Lung Cancer
By Medicover Hospitals / 16 Feb 2021

Home | cancer | Lung Cancer

Article Context

Overview

  • Lung cancer is the deadliest type of cancer. This causes more deaths each year than breast, colon, and prostate cancer combined. Although smoking has been the leading cause of this, there have also been cases among non-smokers. An X-ray can identify it even if it is asymptomatic in the early stages.
  • Symptoms

  • Some of the common symptoms of lung cancers are:
    • Chronic cough for more than a month
    • Coughing up blood (Hemoptysis)
    • Shortness of breath
    • Wheezing
    • Chest Pain
    • Fatigue
    • Difficulty swallowing
    • Progressive weight loss
    • Loss of appetite
    • Joint problems
    • Swelling of the arms and face

    Causes:

    Smoking:

  • Cigarette smoke consists of greater than 60 recognized carcinogens, along with radioisotopes of the radon decay sequence, nitrosamine, and benzopyrene. In addition, nicotine suppresses the immune response of exposed tissue to cancerous growth. Therefore, it is not surprising that smoking accounts for between 80 and 90% of these cases. Passive smoking is the inhalation of smoke resulting from another person who smokes nearby. A passive smoker can be classified as someone who lives or works with a smoker. Those who live with smokers have a 20-30% higher risk, while those in secondhand smoke environments have a 16-19% higher risk compared to non-smokers who are far from such environments.
  • Gas Radon:

  • Radon is a colorless, odorless gas generated by the decay of radioactive radium. The decay products of radiation ionize genetic material and cause mutations that sometimes turn cancerous. For each increase in radon concentration by 100 Becquerel per atomic mass, the risk increases 8-16%. Becquerel is a unit generated for radioactivity measurement.
  • Asbestos:

  • Asbestos can cause a variety of lung diseases, including this. There is a synergistic impact of smoke and asbestos on the formation of this cancer. Asbestos can cause pleural cancer as well (a thin lining between the lung and the chest wall). An aggressive cancer of the pleura is called mesothelioma and affects the lungs, heart, or abdomen.
  • Air Pollution:

  • Outdoor air pollution has little effect on increasing the risk of this. Fine particulates (PM2.5) and sulfate aerosols, which are released in traffic exhaust gases, increase the risk of this. An increase of 10 parts per billion in nitrogen dioxide increases the risk of this by 14%. Outdoor air pollution is estimated to explain 1-2% of that. There is evidence to show that an increased risk of this is attributed to air pollution, such as burning wood, charcoal, manure, or crop residues for cooking and heating. Women exposed to indoor coal smoke are at approximately twice the risk. Some by-products of biomass burning are suspected carcinogens.
  • Genetics:

  • It is estimated that between 8%-14% of this is because of hereditary factors. In relatives of people with this, the risk increases 2.4 times. This is possibly due to a gene combination.
  • Other Cases:

  • Numerous other environmental substances, occupations, and exposures have been linked to lung cancer which are:
    • Production and extraction of some metals and arsenic compounds
    • By-products of combustion such as carbon monoxide, sulfur dioxide, nitrogen oxides, and lead.
    • Ionizing radiation
    • Toxic gases
    • Production of rubber and crystalline silica powder.

    Types:

    Adenocarcinoma:

  • In bronchioles, this type of cancer grows and is typically found in the outer layers of the lungs. This type of lung cancer has a slow growth rate, and women have a higher risk of developing adenocarcinoma. It usually begins in the glandular cell and some internal organs with the possibility of treatment. Adenocarcinoma is a type of NSCLC (non-small cell lung cancer) that accounts for 80-85% of all these. Where adenocarcinoma has spread to a greater extent, it is known as advanced NSCLC. Treatment of adenocarcinoma lung cancer is subject to severity and the modalities may vary depending on the prognosis. During the advanced stage or fourth stage of this, it develops into large cell lung carcinoma where the cancer cells have spread widely within the lungs from the point of origin. In such cases, the occurrence of this treatment varies.
  • Small Cell Lung Cancer (SCLC):

  • One of the most common culprits for this cancer is smoking, and its symptoms include coughing, shortness of breath, and severe chest pain. Usually, in SCLC, there is an uncontrolled growth of cells that form a tumor in the lungs. About 10-15% is SCLC, which is also known as oat cell cancer. When oat cell cancer has spread widely, it is known as advanced SCLC.
  • Diagnosis:

  • Taking a chest X-ray is one of the first steps in the investigation when a person reports symptoms that may suggest this. This may reveal an obvious mass, widening of the mediastinum (suggesting spread to the lymph nodes there), atelectasis (collapse), consolidation (pneumonia), or pleural effusion. CT images are used to provide more information about the type and extent of the disease. A CT-guided biopsy or bronchoscopy is often used to sample the tumor for histopathology. This often appears as a solitary pulmonary nodule on a chest X-ray. However, the differential diagnosis is broad. Many other diseases can also give this appearance, including tuberculosis, yeast infections, and pneumonia. Less common causes of a solitary pulmonary nodule include hamartomas, bronchogenic cysts, adenomas, arteriovenous malformations, pulmonary sequestration, rheumatoid nodules, Wegener syndrome, or lymphoma, and treatment can vary. This can also be an incidental finding, such as a solitary pulmonary nodule on a chest x-ray or a CT scan is done for an unrelated reason. The clinical diagnosis of this is based on a clinical and radiological, histological analysis of the suspect tissue. It is important to note that a detailed diagnosis is necessary to increase the effectiveness of this treatment. A liquid biopsy detects cancer at an early stage by obtaining a blood sample and looking for cancer cells from a tumor or a piece of DNA from tumor cells that are circulating in the blood. A molecular test can be done along with biopsies, to help in diagnosing cancer.
  • Treatment:

  • When it comes to treating this, you need to understand the specific cell type of cancer, how far it has spread, and the person's overall health. Where cancer has spread to other organs, it is called metastatic lung cancer. Common treatments for this include palliative care, surgery, chemotherapy, and radiation therapy, immunotherapy & targeted therapy. Treatment depends entirely on the stage of cancer.
  • Surgery:

  • If investigations confirm NSCLC (non-small cell lung carcinoma), the stage is evaluated to determine whether the disease is localized and can be treated by surgery or has spread to where it cannot be treated surgically, which is commonly known as metastatic non-small cell lung cancer. Computed tomography and positron emission tomography are commonly used to determine the stage of cancer. If mediastinal lymph node involvement is suspected, mediastinoscopy may sample the nodes and aid in staging to treat this. Blood tests and lung function tests are used to assess whether a person is well enough for surgery. during lung cancer treatment. If lung function tests reveal poor respiratory reserve, surgery may not be a possibility. The reduction of the lobe of the lung (lobectomy) is the surgical procedure of choice in most cases of early-stage NSCLC and is part of stage 1. In people who are not eligible for a complete lobectomy, a smaller sublobar excision is performed. Wedge resection, however, has a greater chance of recurrence than lobectomy. In rare cases, an entire lung is removed (pneumonectomy). Video-assisted thoracoscopic surgery and VATS lobectomy use a minimally invasive approach. VATS lobectomy is equally effective compared to conventional open lobectomy, with the less postoperative disease. In SCLC (small cell lung carcinoma), chemotherapy and/or radiation therapy are used. The function of surgery in SCLC, however, is being reconsidered. Surgery may improve outcomes when added to chemotherapy and radiation in early-stage SCLC. Where small cell lung carcinoma has become metastatic, treatment options include chemotherapy and radiation therapy. To avoid complications, it is recommended that you visit the doctor. During the early stages of diagnosis, cancer care becomes easy.
  • Radiotherapy:

  • Radiation therapy is often given with chemotherapy in treating cancer and can be used with curative intent in people with NSCLC who are not eligible for surgery. This method of radiation therapy with high intensity is called radical radiation therapy. A refinement of this technique is Continuous Hyperfractionated Accelerated Radiation Therapy (CHART), in which a high dose of radiation therapy is administered in a short time. If cancer growth blocks a small section of the bronchus, brachytherapy (localized radiation therapy) may be given directly into the airway to open the tube. Compared to external beam radiation therapy, brachytherapy reduces treatment time and radiation exposure for healthcare personnel. Recent developments in targeting and imaging that have contributed to the advancement of stereotactic radiation in the treatment of early-stage lung cancer include some advancements in lung cancer therapies. In this form of radiation therapy, high doses are administered in a few sessions using stereotaxic targeting techniques. Its use is mainly in patients who are not candidates for surgery due to medical comorbidities.
  • Cyber Treatment:

  • Other advancements include the CyberKnife treatment, which streamlines and optimizes SBRT (Stereotactic Body Radiation Therapy). SBRT is a method of delivering targeted radiation therapy to effectively treat cancer tumors. This latest treatment can adjust the beams based on the small movements made by patients and also on the movement of the tumor caused by breathing during treatment. This precise delivery method allows the tumor to quickly receive the full dose of radiation. For patients with NSCLC and SCLC, smaller doses of radiation to the chest may control symptoms (palliative radiation therapy).
  • Chemotherapy:

  • The chemotherapy regimen depends on the type of tumor. Both small cell lung carcinoma (SCLC) and non-small cell lung carcinoma can be treated with chemotherapy and radiation. In advanced non-small cell lung carcinoma (NSCLC), chemotherapy treatment improves survival rate and is used as a first-line treatment against radiation. While metastatic SCLC is being treated, a check is done to see if the patient is fit enough to receive treatment. Fitness is an important factor in determining patient survival. Adjuvant chemotherapy refers to the use of chemotherapy, after curative surgery, to improve the outcome. Chemotherapy is usually given as the next step in treating cancer after surgery. In NSCLC, nearby lymph nodes are sampled during surgery to aid staging. If stage II or III disease is confirmed, adjuvant chemotherapy improves survival by 5% at five years. Adjuvant chemotherapy as a treatment option for cancer during stage IV is debatable, as clinical trials have not shown a survival benefit or standard success rate. Trials of preoperative chemotherapy (neoadjuvant chemotherapy) have been inconclusive. Patients undergoing chemotherapy can experience side effects during this type of lung cancer treatment, such as hair loss, mouth pain, loss of appetite, nausea, and even vomiting, to name a few.
  • Frequently Asked Questions:

    1. A recent cough that doesn’t go away
    2. Blood coughing, even a slight amount
    3. Shortness of breath
    4. Chest pain
    5. Hoarseness
    6. Lose weight without trying
    7. Bone pain
    8. Headache

    The main leading cause of lung cancer is smoking. Around 90% of cases are caused by smoking itself.

    The key to surviving lung cancer is finding it in its early stages when it is most treatable. The survival rate for people with early-stage lung cancer may range from 80 to 90 percent.

    The 5-year survival rate for NSCLC is 24%, compared to 6% for SCLC.

    If cancer affects the lungs, the tumor can grow so large that it blocks one of the main airways, so that part of the lung cannot be used for breathing or an infection can develop due to the blockage.

    1. Shortness of breath
    2. Pain
    3. Cough
    4. Trouble focusing
    5. Confusion
    6. Extreme tiredness and weakness
    7. Little desire to eat or drink
    8. Restlessness

    Smoking men are 23 times more likely than non-smokers to develop cancer. Most of those affected are 65 or older, only a significant fraction of those affected are under 45 age.

    Citations:

  • lung-cancer, https://www.sciencedirect.com/science/article/abs/pii/S0012369215329810
  • lung cancer symptoms,https://www.sciencedirect.com/science/article/pii/S0885392499001505
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