Lung Cancer | Symptoms, Diagnosis & Treatments | MedStar Health
A female doctor consults with an african american female patient in a clinical setting.

We leverage the latest innovative therapies and technologies to deliver personalized, multidisciplinary lung cancer care.

Lung cancer is the leading cause of cancer deaths in both men and women, resulting in more cancer deaths than breast, prostate, and colorectal cancers combined. It can take years to develop and is difficult to detect in early stages when there is greater potential for a cure.

Fortunately, lung cancer survival rates are improving, thanks to advances in screening and treatment options, including breakthrough therapies that we're leading at MedStar Health. In partnership with the Georgetown Lombardi Comprehensive Cancer Center—a National Cancer Institute-designated comprehensive cancer center—we can offer our patients promising clinical trials years before they become the standard of care.

Our team of lung cancer experts is composed of medical and radiation oncologists, as well as thoracic surgeons, interventional pulmonologists, pulmonologists, lung pathologists, and radiologists, all of whom have dedicated training and experience in caring for patients with lung cancer. Working together, our team considers all treatment options to create a personalized care plan that involves the most advanced technologies and therapies to detect, diagnose, and treat your unique lung cancer—and more quickly than ever before.

Symptoms and risk factors

There are typically no signs of lung cancer in early stages.

In the earliest stages of lung cancer, the disease can be "invisible," as there are very few signs. That's why it's crucial to get a lung cancer screening as soon as you're eligible. When troublesome symptoms appear, the disease may have spread to advanced lung cancer, which is harder to treat. When this happens, you may experience:

  • Shortness of breath

  • Cough with blood

  • Increased fatigue

  • Weight loss

  • Wheezing

  • Pain in chest or bones

Many of these symptoms can be confused with an upper respiratory infection, so it's important to talk to your doctor if you notice any signs. If you smoke, don't ignore a "smoker's cough." Getting to the doctor sooner rather than later can be the difference between life and death.

Smoking remains the number one cause of lung cancers, but there are other risk factors, too.

A risk factor increases the likelihood you will develop a disease. Smoking is a major risk factor associated with developing lung cancer, as nearly 80 percent of patients who die from lung cancer were smokers. The more packs you smoke and the longer you smoke, the higher your risk.

It's important to know that there are other causes of lung cancer beyond tobacco use. Anyone with lungs can develop the disease. Non-smokers are increasingly developing lung cancer around the globe. One in five women with lung cancer is a non-smoker, showing anyone can develop the disease. We're not sure why this is, but other risk factors that may impact your chances of developing lung cancer include:

  • Exposure to secondhand smoke
  • A personal or family history of lung cancer
  • Environmental factors, such as exposure to:
    • Radiation
    • Radon
    • Industrial chemicals, such as arsenic, asbestos, or uranium

People who work in shipyards, home construction, landscaping, and mechanics may be at an increased risk for exposure to these harmful substances, as can military veterans with combat experience.

Watch: Dr. Ziv Gamliel, chief of Thoracic Surgery at the Angelos Center for Lung Diseases at MedStar Franklin Square Medical Center, discusses how to minimize your risk of lung cancer during Lung House Calls on WMAR Channel 2.

Screening and prevention

If you're at risk of lung cancer, don't wait for symptoms to get screened.

Early lung cancer detection can significantly increase your chances of survival if you develop the disease. That's why we recommend lung cancer screening using low-dose computed tomography (CT) for individuals who meet all of the following criteria:

  • Are between the ages of 50-80
  • Have no signs or symptoms of lung cancer
  • Have a 20 pack-year smoking history (e.g., you have a history of smoking a pack of cigarettes a day for 20 years or 2 packs of cigarettes a day for 10 years) AND
  • Currently smoke or quit within the past 15 years or less

 

A low-dose CT scan uses advanced x-ray technology to take detailed images of the lungs and track changes over time. This allows us to catch lung cancer in its earliest stages when it may more easily be cured. Many of our sites are accredited by the American College of Radiology, evidence of our commitment to excellence in early lung cancer detection.

Learn More About Lung Cancer Screening

Should you get screened for lung cancer?

Our lung health risk assessment is a brief questionnaire that can help you learn about what increases your chances of developing lung cancer. The information you provide allows our medical experts to predict your risk and offer suggestions to help you defend yourself against lung cancer, like:

  • Modifying your lifestyle and medical conditions, including resources to help you quit smoking
  • Enlisting the support of MedStar Health providers who can help you be as healthy as possible
  • Scheduling a screening at a convenient location nearby, if you're eligible

Find Out If You're Eligible for Screening

It is never too late to stop smoking.

Not all lung cancer cases are preventable, but you can significantly decrease your disease risk by avoiding tobacco (and secondhand smoke). Decades ago, we didn't know the effects of tobacco on the lungs, so don't blame yourself for the hard-to-break-habit. Even if you've been a smoker for a long time, quitting is worth it. Smoking cessation can improve your chances of survival if you develop lung cancer, giving you more time with the people you love.

When you're ready to stop smoking, you won't have to do it alone. We're here to help through one-on-one counseling and free, virtual support from the comfort of your own home. We can also help you with medication that may alleviate withdrawal symptoms.

Explore Our Free, Six-week Virtual Smoking Cessation class

Learn More About Our Smoking Treatment and Recover (STAR) program in D.C.

Diagnosis

Doctors John Lazar and Jessica Wang Memoli stand and pose for a portrait in an operating room at MedStar Washington Hospital Center.

Innovative diagnostics lead to earlier diagnoses and more effective treatment.

Our lung cancer experts use the latest, minimally invasive biopsy tools and technologies to diagnose and stage lung cancer faster than ever before. Robotic navigational bronchoscopy enables our physicians to reach and biopsy tumors in all 18 chambers in the lung that may be considered unreachable by conventional biopsy methods. As a result, we can find, diagnose, and identify the stage at the same time, reducing the time to treatment by two to four weeks. By diagnosing lung cancer more quickly, we can treat it faster and at earlier stages when there is the best potential for a cure.

Watch: Dr. Eric Anderson explains how a new diagnostic tool can help patients receive a diagnosis within hours instead of weeks.

State-of-the-art molecular profiling can identify targets that respond effectively to advanced therapies.

An accurate diagnosis is critical for determining the best treatment options. State-of-the-art biomarker and genetic testing allow us to identify molecular characteristics that may predict how well a tumor will respond to innovative therapies like immunotherapy or groundbreaking targeted drugs. We learn as much as we can about your specific cancer through lung tissue samples and bloodwork, which allows us to personalize our treatment approach.

Combined robotic assisted thoracic surgery (CRATS)

One procedure diagnoses and treats patients with high-risk lung cancer

Combined Robotic Assisted Thoracic Surgery (CRATS) can detect, biopsy, diagnose, stage, and remove lung tumors during a single, minimally invasive procedure. This procedure significantly shortens the time between diagnosis and treatment, cutting it from weeks to hours and limiting the chance for the cancer to spread.

How Combined Robotic Assisted Thoracic Surgery works

The entire process is completed during a single procedure. Patients first undergo a low dose CT scan of the lung to look for tumors. If a tumor is found, the Ion robot bronchoscope is used to biopsy the tumor and determine if it’s cancerous. If cancer is found, a special types of ultrasound called endobronchial ultrasound is used to find out if the cancer has spread to lymph nodes.

If the lymph nodes are normal, the patient immediately has surgery to remove the portion of the lung with the tumor. This surgery is done using the DaVinci robotic video-assisted thoracic surgery system. The entire procedure, from CT scan through surgery, is done during a single administration of anesthesia.

Advantages of CRATS

  •  Less time between diagnosis and treatment can reduce the risk of the cancer spreading and improve outcomes.
  • Minimally invasive procedure makes recovery quicker.
  • Patient only has to go under anesthesia once.

 

Types of lung cancer

There are two main types of lung cancer named for how the cells appear under the microscope:

Non-small cell lung cancer (NSCLC)

About 80 percent of lung cancers are non-small cell lung cancer, which usually grows and spreads to other parts of the body more slowly than small cell lung cancer. The main subtypes of NSCLC are:

  • Adenocarcinoma: Develops in epithelial tissue cells, often in an outer area of the lung
  • Squamous cell (epidermoid) carcinoma: Usually found in the center of the lung next to an air tube (bronchus)
  • Large cell (undifferentiated) carcinoma: Can occur in any part of the lung and tends to grow and spread the fastest

Small cell lung cancer (SCLC)

Small cell lung cancer (SCLC) represents about 10 to 15 percent of cases and is fast-growing, typically found in both lungs, and usually symptom-less until it reaches later stages. It is almost always associated with smoking and often spreads before it's found. The two sub-types of SCLC are:

  • Small cell carcinoma (oat cell cancer)
  • Combined small cell carcinoma (mixed small cell/non-small cell carcinoma)

Other types

It is possible to develop lung cancer with small and non-small cell lung cancer features. While rare, a third type is possible, called lung carcinoid tumors. Fewer than five percent of cases are lung carcinoid tumors, which don't spread quickly and can typically be treated with surgery.

Cancer can spread (metastasize) to the lungs from other parts of the body, through the bloodstream, or lymphatic system. So even though the cancer is now found in the lungs, it's still classified and treated based on where it started.

Lung cancer staging

Once we know the types of lung cancer you have, we determine staging, which tells us how far your cancer has spread to nearby lymph nodes and organs.

  • Stage I - Stage I lung cancer is an isolated tumor in one lung. At this point, it has not yet spread to the other lung, lymph nodes or any other organ which makes it easier to treat surgically, if the patient is in otherwise good health.
  • Stage II - During this stage, lung cancer typically has spread to a lymph node on the side closest to the tumor. This stage could also be determined by the size of the tumor. Often, we treat stage II lung cancer with surgery and a combination of radiation and/or chemotherapy. If patients are not good candidates for surgery due to underlying medical conditions or other lung diseases, we would take a different approach that may involve targeted radiation.
  • Stage III - Lung cancer has spread to lymph nodes in the center of the chest and the other side. Lymph nodes serve as the drainage organ of the body so if cancer spreads, it often starts at the drainage side closest to the side of the lung with cancer. At this stage, it likely spread to the other side as well, and potentially to other organs. Typically, lung cancers at this stage involve more invasive treatment with a combination of surgery, chemotherapy, radiation, and/or immunotherapy.
  • Stage IV - This is the most advanced stage of lung cancer, as cancer has spread to the other lung or elsewhere in the body. Stage IV is the most difficult to cure and treatment options are often working toward extending your life expectancy with the least amount of symptoms and the greatest quality of life. However, even some stage IV cancers respond well to immunotherapy and targeted therapy, offering more hope than ever before.

Treatments

We're researching, innovating, and advancing the next generation of lung cancer treatments.

If you're diagnosed with lung cancer, our multidisciplinary team of oncologists, pulmonologists, thoracic surgeons, radiologists, and nurses will meet to review your case and design a comprehensive and personalized treatment plan that will consider:

  • How far cancer has spread
  • Your general health
  • Your personal preferences

We offer the most advanced treatment options that use minimally invasive technology to minimize pain and speed up your recovery time. You may even be eligible for a groundbreaking clinical trial that offers a safe and effective treatment not yet available to others.

Your treatment may include a combination of the following:

Surgery

When lung cancer is isolated to the lungs, your best treatment option may be for a surgeon to remove cancerous tissue surgically. There are four major types of surgeries used to treat cancer in the lungs, depending on how large the cancerous tumor is in your lung. They range from removing a small tumor in the lung to the removal of an entire lung. Some patients may be candidates for a minimally invasive, robotic-assisted procedure which results in faster recoveries with less pain than traditional surgery.

 

The da Vinci Robot Xi is now in steady use at MedStar St. Mary's Hospital. Surgeon Tushar Samdani, MD, far right, is pictured with Anya Jongen, Kaylee Hartsfield, BSN, RN, LaRuby Holton, CRCST, and Donna Guy, CSFA.

 
At MedStar Health, we use the state-of-the-art da Vinci® Robotic Surgical System to perform robotic-assisted surgery for most cases of non-small cell lung cancer in stages I and II. We also perform robotic surgery for some patients who have already received chemotherapy or radiation to reduce the tumor's size. During the procedure, our thoracic surgeons use the robotic 3-D camera and tiny rotating instruments to operate with extreme precision. Patients benefit from smaller incisions, shorter hospital stays, less pain, fewer complications, and better outcomes.

Previously the time from diagnosis to treatment could take several weeks. Now, removing a cancerous tumor at the time of diagnosis is possible, thanks to robotic-assisted procedures. We're the first in the region to offer a new approach called Combined Robotic Assisted Thoracic Surgery to diagnose and treat lung cancer in the same day.

Watch: Dr. John Lazar, thoracic surgeon at MedStar Health, discusses treatment options for patients with lung cancer.

Learn More About Lung Cancer Surgery

Chemotherapy

Chemotherapy is an effective way to destroy cancer cells that break off from the main tumor. During chemotherapy, your oncology specialists use special medicines to shrink and kill cancer cells in the lungs and other affected organs. It may be given through a pill, injected by a needle into a vein or muscle, or a combination of both.

Depending on your situation, chemotherapy can be used for

  • Eliminating cancer
  • Supporting other treatments
  • Minimizing the spread of cancer
  • Symptom relief when lung cancer is too advanced to be cured

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Your immune system is naturally equipped to protect you from disease. Today, new immunotherapy drugs help your immune system attack cancer cells with more strength than before. Immunotherapy uses your immune system to aggressively fight back against lung cancer cells. In many cases, immunotherapy is replacing chemotherapy because it can improve survival rates while limiting toxicity and side effects. Immunotherapy doesn't work for everyone, but it can be a path to a cure for some.

Learn More About Immunotherapy

Similarly, targeted therapies can work exceptionally well for patients with non-small cell lung cancer tumors that exhibit specific molecular vulnerabilities. When we can identify these biomarkers, we can treat cancer cells as aggressively as possible with targeted agents. These targeted therapies are focused on exclusively weakening or damaging cancer cells, which results in less damage to healthy cells (and often fewer side effects). As a leader in clinical trials involving targeted therapies, we have extensive experience with these drugs and can offer them to eligible patients sooner than other institutions.

Learn More About Targeted Therapy

Radiation therapy

Radiation uses high-energy rays, similar to x-rays, to kill cancerous cells in the lungs. Different kinds of radiation therapy offer benefits for lung cancer tumors, and we were the first in the region to provide several advanced forms of radiation, including:

  • Proton therapy with HYPERSCAN™ technology uses pencil beam scanning, the latest advancement in proton therapy that targets tumors layer-by-layer. At MedStar Health, we were the first in the world to offer HYPERSCAN technology, giving us the most experience in delivering customizable radiation with unmatched precision.
  • CyberKnife treatment delivers high doses of concentrated radiation to unwelcome tumors from every possible angle in 3 to 5 visits compared to 40 necessary for conventional radiation. It's one of the most advanced and effective FDA-approved treatments for cancer, especially if your tumor is inoperable. It also uses a tool called Synchrony to stabilize positioning while the lungs move as patients breathe during treatment, ensuring healthy tissue remains untouched.

Here, you’ll also find other forms of radiation therapy, including:

  • 3-D Conformal Radiotherapy, a radiation therapy technique that sculpts radiation beams to the shape of a tumor. This is ideal for tumors that have irregular shapes or for those that are close to healthy tissues and organs. We view a tumor in three dimensions with the help of imaging, then deliver radiation beams from several directions to the tumor.
  • Intensity-Modulated Radiation Therapy (IMRT) uses devices that allow the radiation beams to move and change intensity depending on what kind of tissue they are targeting. This flexibility allows different areas of a tumor to receive different amounts of radiation and helps protect healthy tissue from unnecessary radiation exposure.
  • Image-Guided Radiation Therapy (IGRT) uses high-quality imaging technology to create images of targeted areas of a tumor during the radiation procedure. Using these images, your radiation oncology team carefully adjusts radiation beams and doses to best fit the size, shape, and location of the tumor during your treatment session
  • Stereotactic Body Radiotherapy (SBRT) is a new form of radiotherapy that uses high doses of radiation to target smaller lesions within the lungs. With a highly targeted dose of radiation, your treatment team can safely deliver radiation to very small regions with a high probability of destroying that particular tumor.
  • 4-D Motion and Gating uses a 4-D computerized tomography scanner to plan treatment, monitor tumor motion while you breathe, and provide gated delivery during treatment. Gating allows us to treat the tumor at its smallest dimension during one phase of your breathing cycle. This limits the radiation delivered to healthy tissue.

Dr Sean Collins talks with a patient who is laying on the bed of the cyberknife at MedStar Georgetown University Hospital.

Watch: Dr. Kelly Orwat, radiation oncologist, explains how radiation can be used to treat lung cancer.

Learn More About Radiation Therapy

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

Our locations

Distance from Change locationEnter your location

MedStar Franklin Square Cancer Center at Loch Raven Campus

5601 Loch Raven Blvd.
Russell Morgan Building
First Floor
Baltimore, MD 21239

MedStar Georgetown Cancer Institute at MedStar St. Mary’s Hospital

25500 Point Lookout Rd.
First Fl.
Leonardtown, MD 20650

MedStar Health: CyberKnife Center at MedStar Franklin Square Medical Center

9103 Franklin Square Dr.
Suite 100
Baltimore, MD 21237

Why choose us

A team of MedStar Health radiologists stands in front of a large scanner machine.


Choosing the right treatment options for your lung cancer starts with working with the right team of experts. As a patient at MedStar Health, you'll benefit from multidisciplinary care based on the latest lung cancer research, technologies, and therapeutic agents available. Here, you have access to:

  • A specialized team with decades of combined experience.

    Our highly experienced and skilled specialists meet weekly on a thoracic tumor board to discuss every lung cancer case. Together, we develop individualized treatment plans that consider every aspect of your care. Evidence suggests this close collaboration leads to better patient care and outcomes. Our team members include:

    • Interventional pulmonologists: Specialists who use advanced tools to diagnose lung and chest conditions
    • Lung pathologists: Specialists who analyze the characteristics of cancerous and non-cancerous lung tumors
    • Medical oncologists: Specialists who use medicine to treat cancer
    • Pulmonologists: Specialists who diagnose and treat lung and other respiratory diseases
    • Radiation oncologists: Specialists who use radiation therapy to treat cancer
    • Radiologists: Specialists who use medical imaging to diagnose and treat lung conditions
    • Thoracic surgeons: Specialists who operate on the lungs and chest conditions
    • And others
  • Innovative robotic-assisted diagnostic and surgical options.

    Innovative robotic-assisted diagnostic and surgical options, including combined diagnosis and surgical removal of the tumor within the same day, shaving weeks off of treatment times and leading to better outcomes.

  • Advanced, safer radiation therapies.

    Advanced, safer radiation therapies including the world's first proton beam therapy with HyperscanTM technology and one of the nation's first CyberKnife® programs. These offer unmatched precision for destroying otherwise "inoperable" tumors in the lungs without anesthesia, hospital stays, or dozens of radiation visits.
  • Groundbreaking clinical trials in immunotherapy and targeted therapies.

    Groundbreaking clinical trials in immunotherapy and targeted therapies, many of which we offer years before they become mainstream. In partnership with the Georgetown Lombardi Comprehensive Cancer Center, we continue to investigate and develop new and better drugs and therapy combinations to improve outcomes for our patients with lung cancer.

  • Patient-first support services.

    Patient-first support services including a dedicated nurse navigator who educates and encourages you throughout your care journey, as well as educational, financial, emotional, or spiritual resources to help you and your loved ones navigate cancer treatment.

  • Convenient locations throughout Washington, D.C., and Maryland.

    Our facilities range from academic hospitals to community-based outpatient offices, giving you access to the latest evidence-based medicines at locations close to where you live and work. Because we all work together, you'll benefit from the entire system's resources, technologies, and expertise.

Clinical trials and research

Clinical trials

We regularly offer clinical trials to our patients with lung cancer to maximize their chances of long-term benefits. Currently, we're involved in investigating new, advanced drugs and novel targeted therapies that are hard to find elsewhere.

Learn More

Research

In partnership with the Georgetown Lombardi Comprehensive Cancer Center, we are involved in many of the latest drug developments and recent FDA approvals, setting the stage for the promising future of lung cancer care.

Learn More

Awards & recognition

Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons' Commission on Cancer (CoC)

Numerous thoracic surgeons, medical oncologists, and surgical oncologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian

Multiple locations designated as a Center of Excellence for Lung Cancer Screening by the American College of Radiology (ACR)

Magnet® designation from the American Nurses Credentialing Center (ANCC)

Patient stories

Support services

When you seek cancer care at MedStar Health, you won't have to navigate your journey alone. We offer a full range of support services to ensure we care for your emotional, financial, and practical needs. Here, a dedicated nurse navigator will help you find your way through each and every appointment. And dedicated lung dietitians, social workers, and rehabilitation experts are available to care for you before, during, and after cancer treatment.

Genetic counseling

Genetic counseling and testing can help you understand any hereditary risks of developing lung cancer and help the next generation of your family. When you and your family know your risk of the disease, you can make informed decisions to prevent or manage your chances of developing lung cancer.

Learn More About Genetic Counseling

Personalized rehabilitation

Exercise is an important part of recovery after lung cancer surgery, as it strengthens the heart and lungs. Our specialized pulmonary rehabilitation program helps you improve your lung function and capacity so you can breathe easier.

Learn More About Pulmonary Rehabilitation

Survivorship

Being cancer-free is something worth celebrating, but your care doesn't come to an abrupt stop. Our lung cancer survivorship program will help you transition to your new normal after cancer treatment. Whether you need follow-up medical care for lingering treatment side effects or encouragement for lifestyle modifications, we offer compassion, education, and support.

Learn More About the Cancer Survivorship Program