Lung Cancer

Lung cancer is cancer that begins in the lungs. Two major types of cancer begin in the lungs: small cell lung cancer and non-small cell lung cancer (NSCLC).

Among small cell lung cancers, there are three subtypes. These lung cancers are grouped together because they share similar treatments.

  • Squamous cell (epidermoid) carcinoma. Forms in early versions of reserve cells—round, flat cells that make up the linings of the bronchi, the lung’s major airways.
  • Large cell carcinoma. Often occurs in the outer regions of the lungs and often grows more quickly than non-small cell lung cancers.
  • Adenocarcinoma. Cancer that starts in the part of the lungs that normally secretes mucus and other substances. It is common in people who smoke, but it is also the most common form of lung cancer in non-smokers.

Small cell lung cancer is less common, but it tends to be more aggressive. These lung cancers are very different from non-small cell lung cancers, and therefore, so are their treatments.

One or more of the following methods may be used for a lung cancer diagnosis:

  • CT-guided fine needle. Samples a lump, suspicious tissue or fluid using a small needle for examination under a microscope.
  • Bronchoscopy. Uses a scope to look inside the trachea and large airways for abnormal areas, and remove tissues for examination under a microscope.
  • Transbronchial biopsy and transesophageal biopsy. Removes tissue through the wall of the bronchus or esophagus for examination under a microscope.
  • Endoscopic bronchoscopic ultrasound (EBUS) or endoscopic ultrasound (EUS via EGD) with biopsy. Ultrasound-directed biopsy via the airway allowing for biopsies of massed or suspicious lymph nodes.
  • Navigational bronchoscopy. A specialized bronchscopy technique that enables the biopsy of more peripheral nodules that cannot be biopsied with traditional bronchscopy techniques.
  • Robotic-assisted surgery. A minimally invasive approach using advanced robotics. 
  • Video-assisted thoracic surgery (VATS) or thoracoscopy. A minimally invasive approach to thoracic surgery, often used in lung and esophageal resections.
  • Mediastinoscopy. Surgically removes tissue and lymph node samples in the mediastinum, or middle portion of the chest.
  • Exploratory thoracotomy. An open surgical operation to search for chest abnormalities.

Imaging services may also aid diagnosis:

  • Spiral computed tomography (CT) scan. A scan that follows a spiral path to create detailed pictures from inside the body.
  • Positron emission tomography (PET) scanning. Takes pictures of the chest and other parts of the body to find cancer cells.
  • Nuclear medicine. Uses a small amount of radioactive material to create images of the body from the inside.
  • Endoscopic ultrasound. Ultrasound via bronchoscopy or esophagogastroduodensocopy (EGD) to view the lung mass or lymph nodes.

IU Health offers lung scans at multiple locations throughout the state. These scans help physicians identify lung cancer early.

Lung Cancer Treatment

The thoracic oncology team at the IU Health Melvin & Bren Simon Cancer Center specializes in diagnosis and treatment of cancers of the chest, including lung, esophagus, pleura, chest wall and mediastinum. Our specialists use a multidisciplinary approach to help patients with thoracic malignancies.

IU Health experts provide leading-edge diagnosis and treatment for patients with lung cancer, with combined expertise in thoracic surgery, radiation oncology, pulmonology, medical oncology, dietetics, psychology, social work and nursing.

At the IU Health Simon Cancer Center, most patients can be evaluated by our specialists and receive treatment recommendations within one week. If lung cancer is diagnosed, your doctor will want to know the stage or extent of the disease, such as how large the tumor is and whether the cancer has spread. We offer advanced treatment options that consider your specific needs, including the stage of your cancer, your life circumstances while recovering from cancer and your individual preferences.

Patients at the IU Health Simon Cancer Center have access to the most advanced diagnostic, treatment and palliative care options. Care of lung cancer patients can be complex and often includes more than one type of treatment, including:

  • Chemotherapy. Medication that destroys cancer cells.
  • Surgery. The primary treatment for non-small cell lung cancers frequently involves removing the cancer and a portion of the lung. The IU Health Simon Cancer Center offers expertise in complicated surgeries, such as segmentectomy, lobectomy and pneumonectomy. The surgical team at the IU Health Simon Cancer Center specialize in thoracic oncology surgeries as well as in minimally invasive techniques (thoracoscopic lobectomy).
  • Radiation therapy. Uses high energy, penetrating waves or particles to destroy cancer cells or keep them from reproducing.
    • Three-dimensional conformal radiotherapy. Uses a computer-generated, three-dimensional picture of the tumor to guide radiation targeting. This allows for a higher dose of radiation while sparing the surrounding normal tissue as much as possible.
    • Stereotactic body radiation. Special equipment targets a large, localized dose of radiation directly at a tumor without affecting the surrounding normal tissue.

Individual treatment recommendations are designed for each patient, emphasizing total care that covers management, rehabilitation, nutrition and your emotional, social and educational needs.

Palliative Care

At IU Health Simon Cancer Center, we offer excellent palliative care that brings you, your family and your doctors together to decide your best care plan. Palliative care offers patients compassionate relief from the symptoms, pain and stress of a serious illness—whatever the diagnosis. Our goal is to improve quality of life for patients and their families.

Lung Cancer Specialists

Lawrence H. Einhorn, MD
Nasser H. Hanna, MD
Paul R. Helft, MD
Shadia Jalal, MD
Patrick J. Loehrer, MD

Radiation Oncology

Mark Langer, MD

Thoracic Surgery

Thomas J. Birdas, MD
DuyKhanh (Mimi) P. Ceppa, MD
Kenneth A. Kesler, MD
Karen Rieger, MD

Lung Cancer Research

We currently explore the nature, treatment and prevention of lung cancer by hosting multiple clinical trials. Our team members write and serve as chairpersons for Eastern Cooperative Oncology Group (ECOG) trials, Hoosier Oncology Group (HOG) trials and trials that physicians themselves initiate. IU Health experts advise companies on drug development, serve on boards, consult on National Cancer Institute (NCI) grants and train physicians on advanced treatments for thoracic malignancies at national and international conferences.

Cancer research conducted through our partnership with the Indiana University School of Medicine sets the standard for treatment of small cell lung cancer, stage III non-small cell lung cancer (NSCLC) and 2nd second line NSCLC. The IU Health Simon Cancer Center also ranks as one of the top resources for treating inoperable stage I lung cancer with stereotactic radiotherapy (XRT).

Our clinical expertise is supported by leading-edge laboratories, where advanced study of molecular biology helps us improve patient care. Promising scientific discoveries undergo rigorous testing in our laboratory and clinic, leading to new and improved treatment options. The IU Health Simon Cancer Center and the IU School of Medicine are at the forefront of these discoveries, and our patients are among the first to benefit through access to standard care and clinical trial treatment options.

More information about cancer research can be found on the IU School of Medicine website.