21st Century Adult Cancer Sourcebook: Non-Small Cell Lung Cancer (NSCLC) - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - October 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
Questions? Suggestions? Comments? Concerns? Please contact the publisher directly at
Remember, the book retailer can't answer your questions, but we can!
* * * * * * * * * * *
Smashwords Edition, License Notes
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each person you share it with. If you're reading this book and did not purchase it, or it was not purchased for your use only, then you should return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
* * * * * * * * * * * *
IMPORTANT NOTE: Information in this e-book is not a substitute for professional medical advice. If you have or suspect that you have any illness, you must consult with a physician or professional healthcare provider! Call 911 and get to the nearest emergency room if you have serious or worsening symptoms.
This material represents a snapshot in time, with authoritative information formatted for ebook reading that was up-to-date at the moment of publication. For the latest cancer updates, please be sure to visit the NCI website:
From our Guide to Leading Medical Websites, here are three valuable sites with authoritative cancer information:
OncoLink * http://www.oncolink.upenn.edu/
eMedicine.com * http://www.emedicine.com/
American Cancer Society (ACS) * http://www.cancer.org/
* * * * * * * * * * * *
This is a privately authored news service and educational publication of Progressive Management. Our publications synthesize official government information with original material - they are not produced by the federal government. They are designed to provide a convenient user-friendly reference work to uniformly present authoritative knowledge that can be rapidly read, reviewed or searched. Vast archives of important data that might otherwise remain inaccessible are available for instant review no matter where you are. This e-book format makes a great reference work and educational tool. There is no other reference book that is as convenient, comprehensive, thoroughly researched, and portable - everything you need to know, from renowned experts you trust. For over a quarter of a century, our news, educational, technical, scientific, and medical publications have made unique and valuable references accessible to all people. Our e-books put knowledge at your fingertips, and an expert in your pocket!
PART ONE
Chapter 1A: Non-Small Cell Lung Cancer Patient Information
Chapter 2A: Non-Small Cell Lung Cancer Health Professional Information
Chapter 3A: Non-Small Cell Lung Cancer NCI Drugs
Chapter 4A: Non-Small Cell Lung Cancer Background Information
Chapter 5A: Non-Small Cell Lung Cancer Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
* * * * * * * * * * * *
PART ONE
* * * * * * * * * * * *
Chapter 1A: Non-Small Cell Lung Cancer Patient Information
Non-Small Cell Lung Cancer Treatment
Patient Version
Last Modified: 12/09/2010
General Information About Non-Small Cell Lung Cancer
Key Points for This Section
* Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.
* There are several types of non-small cell lung cancer.
* Smoking can increase the risk of developing non-small cell lung cancer.
* Possible signs of non-small cell lung cancer include a cough that doesn't go away and shortness of breath.
* Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung cancer.
* Certain factors affect prognosis (chance of recovery) and treatment options.
* For most patients with non-small cell lung cancer, current treatments do not cure the cancer.
Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.
The lungs are a pair of cone-shaped breathing organs in the chest. The lungs bring oxygen into the body as you breathe in. They release carbon dioxide, a waste product of the body’s cells, as you breathe out. Each lung has sections called lobes. The left lung has two lobes. The right lung is slightly larger and has three lobes. Two tubes called bronchi lead from the trachea (windpipe) to the right and left lungs. The bronchi are sometimes also involved in lung cancer. Tiny air sacs called alveoli and small tubes called bronchioles make up the inside of the lungs.
A thin membrane called the pleura covers the outside of each lung and lines the inside wall of the chest cavity. This creates a sac called the pleural cavity. The pleural cavity normally contains a small amount of fluid that helps the lungs move smoothly in the chest when you breathe.
There are two main types of lung cancer: non-small cell lung cancer and small cell lung cancer.
There are several types of non-small cell lung cancer.
Each type of non-small cell lung cancer has different kinds of cancer cells. The cancer cells of each type grow and spread in different ways. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look under a microscope:
* Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.
* Large cell carcinoma: Cancer that may begin in several types of large cells.
* Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.
Smoking can increase the risk of developing non-small cell lung cancer.
Smoking cigarettes, pipes, or cigars is the most common cause of lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk. If a person has stopped smoking, the risk becomes lower as the years pass.
Anything that increases a person's chance of developing a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for lung cancer include the following:
* Smoking cigarettes, pipes, or cigars, now or in the past.
* Being exposed to second-hand smoke.
* Being treated with radiation therapy to the breast or chest.
* Being exposed to asbestos, radon, chromium, nickel, arsenic, soot, or tar.
* Living where there is air pollution.
When smoking is combined with other risk factors, the risk of developing lung cancer is increased.
Possible signs of non-small cell lung cancer include a cough that doesn't go away and shortness of breath.
Sometimes lung cancer does not cause any symptoms and is found during a routine chest x-ray. Symptoms may be caused by lung cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
* A cough that doesn’t go away.
* Trouble breathing.
* Chest discomfort.
* Wheezing.
* Streaks of blood in sputum (mucus coughed up from the lungs).
* Hoarseness.
* Loss of appetite.
* Weight loss for no known reason.
* Feeling very tired.
Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung cancer.
Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the same time. The following tests and procedures may be used:
* Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.
* Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
* Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
* X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
* PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
* PET (positron emission tomography) scan. The patient lies on a table that slides through the PET machine. The head rest and white strap help the patient lie still. A small amount of radioactive glucose (sugar) is injected into the patient's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.
* Sputum cytology: A procedure in which a pathologist views a sample of sputum (mucus coughed up from the lungs) under a microscope, to check for cancer cells.
* Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.
* Lung biopsy. The patient lies on a table that slides through the computed tomography (CT) machine which takes x-ray pictures of the inside of the body. The x-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.
* Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
* Bronchoscopy. A bronchoscope is inserted through the mouth, trachea, and major bronchi into the lung, to look for abnormal areas. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken to be checked under a microscope for signs of disease.
* Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
* Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
* Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
* Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
* The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
* The type of lung cancer.
* Whether there are symptoms such as coughing or trouble breathing.
* The patient’s general health.
For most patients with non-small cell lung cancer, current treatments do not cure the cancer.
If lung cancer is found, taking part in one of the many clinical trials being done to improve treatment should be considered. Clinical trials are taking place in most parts of the country for patients with all stages of non-small cell lung cancer. Information about ongoing clinical trials is available from the NCI Web site 5.
Glossary Terms
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
adenocarcinoma (A-den-oh-KAR-sih-NOH-muh)
* Cancer that begins in cells that line certain internal organs and that have gland-like (secretory) properties.
alveoli (al-VEE-oh-ly)
* Tiny air sacs at the end of the bronchioles (tiny branches of air tubes) in the lungs. The alveoli are where the lungs and the bloodstream exchange carbon dioxide and oxygen. Carbon dioxide in the blood passes into the lungs through the alveoli. Oxygen in the lungs passes through the alveoli into the blood.
antibody (AN-tee-BAH-dee)
* A protein made by plasma cells (a type of white blood cell) in response to an antigen (a substance that causes the body to make a specific immune response). Each antibody can bind to only one specific antigen. The purpose of this binding is to help destroy the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen.
antigen (AN-tih-jen)
* Any substance that causes the body to make a specific immune response.
arsenic (ARS-nik)
* A poisonous chemical used to kill weeds and pests. Also used in cancer therapy.
asbestos (as-BES-tus)
* A group of minerals that take the form of tiny fibers. Asbestos has been used as insulation against heat and fire in buildings. Loose asbestos fibers breathed into the lungs can cause several serious diseases, including lung cancer and malignant mesothelioma (cancer found in the lining of the lungs, chest, or abdomen). Asbestos that is swallowed may cause cancer of the gastrointestinal tract.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
breast (brest)
* Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.
bronchi (BRONG-ky)
* The large air passages that lead from the trachea (windpipe) to the lungs.
bronchiole (BRONG-kee-ole)
* A tiny branch of air tubes in the lungs.
bronchoscope (BRON-koh-SKOPE)
* A thin, tube-like instrument used to examine the inside of the trachea, bronchi (air passages that lead to the lungs), and lungs. A bronchoscope has a light and a lens for viewing, and may have a tool to remove tissue.
bronchoscopy (bron-KOS-koh-pee)
* A procedure that uses a bronchoscope to examine the inside of the trachea, bronchi (air passages that lead to the lungs), and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. The bronchoscope is inserted through the nose or mouth. Bronchoscopy may be used to detect cancer or to perform some treatment procedures.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
carcinoid (KAR-sih-noyd)
* A slow-growing type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors may spread to the liver or other sites in the body, and they may secrete substances such as serotonin or prostaglandins, causing carcinoid syndrome.
cavity (KA-vih-tee)
* A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chest x-ray (chest EX-ray)
* An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
clinical trial (KLIH-nih-kul TRY-ul)
* A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan (… skan)
* A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
electron microscope (ee-LEK-tron MY-kroh-SKOPE)
* A microscope (device used to magnify small objects) that uses electrons (instead of light) to produce an enlarged image. An electron microscope shows tiny details better than any other type of microscope.
esophagus (ee-SAH-fuh-gus)
* The muscular tube through which food passes from the throat to the stomach.
fine-needle aspiration biopsy (... NEE-dul AS-pih-RAY-shun BY-op-see)
* The removal of tissue or fluid with a thin needle for examination under a microscope. Also called FNA biopsy.
fluid (FLOO-id)
* A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
glucose (GLOO-kose)
* A type of sugar; the chief source of energy for living organisms.
imaging procedure (IH-muh-jing proh-SEE-jer)
* A type of test that makes pictures of areas inside the body. Some examples of imaging procedures are CT scans and MRIs. Also called imaging test.
incision (in-SIH-zhun)
* A cut made in the body to perform surgery.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
laboratory test (LA-bruh-tor-ee...)
* A medical procedure that involves testing a sample of blood, urine, or other substance from the body. Tests can help determine a diagnosis, plan treatment, check to see if treatment is working, or monitor the disease over time.
large cell carcinoma (...KAR-sih-NOH-muh)
* Lung cancer in which the cells are large and look abnormal when viewed under a microscope.
light microscope (lite MY-kroh-SKOPE)
* A microscope (device to magnify small objects) in which objects are lit directly by white light.
lobe
* A portion of an organ, such as the liver, lung, breast, thyroid, or brain.
lung
* One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
lung cancer (lung KAN-ser)
* Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
malignant (muh-LIG-nunt)
* Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.
membrane (MEM-brayn)
* A very thin layer of tissue that covers a surface.
microscope (MY-kroh-SKOPE)
* An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
monitor (MAH-nih-ter)
* In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).
mucus (MYOO-kus)
* A thick, slippery fluid made by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.
non-small cell lung cancer (... sel lung KAN-ser)
* A group of lung cancers that are named for the kinds of cells found in the cancer and how the cells look under a microscope. The three main types of non-small cell lung cancer are squamous cell carcinoma, large cell carcinoma, and adenocarcinoma. Non-small cell lung cancer is the most common kind of lung cancer.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
oxygen (OK-sih-jen)
* A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.
pathologist (puh-THAH-loh-jist)
* A doctor who identifies diseases by studying cells and tissues under a microscope.
PET scan (… skan)
* A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. Also called positron emission tomography scan.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)
* An exam of the body to check for general signs of disease.
pleomorphic (PLEE-oh-MOR-fik)
* Occurring in various distinct forms. In terms of cells, having variation in the size and shape of cells or their nuclei.
pleura (PLOOR-uh)
* A thin layer of tissue that covers the lungs and lines the interior wall of the chest cavity. It protects and cushions the lungs. This tissue secretes a small amount of fluid that acts as a lubricant, allowing the lungs to move smoothly in the chest cavity while breathing.
pleural cavity (PLOOR-ul KA-vuh-tee)
* The space enclosed by the pleura, which is a thin layer of tissue that covers the lungs and lines the interior wall of the chest cavity.
prognosis (prog-NO-sis)
* The likely outcome or course of a disease; the chance of recovery or recurrence.
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
* The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.
radioactive (RAY-dee-oh-AK-tiv)
* Giving off radiation.
radioisotope (RAY-dee-oh-I-suh-tope)
* An unstable form of a chemical element that releases radiation as it breaks down and becomes more stable. Radioisotopes may occur in nature or be made in a laboratory. In medicine, they are used in imaging tests and in treatment. Also called radionuclide.
radon (RAY-don)
* A radioactive gas that is released by uranium, a substance found in soil and rock. Breathing in too much radon can damage lung cells and may lead to lung cancer.
risk factor (... FAK-ter)
* Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
salivary gland cancer (SA-lih-VAYR-ee gland KAN-ser)
* A rare cancer that forms in tissues of a salivary gland (gland in the mouth that makes saliva). Most salivary gland cancers occur in older people.
scanner (SKA-ner)
* In medicine, an instrument that takes pictures of the inside of the body.
small cell lung cancer (... sel lung KAN-ser)
* An aggressive (fast-growing) cancer that forms in tissues of the lung and can spread to other parts of the body. The cancer cells look small and oval-shaped when looked at under a microscope.
sputum (SPYOO-tum)
* Mucus and other matter brought up from the lungs by coughing.
sputum cytology (SPYOO-tum sy-TAH-loh-jee)
* Examination under a microscope of cells found in sputum (mucus and other matter brought up from the lungs by coughing). The test checks for abnormal cells, such as lung cancer cells.
squamous cell (SKWAY-mus sel)
* Flat cell that looks like a fish scale under a microscope. These cells cover inside and outside surfaces of the body. They are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder, kidney, and uterus), and the passages of the respiratory and digestive tracts.
squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh)
* Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
symptom (SIMP-tum)
* An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
thoracentesis (THOH-ruh-sen-TEE-sis)
* Removal of fluid from the pleural cavity through a needle inserted between the ribs.
thoracoscope (thoh-RAY-koh-skope)
* A thin tube-like instrument used to examine the inside of the chest. A thoracoscope has a light and a lens for viewing and may have tool to remove tissue.
thoracoscopy (THOR-uh-KOS-koh-pee)
* Examination of the inside of the chest, using a thoracoscope. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
thoracotomy (THOR-uh-KAH-toh-mee)
* An operation to open the chest.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
trachea (TRAY-kee-uh)
* The airway that leads from the larynx (voice box) to the bronchi (large airways that lead to the lungs). Also called windpipe.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ultrasound (UL-truh-SOWND)
* A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.
urine (YOOR-in)
* Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.
vein (vayn)
* A blood vessel that carries blood to the heart from tissues and organs in the body.
x-ray (EX-ray)
* A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Table of Links
1 http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/Patient
2 http://www.cancer.gov/cancertopics/pdq/prevention/lung/Patient
3 http://www.cancer.gov/cancertopics/pdq/screening/lung/Patient
4 http://www.cancer.gov/cancertopics/pdq/supportivecare/smokingcessation/Patient
5 http://cancer.gov/clinicaltrials Stages of Non-Small Cell Lung Cancer
Key Points for This Section
* After lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lungs or to other parts of the body.
* There are three ways that cancer spreads in the body.
* The following stages are used for non-small cell lung cancer:
* Occult (hidden) stage
* Stage 0 (carcinoma in situ)
* Stage I
* Stage II
* Stage IIIA
* Stage IIIB
* Stage IV
After lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lungs or to other parts of the body.
The process used to find out if cancer has spread within the lungs or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnose non-small cell lung cancer are also used to stage the disease. (See the General Information 1 section.) Other tests and procedures that may be used in the staging process include the following:
* Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
* MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. This procedure is also called nuclear magnetic resonance imaging (NMRI).
* Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
* Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.
* Endoscopic ultrasound-guided fine-needle aspiration biopsy. An endoscope that has an ultrasound probe and a biopsy needle is inserted through the mouth and into the esophagus. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the lymph nodes near the esophagus. The sonogram helps the doctor see where to place the biopsy needle to remove tissue from the lymph nodes. This tissue is checked under a microscope for signs of cancer.
* Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
* Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.
* Mediastinoscopy. A mediastinoscope is inserted into the chest through an incision above the breastbone to look for abnormal areas between the lungs. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken from lymph nodes on the right side of the chest and checked under a microscope for signs of cancer. In an anterior mediastinotomy (Chamberlain procedure), the incision is made beside the breastbone to remove tissue samples from the lymph nodes on the left side of the chest.
* Anterior mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. An incision (cut) is made next to the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. This is also called the Chamberlain procedure.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for non-small cell lung cancer:
Occult (hidden) stage
In the occult (hidden) stage, cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy, or the tumor is too small to be checked.
Stage 0 (carcinoma in situ)
In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
Stage I non-small cell lung cancer. In stage IA, cancer is in the lung only and is 3 cm or smaller. In stage IB, the cancer is (a) larger than 3 cm but not larger than 5 cm, (b) has spread to the main bronchus, and/or (c) has spread to the innermost layer of the lung lining. Part of the lung may have collapsed or become inflamed.
In stage I, cancer has formed. Stage I is divided into stages IA and IB:
* Stage IA: The tumor is in the lung only and is 3 centimeters or smaller.
* Stage IB: Cancer has not spread to the lymph nodes and one or more of the following is true:
* The tumor is larger than 3 centimeters but not larger than 5 centimeters.
* Cancer has spread to the main bronchus and is at least 2 centimeters below where the trachea joins the bronchus.
* Cancer has spread to the innermost layer of the membrane that covers the lung.
* Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the area where the trachea joins the bronchus.
Stage II
Stage II is divided into stages IIA and IIB. Stage IIA and IIB are each divided into two sections depending on the size of the tumor, where the tumor is found, and whether there is cancer in the lymph nodes.
* Stage IIA:
* Stage IIA non-small cell lung cancer. Cancer has spread to certain lymph nodes on the same side of the chest as the primary tumor; the cancer is (a) 5 cm or smaller, (b) has spread to the main bronchus, and/or (c) has spread to the innermost layer of the lung lining. OR, cancer has not spread to lymph nodes; the cancer is (d) larger than 5 cm but not larger than 7 cm, (e) has spread to the main bronchus, and/or (f) has spread to the innermost layer of the lung lining. Part of the lung may have collapsed or become inflamed.
* (1) Cancer has spread to lymph nodes on the same side of the chest as the tumor. The lymph nodes with cancer are within the lung or near the bronchus. Also, one or more of the following is true:
* The tumor is not larger than 5 centimeters.
* Cancer has spread to the main bronchus and is at least 2 centimeters below where the trachea joins the bronchus.
* Cancer has spread to the innermost layer of the membrane that covers the lung.
* Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the area where the trachea joins the bronchus.
* or
* (2) Cancer has not spread to lymph nodes and one or more of the following is true:
* The tumor is larger than 5 centimeters but not larger than 7 centimeters.
* Cancer has spread to the main bronchus and is at least 2 centimeters below where the trachea joins the bronchus.
* Cancer has spread to the innermost layer of the membrane that covers the lung.
* Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the area where the trachea joins the bronchus.
* Stage IIB:
* Stage IIB non-small cell lung cancer. Cancer has spread to certain lymph nodes on the same side of the chest as the primary tumor; the cancer is (a) larger than 5 cm but not larger than 7 cm, (b) has spread to the main bronchus, and/or (c) has spread to the innermost layer of the lung lining. Part of the lung may have collapsed or become inflamed. OR, (d) the cancer is larger than 7 cm; (e) has spread to the main bronchus, (f) the diaphragm, (g) the chest wall or the lining of the chest wall; and/or (h) has spread to the membrane around the heart. There may be one or more separate tumors in the same lobe of the lung; cancer may have spread to the nerve that controls the diaphragm; the whole lung may have collapsed or become inflamed.
* (1) Cancer has spread to nearby lymph nodes on the same side of the chest as the tumor. The lymph nodes with cancer are within the lung or near the bronchus. Also, one or more of the following is true:
* The tumor is larger than 5 centimeters but not larger than 7 centimeters.
* Cancer has spread to the main bronchus and is at least 2 centimeters below where the trachea joins the bronchus.
* Cancer has spread to the innermost layer of the membrane that covers the lung.
* Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the area where the trachea joins the bronchus.
* or
* (2) Cancer has not spread to lymph nodes and one or more of the following is true:
* The tumor is larger than 7 centimeters.
* Cancer has spread to the main bronchus (and is less than 2 centimeters below where the trachea joins the bronchus), the chest wall, the diaphragm, or the nerve that controls the diaphragm.
* Cancer has spread to the membrane around the heart or lining the chest wall.
* The whole lung has collapsed or developed pneumonitis (inflammation of the lung).
* There are one or more separate tumors in the same lobe of the lung.
Stage IIIA
Stage IIIA is divided into three sections depending on the size of the tumor, where the tumor is found, and which lymph nodes have cancer (if any).
Stage IIIA non-small cell lung cancer (1). Cancer has spread to certain lymph nodes on the same side of the chest as the primary tumor. The cancer may have spread to (a) the main bronchus; (b) lung lining, chest wall lining, or chest wall; (c) diaphragm; and/or (d) membrane around the heart; and/or (e) there may be one or more separate tumors in the same lobe of the lung. Cancer may have spread to the nerve that controls the diaphragm, and part or all of the lung may have collapsed or become inflamed.
(1) Cancer has spread to lymph nodes on the same side of the chest as the tumor. The lymph nodes with cancer are near the sternum (chest bone) or where the bronchus enters the lung. Also:
* The tumor may be any size.
* Part of the lung (where the trachea joins the bronchus) or the whole lung may have collapsed or developed pneumonitis (inflammation of the lung).
* There may be one or more separate tumors in the same lobe of the lung.
* Cancer may have spread to any of the following:
* Main bronchus, but not the area where the trachea joins the bronchus.
* Chest wall.
* Diaphragm and the nerve that controls it.
* Membrane around the lung or lining the chest wall.
* Membrane around the heart.
Stage IIIA lung cancer (2). Cancer has spread to certain lymph nodes on the same side of the chest as the primary tumor. The cancer may have spread to (a) the main bronchus; (b) the lung lining, chest wall lining, or chest wall; (c) diaphragm; (d) heart and/or membrane around the it; (e) major blood vessels that lead to or from the heart; (f) trachea; (g) esophagus; (h) sternum; and/or (i) carina; and/or (j) there may be one or more separate tumors in any lobe of the same lung. Cancer may have spread to the nerves that control the diaphragm and larynx, and the whole lung may have collapsed or become inflamed.
(2) Cancer has spread to lymph nodes on the same side of the chest as the tumor. The lymph nodes with cancer are within the lung or near the bronchus. Also:
* The tumor may be any size.
* The whole lung may have collapsed or developed pneumonitis (inflammation of the lung).
* There may be one or more separate tumors in any of the lobes of the lung with cancer.
* Cancer may have spread to any of the following:
* Main bronchus, but not the area where the trachea joins the bronchus.
* Chest wall.
* Diaphragm and the nerve that controls it.
* Membrane around the lung or lining the chest wall.
* Heart or the membrane around it.
* Major blood vessels that lead to or from the heart.
* Trachea.
* Esophagus.
* Nerve that controls the larynx (voice box).
* Sternum (chest bone) or backbone.
* Carina (where the trachea joins the bronchi).
Stage IIIA non-small cell lung cancer (3). Cancer has spread to (a) the heart; (b) major blood vessels that lead to or from the heart; (c) trachea; (d) esophagus; (e) sternum; and/or (f) carina. Cancer may have spread to the nerve that controls the larynx.
(3) Cancer has not spread to the lymph nodes and the tumor may be any size. Cancer has spread to any of the following:
* Heart.
* Major blood vessels that lead to or from the heart.
* Trachea.
* Esophagus.
* Nerve that controls the larynx (voice box).
* Sternum (chest bone) or backbone.
* Carina (where the trachea joins the bronchi).
Stage IIIB
Stage IIIB is divided into two sections depending on the size of the tumor, where the tumor is found, and which lymph nodes have cancer.
Stage IIIB non-small cell lung cancer (1). Cancer has spread to lymph nodes above the collarbone or on the opposite side of the chest as the primary tumor. The cancer may have spread to (a) the main bronchus; (b) lung lining, chest wall lining, or chest wall; (c) diaphragm; (d) heart or the membrane around it; (e) major blood vessels that lead to or from the heart; (f) trachea; (g) esophagus; (h) sternum; and/or (i) carina; and/or (j) there may be one or more separate tumors in any of the lobes of the lung. Part or all of the lung may have collapsed or become inflamed and cancer may have spread to the backbone and/or the nerves that control the diaphragm and larynx.
(1) Cancer has spread to lymph nodes above the collarbone or to lymph nodes on the opposite side of the chest as the tumor. Also:
* The tumor may be any size.
* Part of the lung (where the trachea joins the bronchus) or the whole lung may have collapsed or developed pneumonitis (inflammation of the lung).
* There may be one or more separate tumors in any of the lobes of the lung with cancer.
* Cancer may have spread to any of the following:
* Main bronchus.
* Chest wall.
* Diaphragm and the nerve that controls it.
* Membrane around the lung or lining the chest wall.
* Heart or the membrane around it.
* Major blood vessels that lead to or from the heart.
* Trachea.
* Esophagus.
* Nerve that controls the larynx (voice box).
* Sternum (chest bone) or backbone.
* Carina (where the trachea joins the bronchi).
Stage IIIB non-small cell lung cancer (2). Cancer has spread to certain lymph nodes on the same side of the chest as the primary tumor and to (a) the heart; (b) major blood vessels that lead to or from the heart; (c) trachea; (d) esophagus; (e) sternum; and/or (f) carina; and/or (g) there may be separate tumors in different lobes of the same lung. Cancer may have spread to the backbone and/or the nerve that controls the larynx.
(2) Cancer has spread to lymph nodes on the same side of the chest as the tumor. The lymph nodes with cancer are near the sternum (chest bone) or where the bronchus enters the lung. Also:
* The tumor may be any size.
* There may be separate tumors in different lobes of the same lung.
* Cancer has spread to any of the following:
* Heart.
* Major blood vessels that lead to or from the heart.
* Trachea.
* Esophagus.
* Nerve that controls the larynx (voice box).
* Sternum (chest bone) or backbone.
* Carina (where the trachea joins the bronchi).
Stage IV
Stage IV non-small cell lung cancer. The cancer has spread to the other lung, and/or to lymph nodes, fluid around the lungs or heart, and/or other places in the body, such as the brain, liver, adrenal glands, kidneys, or bones.
In stage IV, the tumor may be any size and cancer may have spread to lymph nodes. One or more of the following is true:
* There are one or more tumors in both lungs.
* Cancer is found in fluid around the lungs or the heart.
* Cancer has spread to other parts of the body, such as the brain, liver, adrenal glands, kidneys, or bone.
Glossary Terms
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
adrenal gland (uh-DREE-nul...)
* A small gland that makes steroid hormones, adrenaline, and noradrenaline. These hormones help control heart rate, blood pressure, and other important body functions. There are two adrenal glands, one on top of each kidney. Also called suprarenal gland.
anterior mediastinotomy (an-TEER-ee-er MEE-dee-A-stih-NAH-toh-mee)
* A procedure in which a tube is inserted into the chest to view the tissues and organs in the area between the lungs and between the breastbone and heart. The tube is inserted through an incision next to the breastbone. This procedure is usually used to get a tissue sample from the lymph nodes on the left side of the chest. Also called Chamberlain procedure.
backbone (BAK-bone)
* The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The backbone encloses the spinal cord and the fluid surrounding the spinal cord. Also called spinal column, spine, and vertebral column.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood vessel (blud VEH-sel)
* A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.
bone cancer (bone KAN-ser)
* Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
breast cancer (brest KAN-ser)
* Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
bronchoscopy (bron-KOS-koh-pee)
* A procedure that uses a bronchoscope to examine the inside of the trachea, bronchi (air passages that lead to the lungs), and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. The bronchoscope is inserted through the nose or mouth. Bronchoscopy may be used to detect cancer or to perform some treatment procedures.
bronchus (BRON-kus)
* A large airway that leads from the trachea (windpipe) to a lung. The plural of bronchus is bronchi.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
capillary (KA-pih-layr-ee)
* The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.
carcinoma in situ (KAR-sih-NOH-muh in SY-too)
* A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.
carina of trachea (kuh-RY-nuh ... TRAY-kee-uh)
* A ridge at the base of the trachea (windpipe) that separates the openings of the right and left main bronchi (the large air passages that lead from the trachea to the lungs). Also called tracheal carina.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
centimeter (SEN-tih-MEE-ter)
* A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.
chest wall (chest wawl)
* The muscles, bones, and joints that make up the area of the body between the neck and the abdomen.
collarbone (KAH-lur …)
* One of a pair of bones at the base of the front of the neck. The clavicles connect the breastbone to the shoulder blades. Also called clavicle.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
diaphragm (DY-uh-fram)
* The thin muscle below the lungs and heart that separates the chest from the abdomen.
endoscope (EN-doh-SKOPE)
* A thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may have a tool to remove tissue.
endoscopic ultrasound (en-doh-SKAH-pik...)
* A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument that has a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal organs to make a picture (sonogram). Also called endosonography and EUS.
esophagus (ee-SAH-fuh-gus)
* The muscular tube through which food passes from the throat to the stomach.
fine-needle aspiration biopsy (... NEE-dul AS-pih-RAY-shun BY-op-see)
* The removal of tissue or fluid with a thin needle for examination under a microscope. Also called FNA biopsy.
fluid (FLOO-id)
* A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
imaging (IH-muh-jing)
* In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as x-rays (high-energy radiation), ultrasound (high-energy sound waves), and radio waves.
incision (in-SIH-zhun)
* A cut made in the body to perform surgery.
inflammation (IN-fluh-MAY-shun)
* Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
invasive cancer (in-VAY-siv KAN-ser)
* Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
kidney (KID-nee)
* One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.
laboratory test (LA-bruh-tor-ee...)
* A medical procedure that involves testing a sample of blood, urine, or other substance from the body. Tests can help determine a diagnosis, plan treatment, check to see if treatment is working, or monitor the disease over time.
larynx (LAYR-inx)
* The area of the throat containing the vocal cords and used for breathing, swallowing, and talking. Also called voice box.
liver (LIH-ver)
* A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.
lobe