This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 18, called “Babies & Bathwater”, a young pregnant woman named Naomi is having brain and kidney dysfunction. An x-ray shows a mass in her lung, which turns out to be a type of lung cancer, called small cell lung cancer. The problems she had with her kidney and brain are related to a phenomenon called paraneoplastic syndrome, which often comes with that type of lung cancer.

Photo by Fox.

Danger level: High

What is it?

Lung cancer is a disease in which malignant cells form in the lung.

Who gets it?

Lung cancer is second most common cancer in the US, second only to prostate cancer in men and breast cancer in women. (Throughout the world it’s number 1 in men, and number 5 in women). It’s the leading cause of cancer death in the US.

Lung cancer is twice as common in men than in women. The chances of having it grow as you age.

People who smoke have the greatest risk of developing lung cancer (at least 4 out of 5 cases are associated with cigarette smoking). The risk of lung cancer increases with the number of cigarettes you smoke per day and the number of years you have smoked. About 10% of all smokers eventually develop lung cancer.

There are other risk factors related to developing lung cancer:

1. Exposure to secondhand smoke: Even if you don’t smoke yourself and only exposed to other people’s smoking your risk is higher.
2. Exposure to radon gas in the home: It hasn’t been completely proven, but some studies suggest there’s a relation between this and lung cancer.
3. Exposure to carcinogens: A carcinogen is a substance that’s involved in cancer formation. Examples include asbestos, radiation, arsenic, chromates, nickel, and others.

Smoking is the most proven risk factor for lung cancer. Photo by Helga Weber

What causes it?

The exact mechanism isn’t known. What is known is that there are several types of lung cancer, broadly divided into 2 categories: Small cell lung cancer (the one featured on the House episode) and Non-small cell lung cancer.

These names have been given because of the way the cancer looks under the microscope. But their separation means more than that: Small cell lung cancer is much more aggressive. It spreads quickly, making it particularly threatening. Up to 75% of people diagnosed with this type have a metastatic disease (cancer that has spread) by the time they are diagnosed.

Large cell lung cancer divides into further 3 types, but this is beyond the scope of this article.

How does it feel?

That depends on the type of lung cancer, where the cancer is, and the way it spreads.

One common symptom is a chronic cough. Some people cough up blood or sputum streaked with blood. Other things which may appear include loss of appetite, weight loss, fatigue, chest pain, and weakness.

Lung cancer can also cause all sorts of complications:

1. It can block the airways: This can lead to anything from wheezing, to a collapse of the lungs, to pneumonia.
2. It can cause a “pleural effusion” – that’s fluid that accumulates around your lungs.
3. It can cause something called Horner’s syndrome: Which is a condition in which you have a droopy eyelid, a small pupil, and reduced respiration on one side of the face. This can happen if the tumor hits a nerve on its surroundings.
4. It can cause paraneoplastic syndromes: This is the phenomenon shown on the House episode. These are things caused by the cancer at places far from the cancer itself
5. It can spread to other parts of the body through the bloodstream: areas it tends to spread to include the liver, brain, adrenal glands, spinal cord, or bones.

That’s a partial list. If not treated, it can also lead to death.

How is it discovered?

The first thing done is usually a chest X-ray. A CT scan will show the tumor with more detail, and also discover tumors that an X-ray may have missed.

A biopsy (a piece of the lung taken for examination under a microscope) is usually needed to confirm the diagnosis.

How is it treated?

There are various ways to treat lung cancers. They depend on the type of cancer, its location, its severity, whether it has spread, and the person’s overall health.

Treatments include surgery, chemotherapy and radiation therapy.

What happens after treatment?

Lung cancer isn’t good news, even when treated. On average, people with non-small cell cancer who aren’t treated survive 6 months. Treated, 70% of them may get well and live after 5 years. With small cell lung cancer, less than 1% will live after 5 years.

• Don’t smoke! Also, quitting smoking can lower your chances of developing lung cancer considerably.
• If you live or work with smokers, encourage them to quit and ask them not to smoke around you.
• If you’re exposed to cancer-causing chemicals at work, take necessary safety measures to limit inhalation.

What next?

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