Lung Cancer

lung cancer

    In the early years of the 20th century, Lung cancer was a rare prognosis. But in the past few years, its incidence has gradually increased and now lung cancer has become the most serious common cancer worldwide that accounts for most cancer-deaths around the world. 

    Today, on World Lung Cancer Day, we take an initiative to educate the public about the complexities of the disease and help improve patient outcomes along with the quality of life.

    What is Lung Cancer

    Lung cancer is the form of cancer that begins in any part of the lungs. As already known, cancer is the condition that leads to the rapid and uncontrollable division of the cells which results in the growth of tumors. Since lungs play a crucial role in the process of respiration, the growth of tumors in the lungs can reduce one’s ability to breathe. 

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    Lung Cancer Causes

    Unlike other forms of cancers, lung cancer is mostly preventable as the major cause for the disease is continued exposure to smoke that damages the lung tissues. Lung cancer can occur in both smokers and non-smokers. 

    To explain in detail, when a person smokes or is exposed to smoke in the case of secondhand or passive smoking, the healthy tissues of lungs get damaged. Fortunately, the damaged cells can be repaired by the lungs over time. But, when the exposure to smoke is consistent for the long-term, it would be difficult for lungs to work on the repair and this leads to permanent damage to the cells. 

    Once the healthy cells or tissues of the lungs get damaged to a much extent and cannot be repaired, they no longer function normally and gradually lead to lung cancer. The risk of developing lung cancer increases with the time how long your lungs are exposed to the smoke. It is obvious that people who smoke are at greater risk, but those who never smoked are also at risk of lung cancer, if they have higher chances of getting exposed to passive smoking. 

    There are significant chances to lower the risk of developing lung cancer and even reduce further damage in case of existing lung cancer, if one quits smoking. Even people who smoked for a long time, have seen great results in improving the symptoms when they stopped smoking. So, it is evident that the risk of developing lung cancer is associated with heavy smoking or persistent exposure to smoke.

    Lung Cancer Symptoms

    Usually, lung cancer doesn’t show any symptoms in its early stages. Patients who develop lung cancer can experience the symptoms as the disease advances, since the tumor growth in the lungs can interfere with respiration and causes difficulty in breathing. 

    Some of the common symptoms of lung cancer may include:

    • Persistent cough that may last up to weeks
    • Shortness of breath
    • Blood in sputum
    • Chest pain while laughing, coughing or taking a deep breathe
    • Wheezing
    • Changes in voice like hoarseness
    • Unexplained weight loss
    • Loss of appetite
    • Fatigue
    • Frequent headaches

    As the lung cancer advances, a person might have severe symptoms such as;

    • frequent respiratory infections such as bronchitis, pneumonia
    • Bone pain, especially at the ribs
    • Difficulty in swallowing
    • Swelling in face, neck or arms

    Lung Cancer Diagnosis

    When a person approaches a doctor with symptoms that might indicate the existence of lung cancer, he/ she will be asked to undergo below mentioned diagnostic tests for further evaluation. These may include:
    • Imaging tests: At first, an x-ray is prescribed to find out the presence of abnormal mass, if any. Otherwise, the patient might ask to get a CT scan done, to reveal any lesions in the lung tissues that might not be detected with the help of an X-ray. In some cases, a CT Angiogram is also prescribed to check out if there are any blood clots or blockages in the lungs. 
    • Sputum cytology: If the patient has a persistent cough that produces phlegm, the doctor asks him/her to get sputum cytology, a study that examines phlegm to determine the presence of cancerous cells in it.
    • Biopsy: In case any lesions or tumors are found in imaging tests, a biopsy is carried out to find out the potential cancer cells. The type of biopsy that has to be carried out depends on the accessibility of the tumors in the lungs. If the lesions can be easily accessible, a bronchoscopy is done to obtain the samples. And the samples from the less accessible tumors in the lung tissues need to be removed with the help of a video-assisted thoracic surgery known as thoracoscopy. 

    Lung Cancer Stages

    Similar to other forms of cancer, even the staging in lung cancer determines the extent of cancer spread in the body.  As the lung cancer is asymptomatic in its early stages, the disease is often diagnosed after its spread. The stages of lung cancer is as mentioned below:

    • Occult stage (Hidden): This is the earliest stage of lung cancer, in which no tumour can be found, but still the cancer cells are present in sputum. 
    • Stage 0: This is the non-invasive stage of lung cancer, where the cancer cells remain in the lung tissues where they have originated and do not spread to the other tissues.
    • Stage I: At this stage, the cancer cells might be present in the underlying tissues of the lungs, but have not spread to the nearby lymph nodes yet. 
    • Stage II: The cancer has affected the nearby lymph nodes and might have spread into the healthy tissues of the chest wall.
    • Stage III: The spread of cancer cells is advanced at this stage, affecting the lymph nodes and nearby structures or organs such as esophagus, trachea and the heart.
    • Stage IV: It is the most advanced stage of lung cancer, in which the cancer has spread beyond the lungs to distant organs of the body.

    Lung Cancer Treatment

    The treatment options for lung cancer will be determined based on the location, stage of the disease and overall well being of the patient.

    The treatment for lung cancer usually involves removal of the cancer or tumor primarily with surgery, radiation or chemotherapy or either with the combination of these treatments in some cases. 

    The various treatment options available for lung cancer are as follows:

    Radiation Therapy:

    Radiation therapy is one of the most effective and primary options for treating cancer. It involves high-powered energy beams from X-rays and protons to destroy cancer cells. 

    In cases of locally advanced lung cancers, radiation therapy can be used to either shrink the size of tumor prior to the surgery or to remove the remaining cancer cells after the surgery is done. Radiation therapy also helps in relieving symptoms of lung cancers in advanced stages. 

    Chemotherapy:

    Chemotherapy uses drugs to kill rapidly growing cancer cells. These drugs are either taken orally or can be given intravenously. Like radiation therapy, chemotherapy can also be used prior to or after the surgery. And, it can be the only treatment option or can be combined with radiation therapy. 

    Immunotherapy:

    Immunotherapy uses drugs to improve one’s immunity to fight back against cancer cells. It is an effective treatment option when cancer cells produce proteins in order to hide from the body’s immune system. Thus, immunotherapy interferes with this process and helps the body’s immune system to attack the cancer.

    Surgery:

    Surgery to treat lung cancer involves removal of the tumor to eliminate cancer from the body. The most common surgeries to treat lung cancer includes.
    • Wedge Resection: Removal of a wedge-shaped section of lung surrounding the tumor along with a margin of healthy tissue
    • Segmental Resection: Removal of a larger section of the lung, but smaller than the lobe of the lung
    • Lobectomy: Removal of an entire lobe of the lung that contains tumor
    • Pneumonectomy: Removal of the entire lung
    lung-cancer-surgery

    Lung Cancer Complications

    As the lung cancer advances, patients might experience severe symptoms that can lead to various complications.  Here are the possible complications of lung cancer:

    • Metastasis: In the advanced stages, lung cancer can spread to the distant parts of the body which include the heart, brain and the bones. This can affect various organs and can cause symptoms like pain, headaches, nausea etc. which can interfere with the patient’s quality of life.
    • Pleural Effusion: Lung cancer can cause fluid buildup in the chest cavity around the affected lung. This can hamper respiration and leads to difficulty in breathing. 
    • Pain: When the cancer spreads to the lining of the lungs or to other parts of the body such as bones, it can cause severe pain. However, with available treatment options, pain can be controlled.
    • Coughing up blood: During the advanced stages of lung cancer, the lining of lungs gets damaged which causes bleeding in the airways. This results in hemoptysis, a condition of coughing up blood.
    • Shortness of breath: When the tumor grows large in size, it can block the major airways that are involved in respiration. Also, there could be fluid accumulation around the lung affected by cancer, which limits the expansion of the lung while inhalation. These reasons can reduce a person’s ability to breathe and lead to shortness of breath.
       MS(AIIMS), MRCS(Edinburgh, UK), M.Ch(Surgical Oncology-Tata Memoral Hospital)
      Director- Surgical Oncology
       MD- Medicover Oncology Institute

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