Lung Cancer

Lung Cancer

What is lung cancer?

Lung cancer begins in the lungs and may spread to lymph nodes or other organs in the body, such as the brain. Cancer from other organs also may spread to the lungs.

How does lung cancer start?

Lung cancer begins in the lungs and may spread to lymph nodes or other organs in the body, such as the brain. Cancer from other organs also may spread to the lungs.

Can lung cancer be cured?

A key to surviving lung cancer is catching it in its earliest stages, when it is most treatable. For patients who have small, early-stage lung cancer.

Stages of lung cancer

Non-small cell lung cancer has four main stages. In stage 1, the Cancer is found in the lung, but it has not spread outside the lung. Whereas when the cancer is found in the lung and also in nearby nodes is stated as stage 2. And when the cancer is in the lung and lymph nodes in the middle of the chest, is termed as stage 3. The last stage is stage 4 when cancer has spread to both lungs, into the area around the lungs, or to distant organs. The general prognosis of lung cancer is poor in India because doctors tend not to find the disease until it is at an advanced stage.

What is life expectancy with stage 1 lung cancer?

Current statistics suggest that anywhere from 70% to 92% of people with stage 1 non-small cell lung cancer (NSCLC) can expect to live at least five years following their diagnosis.

Can you beat lung cancer if caught early?

Yes, lung cancer can be managed with good quality of life, if diagnosed early

Where does lung cancer spread first?

The lung cancer spreads usually at the lymph nodes.

Symptoms

Symptoms and signs of lung cancer
Symptoms of lung cancer are varied depending upon where and how widespread the tumor is.

A person with lung cancer may have the following kinds of symptoms:

• No symptoms: In up to 25% of people who get lung cancer, the cancer is first discovered on a routine chest X-ray or CT scan as a solitary small mass sometimes called a coin lesion, since on a two-dimensional X-ray or CT scan, the round tumor looks like a coin. These patients with small, single masses often report no symptoms at the time of the cancer discovery.

• Symptoms related to the cancer: The growth of the cancer and invasion of lung tissues and surrounding tissue may interfere with breathing, leading to symptoms such as cough, shortness of breath, wheezing, chest pain, and coughing up blood (hemoptysis). If the cancer has invaded nerves, for example, it may cause shoulder pain that travels down the outside of the arm (called Pancoast syndrome) or paralysis of the vocal cords leading to hoarseness.
  
• Nonspecific symptoms: Nonspecific symptoms seen with many cancers, including lung cancers, include weight loss, weakness, and fatigue. Psychological symptoms such as depression and mood changes also are common.

One should consult a health care professional if he or she develops the symptoms associated with lung cancer, in particular, if they have a persistent cough or worsening of an existing chronic cough, with bronze color blood in the sputum, persistent bronchitis or repeated respiratory infections, chest pain, unexplained weight loss and/or fatigue, and breathing difficulties such as shortness of breath or wheezing.

How quickly can lung cancer develop?

Patients can live with lung cancer for many years before they show any signs or symptoms. For example, it takes around eight years for a type of lung cancer known as squamous cell carcinoma to reach a size of 30 mm when it is most commonly diagnosed.

What is a lung cancer cough like?

A lung cancer cough can either be wet or dry cough and it can occur at any time of day. Many individuals note that the cough interferes with their sleep and feels similar to symptoms of allergies or a respiratory infection.

Diagnosis

Diagnosis of lung cancer

Tests to diagnose lung cancer include imaging tests like an X-ray and a CT scan, sputum cytology and tissue biopsy. Once the diagnosis is made, the state of the cancer is determined using CT scans, magnetic resonance imaging (MRI), positron emission tomography (PET) and bone scans.

At what stage is lung cancer usually diagnosed?

In most cases, patients first diagnosed with either type are found to have stage IV disease. As their names suggests, these types of lung cancer are diagnosed when a pathologist identifies a specific type of diseased cell.

Causes

Causes of lung cancer

While anyone can develop lung cancer, the incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising because of tobacco use.

Lung cancer can also develop if a person has a history of exposure to inhaled chemicals or other toxins. Even if this exposure to chemicals and other toxins was a long time ago, it could cause changes in lung cells that lead to cancer. There are various other risks factors that can cause Lung cancer such as passive smoking, exposure to asbestos fibers, radon gas, and diesel exhaust, familial disposition, HIV infection, various pulmonary diseases, air pollution and other environmental risk factors.

What type of people get lung cancer?

Lung cancer mainly occurs in older people. Most people diagnosed with lung cancer are 65 or older; a very small number of people diagnosed are younger than 45. The average age of people when diagnosed is about 70.

Treatment

Treatments for lung cancer depend on its location and stage, as well as the overall health of the individual. Surgery and radiation are the most common approaches to treating lung cancer, but other treatments are also widely available such as, Chemotherapy and Targeted therapy.

Surgery

Lobectomy: The lungs are made up of 5 lobes (3 on the right and 2 on the left). In this surgery, the entire lobe containing the tumor(s) is removed. If it can be done, this is often the preferred type of operation for NSCLC.

Radiation

The radiation is aimed at the lung cancer tumor and kills the cancer cells only in that area of the lungs. Radiation can be used before lung cancer surgery to shrink the tumor or after surgery to kill any cancer cells left in the lungs. Sometimes external radiation is used as the main type of lung cancer treatment

Targeted Therapy

The most common cancer worldwide is lung cancer. It is marked by having the highest mortality rate among most of the common cancer.

Once lung cancer is diagnosed, it is important to find out how much the cancer has spread. For this, the stage of lung cancer is evaluated, and based on the stage, the treatment is planned. The treatment depends on its type, size of the tumour, the extent to which it has spread and the condition of the patient.

Lung cancer is classified into two major types based upon the microscopic appearance of the tumor cells – Small cell lung cancers and Non-small cell lung cancers.  These two types of cancers grow, spread in different ways with different treatment methods. Now, modern research has revealed several sub-types, each characterized by mutated genes and abnormal proteins. Each of these sub-types can be treated using the new targeted therapies.

Non-small cell lung cancer has four main stages. In stage 1, the Cancer is found in the lung, but it has not spread outside the lung. Whereas when the cancer is found in the lung and also in nearby nodes is stated as stage 2. And when the cancer is in the lung and lymph nodes in the middle of the chest, is termed as stage 3. The last stage is stage 4 when cancer has spread to both lungs, into the area around the lungs, or to distant organs.

Small-cell lung cancer has two main stages. Cancer is found in only one lung or nearby lymph nodes on the same side of the chest in the limited stage, while in the extensive stage, the cancer has spread to complete one lung, to opposite lung, to opposite side lymph nodes, to the pleural fluid and metastasised to distant organs and bone marrow.

The prognosis depends on the stage and is always better in early stage of the cancer when it is localised and not spread to other parts. This is where the role of regular screening comes in particularly in asymptomatic high risk populations.

A low-dose CT scan screening can help show any abnormalities in the lung as small as the size of a grain of rice. This helps to find Stage I curable lung cancer with less likelihood of metastasis to other parts of the body. This gives the doctor more options for the treatment and the patient a higher chance of survival.

In stage 0 and state 1 Non-small cell lung cancer, surgery may be the only treatment needed that removes part of the affected area of lung and lymph nodes. Stage 2 and Stage 3 may need to be treated by a combination of surgery, radiation, chemotherapy and surgery with removal of the cancer affected portion of the lung or even the entire lung along with affected lymph nodes. Immunotherapy and targeted therapy can be of help in treating cancers in Stage 3 and 4, which is otherwise very difficult to treat.

Targeted therapies use drugs or other substances to ‘target’ the cancer cells more precisely and avoid any damage to surrounding normal cells. Targeted therapy is most effective for Non-small cell lung cancer. Targeted therapies work by targeting specific areas in the cancer cells. Targeted therapy matches the therapy to a particular type of cancer in an individual patient which makes it more effective in treating certain types of cancer like lung cancer. The other advantages include fewer side-effects as compared to standard methods of treatment.

There are two main types of targeted therapy – Monoclonal antibodies, called as mAbs and Small molecule drugs. mAbs block a specific target on or around the cancer cells and prevent them from growing further. Given with standard treatment like chemotherapy, they help medication reach cancer cells better. mAbs are usually given intravenously, i.e. in the bloodstream. Small molecule drugs are usually taken orally and they work by preventing the growth and spread of cancer cells.

To ensure greater chance of success with targeted therapy, the patient’s tumor tissue is tested to determine if an appropriate target is present or not. Targeted therapy is most beneficial for patients whose tumor cells have a specific mutation in the gene that defines the target. Patients without the mutation would not be chosen as in their case, the drug would not have anything to target. If a patient has not responded to other therapies or is inoperable, then targeted therapy may be of help.

Immunotherapy in Lung Cancer

The U.S. FDA approved the first immunotherapy to treat a subset of lung cancer patients. Immunotherapy is class of treatments that helps a person’s own immune system eliminate or control cancer. Recent clinical studies treating patients with immunotherapy, either alone or in combination with other treatments, have shown significant patient improvement, resulting in FDA approval of several other immunotherapy options for more lung cancer patients, including approvals to treat patients with immunotherapy as a first-line therapy instead of conventional treatments