to provide highly visual formats of learning for patients to improve their understanding, make informed decisions, and partner with their health care professionals for optimal outcomes.