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Lung Cancer Causes, Types, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies
Lung Cancer Causes, Types, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies
Understanding the Cancer Process
All types of cancer develop in our cells, the body's basic unit of life. To understand cancer, it is helpful to know how normal cells become cancerous.
The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes astray -- cells keep dividing when new cells are not needed. The mass of extra cells forms a growth or tumor. Tumors can be benign or malignant.
Benign tumors are not cancer. They often can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.
Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system (the tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases). This process, called metastasis, is how cancer spreads from the original (primary) tumor to form new (secondary) tumors in other parts of the body.
The Lungs
The lungs, a pair of sponge-like, cone-shaped organs, are part of the respiratory system. The right lung has three sections, called lobes; it is a little larger than the left lung, which has two lobes. When we breathe in, the lungs take in oxygen, which our cells need to live and carry out their normal functions. When we breathe out, the lungs get rid of carbon dioxide, which is a waste product of the body's cells.
What is lung cancer?
Cancer of the lung, like all cancers, results from an abnormality in the body's basic unit of life, the cell. Normally, the body maintains a system of checks and balances on cell growth so that cells divide to produce new cells only when new cells are needed. Disruption of this system of checks and balances on cell growth results in an uncontrolled division and proliferation of cells that eventually forms a mass known as a tumor.
Tumors can be benign or malignant; when we speak of "cancer," we are referring to those tumors that are malignant. Benign tumors usually can be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system and then to other sites in the body. This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastases. Since lung cancer tends to spread or metastasize very early after it forms, it is a very life-threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain locations -- particularly the adrenal glands, liver, brain, and bones -- are the most common sites for lung cancer metastasis.
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The lung also is a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original (primary) tumor. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer in the lung and is not lung cancer.
The principal function of the lungs is to exchange gases between the air we breathe and the blood. Through the lung, carbon dioxide is removed from the bloodstream and oxygen from inspired air enters the bloodstream. The right lung has three lobes, while the left lung is divided into two lobes and a small structure called the lingula that is the equivalent of the middle lobe on the right. The major airways entering the lungs are the bronchi, which arise from the trachea. The bronchi branch into progressively smaller airways called bronchioles that end in tiny sacs known as alveoli where gas exchange occurs. The lungs and chest wall are covered with a thin layer of tissue called the pleura.
Lung cancers can arise in any part of the lung, but 90% to 95% of cancers of the lung are thought to arise from the epithelial cells, the cells lining the larger and smaller airways (bronchi and bronchioles); for this reason, lung cancers are sometimes called bronchogenic cancers or bronchogenic carcinomas. (Carcinoma is another term for cancer.) Cancers also can arise from the pleura (called mesotheliomas) or rarely from supporting tissues within the lungs, for example, the blood vessels.
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How common is lung cancer?
Lung cancer is the most common cause of death due to cancer in both men and women throughout the world. Statistics from the American Cancer Society estimated that about 228,000 new cases of lung cancer in the U.S. will be diagnosed and about 159,000 deaths due to lung cancer would occur in 2013. According to the U.S. National Cancer Institute, approximately one out of every 14 men and women in the U.S. will be diagnosed with cancer of the lung at some point in their lifetime.
Lung cancer is predominantly a disease of the elderly; almost 70% of people diagnosed with lung cancer are over 65 years of age, while less than 3% of lung cancers occur in people under 45 years of age.
Lung cancer was not common prior to the 1930s but increased dramatically over the following decades as tobacco smoking increased. In many developing countries, the incidence of lung cancer is beginning to fall following public education about the dangers of cigarette smoking and the introduction of effective smoking-cessation programs. Nevertheless, lung cancer remains among the most common types of cancers in both men and women worldwide. In the U.S., lung cancer has surpassed breast cancer as the most common cause of cancer-related deaths in women.
What causes lung cancer?
The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use. The risk of lung cancer increases with the number of cigarettes smoked and the time over which smoking has occurred; doctors refer to this risk in terms of pack-years of smoking history (the number of packs of cigarettes smoked per day multiplied by the number of years smoked). For example, a person who has smoked two packs of cigarettes per day for 10 years has a 20 pack-year smoking history. While the risk of lung cancer is increased with even a 10-pack-year smoking history, those with 30-pack-year histories or more are considered to have the greatest risk for the development of lung cancer. Among those who smoke two or more packs of cigarettes per day, one in seven will die of lung cancer.
|Smoking Causes Lung Cancer
Pipe and cigar smoking also can cause lung cancer, although the risk is not as high as with cigarette smoking. Thus, while someone who smokes one pack of cigarettes per day has a risk for the development of lung cancer that is 25 times higher than a nonsmoker, pipe and cigar smokers have a risk of lung cancer that is about five times that of a nonsmoker.
Tobacco smoke contains over 4,000 chemical compounds, many of which have been shown to be cancer-causing or carcinogenic. The two primary carcinogens in tobacco smoke are chemicals known as nitrosamines and polycyclic aromatic hydrocarbons. The risk of developing lung cancer decreases each year following smoking cessation as normal cells grow and replace damaged cells in the lung. In former smokers, the risk of developing lung cancer begins to approach that of a nonsmoker about 15 years after cessation of smoking.
Passive smoking
Passive smoking or the inhalation of tobacco smoke by nonsmokers who share living or working quarters with smokers, also is an established risk factor for the development of lung cancer. Research has shown that nonsmokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with nonsmokers who do not reside with a smoker. The risk appears to increase with the degree of exposure (number of years exposed and number of cigarettes smoked by the household partner). An estimated 3,000 lung cancer deaths that occur each year in the U.S. are attributable to passive smoking.
Asbestos fibers
Asbestos fibers are silicate fibers that can persist for a lifetime in lung tissue following exposure to asbestos. The workplace was a common source of exposure to asbestos fibers, as asbestos was widely used in the past as both thermal and acoustic insulation. Today, asbestos use is limited or banned in many countries, including the U.S. Both lung cancer and mesothelioma (cancer of the pleura of the lung as well as of the lining of the abdominal cavity called the peritoneum) are associated with exposure to asbestos. Cigarette smoking drastically increases the chance of developing an asbestos-related lung cancer in workers exposed to asbestos. Asbestos workers who do not smoke have a fivefold greater risk of developing lung cancer than nonsmokers, but asbestos workers who smoke have a risk that is fifty- to ninety-fold greater than nonsmokers.
Radon gas
Radon gas is a natural radioactive gas that is a natural decay product of uranium. Uranium decays to form products, including radon, that emit a type of ionizing radiation. Radon gas is a known cause of lung cancer, with an estimated 12% of lung-cancer deaths attributable to radon gas, or about 20,000 lung-cancer-related deaths annually in the U.S., making radon the second leading cause of lung cancer in the U.S. As with asbestos exposure, concomitant smoking greatly increases the risk of lung cancer with radon exposure. Radon gas can travel up through soil and enter homes through gaps in the foundation, pipes, drains, or other openings. The U.S. Environmental Protection Agency estimates that one out of every 15 homes in the U.S. contains dangerous levels of radon gas. Radon gas is invisible and odorless, but it can be detected with simple test kits.
Familial predisposition
While the majority of lung cancers are associated with tobacco smoking, the fact that not all smokers eventually develop lung cancer suggests that other factors, such as individual genetic susceptibility, may play a role in the causation of lung cancer. Numerous studies have shown that lung cancer is more likely to occur in both smoking and nonsmoking relatives of those who have had lung cancer than in the general population. One study in never-smokers showed that a genetic change at a single region on chromosome 13 was associated with an increase in risk for developing non-small cell lung cancer. A large genetic study of lung cancer that involved over 10,000 people from 18 countries and led by the International Agency for Research on Cancer (IARC), identified a small region in the genome (DNA) that contains genes that appear to confer an increased susceptibility to lung cancer in smokers. The specific genes, located on the q arm of chromosome 15, code for proteins that interact with nicotine and other tobacco toxins (nicotinic acetylcholine receptor genes).
Lung diseases
The presence of certain diseases of the lung, notably chronic obstructive pulmonary disease (COPD), is associated with an increased risk (four- to six-fold the risk of a nonsmoker) for the development of lung cancer even after the effects of concomitant cigarette smoking are excluded. Pulmonary fibrosis (scarring of the lung) appears to increase the risk about seven-fold, and this risk does not appear to be related to smoking.
Prior history of lung cancer
Survivors of lung cancer have a greater risk of developing a second lung cancer than the general population has of developing a first lung cancer. Survivors of non-small cell lung cancers (NSCLCs, see below) have an additive risk of 1% to 2% per year for developing a second lung cancer. In survivors of small cell lung cancers (SCLCs, see below), the risk for development of second lung cancers approaches 6% per year.
Air pollution
Air pollution from vehicles, industry, and power plants can raise the likelihood of developing lung cancer in exposed individuals. Up to 1% of lung cancer deaths are attributable to breathing polluted air, and experts believe that prolonged exposure to highly polluted air can carry a risk for the development of lung cancer similar to that of passive smoking.
Researchers continue to study the causes of lung cancer and to search for ways to prevent it. We already know that the best way to prevent lung cancer is to quit (or never start) smoking. The sooner a person quits smoking the better. Even if you have been smoking for many years, it's never too late to benefit from quitting.
What are the types of lung cancer?
Lung cancers, also known as bronchogenic carcinomas, are broadly classified into two types: small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). This classification is based upon the microscopic appearance of the tumor cells themselves. These two types of cancers grow and spread in different ways and may have different treatment options, so a distinction between these two types is important.
SCLC comprise about 20% of lung cancers and are the most aggressive and rapidly growing of all lung cancers. SCLC are strongly related to cigarette smoking, with only 1% of these tumors occurring in nonsmokers. SCLC metastasize rapidly to many sites within the body and are most often discovered after they have spread extensively. Referring to a specific cell appearance often seen when examining samples of SCLC under the microscope, these cancers are sometimes called oat cell carcinomas.
NSCLC are the most common lung cancers, accounting for about 80% of all lung cancers. NSCLC can be divided into three main types that are named based upon the type of cells found in the tumor:
Adenocarcinomas are the most commonly seen type of NSCLC in the U.S. and comprise up to 50% of NSCLC. While adenocarcinomas are associated with smoking, like other lung cancers, this type is observed as well in nonsmokers who develop lung cancer. Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs.
Bronchioloalveolar carcinoma
Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.
Squamous cell carcinomas
Squamous cell carcinomas were formerly more common than adenocarcinomas; at present, they account for about 30% of NSCLC. Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi.
Large cell carcinomas
Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC.
Mixtures of different types of NSCLC are also seen.
Other types of cancers can arise in the lung; these types are much less common than NSCLC and SCLC and together comprise only 5% to 10% of lung cancers:
Bronchial carcinoids
Bronchial carcinoids account for up to 5% of lung cancers. These tumors are generally small (3 cm to 4 cm or less) when diagnosed and occur most commonly in people under 40 years of age. Unrelated to cigarette smoking, carcinoid tumors can metastasize, and a small proportion of these tumors secrete hormone-like substances that may cause specific symptoms related to the hormone being produced. Carcinoids generally grow and spread more slowly than bronchogenic cancers, and many are detected early enough to be amenable to surgical resection.
Cancers of supporting lung tissue such as smooth muscle, blood vessels, or cells involved in the immune response can rarely occur in the lung.
As discussed previously, metastatic cancers from other primary tumors in the body are often found in the lung. Tumors from anywhere in the body may spread to the lungs either through the bloodstream, through the lymphatic system, or directly from nearby organs. Metastatic tumors are most often multiple, scattered throughout the lung, and concentrated in the peripheral rather than central areas of the lung.
What are lung cancer symptoms and signs?
Symptoms of lung cancer are varied depending upon where and how widespread the tumor is. Warning signs of lung cancer are not always present or easy to identify. Lung cancer may not cause pain or even any symptoms at all in some cases. A person with lung cancer may have the following kinds of symptoms:
No symptoms:
In up to 25% of people who get lung cancer, the cancer is first discovered on a routine chest X-ray or CT scan as a solitary small mass sometimes called a coin lesion, since on a two-dimensional X-ray or CT scan, the round tumor looks like a coin. These patients with small, single masses often report no symptoms at the time the cancer is discovered.
Symptoms related to the cancer:
The growth of the cancer and invasion of lung tissues and surrounding tissue may interfere with breathing, leading to symptoms such as cough, shortness of breath, wheezing, chest pain, and coughing up blood (hemoptysis). If the cancer has invaded nerves, for example, it may cause shoulder pain that travels down the outside of the arm (called Pancoast syndrome) or paralysis of the vocal cords leading to hoarseness. Invasion of the esophagus may lead to difficulty swallowing (dysphagia). If a large airway is obstructed, collapse of a portion of the lung may occur and cause infections (abscesses, pneumonia) in the obstructed area.
Symptoms related to metastasis:
Lung cancer that has spread to the bones may produce excruciating pain at the sites of bone involvement. Cancer that has spread to the brain may cause a number of neurologic symptoms that may include blurred vision, headaches, seizures, or symptoms of stroke such as weakness or loss of sensation in parts of the body.
Paraneoplastic symptoms:
Lung cancers frequently are accompanied by symptoms that result from production of hormone-like substances by the tumor cells. These paraneoplastic syndromes occur most commonly with SCLC but may be seen with any tumor type. A common paraneoplastic syndrome associated with SCLC is the production of a hormone called adrenocorticotrophic hormone (ACTH) by the cancer cells, leading to oversecretion of the hormone cortisol by the adrenal glands (Cushing's syndrome). The most frequent paraneoplastic syndrome seen with NSCLC is the production of a substance similar to parathyroid hormone, resulting in elevated levels of calcium in the bloodstream.
Nonspecific symptoms:
Nonspecific symptoms seen with many cancers, including lung cancers, include weight loss, weakness, and fatigue. Psychological symptoms such as depression and mood changes are also common.
When should one consult a doctor?
One should consult a health care professional if he or she develops the symptoms associated with lung cancer, in particular, if they have
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- a new persistent cough or worsening of an existing chronic cough
- blood in the sputum
- persistent bronchitis or repeated respiratory infections
- chest pain
- unexplained weight loss and/or fatigue
- breathing difficulties such as shortness of breath or wheezing
How is lung cancer diagnosed?
Doctors use a wide range of diagnostic procedures and tests to diagnose lung cancer. These include the following:
The history and physical examination
The history and physical examination may reveal the presence of symptoms or signs that are suspicious for lung cancer. In addition to asking about symptoms and risk factors for cancer development such as smoking, doctors may detect signs of breathing difficulties, airway obstruction, or infections in the lungs. Cyanosis, a bluish color of the skin and the mucous membranes due to insufficient oxygen in the blood, suggests compromised function due to chronic disease of the lung. Likewise, changes in the tissue of the nail beds, known as clubbing, also may indicate chronic lung disease.
The chest X-ray
The chest X-ray is the most common first diagnostic step when any new symptoms of lung cancer are present. The chest X-ray procedure often involves a view from the back to the front of the chest as well as a view from the side. Like any X-ray procedure, chest X-rays expose the patient briefly to a small amount of radiation. Chest X-rays may reveal suspicious areas in the lungs but are unable to determine if these areas are cancerous. In particular, calcified nodules in the lungs or benign tumors called hamartomas may be identified on a chest X-ray and mimic lung cancer.
CT (computerized tomography, computerized axial tomography, or CAT) scans
CT (computerized tomography, computerized axial tomography, or CAT) scans may be performed on the chest, abdomen, and/or brain to examine for both metastatic and lung tumors. A CT scan of the chest may be ordered when X-rays do not show an abnormality or do not yield sufficient information about the extent or location of a tumor. CT scans are X-ray procedures that combine multiple images with the aid of a computer to generate cross-sectional views of the body. The images are taken by a large donut-shaped X-ray machine at different angles around the body. One advantage of CT scans is that they are more sensitive than standard chest X-rays in the detection of lung nodules, that is, they will demonstrate more nodules. Sometimes intravenous contrast material is given prior to the scan to help delineate the organs and their positions. A CT scan exposes the patient to a minimal amount of radiation. The most common side effect is an adverse reaction to intravenous contrast material that may have been given prior to the procedure. This may result in itching, a rash, or hives that generally disappear rather quickly. Severe anaphylactic reactions (life-threatening allergic reactions with breathing difficulties) to contrast material are rare. CT scans of the abdomen may identify metastatic cancer in the liver or adrenal glands, and CT scans of the head may be ordered to reveal the presence and extent of metastatic cancer in the brain.
Low-dose helical CT scan (or spiral CT scan)
A technique called a low-dose helical CT scan (or spiral CT scan) is sometimes used in screening for lung cancers. This procedure requires a special type of CT scanner and has been shown to be an effective tool for the identification of small lung cancers in smokers and former smokers. However, it has not yet been proven whether the use of this technique actually saves lives or lowers the risk of death from lung cancer. The heightened sensitivity of this method is actually one of the sources of its drawbacks, since lung nodules requiring further evaluation will be seen in approximately 20% of people with this technique. Of the nodules identified by low-dose helical screening CTs, 90% are not cancerous but require up to 2 years of costly and often uncomfortable follow-up and testing. Trials are underway to further determine the utility of spiral CT scans in screening for lung cancer.
Magnetic resonance imaging (MRI) scans
Magnetic resonance imaging (MRI) scans may be appropriate when precise detail about a tumor's location is required. The MRI technique uses magnetism, radio waves, and a computer to produce images of body structures. As with CT scanning, the patient is placed on a moveable bed which is inserted into the MRI scanner. There are no known side effects of MRI scanning, and there is no exposure to radiation. The image and resolution produced by MRI is quite detailed and can detect tiny changes of structures within the body. People with heart pacemakers, metal implants, artificial heart valves, and other surgically implanted structures cannot be scanned with an MRI because of the risk that the magnet may move the metal parts of these structures.
Positron emission tomography (PET)
Positron emission tomography (PET) scanning is a specialized imaging technique that uses short-lived radioactive drugs to produce three-dimensional colored images of those substances in the tissues within the body. While CT scans and MRI scans look at anatomical structures, PET scans measure metabolic activity and the function of tissues. PET scans can determine whether a tumor tissue is actively growing and can aid in determining the type of cells within a particular tumor. In PET scanning, the patient receives a short half-lived radioactive drug, receiving approximately the amount of radiation exposure as two chest X-rays. The drug accumulates in certain tissues more than others, depending on the drug that is injected. The drug discharges particles known as positrons from whatever tissues take them up. As the positrons encounter electrons within the body, a reaction producing gamma rays occurs. A scanner records these gamma rays and maps the area where the radioactive drug has accumulated. For example, combining glucose (a common energy source in the body) with a radioactive substance will show where glucose is rapidly being used, for example, in a growing tumor. PET scanning may also be integrated with CT scanning in a technique known as PET-CT scanning. Integrated PET-CT has been shown to improve the accuracy of staging (see below) over PET scanning alone.
Bone scans
Bone scans are used to create images of bones on a computer screen or on film. Doctors may order a bone scan to determine whether a lung cancer has metastasized to the bones. In a bone scan, a small amount of radioactive material is injected into the bloodstream and collects in the bones, especially in abnormal areas such as those involved by metastatic tumors. The radioactive material is detected by a scanner, and the image of the bones is recorded on a special film for permanent viewing.
Sputum cytology
Sputum cytology: The diagnosis of lung cancer always requires confirmation of malignant cells by a pathologist, even when symptoms and X-ray studies are suspicious for lung cancer. The simplest method to establish the diagnosis is the examination of sputum under a microscope. If a tumor is centrally located and has invaded the airways, this procedure, known as a sputum cytology examination, may allow visualization of tumor cells for diagnosis. This is the most risk-free and inexpensive tissue diagnostic procedure, but its value is limited since tumor cells will not always be present in sputum even if a cancer is present. Also, noncancerous cells may occasionally undergo changes in reaction to inflammation or injury that makes them look like cancer cells.
Examination of the airways by bronchoscopy (visualizing the airways through a thin, fiberoptic probe inserted through the nose or mouth) may reveal areas of tumor that can be sampled (biopsied) for diagnosis by a pathologist. A tumor in the central areas of the lung or arising from the larger airways is accessible to sampling using this technique. Bronchoscopy may be performed using a rigid or a flexible fiberoptic bronchoscope and can be performed in a same-day outpatient bronchoscopy suite, an operating room, or on a hospital ward. The procedure can be uncomfortable, and it requires sedation or anesthesia. While bronchoscopy is relatively safe, it must be carried out by a lung specialist (pulmonologist or surgeon) experienced in the procedure. When a tumor is visualized and adequately sampled, an accurate cancer diagnosis usually is possible. Some patients may cough up dark-brown blood for 1 to 2 days after the procedure. More serious but rare complications include a greater amount of bleeding, decreased levels of oxygen in the blood, and heart arrhythmias as well as complications from sedative medications and anesthesia.
Needle biopsy
Fine needle aspiration (FNA) through the skin, most commonly performed with radiological imaging for guidance, may be useful in retrieving cells for diagnosis from tumor nodules in the lungs. Needle biopsies are particularly useful when the lung tumor is peripherally located in the lung and not accessible to sampling by bronchoscopy. A small amount of local anesthetic is given prior to insertion of a thin needle through the chest wall into the abnormal area in the lung. Cells are suctioned into the syringe and are examined under the microscope for tumor cells. This procedure is generally accurate when the tissue from the affected area is adequately sampled, but in some cases, adjacent or uninvolved areas of the lung may be mistakenly sampled. A small risk (3% to 5%) of an air leak from the lungs (called a pneumothorax, which can easily be treated) accompanies the procedure.
Sometimes lung cancers involve the lining tissue of the lungs (pleura) and lead to an accumulation of fluid in the space between the lungs and chest wall (called a pleural effusion). Aspiration of a sample of this fluid with a thin needle (thoracentesis) may reveal the cancer cells and establish the diagnosis. As with the needle biopsy, a small risk of a pneumothorax is associated with this procedure.
Major surgical procedures
If none of the aforementioned methods yields a diagnosis, surgical methods must be employed to obtain tumor tissue for diagnosis. These can include mediastinoscopy (examining the chest cavity between the lungs through a surgically inserted probe with biopsy of tumor masses or lymph nodes that may contain metastases) or thoracotomy (surgical opening of the chest wall for removal or biopsy of a tumor). With a thoracotomy, it is rare to be able to completely remove a lung cancer, and both mediastinoscopy and thoracotomy carry the risks of major surgical procedures (complications such as bleeding, infection, and risks from anesthesia and medications). These procedures are performed in an operating room, and the patient must be hospitalized.
Blood tests
While routine blood tests alone cannot diagnose lung cancer, they may reveal biochemical or metabolic abnormalities in the body that accompany cancer. For example, elevated levels of calcium or of the enzyme alkaline phosphatase may accompany cancer that is metastatic to the bones. Likewise, elevated levels of certain enzymes normally present within liver cells, including aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT), signal liver damage, possibly through the presence of tumor metastatic to the liver. One current focus of research in the area of lung cancer is the development of a blood test to aid in the diagnosis of lung cancer. Researchers have preliminary data that has identified specific proteins, or biomarkers, that are in the blood and may signal that lung cancer is present in someone with a suspicious area seen on a chest X-ray or other imaging study.
What is the treatment for lung cancer?
Treatment for lung cancer can involve surgical removal of the cancer, chemotherapy, or radiation therapy, as well as combinations of these treatments. The decision about which treatments will be appropriate for a given individual must take into account the location and extent of the tumor as well as the overall health status of the patient.
As with other cancers, therapy may be prescribed that is intended to be curative (removal or eradication of a cancer) or palliative (measures that are unable to cure a cancer but can reduce pain and suffering). More than one type of therapy may be prescribed. In such cases, the therapy that is added to enhance the effects of the primary therapy is referred to as adjuvant therapy. An example of adjuvant therapy is chemotherapy or radiotherapy administered after surgical removal of a tumor in an attempt to kill any tumor cells that remain following surgery.
Surgical removal of the tumor is generally performed for limited-stage (stage I or sometimes stage II) NSCLC and is the treatment of choice for cancer that has not spread beyond the lung. About 10% to 35% of lung cancers can be removed surgically, but removal does not always result in a cure, since the tumors may already have spread and can recur at a later time. Among people who have an isolated, slow-growing lung cancer removed, 25% to 40% are still alive 5 years after diagnosis. It is important to note that although a tumor may be anatomically suitable for resection, surgery may not be possible if the person has other serious conditions (such as severe heart or lung disease) that would limit their ability to survive an operation. Surgery is less often performed with SCLC than with NSCLC because these tumors are less likely to be localized to one area that can be removed.
The surgical procedure chosen depends upon the size and location of the tumor. Surgeons must open the chest wall and may perform a wedge resection of the lung (removal of a portion of one lobe), a lobectomy (removal of one lobe), or a pneumonectomy (removal of an entire lung). Sometimes lymph nodes in the region of the lungs also are removed (lymphadenectomy). Surgery for lung cancer is a major surgical procedure that requires general anesthesia, hospitalization, and follow-up care for weeks to months. Following the surgical procedure, patients may experience difficulty breathing, shortness of breath, pain, and weakness. The risks of surgery include complications due to bleeding, infection, and complications of general anesthesia.
Radiation therapy may be employed as a treatment for both NSCLC and SCLC. Radiation therapy uses high-energy X-rays or other types of radiation to kill dividing cancer cells. Radiation therapy may be given as curative therapy, palliative therapy (using lower doses of radiation than with curative therapy), or as adjuvant therapy in combination with surgery or chemotherapy. The radiation is either delivered externally, by using a machine that directs radiation toward the cancer, or internally through placement of radioactive substances in sealed containers within the area of the body where the tumor is localized. Brachytherapy is a term used to describe the use of a small pellet of radioactive material placed directly into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope.
Radiation therapy can be given if a person refuses surgery, if a tumor has spread to areas such as the lymph nodes or trachea making surgical removal impossible, or if a person has other conditions that make them too ill to undergo major surgery. Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy, yet in 10% to 15% of people it leads to long-term remission and palliation of the cancer. Combining radiation therapy with chemotherapy can further prolong survival when chemotherapy is administered. External radiation therapy can generally be carried out on an outpatient basis, while internal radiation therapy requires a brief hospitalization. A person who has severe lung disease in addition to a lung cancer may not be able to receive radiotherapy to the lung since the radiation can further decrease function of the lungs. A type of external radiation therapy called the "gamma knife" is sometimes used to treat single brain metastases. In this procedure, multiple beams of radiation coming from different directions are focused on the tumor over a few minutes to hours while the head is held in place by a rigid frame. This reduces the dose of radiation that is received by noncancerous tissues.
For external radiation therapy, a process called simulation is necessary prior to treatment. Using CT scans, computers, and precise measurements, simulation maps out the exact location where the radiation will be delivered, called the treatment field or port. This process usually takes 30 minutes to 2 hours. The external radiation treatment itself generally is done 4 or 5 days a week for several weeks.
Radiation therapy does not carry the risks of major surgery, but it can have unpleasant side effects, including fatigue and lack of energy. A reduced white blood cell count (rendering a person more susceptible to infection) and low blood platelet levels (making blood clotting more difficult and resulting in excessive bleeding) also can occur with radiation therapy. If the digestive organs are in the field exposed to radiation, patients may experience nausea, vomiting, or diarrhea. Radiation therapy can irritate the skin in the area that is treated, but this irritation generally improves with time after treatment has ended.
Both NSCLC and SCLC may be treated with chemotherapy. Chemotherapy refers to the administration of drugs that stop the growth of cancer cells by killing them or preventing them from dividing. Chemotherapy may be given alone, as an adjuvant to surgical therapy, or in combination with radiotherapy. While a number of chemotherapeutic drugs have been developed, the class of drugs known as the platinum-based drugs have been the most effective in treatment of lung cancers.
Chemotherapy is the treatment of choice for most SCLC, since these tumors are generally widespread in the body when they are diagnosed. Only half of people who have SCLC survive for 4 months without chemotherapy. With chemotherapy, their survival time is increased up to four- to fivefold. Chemotherapy alone is not particularly effective in treating NSCLC, but when NSCLC has metastasized, it can prolong survival in many cases.
Chemotherapy may be given as pills, as an intravenous infusion, or as a combination of the two. Chemotherapy treatments usually are given in an outpatient setting. A combination of drugs is given in a series of treatments, called cycles, over a period of weeks to months, with breaks in between cycles.
Unfortunately, the drugs used in chemotherapy also kill normally dividing cells in the body, resulting in unpleasant side effects. Damage to blood cells can result in increased susceptibility to infections and difficulties with blood clotting (bleeding or bruising easily). Other side effects include fatigue, weight loss, hair loss, nausea, vomiting, diarrhea, and mouth sores. The side effects of chemotherapy vary according to the dosage and combination of drugs used and may also vary from individual to individual. Medications have been developed that can treat or prevent many of the side effects of chemotherapy. The side effects generally disappear during the recovery phase of the treatment or after its completion.
Prophylactic brain radiation:
SCLC often spreads to the brain. Sometimes people with SCLC that is responding well to treatment are treated with radiation therapy to the head to treat very early spread to the brain (called micrometastasis) that is not yet detectable with CT or MRI scans and has not yet produced symptoms. Brain radiation therapy can cause short-term memory problems, fatigue, nausea, and other side effects.
Treatment of recurrence:
Lung cancer that has returned following treatment with surgery, chemotherapy, and/or radiation therapy is referred to as recurrent or relapsed. If a recurrent cancer is confined to one site in the lung, it may be treated with surgery. Recurrent tumors generally do not respond to the chemotherapeutic drugs that were previously administered. Since platinum-based drugs are generally used in initial chemotherapy of lung cancers, these agents are not useful in most cases of recurrence. A type of chemotherapy referred to as second-line chemotherapy is used to treat recurrent cancers that have previously been treated with chemotherapy, and a number of second-line chemotherapeutic regimens have been proven effective at prolonging survival. People with recurrent lung cancer who are well enough to tolerate therapy also are good candidates for experimental therapies (see below), including clinical trials.
Targeted therapy:
The drugs erlotinib (Tarceva) and gefitinib (Iressa) are so-called targeted drugs, which may be used in certain patients with NSCLC who are no longer responding to chemotherapy. Targeted therapy drugs more specifically target cancer cells, resulting in less damage to normal cells than general chemotherapeutic agents. Erlotinib and gefitinib target a protein called the epidermal growth factor receptor (EGFR) that is important in promoting the division of cells. This protein is found at abnormally high levels on the surface of some types of cancer cells, including many cases of non-small cell lung cancer.
Other attempts at targeted therapy include drugs known as antiangiogenesis drugs, which block the development of new blood vessels within a cancer. Without adequate blood vessels to supply oxygen-carrying blood, the cancer cells will die. The antiangiogenic drug bevacizumab (Avastin) has also been found to prolong survival in advanced lung cancer when it is added to the standard chemotherapy regimen. Bevacizumab is given intravenously every 2 to 3 weeks. However, since this drug may cause bleeding, it is not appropriate for use in patients who are coughing up blood, if the lung cancer has spread to the brain, or in people who are receiving anticoagulation therapy ("blood thinner" medications). Bevacizumab also is not used in cases of squamous cell cancer because it leads to bleeding from this type of lung cancer.
Cetuximab is an antibody that binds to the epidermal growth factor receptor (EGFR). In patients with NSCLC whose tumors have been shown to express the EGFR by immunohistochemical analysis, the addition of cetuximab may be considered for some patients.
Photodynamic therapy (PDT):
One newer therapy used for different types and stages of lung cancer (as well as some other cancers) is photodynamic therapy. In photodynamic treatment, a photosynthesizing agent (such as a porphyrin, a naturally occurring substance in the body) is injected into the bloodstream a few hours prior to surgery. During this time, the agent is taken up in rapidly growing cells such as cancer cells. A procedure then follows in which the physician applies a certain wavelength of light through a handheld wand directly to the site of the cancer and surrounding tissues. The energy from the light activates the photosensitizing agent, causing the production of a toxin that destroys the tumor cells. PDT has the advantages that it can precisely target the location of the cancer, is less invasive than surgery, and can be repeated at the same site if necessary. The drawbacks of PDT are that it is only useful in treating cancers that can be reached with a light source and is not suitable for treatment of extensive cancers. The U.S. Food and Drug Administration (FDA) has approved the photosensitizing agent called porfimer sodium (Photofrin) for use in PDT to treat or relieve the symptoms of esophageal cancer and non-small cell lung cancer. Further research is ongoing to determine the effectiveness of PDT in other types of lung cancer.
Radiofrequency ablation (RFA):
Radiofrequency ablation is being studied as an alternative to surgery, particularly in cases of early stage lung cancer. In this type of treatment, a needle is inserted through the skin into the cancer, usually under guidance by CT scanning. Radiofrequency (electrical) energy is then transmitted to the tip of the needle where it produces heat in the tissues, killing the cancerous tissue and closing small blood vessels that supply the cancer. RFA usually is not painful and has been approved by the U.S. Food and Drug Administration for the treatment of certain cancers, including lung cancers. Studies have shown that this treatment can prolong survival similarly to surgery when used to treat early stages of lung cancer but without the risks of major surgery and the prolonged recovery time associated with major surgical procedures.
Experimental therapies:
Since no therapy is currently available that is absolutely effective in treating lung cancer, patients may be offered a number of new therapies that are still in the experimental stage, meaning that doctors do not yet have enough information to decide whether these therapies should become accepted forms of treatment for lung cancer. New drugs or new combinations of drugs are tested in so-called clinical trials, which are studies that evaluate the effectiveness of new medications in comparison with those treatments already in widespread use. Experimental treatments known as immunotherapies are being studied that involve the use of vaccine-related therapies or other therapies that attempt to utilize the body's immune system to fight cancer cells. Vaccine therapies against lung cancer are another area in which research is ongoing. In 2010, a treatment vaccine for advanced prostate cancer gained approval by the FDA, and lung cancer treatment vaccines are also being studied in clinical trials.
Treating Nonsmall Cell Lung Cancer
Patients with non-small cell lung cancer may be treated in several ways. The choice of lung cancer treatment depends mainly on the size, location, and extent of the tumor. Surgery is the most common way to treat this type of lung cancer. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of non-small cell lung cancer. Radiation therapy and chemotherapy may also be used to slow the progress of the disease and to manage symptoms.
Treating Small Cell Lung Cancer
Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy. Treatment may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body (such as in the brain). Some patients have radiation therapy to the brain even though no cancer is found there. This treatment, called prophylactic cranial irradiation (PCI), is given to prevent tumors from forming in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.
Side Effects of Lung Cancer Treatment
The side effects of cancer treatment depend on the type of treatment and may be different for each person. Side effects are often only temporary. Doctors and nurses can explain the possible side effects of treatment, and they can suggest ways to help relieve symptoms that may occur during and after lung cancer treatment.
Surgery for lung cancer is a major operation. After lung surgery, air and fluid tend to collect in the chest. Patients often need help turning over, coughing, and breathing deeply. These activities are important for recovery because they help expand the remaining lung tissue and get rid of excess air and fluid. Pain or weakness in the chest and the arm and shortness of breath are common side effects of lung cancer surgery. Patients may need several weeks or months to regain their energy and strength.
Chemotherapy affects normal as well as cancerous cells. Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores, and fatigue.
Radiation therapy
Radiation therapy, like chemotherapy, affects normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the part of the body that is treated and the treatment dose. Common side effects of radiation therapy are a dry, sore throat; difficulty swallowing; fatigue; skin changes at the site of treatment; and loss of appetite. Patients receiving radiation to the brain may have headaches, skin changes, fatigue, nausea and vomiting, hair loss, or problems with memory and thought processes.
Photodynamic therapy
Photodynamic therapy makes the skin and eyes sensitive to light for 6 weeks or more after treatment. Patients are advised to avoid direct sunlight and bright indoor light for at least 6 weeks. If patients must go outdoors, they need to wear protective clothing, including sunglasses. Other temporary side effects of PDT may include coughing, trouble swallowing, and painful breathing or shortness of breath. Patients should talk with their doctor about what to do if the skin becomes blistered, red, or swollen.
Today, because of what has been learned in clinical trials, doctors are able to control, lessen, or avoid many of the side effects of treatment.
How can lung cancer be prevented?
Experts have identified several causes of lung cancer. Most lung cancers are caused by the use of tobacco. Changing your lifestyle can, over time, gradually reduce some of your risk for lung cancer.
Tobacco use is the leading cause of lung cancer. More than 85% of lung cancers are caused by smoking.
To prevent lung and other cancers, do not use tobacco. If you do use tobacco, you can reduce your risk of lung cancer by quitting. Your risk will gradually decrease with time as your lungs recover. Quitting smoking reduces your risk for cancer, and your risk continues to decrease as long as you do not smoke. The benefit of quitting smoking is greater the younger you quit.
Even cutting down how much you smoke may reduce your risk (but not as much as quitting completely). In one study, cutting in half the number of cigarettes smoked each day significantly reduced the risk of getting lung cancer during a 5- to 10-year period.
Other exposure risk factors
Other things that increase your risk of lung cancer include asbestos, secondhand smoke, and radon exposure. Certain occupations, such as mining and farming, expose people to fumes, radioactive dust, or other chemicals that may be harmful. Taking precautions to reduce your exposure to harmful substances in your environment can reduce your risk of developing lung cancer.
Radiation therapy to the chest area can increase your risk.
Recent studies on the connection between diet and lung cancer have shown mixed results. Antioxidants, phytoestrogens (found in a wide variety of whole grains, legumes, vegetables, and soy products), and cruciferous vegetables (like broccoli) may reduce the risk of lung cancer. But there is not clear evidence that these foods help protect high risk people. Other research shows that taking supplements of beta-carotene, vitamin E, and retinoids may actually be harmful and increase the risk of lung cancer in people who continue to smoke.
Nicotine gum, medicated nicotine inhalers, nicotine patches, and oral medicines such as varenicline (Chantix)) or bupropion are available to help you to quit smoking.
Lung Cancer - Home Treatment
During treatment for any stage of lung cancer, you can manage some side effects that may accompany lung cancer or cancer treatment. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet, getting enough sleep, and exercising regularly may help control your symptoms.
Home treatment may help relieve some common side effects of cancer treatment.
Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Your doctor also may prescribe medicines to control nausea and vomiting.
Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.
Home treatment for constipation includes gentle exercise along with adequate intake of fluids and a diet that is high in fruits, vegetables, and fiber. Check with your doctor before using a laxative for your constipation.
Home treatment for fatigue includes making sure you get extra rest while you are receiving chemotherapy or radiation therapy. Let your symptoms be your guide. You may be able to keep your usual routine and just get some extra sleep. Fatigue is often worse at the end of treatment or just after treatment is completed.
Other issues that may arise include:
Hair loss. You may be concerned about losing your hair from cancer treatment. Not all chemotherapy medicines cause hair loss, and some people have only mild thinning that is noticeable only to them. Talk to your doctor about whether hair loss is an expected side effect of the medicines you will receive.
Sleep problems. If you find you have trouble sleeping, having a regular bedtime, doing some exercise during the day, avoiding caffeine late in the day, and taking other steps to relieve sleep problems may help you sleep more easily.
Loss of appetite or difficulty eating. Eating several small meals throughout the day or eating soft, bland foods may help if you do not have an appetite or if certain foods are difficult to eat.
Mouth sores (stomatitis) can be a side effect of certain chemotherapy drugs. There are ways you can reduce your discomfort:
- Drink cold liquids, such as water or iced tea, or eat flavored ice treats or frozen juices.
- Eat foods that are easy to swallow such as gelatin, ice cream, or custard.
- Drink from a straw.
- Rinse your mouth several times a day with a warm saltwater solution. You can make the saltwater mixture with 1 tsp (5 g) of salt in 8 fl oz (0.2 L) of warm water.
- Do not eat or drink acidic foods, such as tomatoes or oranges.
- See other home treatments for a sore mouth.
Coughing. You may have an ongoing cough or develop a severe cough. Your doctor can recommend some nonprescription cough medicines or prescribe some medicines to help relieve your symptoms.
The Importance of Followup Care
Followup care after lung cancer treatment is very important. Regular checkups ensure that changes in health are noticed, and if the cancer returns or a new cancer develops, it can be treated as soon as possible. Checkups may include physical exams, chest x-rays, or lab tests. Between scheduled appointments, people who have had lung cancer should report any health problems to their doctor as soon as they appear.
Providing Emotional Support
Living with a serious disease, such as cancer, is challenging. Apart from having to cope with the physical and medical challenges, people with cancer face many worries, feelings, and concerns that can make life difficult. They may find they need help coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional and psychological burden of having cancer is often part of a patient's treatment plan. The support of the health care team (doctors, nurses, social workers, and others), support groups, and patient-to-patient networks can help people feel less alone and upset, and improve the quality of their lives. Cancer support groups provide a safe environment where cancer patients can talk about living with cancer with others who may be having similar experiences. Patients may want to speak to a member of their health care team about finding a support group.
Questions for Your Doctor
This booklet is designed to help you get information you need from your doctor, so that you can make informed decisions about your health care. In addition, asking your doctor the following questions will help you further understand your condition. To help you remember what the doctor says, you may take notes or ask whether you may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.
- What tests can diagnose lung cancer? Are they painful?
- How soon after the tests will I learn the results?
- What type of lung cancer do I have?
- What lung cancer treatments are recommended for me?
- What clinical trials are appropriate for my type of cancer?
- Will I need to be in the hospital to receive my lung cancer treatment? For how long?
- How might my normal activities change during my lung cancer treatment?
Side Effects of Lung Cancer Treatment
- What side effects should I expect? How long will they last?
- What side effects should I report? Whom should I call?
- After treatment, how often do I need to be checked? What type of followup care should I have?
- Will I eventually be able to resume my normal activities?
The Health Care Team
- Who will be involved with my treatment and rehabilitation? What is the role of each member of the health care team in my care?
- What has been your experience in caring for patients with lung cancer?
Are there support groups in the area with people I can talk to? Are there organizations where I can get more information about cancer, specifically lung cancer?


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Buidling New Bathroom with Bathroom Remodel Ideas
Bathroom remodel ideas will help you in choosing the perfect design for your bathroom in the future. The bathroom becomes an important part in your home. You will definitely feel bothered if you do not have a bathroom. Therefore, you should not underestimate the existence of a bathroom in your home. Make sure you also have a bathroom with a nice style. You should consider it well because after all the bathrooms will always be a part of your home that is paramount.
How to Get Bathroom Remodel Ideas
If you feel bored with the old bathroom you have, you can change it to the bathroom with different models. Bathroom remodeling is certainly not easy. You have to dismantle the bathroom you have first, after that you can only build a new bathroom, Do not let you choose the wrong bathroom design. Give a new twist for the bathroom in order to have a different impression to the bathroom earlier.
What You Need to Consider in Remodelling Bathroom
In addition, you need to consider a few things for the bathroom resulting in a maximum scale. You need to consider some important things like budget that you will spend to remodel your bathroom. Also choose a fresher design than ever before. Of course it will be useless if you change it in the same model again, it will be so boring.
How to Opt Your Best Bathroom Shelves
Bathroom shelves furniture would be interesting to put in your bathroom. If you need a bathroom shelf so you have to choose it wisely. The bathroom is part of your home that plays an important role in your daily life. You must every day go to the bathroom. Therefore, create a bathroom that is convenient and effective for your needs.
How to Choose Bathroom Shelves for Your Minimalist Bathroom
Everyone has different needs, but these shelves will be the same need for everyone. Everyone will need shelves in the bathroom, both start from the usual resident to the top person like a president. Try to choose the appropriate shelves with a bathroom that you have. If you have a bathroom minimalist try to choose shelves with a small size and bright color.
Hot to Style Bathroom
Minimalist bathroom will certainly require you to be more creative in arranging everything. Starting from furniture, and decoration, and so on. Then make sure you have a partner or advisor as an interior designer to help you choose the right rack for your bathroom. You are also strongly advised to choose a decorative shelf to make it look more beautiful.
Inspoirational Double Bathroom Vanities You Need to Try
Double bathroom vanities can be an option for you. If you think one bathroom vanity is usual, then maybe you will feel amazing with double vanities. Double vanities will be interesting because it will make you more practical. You do not need to queue for the mirror because you already have two vanities that will make you reflect along with other people. This sounds interesting and if you are may interested to try it.
What Are Stape in Actualizing Nice Double Bathroom Vanities
The first thing you need to consider in choosing a bathroom vanity is that you have to suit it to your needs. You also have to choose a model that will be available in various models. The model will vary starting from modern models, models of vintage, retro and so forth. You, as a buyer should be smart in choosing furniture that you need. Bathroom vanity with a vintage style will be given its own color to the atmosphere of your bathroom.
The Idea of Vintage Style for Your Bathroom Vanity
Vintage and retro style give the impression of class to your bathroom. You can apply this theme if you want a warmer atmosphere in the bathroom. Vintage style can be actualized through muted colors which are applied to the bathroom vanity. In addition, you can also apply a shabby chic style that seemed so unique. To support the performance of bathroom vanity, you also need to determine the right lighting like chandeliers or LED lighting.
Minimalist Bathroom Storage Ideas
Bathroom storage ideas are the very good thing that you should have if you want to makes your bathroom in the house can looks much more spacious than before. especially if youre one of the people who have the bathroom with small size.
Simple Bathroom Storage Ideas
Having some storage on your bathroom can be the very good thing that will really useful for you, because you can put all the things on your bathroom into this storage and itll makes you have a spacious bathroom without needing you to doing some renovation on it. Add some simple storage on your bathroom also can be the very good thing for you, because besides it can makes your bathroom looks even larger than before. Adding a simple storage on your bathroom also can makes your bathroom looks different.
Cheap and Simple Bathroom Storage
There are also many different kind of storage that you can choose and of course you also will find the different prices on them. If you dont have much money, then maybe the simple and cheap can be the perfect choice for you, because you can safe more money for your another needs. You also dont need to worry, because the cheap one still have a good looks and also good quality.
Small Corner Bathroom Vanity
Corner bathroom vanity can be the good additional accessory that you can use in your bathroom in the house. adding this kind of thing also will makes your bathroom in the house bring something that will makes it looks really different than before. so, if you looking for the best bathroom accessories, this one can be the good choice for you.
How to Choose the Good Corner Bathroom Vanity
The first step that you need to do is knows exactly how large your bathroom. And then the next step is choosing the models that you like. And make sure if it can perfectly suitable for your bathroom theme. And the last step that you need to do is find the one that suitable with your pocket, because it wont makes you spend much money. And thats the three steps that you can do if you looking for the good bathroom vanity for your bathroom in the house.
Simple Small Bathroom Vanity
If you have a small bathroom in your house, choosing the small one is the best choice for you, because with it, you can still makes your bathroom in the house looks really larger and also bigger. And of course you can bring the new different looks inside your bathroom.

subset: commoncrawl


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The 2018 FIFA World Cup was the 21st FIFA World Cup, an international football tournament contested by the men's national teams of the member associations of FIFA once every four years.
Jacksonville Crab Shack Patrice Dunbar, a Joe's Crab Shack customer visiting Wednesday from Jacksonville, said she opposes no tipping. "If you're a good server, you should be rewarded for that," she said. Wayne Gore, a Rock … Panera Bread: Get $3 off an
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Ride To Eat – A list of great places to eat … each worthy of a road trip!


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Its July 4th weekend! Hope everyone's bbq's and pool parties turn out awesome!
This week on @blueleafcom, the articles we posted took on a serious tone. We posted a good few on retirement planning, but also some on the recent decline in the economy and what this means for the long run. We also had a very surprising one on U.S. bank involvement in money laundering. If you've missed them, see below:
Should I Invest or Prepay My Mortgage? – Get Rich Slowly
S&P Index Soon To Be Cheapest Since 1989 – Peridot Capitalist
10 Questions You Should Ask When Considering Retirement – Tech Republic
I Lost A Lot of Money In The Market: Should I Get Out? – Generation X Finance
Why Auto-Enroll 410(k)s May Reduce Retirement Savings – Tax Policy Center
What Happens to Your Stuff When You Die? – Get Rich Slowly
Greenspan: Recent Decline 'Typical' Of Recovery – Yahoo Finance
Reverse Mortgages Now A Less Costly Lifeline – Yahoo Finance
30 vs 15 year Mortgage. Which is Best for First Time Homebuyers? – Wealth Pligrim
IRA Beneficiary Rules: The "Stretch" IRA – Oblivious Investor
How to Create a CD Ladder – Frugal Dad
With Rates This Low, Should You Be Borrowing to Invest? – Darwin's Finance
Volatility On No News – Reuters
U.S. Banks Still Very Involved in Money Laundering – Reuters
What is Goldman Sachs Thinking? – Baseline Scenario
Yet Another Sign of a Shaky Economy – Motley Fool
Personal Income Edges Higher – CNN Money
Who to Blame for The National Debt – Motley Fool
The U.S. Economy Is Headed for A Second-Half Slowdown – Money Morning
Banks Worth a Second Look – Investment News
Have a great weekend!
Photo by: http://www.flickr.com/photos/expressmonorail/ / CC BY-SA 2.0


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Remark: Alluring & enticing, this beautiful Chinese mandarin dress will take your breathe away. Features hand-stitched embroidery of peony flowers in white pure silk and comes with Chinese traditional frog closure, it is sure to turn all heads! Wear this and be the focus of all!
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Details: Charm of Oriental Clothing. Possessing such a fairyland in this city, no wonder Hangzhou enjoys the fame "There is a paradise in heaven and Suzhou and Hangzhou on earth." The name "cheongsam," meaning simply "long dress," entered the English vocabulary from the dialect of China's Guangdong Province (Cantonese). In other parts of the country including Beijing, however, it is known as "qipao", which has a history behind it.
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From a very, very good customer:
"Users are still having issues printing multiple documents. As a workaround, we're having users print out one copy and then photocopying. It seems as if the auto-select paper tray function isn't working. For example, if someone wants to print more than one copy of a print job, the first copy will come out and maybe 1-2 pages of the second copy and then we'll get an error and be asked to select which paper tray to choose. If we select a tray, 1-2 pages will print but then it'll say the job is finished when it isn't."
These are the Ricoh 04 series devices, which now are looking like they were rushed to market. Most users are trying to secure release print documents, though some might be printing directly.
Is anyone else who is using Ricoh and Pharos having these problems?


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Meghan Markle's Ex Is Making a Show About a Woman Who Moves on With a British Prince After Divorce
There are plenty of ways to thrive after a breakup. You could go on a soul-searching vacay or opt for a fresh and fab new haircut. Or you could create a fictional television show that sounds suspiciously familiar to your own experience. Unfortunately for Meghan Markle, who is dating (and may soon be engaged to) Prince Harry, that's exactly what her ex-husband, producer Trevor Engelson, is doing. According to reports, Engelson is working on a series about a man whose ex moves on with a British prince.
Deadline stresses that the currently untitled project, which apparently has interest from Fox, is fictional, and that the lead characters are not based on the actress and her ex. According to the site, the premise is simple (but with oh so many possibilities for quirky comedy and plenty of drama): "Divorce is hard. Sharing custody is harder. Sharing custody with the British Royal family when your wife marries a prince, in the unforgiving spotlight of London's tabloid media, is next level."
While Markle and Engelson, who were married from 2011 to 2013, don't have any children together IRL, you can see why the series would take their situation to the (fictional) extreme.
Per Deadline, Markle has no connection to the project (other than the obvious). But we can't imagine that she'll be especially thrilled over this development.
The 36-year-old actress has kept her romance with the young prince relatively private since the two started dating last year, but she recently opened up to Vanity Fair about their relationship, saying, "We're two people who are really happy and in love. We were very quietly dating for about six months before it became news, and I was working during that whole time, and the only thing that changed was people's perception."
We wonder how people's perception would change (for better or worse) if this show were to get more than just a pilot order.
Would you want to watch Engelson's new show? Let us know @BritandCo.
(Photo via Amanda Edwards/Getty)


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the review site with a difference since 1999
Keyword View: porn
News Jared Fogle reaches plea agreement in porn case
Posted by: News Editor - August 20, 2015, 6:12 am - News
PR HeForShe Campaign Features Star-Studded Cannes Conversation
Leading entertainment journal Variety has partnered with UN Women's HeForShe campaign to host a landmark event on the subject of gender equality within the film industry. Taking place on Saturday 16 May, speakers include Academy Award-nominated actress and producer Salma Hayek, Bollywood star Aishwarya Rai Bachchan, and actress Parker Posey.
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PR The Man with the Iron Fists 2 Unrated on DVD & Digital HD Apr 14
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PR 2 Broke Girls: The Complete Third Season on DVD Sep 30
The comedic duo that goes together like cupcakes and frosting is back in business and more hilarious than ever. Season Three serves up sweet surprises for two of Brooklyn's hottest waitresses, Max (Kat Dennings) and Caroline (Beth Behrs), who continue to dish up sarcasm and smarts. They've got a new cupcake business at the diner's back walk-up window, and Caroline and Max negotiate a work-study program at the Manhattan School of Pastry: Caroline works in the office so Max can study professional baking. Plus, love - and the aroma of freshly cooked tarts - is in the air!
Warner Bros Home Entertainment
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PR Clips from Lovelace on DVD & Blu-ray Nov 5
In 1972 before the internet, before the porn explosion Deep Throat was a phenomenon: the first scripted pornographic theatrical feature film, featuring a story, some jokes, and an unknown and unlikely star, Linda Lovelace. Escaping a strict religious family, Linda discovered freedom and the high-life when she fell for and married charismatic hustler Chuck Traynor. As Linda Lovelace, she became an international sensation.
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DVD Review AROUSED
This is a documentary about 16 porn stars...I don't need to say another word.
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Suffers from a multitude of problems including lack of charisma and drama. Tom Cruise is not a good fit in the Salvation Army clothes of military cop turned heroic drifter, Jack Reacher. Rental only and you really might as well wait for it be on TBS.
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A skin flick of legendary lost status. Shot in Vancouver, British Columbia, it was screened once before disappearing and sought after by cult aficionados for decades. Sex film fans can finally get a look at this elusive crazy Canadian erotic/horror hybrid for the first time ever.
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PR Muay Thai Warrior on Blu-ray, DVD & Digital Mar 5
Betrayed and left for dead, a young Japanese samurai finds a new home in Siam and soon faces his greatest battle against the elite warriors he once regarded as brothers. Based on actual events from the 17th century's Ayutthaya period, Muay Thai Warrior combines lush visuals with a cast of Olympic athletes to provide viewers some of the most stunning and realistic Muay Thai techniques ever filmed for the big screen.
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News Don Jon's Addiction, Lovelace, Kink: It's a "big porn year" at Sundance. (VIDEO)
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DVD Review VISIONS OF ECSTASY
This short, experimental film has been tough to get a hold of for years, thanks, in large part, to it being banned in the UK. Now that such a ban has been lifted, we can see for ourselves what the fuss was all about.
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PR Au Pair Girls on blu-ray Sep 25
Helmed by veteran director Val Guest this '70s British sex comedy about four girls who come to London to work in au pair jobs and immerse themselves in the wild lifestyles of swinging London.
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PR Kill List on DVD & Blu-ray Aug 14
The story of an ex-soldier turned contract killer who plunges into the heart of darkness - and takes the viewer with him on a ride from which there is no return. From director Ben Wheatley comes a mind-blowing genre concoction that marks a new milestone in the annals of modern horror.
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News Henry Winkler, Cheyenne Jackson to play porn stars on Broadway
Posted by: News Editor - July 27, 2012, 9:31 am - News
PR The Life And Death Of A Porno Gang on Blu-ray & DVD Aug 14
During the final days of Slobodan Milosevic's Serbian rule, a young film student named Marko becomes desperate to make a feature film. Finally getting a job as an adult film director, he quickly runs afoul of the mob and needs to get out of town fast! Assembling a traveling group of misfits, Marko and his new friends drive though the quiet countryside in a beat-up van performing live sex acts for peasants and farmers. But life is hard on the road, and they find it hard to earn enough money to survive.
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A funny and perceptive examination into the subculture of big, beefy, burly gay men. After premiering at SXSW in 2010, Bear Nationalso played at the San Francisco International LGBT Film Festival, Outfest Film Festival, Edmonton International Film Festival, and Warsaw Film Festival - among others.
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DVD Review HOUSE OF PLEASURES:
Heavily represented on 2011 "Best Of" lists, this French film promises to be both an erotic and visual treat, boasting one of the largest casts in recent memory.
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Last weekend I had to come up with a fun and festive but healthy treat to bring, and I know the easy thing to do would have been to go out and buy a fruit or veggie tray, but I wanted to make it fun for my daughter so I came up with the idea to use mini cookie cutters to make the cheese in festive shapes.
Here is what I learned and suggest. I bought cracker cuts-precut small squares of cheese and that made the cutting so much easier. I also saved all my cheese scraps for my husband and kids! The cookie cutters were perfect though! I had an old set, but do you think I could remember where I put those? So, Amazon to the rescue!! I ordered this set!
Of course I lined the perimeter of the tray with snowflake crackers! I had to share, because even in the midst of crazy holiday busy-there are so many ways to make it fun and festive and not break the bank! I am simple that's for sure-but this cheese tray made my daughter smile when she took it to school!
Crazy Happy Mom Life


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Ever heard of a dental makeover from the best dentist in the Philippines? Okay, you might've heard of the former but you're not so sure about the latter, right? When looking for the best dentist in the Philippines, there are a few qualities you should remember. Now, I've previously talked about the qualities of the best dental clinic in the Philippines. However, I am yet to talk about the things the best dentist in the Philippines can do for you. I mean, skills and experience are impressive but you'd rather hear of the services available, right? This article will talk about the many things the best dentist can do for you.
Best Dentist in the Philippines: The Services
Now, the best dentist in the Philippines can handle whatever issues you have. But, most people are interested in the cosmetic of dentistry. Fortunately for you, the best dentist offers a myriad of cosmetic dentistry services. Let's start with most common one, teeth whitening. Though there are a couple of methods for dental whitening, the best dentist will offer you the better one.
The next cosmetic service would be tooth repairs. Damaged teeth are a common thing for dental patients. It'd be no surprise to find that most people would find a dentist that specialized in tooth repairs. Luckily, Asian Sun, the best dentist in the Philippines, can offer you a wide array of services regarding that issue.
Services such as dental crowns, porcelain veneers, composite restorations, inlay/onlay, and more. These are the services that aim to fix damaged tooth and improve their aesthetic at the same time. The best one would be dental crowns since they offer a level of versatility no other service can.
But what about missing teeth? I'd go for dentures. However, a lot of patients may not be too welcoming of the idea of it. So, Asian Sun Dental Clinic can offer something a lot better, dental implants. Dental implants are undoubtedly the best service for missing teeth. The only downside, however, is its price. Dental implants are highly expensive.
Image by Cloverdale Crossing Dental Group
Unsure What To Get?
Don't worry, patients are always unsure whether or not a certain service is for them. Fortunately for you, Asian Sun Dental Clinic cares for its patients. So much so that they are the best clinics to consult with. Whatever service or procedure that you're currently confused about, they shall clear everything up.
What Else Do They Offer?
Only the best dentist in the Philippines can give you high-quality dental services at AN AFFORDABLE RATE. You heard that right, Asian Sun's services are affordable. "Which ones?" All of them! Dental crowns, implants, teeth whitening, bridges, and more. All of these services have been made affordable by Asian Sun to benefit the dental needs of the patient. You won't find a dental service on their list that is overpriced. All of the services they offer are made affordable.
So, if you are indeed looking for the best dentist in the Philippines, then Asian Sun Dental Clinic is definitely for you. Theirs is a clinic that genuinely cares for the patient. You won't find a dental clinic that offers better services than they do.


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Putting event technology firmly in the spotlight, Prolight + Sound returned to Messe Frankfurt in Germany for four jam-packed days of product launches, events and networking opportunities. With numerous halls of audio and lighting technology, the show providing a comprehensive overview of the latest industry trends and technologies whilst also offering a huge range of lectures and presentations. Our Asset Operation Manager Adrian Searle headed over to the show to get clued up on the latest innovations hitting the technical production scene in 2018. Adrian talks us through his top Prolight + Sound highlights.
The GrandMA3
The talk of the show from a lighting perspective was the official launch of the new range of control systems from MA lighting - the grandMA3 lighting console series. Announced earlier this year, the grandMA3 was shown to the public for the very first time at the show. The system features ground-breaking concepts from top industry visionaries, presented within a refined user interface, and is designed to make practical tasks more intuitive. With over 13 fully staffed grandMA3 demo stations, it was great to get hands-on with the consoles and see this radical re-think first hand.
Philips Vari-Lite VL2600
The show saw Philips Vari-Lite launch a new family of LED sourced lighting fixtures based on one of its best known products, the VL2500. The New VL2600 family certainly looks to be an impressive line-up with Spot, Wash and Profile in the range. The great news is that all models share common parts so they've been engineered for easy maintenance.
The folks over at Robe are renowned for their show-stopping and spectacular stand designs and Prolight was no exception. Complete with an amazing live Circus show, the manufacturer displayed a huge array of innovative and exciting new products. Robe's incredible new MegaPointe "all-in-one" fixture took centre stage working alongside Tarrantula, their powerful LED beam, wash and effects fixture. The unique design of the stand, along with their live entertainment shows, definitely secured Robe a top spot in my show highlights.
Dante AVIO Adapter
My gadget of the show has to be the Dante AVIO adapters. With Dante becoming the more dominate protocol, the big question has always been how do you integrate audio products that are not Dante enabled? That's not an issue now that the AVIO adapters have arrived. These cool pieces of kit can take a network connection and then convert the Dante to various audio formats. Given the relatively low cost, I can definitely see these becoming a bit of a "Get you out of jail" device.
Main image & Robe image: Messe Frankfurt exhibition GmbH - Jochen Gunther


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Badges (Promotional Items)
Personalised round-shaped badges tend to be a great idea as a fashion article, gift, publicity object, merchandising, advertisement and promotion material.
Each badge can be different and you can put different sentences, images or even the names of your guests.
All prices are subject to VAT (8%)


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Soft & Sweet
Posted by Marla Malcolm Beck on
While there are many bold and bright spring trends, I must say, I am always partial to the soft and sweet nude lip. I have the good fortune to have oodles and oodles of stuff sent to me by the most creative brands in the world. As I got up this morning, I was looking around for a lip color, and came upon NARS Mayflower. I don't know when I got it, or how. I have a feeling they gave it to me in their office one day, but I LOVE this color. It was from Spring 2011's collection and...
- bluemercury, Fall Makeup Trends 2011, Lip Color, Lipstick, NARS, nude lip, sheer, softening lip balm, sweet


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President-elect Donald Trump's recent nominations of Senator Jeff Sessions for Attorney General and retired Gen. Mike Flynn for National Security Advisor are the latest examples of how Trump's administration is shaping up to be a nationalist dream team, says insider Roger Stone.
"We're seeing beginnings of a team of nationalists," Stone said on The Alex Jones Show Friday. "A team of men and women who will put America, not the globalist agenda, first."
"Jeff Sessions is the law-and-order Attorney General that Trump was describing," he continued. "An early Trump supporter, a believer in sealing our borders and the rule of law, and the right man to proceed against the Clintons with a grand jury proceeding."
Gen. Flynn's nomination by Trump for National Security Advisor is also an encouraging sign that America will discontinue its interventionist foreign policy and take the threat of radical Islamic terrorism more seriously.
"It's an enormous deal because it coordinates the activities of the Central Intelligence Agency, Defense Intelligence, the Pentagon – I mean, this is the job Henry Kissinger had," Stone said. "This is the molder of the president's foreign policy."
"He's reflective of the kind of men and women that you're going to get out of a Trump administration."
The globalists had tried and failed to derail Gen. Flynn by claiming he failed to turn in certain paperwork when he filed with the Congress to do some lobbying, Stone pointed out.
"It's not clear that he needed to," he said. "It was an oversight. In no way should it keep with distinguished man from serving in the Trump cabinet."
So far, Trump has appointed Breitbart CEO Steve Bannon as his chief strategist and RNC Chairman Reince Preibus as his Chief of Staff, and nominated Kansas congressman Mike Pompeo for CIA Director, a critic of both Obama's Iran deal and Clinton's handling of Benghazi in 2011.
Fight against the globalists with one of nature's greatest essentials. Survival Shield X-2 is now back in stock at 50% off!


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The past history of Phillip Masters of Earth-772 mirrors that of his Earth-616 counterpart up until the point in which Spider-Man joined the Fantastic Four. Spider-Man's inclusion on the team would lead to Sue being put on the sidelines while the team traveled to the moon and battle Red Ghost and his Super-Apes.
Like his Earth-616 counterpart, Puppet Master would take control of the Sub-Mariner, only in this reality he would capitalize on the fact that Sue Storm was alone on Earth, using her torn emotions between Mr. Fantastic and Namor to lure her to meet the Sub-Mariner and be captured. Using the Sub-Mariner as his pawn, the Puppet Master would lure the rest of the Fantastic Five to battle Namor in Atlantis. In this reality, Namor would shake off the Puppet Master's control, and he would be defeated much in the same way on Earth-616: His submarine being crushed by a giant octopus originally used to guard Susan Storm while Namor battled her comrades[1].
The ultimate fate of the Puppet Master of Earth-772 remains unrevealed, however as his Earth-616 counterpart survived a similar fate it seems unlikely that his encounter with the octopus ended in his death[2].
Powers and Abilities
Seemingly those of Phillip Masters (Earth-616)#Powers.
Links and References
- 1 Appearances of Phillip Masters (Earth-772)
- Minor Appearances of Phillip Masters (Earth-772)
- Media Phillip Masters (Earth-772) was Mentioned in
- 1 Images featuring Phillip Masters (Earth-772)
- Quotations by or about Phillip Masters (Earth-772)
- Character Gallery: Phillip Masters (Earth-772)
Discover and Discuss
- Search this site for: Puppet Master · Phillip Masters · Phillip Masters (Earth-772)
- ↑ What If? #1
- ↑ See Fantastic Four #14 and #19
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