Lung cancer | My Site

What is lung cancer ?

Lung cancer is a disease caused by uncontrolled cell division in your lungs. Your cells divide and make more copies of themselves as a part of their normal function. But sometimes, they get changes (mutations) that cause them to keep making more of themselves when they shouldn’t. Damaged cells dividing uncontrollably create masses, or tumors, of tissue that eventually keep your organs from working properly.

Lung cancer is the name for cancers that start in your lungs — usually in the airways (bronchi or bronchioles) or small air sacs (alveoli).

Who gets lung cancer ?

Lung cancer can take several years to develop. Tobacco smoking (including cigarettes, bidis, cigars or pipes) is the most common risk factor for developing lung cancer. Many people exposed to tobacco smoke – or some of its components – will end up with permanent abnormal changes in their lungs. These changes can cause a cancerous tumor to develop within the lung. Twenty-five percent of all cases of lung cancer worldwide are diagnosed in people who have never smoked. The underlying cause in these cases is not well understood. Two out of three people diagnosed with lung cancer are over age 65. The most common age at diagnosis is 70 years.

Other risk factors include:

Being exposed to secondhand tobacco smoke.
Being exposed to harmful substances, like air pollution, radon, asbestos, uranium, diesel exhaust, silica, coal products and others.
Having previous radiation treatments to your chest (for instance, for breast cancer or lymphoma).
Having a family history of lung cancer.

What are the types of lung cancer ?

There are many cancers that affect the lungs, but we usually use the term “lung cancer” for two main kinds: non-small cell lung cancer and small cell lung cancer. A third less common type of lung cancer is called carcinoid.

Non-small cell lung cancer (NSCLC)

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. It accounts for over 80% of lung cancer cases. Common types: adenocarcinoma, squamous cell carcinoma and large cell carcinoma

Less common types: Adenosquamous carcinoma and sarcomatoid carcinoma.

Small cell lung cancer (SCLC)

Small cell lung cancer (SCLC) grows more quickly and is harder to treat than NSCLC. It’s often found as a relatively small lung tumor that’s already spread to other parts of your body. Specific types of SCLC include small cell carcinoma (also called oat cell carcinoma) and combined small cell carcinoma.

Other types of cancer in the lungs

Other types of cancer can start in or around your lungs, including lymphomas (cancer in your lymph nodes), sarcomas (cancer in your bones or soft tissue) and pleural mesothelioma (cancer in the lining of your lungs). These are treated differently and usually aren’t referred to as lung cancer.

What are the stages of lung cancer ?

Cancer is usually staged based on the size of the initial tumor, how far or deep into the surrounding tissue it goes, and whether it’s spread to lymph nodes or other organs. Each type of cancer has its own guidelines for staging.

Lung cancer staging

Each stage has several combinations of size and spread that can fall into that category. For instance, the primary tumor in a Stage III cancer could be smaller than in a Stage II cancer, but other factors put it at a more advanced stage. The general staging for lung cancer is:

Stage 0 (in-situ): Cancer is in the top lining of the lung or bronchus. It hasn’t spread to other parts of the lung or outside of the lung.
Stage I: Cancer hasn’t spread outside the lung.
Stage II: Cancer is larger than Stage I, has spread to lymph nodes inside the lung, or there’s more than one tumor in the same lobe of the lung.
Stage III: Cancer is larger than Stage II, has spread to nearby lymph nodes or structures or there’s more than one tumor in a different lobe of the same lung.
Stage IV: Cancer has spread to the other lung, the fluid around the lung, the fluid around the heart or distant organs.

Limited vs. extensive stage

While providers now use stages I through IV for small cell lung cancer, you might also hear it described as limited or extensive stage. This is based on whether the area can be treated with a single radiation field.

Limited stage SCLC is confined to one lung and can sometimes be in the lymph nodes in the middle of the chest or above the collar bone on the same side.
Extensive stage SCLC is widespread throughout one lung or has spread to the other lung, lymph nodes on the opposite side of the lung, or to other parts of the body.

What is metastatic lung cancer ?

Metastatic lung cancer is cancer that starts in one lung but spreads to the other lung or to other organs. Metastatic lung cancer is harder to treat than cancer that hasn’t spread outside of its original location.

What are the symptoms of lung cancer ?

Most lung cancer symptoms look similar to other, less serious illnesses. Many people don’t have symptoms until the disease is advanced, but some people have symptoms in the early stages. For those who do experience symptoms, it may only be one or a few of these:

A cough that doesn’t go away or gets worse over time.
Trouble breathing or shortness of breath (dyspnea).
Chest pain or discomfort.
Wheezing.
Coughing up blood (hemoptysis).
Hoarseness.
Loss of appetite.
Unexplained weight loss.
Unexplained fatigue (tiredness).
Shoulder pain.
Swelling in the face, neck, arms or upper chest (superior vena cava syndrome).
Small pupil and drooping eyelid in one eye with little or no sweating on that side of your face (Horner’s syndrome).

How is lung cancer diagnosed ?

Diagnosing lung cancer can be a multi-step process. Your first visit to a doctor will usually involve them listening to your symptoms, asking you about your health history and performing a physical exam (like listening to your heart and lungs). Since lung cancer symptoms are similar to many other, more common illnesses, you provider may start by getting blood tests and a chest X-ray.

If your provider suspects you could have lung cancer, your next steps in diagnosis would usually involve more imaging tests, like a CT scan, and then a biopsy. Other tests include using a PET/CT scan to see if cancer has spread, and tests of cancerous tissue from a biopsy to help determine the best kind of treatment.

Biopsy

Procedures used to initially diagnose lung cancer or learn more about its spread include:

Needle biopsy: During this procedure, your provider will use a needle to collect samples of fluid or tissue for testing.
Bronchoscopy, thoracoscopy or video-assisted thoracic surgery (VATS): A provider uses these procedures to look at parts of your lungs and take tissue samples.
Thoracentesis: A provider uses this procedure to take a sample of the fluid around your lungs for testing.
Endobronchial ultrasound or endoscopic esophageal ultrasound: A provider uses these procedures to look at and biopsy lymph nodes.
Mediastinoscopy or mediastinotomy: A provider uses these procedures to look at and take samples from the area between your lungs (mediastinum).

How is lung cancer treated ?

Lung cancer is a very challenging cancer to treat. Cell type and stage are the most critical factors in determining the survival rate is the stage at the time of diagnosis. Those that are diagnosed at a localized stage may be curable. Unfortunately, most people are diagnosed when the disease has spread outside the chest (advanced or distant) or involves the nodes in the chest (regional). Also, the lungs are very sensitive organs and may not handle some forms of treatment easily. The overall two-year survival rate of those diagnosed with lung cancer is 25%. At five years, survival rate drops to 15%.

Chemotherapy and targeted therapies

Chemotherapy is the use of drugs that are designed to kill rapidly growing cells, such as cancer cells.
Chemotherapy may be injected directly into a vein (by IV, or intravenously) or given through a catheter, which is a thin tube placed into a large vein and kept there until it is no longer needed. Some chemotherapy drugs are taken orally in pill form.
Targeted agents are a newer class of drugs that are designed to act against specific weaknesses in cancer cells or surrounding supportive tissues, such as blood vessels. These drugs can also be taken orally or by IV. They are most effective in cancers with specific changes in their genes or cell receptors.
Chemotherapy affects both normal cells and cancer cells.
Your doctors will try to prevent side effects as much as possible while treating the cancer appropriately. Side effects depend largely on the specific type of drug and the amount given. They can be different for each person and may be only temporary. Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores and/ or fatigue. Your healthcare providers can suggest ways to make any side effects manageable and to help improve symptoms that may occur during and after procedures.

Radiation therapy

Radiation therapy is a form of high energy X-ray that kills cancer cells. It can be used as a primary treatment, or in combination with chemotherapy (with or without surgery). It often can play an important role in advanced cancer patients by providing relief from pain, blockage of the airways, shortness of breath or coughing.
Radiation therapy is a “focused” treatment, meaning it is designed to maximize its effect on the cancer cells while minimizing injury to normal cells. Radiation to treat lung cancer most often comes from a machine (external radiation). Occasionally, the radiation may be delivered internally using tubes that place a radioactive seed directly near the tumor (internal radiation or brachytherapy).
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 to the chest are a dry, sore throat; difficulty swallowing; fatigue; skin changes at the site of treatment; and/or loss of appetite.

Surgery

Surgery is still considered the “gold standard” for treating early-stage lung cancer. Removing the tumour and surrounding lung tissue gives the best chance for cure for patients whose disease is localized. Surgery should be performed by specialized thoracic surgeons with particular expertise in treatment of lung cancer and other chest malignancies. Your surgeon will determine whether a tumour is removable

What types of surgery are used to treat lung cancer ?

Limited resection: An operation to remove only a small portion of the lung is called a segmental or wedge resection.

Lobectomy: Removal of a defined section of the lung, (there are three lobes of the lung on the right and two on the left), is a lobectomy. This is the most common surgery performed for lung cancer.

Pneumonectomy: The removal of an entire lung is called a pneumonectomy.

Recovery after thoracic surgery depends on the extent of the surgery, whether or not it is performed minimally invasively, as well as the age and overall fitness of the patient.

How can I prevent lung cancer ?

Don’t smoke or quit smoking if you do. Your risk of lung cancer starts coming down within five years of quitting.
Avoid second hand smoke and other substances that can harm your lungs.
Eat a healthy diet and maintain a weight that’s healthy for you. Some studies suggest that eating fruits and vegetables (two to six-and-a-half cups per day) can help reduce your risk of cancer.
Get screened for lung cancer if you’re at high risk.

Lung cancer screening

You can increase your chances of catching cancer in its earliest stages with screening tests. You’re eligible for lung cancer screening if you meet all of these requirements:

You’re between the ages of 50 and 80.
You either currently smoke or have quit smoking within the last 15 years.
You have a 20 pack-year smoking history (number of packs of cigarettes per day times the number of years you smoked).

Ask your provider about the benefits and risks of yearly screening.

What is the outlook for people with lung cancer ?

Your healthcare providers will help you understand what to expect after cancer treatment in terms of follow-up care, lifestyle changes, and making important health-related decisions. If lung cancer is localized or regional and treatment has been administered with the intention of curing the cancer, follow-up testing will be performed to ensure the cancer does not recur. You also will be assessed for side effects related to the treatment received, and treatment will be offered to help with any related symptoms.