Lung Cancer

Cancer is a condition in which the cells of the body multiply in an uncontrolled manner. In the case of lung cancers, this abnormal growth either occurs within the lungs or due to spread of cancer cells from another part of the body to the lungs. 

In India, among the new cancer cases, 6.9% are of lung cancer and accounts for 9.3% of deaths caused due to cancer in both men and women. The number of lung cancer cases has increased over time in the cities of Chennai, Bengaluru and Delhi.

There are three types of lung cancer: non-small cell lung cancer, small cell lung cancer and lung carcinoid tumour.

Small cell lung cancer

In small cell lung cancer, the growth of cells and the spread of cancer in the lungs, as well as the other parts of the body, is very quick. When observed under a microscope, the cancer cells of this type appear small and oval shaped. Oat cell cancer is another term that is used to denote small cell lung cancer. It accounts for about 10% to 15% of the cases of lung cancer.

Non-small cell lung cancer

The group of lung cancers under this category have been named based on the appearance of the cancer cells under a microscope. This is the most common type of lung cancer. They account for more than 80% of lung cancer cases. Non-small cell lung cancers are further classified into the following categories:

• Squamous cell carcinoma
• Large cell carcinoma
• Adenocarcinoma 

Lung carcinoid tumour

Lung carcinoid tumours, also called lung neuroendocrine tumours, rarely spread. They have slow growth and constitute less than 5% of all lung cancer cases. This type of cancer originates from the neuroendocrine cells (cells that receive nerve signals and in turn, produce hormones) present in the lungs.

The stages of small cell lung cancer are:

• Limited-stage small cell lung cancer
  In this stage, cancer that has originated in the lung may spread to the collarbone, lymph nodes or the area between the lungs. The spread of cancer cells is limited to the same side of the chest and doesn’t involve the opposite side or other body parts.
• Extensive-stage small cell lung cancer 
  In this stage, cancer spreads outside the lymph nodes or the area between the lungs. It spreads above the collarbone, the opposite side of the chest, and to other body parts.
• Recurrent small cell lung cancer 
  In this stage, cancer comes back after it’s treated. Cancer may recur and spread to the central nervous system, chest, or other body parts.

The stages of non-small cell lung cancer are:

• Stage 0 
  This stage is also called carcinoma in situ (CIS). In this stage, the cancer cells remain at the site of their origin and do not spread.
• Stage 1 – 4 
  Variations in the size of a tumour and its spread into the surrounding tissues.

A lower stage indicates that the extent of spread is less, while a higher stage indicates that the spread is more or extensive. The American Joint Committee on Cancer has provided a staging system for non-small cell lung cancer, known as the TNM system, which uses the following information:

• Tumour (T) 
  The size and growth of a tumour.
• Nodes (N) 
  Presence or spread of cancer in the neighbouring lymph nodes.
• Metastasis (M) 
  Spread of cancer to the glands, bones, the distant organs or the other lung.

The TNM staging system is used to determine the stages of lung carcinoid tumours as well.

Symptoms of lung cancer can be seen in the chest as well as in the rest of the body.

They develop after years and may not be apparent until the advanced stage of the condition. Symptoms of lung cancer that appear in the chest are as follows:

• Haemoptysis (coughing up blood) or a change in sputum colour and amount.
• Recurrent pneumonia (inflammation or swelling and fluid collection in the air sacs) or bronchitis (inflammation in the tubes, which carry air from and to the lungs).
• Chest pain.
• Stridor (making noises while breathing).
• Shortness of breath.
• Shoulder pain.
• Pain at unfamiliar sites while coughing.

When cancer spreads beyond the lungs, the following symptoms are seen in the rest of the body:

• Weakness.
• Cachexia (wasting of muscles as a result of severe illness).
• Bleeding and formation of blood clots.
• Swelling on the face and neck.
• Fractures in the bones without any injuries or accidents.
• Bone and joint pain.
• Memory loss.
• Fatigue.
• Imbalanced gait.
• A headache.
• Weight loss without an apparent reason.
  
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Causes

Leading causes of lung cancer are as follows:

• Cigarette smoking (tobacco)
  A vast majority of the cases of lung cancer are reported in people who smoke. However, people who do not smoke can also develop lung cancer. Cigarette smoking is known to be the cause for more than 85% of lung cancers. Cigarettes contain tobacco and over 60 other toxic cancer-causing elements. Apart from lung cancer, the use of other tobacco products like snuff (powdered tobacco), chewable tobacco, pipe tobacco and cigars also cause mouth cancer and throat cancer.
• Smoking cannabis
  Cannabis has also been linked with lung cancer. People who smoke cannabis usually mix it with tobacco. Cannabis smokers do not smoke frequently but inhale and hold the smoke deep into their lungs for a more extended period than usual. Doctors suggest that smoking four joints (rolled cigars made at home by mixing tobacco and cannabis) may be as detrimental to the lungs as smoking 20 cigarettes. Cannabis also contains cancer-causing substances; therefore, smoking cannabis without tobacco is also dangerous.
• Exposure to harmful chemicals and pollution
  Exposure to certain toxic chemicals in some workplaces, such as industries, increases the risk of developing lung cancer. These substances include:
  • Nickel
  • Cadmium
  • Asbestos
  • Silica
  • Coke fumes
  • Beryllium
  • Arsenic
  • Coal fumes

The risk of developing lung cancer increases by up to 50% in people who are chronically exposed to diesel fumes.

• Radon
  Radon comes from uranium found in rocks and soils. It is a radioactive gas that causes damage to the lungs. The effect of radon is particularly more dangerous to smokers. Approximately 20,000 cases of lung cancer have been reported due to radon, making it the second major cause of lung cancer.

Risk Factors

Some of the risk factors for developing lung cancer are:

• Passive smoking
  Being frequently exposed to others’ tobacco smoke can increase the risk of developing lung cancer.
• Radiation therapy
  People who have been administered radiation therapy to the chest region have a higher risk of developing lung cancer.
• Family history
  People who have a family history of lung cancer or are lung cancer survivors themselves may also be at a higher risk of developing lung cancer.
• Tuberculosis 
  People with tuberculosis tend to have scar tissues in the lungs, which, under certain circumstances, could lead to lung cancer.
• Industrial pollutants 
  Exposure to gasoline, arsenic, mustard gas, coal products, chloromethyl ethers, chromates, uranium, diesel exhaust and beryllium are known risk factors for lung cancer.
• Members of the armed forces 
  Smoking rates are significantly high among past and current military personnel. Military personnel are also at a higher risk of being exposed to materials that contain asbestos and strategic chemicals such as agent orange.

Quitting smoking is the best possible way to prevent the development of lung cancer. The chances of developing lung cancer almost decrease by half if smoking is discontinued for at least ten years. Personalised counselling sessions with physicians or therapists can help individuals quit smoking. Using face masks to prevent inhaling toxic fumes and pollutants also prevents the development of lung cancer.

Some of the diagnostic procedures used by doctors to detect lung cancers include:

• Biopsy 
  A biopsy result allows doctors to assess the severity of cancer. It helps to confirm the diagnosis, grade cancer, and decide the treatment protocol.
• Bronchoscopy 
  The doctor might order a bronchoscopy if CT scan results detect the presence of cancer in the central part of the chest. The procedure takes only a few minutes. The doctor observes the lining and tissues in the lung and examines the airways while performing a bronchoscopy.
• Genetic testing 
  Doctors perform a mutation profiling or molecular profiling to observe the tumour cells of the lung for any changes or mutations that may be the cause of cancer.
• Liquid biopsy 
  A liquid biopsy is a cheaper, non-invasive method used in the diagnosis of lung cancer. It is a blood test that helps detect tumour cells and their DNA fragments in the blood sample.

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Treatment for lung cancer is based on the type and stage of cancer. The following methods are used to treat lung cancer:

Small cell lung cancer

• The concept of treating small cell lung cancer is to reduce the symptoms of cancer and improve the length of life. The treatment regimen includes chemotherapy and radiotherapy or a combination of the two.
• Since small cell lung cancer often spreads to the rest of the body soon, surgery is not considered as a treatment option. However, surgery may be performed if the cancer is detected before it has spread to the rest of the body.
• To reduce the risk of cancer recurrence in people who undergo surgeries, they are given radiotherapy and/or chemotherapy.

Non-small cell lung cancer

Treatment of non-small cell lung cancer can change depending on the development of cancer in the body. The following are the three levels of non-small cell lung cancer according to which the treatment protocol changes:

• When only one lung is affected 
  Surgery may be performed to remove cancer cells from the lung. A course of chemotherapy may also be provided after the surgery to destroy cancer cells that may be present elsewhere in the body.
• When cancer has moderately spread 
  Surgery may not be possible if cancer has spread. Chemotherapy may be given along with radiotherapy, or a radiotherapy only may be provided to destroy any remnants of cancer cells.
• When cancer has spread extensively 
  Chemotherapy is recommended when cancer has spread too far. Radiotherapy or surgery may not be feasible and effective at this point. A chemotherapy course is repeated if cancer continues to grow after the previous course of chemotherapy.

In treating some cases of lung cancer, chemotherapy is replaced by biological therapies. They help in controlling the growth of tumour cells. Targeted therapies are also used in place of chemotherapy in some cases.

Surgical procedures

The surgical options in lung cancer treatment include:

• Pneumonectomy 
  Pneumonectomy is a surgical procedure to remove the lung that is affected by cancer. This surgery is typically performed if the cancer is in the advanced stage and involves major parts of the lung.
• Lobectomy 
  It is a surgical procedure where small sections called lobes of the diseased lung are removed.
• Segmentectomy 
  Segmentectomy is used only in few cases of lung cancer. This surgery is performed when the cancer is confined to one small segment of a lobe of the lung and is small in size. The tiny fragment of the lung that is affected by cancer is removed in this surgery. Segmentectomy is typically performed in the initial stage of non-small cell lung cancer. The other name for this surgery is wedge resection.
• Sleeve resection 
  A fraction of a large airway is surgically removed in this procedure. Achieving or preserving better lung function is possible when there is a possibility to opt for this surgery over pneumonectomy.

Doctors perform spirometry, electrocardiogram and other fitness tests before performing lung cancer surgeries.

Lung carcinoid tumours

Treatment of lung carcinoid tumours depends on the parameters of a tumour such as the size, location and the type of carcinoid tumour. Symptoms presented due to cancer and the presence of any other medical condition affect the treatment protocol. Treatment also depends upon the extent to which cancer has spread, whether it has spread to the lymph nodes or other organs.

The treatment regimens used for lung carcinoid tumours are:

• Surgery.
• Chemotherapy.
• Radiation therapy. 
• Targeted therapies and somatostatin analogues (medicines that reduce the production of certain hormones responsible for the growth of cancer) are given. 
• Treating fluid build-up and airway blockage, performing pleurodesis (a procedure in which medicines are used to attach the lung to the chest wall), are among some of the procedures employed in the treatment of carcinoid tumours.

Lifestyle management

The following tips can help you live better while battling lung cancer:

• Make sure to talk to your doctor about the changes you and your family need to incorporate in daily life.
• Join support groups.
• Discuss your cancer journey with your partner/spouse, friends, or children.
• Seek support from your loved ones and people who have survived cancer.
• Take help from professionals or take up counselling sessions.
• Get tips from your doctor on how to deal with the emotional and physical changes that your body will go through during the cancer treatment.
• Follow up with your medications regularly.
• If the cancer is at its advanced stage, talk to your doctor and counsellors to cope with financial and family burdens.
• Exercise how much you can in order to keep yourself active, positive and keep up your breathing capacity, which tends to reduce in lung cancer.
• Eat healthy food and consume plenty of fresh fruits and vegetables that contain antioxidants and can fight cancer.

Prognosis

The outcomes of lung cancer are better when it is diagnosed in the earlier stages. When the symptoms are produced by the primary tumours (tumours that develop within the lung) rather than metastatic (tumours that spread to the lungs from other areas of the body) tumours or paraneoplastic syndromes (rare disorders that are triggered by a difference in the immune system response to cancer cells), the outcomes are better and survival rates are higher.

Complications

Complications of lung cancer are as follows:

• Problems with concentration and loss of memory.
• Fatigue.
• Mouth sores.
• Bone problems, such as weakening and fractures.
• Weight gain or weight loss due to hormone therapies, chemotherapy and steroid medications.
• Hair loss.
• Pain due to cancer treatment.
• Dental problems.
• Formation of blood clots.
• Rashes.
• Diarrhoea.
• Nausea and vomiting due to medications.