Lung cancer is one of the most common types of cancer: In 2018, 35,290 men and 21,930 women were diagnosed in Germany, with the average age of onset being 69 (women) and 70 (men) years [1]. On this page, we provide information about warning signs, causes, and risk factors, as well as tailored treatment options.
At ERCM, we support you on your path to your optimal treatment plan. With CyberKnife radiosurgery, for example, we can treat stage T1 and T2 lung cancers if there are no lymph node metastases.
Individual treatment planning for the best possible quality of life: Use our initial consultation to clarify all your questions with our experts.
Worldwide, lung cancer is the most common form of cancer – but its geographical distribution varies greatly from region to region [1]. Lung cancer occurs most frequently in developed countries in Europe and North America – and less frequently in developing countries, especially in parts of Africa and Central America. The incidence also varies considerably within individual countries.
In Germany, lung cancer is the third most common form of cancer in women after breast and colon cancer; in men, lung cancer is the second most common tumor after prostate cancer [1]. The average age of onset is around 70 years. The frequency of initial symptoms increases with advanced stages of cancer [1].
In principle, decisions regarding the individual treatment concept are always discussed and decided together with you as the patient and an interdisciplinary treatment team. These include, for example, oncologists, radiologists, experts in thoracic surgery and radiotherapy.
These interdisciplinary teams have also made progress in recent years, particularly in the treatment of various types of cancer.
At the European Radiosurgery Center Munich, we have extensive experience in the non-invasive treatment of cancer and metastases in the lung area.
The treatment of lung cancer generally requires precise classification of each tumor in terms of size (T), lymph node involvement (N), and additional metastases to other parts of the body (distant metastases, M) [2]. The further the disease progresses, the more pronounced initial symptoms may be [1, 3].
We can treat some patients with the CyberKnife – a robot-guided precision therapy – on an outpatient basis and without surgical intervention, usually in just a single session (average duration: 20 to 30 minutes) [4].
Thanks to modern radiosurgery, our patients benefit from effective, painless and comfortable tumor treatment that is particularly gentle on the surrounding tissue.
No complications arise from fixation or open surgery. An inpatient hospital stay, follow-up treatment, or rehabilitation stay are not required. In most cases, you can resume your normal daily routine and activities after your treatment with us.
Lung cancer – also known in medicine as bronchial carcinoma – occurs when cells of the lung tissue itself degenerate, usually in the alveoli or bronchi [5].
The disease can occur in all areas of the lungs, but the tumors are more commonly found in the upper parts of the lungs [5].
A suspicion of lung cancer should be medically clarified as soon as possible.
The stage of lung cancer is described using the TNM classification. This classification is regularly revised by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) for solid tumors of various organs – for lung cancer, in collaboration with the International Association for the Study of Lung Cancer (IASLC).
T1 primary lung tumors, for example, measure a maximum of 3 cm at their greatest dimension [2]. The main bronchus is not involved at this stage.
T2 lung tumors measure more than 3 cm but less than 5 cm at their greatest dimension. Cancer involving the main bronchus or pleura is also classified at this stage.
Tumors larger than 5 cm are classified as T3, tumors larger than 7 cm as T4 [2].
Lung cancer is further classified according to tissue type into non-small cell A distinction is made between non-small cell lung cancer (NSCLC) tumors—which account for the majority of cases—and small cell lung cancer (SCLC) [3]. This classification is also very important with regard to treatment decisions.
30% of all cancer patients suffer from lung metastases
Metastases from primary tumors in other organs that spread to the lungs are called lung metastases. They can occur either individually (solitary) or as multiple metastases.
Common primary tumors are cancers of the gastrointestinal tract (e.g. stomach, intestine, pancreas), head and neck region (e.g. brain tumors), esophagus, thyroid, adenocarcinomas of the breast, testicular tumors and renal cell carcinomas [6].
In its early stages, lung cancer often causes no symptoms, making diagnosis difficult. It can take several weeks or months for a correct diagnosis to be made. Therefore, any suspected lung cancer should always be medically investigated as soon as possible.
The first warning signs can be, for example:
including possibly weight loss, night sweats, fever
Signs in later stages of the disease may include:
Current research into causes and risk factors shows that air pollution in industrialized regions makes a comparatively smaller contribution than previously assumed [1]. Heavier smoking and more frequent occupational exposure to harmful substances are clearly associated with the increased incidence of lung cancer.
Scientifically proven risk factors include:
The most important sources of particulate matter are combustion processes in industry, coal-fired power plants, household heating, and traffic. However, despite the much-discussed aspect of air pollution, the persistent irritation of lung tissue cells caused by tobacco smoke remains the most important risk factor (as of 2024). The duration of smoking and the number of cigarettes smoked are crucial factors: the earlier smoking begins and the longer smoking continues, the higher the risk.
Exposure to harmful substances at work is thought to be responsible for approximately 9 to 15% of all lung cancer cases [1].
Modern imaging plays a key role in the assessment of lung cancer tumors [7]. Advanced imaging techniques include, in particular, computed tomography (CT) and positron emission tomography (PET) with new tracers.
The tracer method, originating from nuclear medicine, is primarily used for the characterization of smaller lesions, starting from approximately 10 mm in size [6]. The procedure also supports, for example, the precise location of the tumor (localization) and allows conclusions to be drawn about organ function.
Additional tests include laboratory diagnostics (e.g., complete blood count). Depending on the individual, a pulmonary function test (to check your respiratory volume) and a tissue sample (biopsy) may be required.
Modern personalized therapy approaches are based on a variety of factors, including age, other existing medical conditions, and the patient's personal preferences and wishes. Depending on the stage and tissue type of the tumor, various options are considered.
The research and development of effective targeted therapies has brought revolutionary progress in recent years – especially for advanced stages of the disease [ 2, 7, 8]. Insights into genetics have also contributed to a better understanding of lung cancer and the development of new treatment options.
Common treatment methods are:
Microsurgical resection is also a standardized treatment strategy for lung metastases (pulmonary metasectomy) [9]. The most common underlying primary tumor is colorectal cancer [6, 9].
As with primary lung cancer, the individually appropriate treatment concept is always discussed and decided together with you personally and all medical partners of a multidisciplinary team.
Careful follow-up is also crucial for early detection and treatment of potential recurrences. Standard follow-up intervals are usually quarterly for the first two years after completion of initial therapy [3].
As with primary lung cancer, the individually suitable therapy concept is always discussed and decided together with you personally and all medical partners in an interdisciplinary, interdisciplinary team.
Careful aftercare is also crucial in order to be able to detect and treat possible recurrent tumors (recurrences) at an early stage. Usual check-up intervals usually take place at quarterly intervals in the first two years after the end of initial therapy [3].
Robot-guided local precision treatment using CyberKnife technology represents an effective, non-invasive, and safe treatment method for lung cancer, especially in early stages [10, 11, 12]. Suitable situations can particularly benefit from the high targeting accuracy of this novel method when treating tumors with the CyberKnife.
What makes precision medicine so special
CyberKnife therapy combines high-dose, local photon treatment with precise respiratory tracking in a robot-assisted real-time system. We can therefore enable highly precise treatment through optimal tumor tracking [10, 12, 13, 14]. Cancer cells can be precisely targeted and destroyed while simultaneously minimizing damage to surrounding healthy tissue.
In detail, this means that CyberKnife technology – which combines precision robotics with precise image tracking – can compensate for natural movements of your lung or tumor throughout the entire treatment. We know the exact location of the tumor at all times. This enables targeted treatment with a precision of less than 1 mm [10, 15] .
CyberKnife therapy – also for lung metastases
Lung metastases with individual lesions up to 4 cm in diameter and without lymph node involvement can also be treated with the CyberKnife precision robot [12, 13, 15]. This is generally safe and well tolerated by patients [9].
Studies show that robot-guided CyberKnife treatment can be a valuable treatment option for patients with metastatic colorectal cancer and lung metastases who are not surgical candidates [9]. This precision treatment leads to a high local control rate and thus excellent treatment outcomes [11].
It's important to us that you, your family, and loved ones fully understand and assess all aspects of your illness and its treatment options. Together with our medical partners, we will support you throughout this journey and, together with our team, ensure that you feel well cared for at ERCM from the very beginning.
For treatment inquiries, please use the contact form. You can also reach us by phone during our opening hours or via our social media channels.
Your request will be processed individually and promptly.
Surgery is primarily used to treat non-small cell lung cancer. If no lymph nodes are involved and no metastases have formed, surgery is the most effective treatment. In special cases, radiosurgical treatment with the CyberKnife may also be offered. In cases of small cell lung cancer, surgery is often no longer possible.
Brain metastases occur when individual cells from other cancers in the body spread to the brain. Brain metastases are relatively common in lung cancer. Brain metastases are found in as many as 20% of newly diagnosed lung cancer patients.
Lung cancer is often diagnosed at an advanced stage because bronchial carcinoma only causes symptoms late in the disease process. The main risk factor is smoking.
Even passive smokers (people who do not smoke themselves but spend time in rooms where smoking is practiced) have an increased risk of cancer: passive smoking increases the risk of lung cancer by a factor of 1.3.
In addition to chemotherapy, there are novel drug therapies for lung cancer. These include targeted therapy approaches and immunotherapy. In these therapies, special active substances penetrate the bloodstream and destroy or combat the lung tumor.
[1] Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF Leitlinienprogramm Onkologie, Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms, Langversion Version 3.0, 2024, AWMF Registernummer: 020/007 OL; https://www.leitlinienprogramm-onkologie.de/leitlinien/lungenkarzinom/; [letzter Zugriff: 15.12.2024].
https://www.leitlinienprogramm-onkologie.de/leitlinien/lungenkarzinom/
[2] Niehoff, J., Diederich, S., Höink, A., Staging des Lungenkarzinoms nach der revidierten TNM-Klassifikation, Radiol. up2date 2017;17:347-359.
https://doi.org/10.1055/s-0043-119186
[3] Hoch, K., Lungenkarzinom, Radiopraxis 2017;10:47-55.
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https://doi.org/10.1007/s00117-007-1571-z
[5] ONKO-Internetportal Berlin in Kooperation mit der Deutschen Krebsgesellschaft e. V. online, Lungenkrebs, Bronchialkarzinom: Definition und Häufigkeit: https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/definition/lunge-seite-1.html; [letzter Zugriff: 15.12.2024].
https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/definition/lunge-seite-1.html
[6] Krämer, S., Bläker, H., Denecke, T., Nicolay, N., von Laffert, M., et al., Lungenmetastasen: Onkologische Bedeutung und Therapie, Onkologie. 2023;29(3):202-212., S., Bläker, H., Denecke, T., Nicolay, N., von Laffert, M., et al., Lungenmetastasen: Onkologische Bedeutung und Therapie, Onkologie. 2023;29(3):202-212.
https://doi.org/10.1007/s00761-023-01303-2
[7] Nishino, M., Hatabu, H., Johnson, B. E., McLoud, T. C., State of the art: response assessment in lung cancer in the era of genomic medicine, Radiology 2014;271:6-27.
https://doi.org/10.1148/radiol.14122524
[8] ONKO-Internetportal Berlin in Kooperation mit der Deutschen Krebsgesellschaft e. V. online, Genetik verbessert Verständnis von Lungenkrebs: https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/lungenkrebs/genetik-verbessert-verstaendnis-von-lungenkrebs.html; [letzter Zugriff: 15.12.2024].
https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/lungenkrebs/genetik-verbessert-verstaendnis-von-lungenkrebs.html
[9] Von Einem, J. C., Stinzing, S., Modest, D. P., Wiedemann, M., Fürweger, C., et al., Frameless Single Robotic Radiosurgery for Pulmonary Metastases in Colorectal Cancer Patients, Cureus 2020;12(3):e7305.
https://doi.org/10.7759/cureus.7305
[10] Muacevic, A., Drexler, C., Wowra, B., Schweikard, A., Schlaefer, A., et al., Technical description, phantom accuracy and clinical feasibility for single-session lung, radiosurgery using robotic image-guided real-time respiratory tumor tracking, Technol Cancer Res Treat. 2007;6(4):321-328.
https://doi.org/10.1177/153303460700600409
[11] Yan, M., Louie, A. V., Kotecha, R., Ahmed, A., Zhang, Z., Stereotactic body radiotherapy for Ultra-Central lung Tumors: A systematic review and Meta-Analysis and International Stereotactic Radiosurgery Society practice guidelines, Lung Cancer 2023;182:107281.
https://doi.org/10.1016/j.lungcan.2023.107281
[12] Oudin, V., Salleron, J., Marchesi, V., Peiffert, D., Khadige, M., et al., Cyberknife stereotaktische Strahlentherapie für Lungenkrebs im Stadium I und pulmonale Oligometastasen: Ist die Fiducial Implantation noch relevant? – eine Kohortenstudie. J Thorac Dis. 2023;15(9):4636-4647.
https://doi.org/10.21037/jtd-22-1245
[13] Davis, J. N., Medbery, C., Sharma, S., Pablo, J., Kimsey, F., et al., Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch patient registry, Radiat Oncol. 2015;15:10:113.
https://doi.org/10.1186/s13014-015-0417-5
[14] Trumm, C. G., Häußler, S. M., Muacevic, A., Jakobs, T. F., Reiser, M. F., et al., CT Fluoroscopy–Guided Percutaneous Fiducial Marker Placement for Cyberknife Stereotactic Radiosurgery: Technical Results and Complications in 222 Consecutive Procedures, J Vasc Interv Radiol. 2014;25(5):760-768.
https://doi.org/10.1016/j.jvir.2014.01.004
[15] Rentsch, M., Winter, H., Bruns, C. J., Stinzing, S., Angele, M. K., et al., Cyberknife surgery with a radio-scalpel: a new treatment option for patients with unresectable metastases, Zentralbl Chir. 2010;135(2):175-180.
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