Lung Cancer
Lung cancer is a type of cancer that affects the respiratory epithelium, or the cells that make up the lungs. It is often caused by exposure to tobacco or other carcinogens, such as asbestos or due to air pollution. The development of lung cancer is a gradual process that can take several years, starting with premalignant changes in the affected cells that evolve gradually, eventually progressing and developing into a frank malignancy. Stopping exposure to the inciting carcinogen may halt or reverse the progression of the disease, but once it has reached the malignant stage, it is likely to continue to progress.
Lung Cancer Symptoms
What are the symptoms of Lung Cancer?
Persistent coughing
Including coughing up blood
Chest pain
Discomfort, especially when breathing deeply or coughing
Breathlessness
Shortness of breath or difficulty breathing
Voice
Hoarseness or changes in the voice
Frequent infections
Such as bronchitis or pneumonia
Wheezing
Whistling sounds when breathing
Types of Lung Cancer
1. Non-Small Cell Lung Cancer:
- Squamous Carcinoma: seen in smokers and tobacco chewers. Considered highly aggressive, rapidly progressive, and almost always diagnosed in the advanced stages. It is generally diagnosed in an inoperable stage. Treatment is usually palliative, not curative. It is one of the few malignancies that respond extremely well to targeted therapy/ Immunotherapy, usually in combination with chemotherapy. The Immunotherapy response and the need for chemotherapy depend on the PDL1 levels, the classical marker for Immunotherapy. With treatment, the disease can be effectively controlled and the patient can live a good quality life over an extended period.
Adenocarcinoma: Considered the less aggressive type, it consists of the classical triad-so called as it is seen commonly in Asians, women, and non-smokers. It is rarely seen in smokers. Also usually found in the advanced, inoperable stage. However, its trigger involves particular mutations- namely involving EGFR/ALK/ROS 1.
In the majority of patients, one of these mutations is detected on molecular profiling. Air pollution and secondhand smoke are believed to be other causative agents. The above mutations can be targeted with oral tablets, which by setting up a block, suppress the tumor proliferation and push the cancer into remission. The average life span is longer than seen with Squamous carcinomas.
In the absence of the common 3 mutations, others like RAS, MET, RAF, NTRK, and NRG1 are others that should be looked for. Immunotherapy is usually a part of later treatment protocols along with chemotherapy. Another targeted therapy used in Adenocarcinoma is the injectable drug Pemetrexed which is administered in combination with chemotherapy in the absence of a detectable mutation. Most patients will live for a few years with this malignancy, maintaining an excellent quality of life.
2. Small Cell Lung Cancer
This is a malignancy found almost exclusively in smokers. It is a very rapidly multiplying tumor, highly aggressive, and carries a poor prognosis even if detected in the initial stages. It is almost always metastatic, with the brain being involved in a large number of patients. Surgery is usually impossible. Palliative treatment in the form of chemotherapy with or without Immunotherapy forms the back bone of treatment. Radiation is also utilized if the disease is picked up in the limited stage. Survival is usually about 12 to 18 months with treatment as the disease progresses at a frenetic pace. Multiple ongoing clinical trials give us hope of newer therapies to come for this highly lethal disease.
3. Neuroendocrine Cancer or Large cell Neuroendocrine Carcinoma
Carries an intermediate prognosis and is considered less aggressive then Squamous and Small Cell Carcinomas. If detected early, surgery is an option. In the advanced stages it is almost exclusively treated with targeted therapy, directed against particular molecules detected on the tumour. This is a combination of an injection along with oral tablets. Chemotherapy response is inadequate and it is usually not utilised. Extended survival is possible with treatment.
Lung Cancer Identification
Lung Cancer in Non-Smokers
Lung cancer in non-smokers is on the rise globally, with an increasing number of women and younger individuals being affected. Risk factors for this type of cancer include exposure to air pollution, secondhand smoke, indoor air pollution, toxins like arsenic and asbestos, and a positive family history of lung cancer or a damaged lung parenchyma from an inflammatory process. The molecular and genetic changes seen in lung cancer in non-smokers differ from those seen in smokers, with a majority of lung adenocarcinomas exhibiting a particular molecular profile with EGFR mutations. Targeted therapies, such as tyrosine kinase inhibitors and pemetrexed, can be effective in controlling this type of cancer and improving patient prognosis.
Inhaling smoke from others' tobacco increases risk of lung cancer.
13 Signs of Lung Cancer
There are no distinct signs and symptoms that can be definitively attributed to lung cancer. However, given below are those which should arouse suspicion and lead to further evaluation to rule out a possible lung cancer.
- Cough, which is present since awhile, is long lasting, has become chronic and is not responding to antibiotics or supportive care. It may initially be a dry cough and may progress to become productive, bringing out phlegm or blood-streaked mucus.
- A gradual loss of appetite which has developed over a few months. It is unexplained with no known contributing factors.
- Weight loss due to the anorexia ( appetite loss), which is rapid, disproportionate to the food intake, not aided by exercise or any dietary restrictions.
- Weakness and fatigue, with significant restrictions in the daily activities.
- Tendency to feel tired all the time, reluctance in getting out of bed, eating, moving around.
- Fracture of one of the limbs caused by mild trauma.
- Wheezing, hoarseness of voice.
- Haemoptysis, initially seen as blood-streaked sputum, then as clots in the saliva and may later occur in large quantities and prove life-threatening.
- Pain, which may at times be the presenting symptom. Can occur at the primary tumor site or arise at the site of metastases. For example, bony pain due to deposits in the ribs, and vertebrae.
- Sudden onset lower limb weakness and paralysis due to tumor involvement of the vertebrae resulting in spinal cord compression.
- Pleural effusion causing breathlessness and chest pain.
- Headache, vomiting, vision disturbances, imbalance, gait difficulty, weakness or paralysis of upper/lower limbs, all of which can occur to brain metastases of lung cancer.
- Breathlessness which may initially occur on exertion, later progresses to being present at rest. May be intermittent, to begin with, and later become continuous with disease progression.
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Smoking and Cancer Risk
In the 19th and early mid-20th centuries, smoking and tobacco consumption was considered fashionable and initially remained a realm of the rich.
Tons of money was made by tobacco plantation owners, so much so that tobacco actually supported the economy of countries with these plantations. Movies and serials developed in the 1940s and 50s portrayed the protagonist with a cigarette loosely dangling from his lips as he courted his beloved or had a war of words with his nemesis. Actresses smoking were believed to look enigmatic with an air of allure around them.
It was only in the late 60s that definitive reports emerged linking smoking with cancer, primarily lung cancer.
Over time, and currently, it is now a proven fact that tobacco and nicotine are known carcinogens.
Smoking, tobacco chewing, pipe puffing, hookahs, supari, and pan masala with tobacco ingredients all pose a significant risk for the later development of cancer. The lifetime risk of lung cancer in smokers is as high as 30%, compared to non-smokers. The lung cancer risk remains high in these individuals even after an extended duration of smoking having being reduced or stopped.
The mucosa and the epithelium begin to develop molecular changes as a result. This results in changes at a cellular level, mutations, and genetic alterations. All of these result in the development of a pre-malignant condition called field cancerization, which involves all the exposed areas. Smoking cessation can halt and occasionally reverse some of these changes.
The concept that a short duration of tobacco exposure is safe is incorrect and a myth. Smoking affects the health of an individual and their quality of life adversely and is best avoided.
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Son of a patient with stage 4 uterine cancer that spread into the lung.
Lung Cancer Cough: What to know?
A cough can be a symptom of lung cancer, but it is not specific to the disease and can also be caused by other conditions such as infections, allergies, and chronic obstructive pulmonary disease (COPD). Other symptoms of lung cancer include chest pain, shortness of breath, weight loss, and hoarseness of voice. If you have a persistent cough or other symptoms that concern you, it is important to see a doctor for a proper diagnosis. Your doctor may perform tests such as chest X-rays, CT scans, or a biopsy to determine the cause of your symptoms and rule out or confirm a diagnosis of lung cancer.
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Survival Rates: Lung Cancer
Lung cancer is a lethal disease , generally diagnosed in the advanced stages which results in the poor prognosis it carries. Treatments in the advanced stages are palliative and not curative. Meaning they can control the cancer for a period of time but cannot cure it. The higher the stage the disease is detected in, the worse the prognosis. Due to its aggressive nature, there remains a high risk of recurrence even if detected in the initial stages. This holds true even when the cancer has been completely resected and post operative chemotherapy and radiation have been given. Recurrence rates as high as 41% have been observed in some international trials. However, the treatment administered definitely improves the progression free survival and the quality of life.
In stages 3 and 4 where the lung cancer is locally advanced and metastatic respectively, the malignancy usually does recur. The cancer eventually proves terminal as a result. Initial survival rates for a stage 4 lung cancer were less then a year. With systematic treatment guided by molecular evaluation, the overall survival has now improved beyond a year, even with extensive metastases. In Lung Adenocarcinoma, this can stretch to a few years with the use of oral medication. Immunotherapy is another treatment modality which is showing extended periods of survival beyond 18 months in all types of lung cancer including stage 4 Squamous Carcinoma of Lung, which is an extremely aggressive cancer.
Immunotherapy for Lung Cancer
- Immunotherapy is a treatment for lung cancer that uses the body’s immune system to attack and eliminate cancer cells.
- It is used in the treatment of Squamous Carcinoma, Adenocarcinoma and Small Cell Lung Carcinoma.
- Immunotherapy is administered intravenously through a saline solution and is generally well-tolerated.
- Molecular profiling is used to determine if the patient will respond to immunotherapy alone or if it should be used with chemotherapy.
- There are several brands of immunotherapy available, including Nivolumab and Pembrolizumab.
- The precise duration of treatment with immunotherapy is not known, but it has been given for up to 2 years in some cases.
- A number of patients who received extended immunotherapy treatment have experienced long-term remission of their stage 4 lung cancer, although it is not yet clear if it can cure the disease.
- Immunotherapy has been shown to improve overall and progression-free survival in lung cancer patients.
- Research is ongoing to determine the full effects of immunotherapy on lung cancer.
- It is hoped that immunotherapy may eventually be able to cure lung cancer.
Frequently Asked Questions
Lung cancer is a type of cancer that originates in the lungs. It occurs when cells in the lungs grow and divide uncontrollably, forming a mass called a tumor. Lung cancer can be either non-small cell lung cancer or small cell lung cancer, depending on the type of cells involved.
Symptoms of lung cancer can include coughing (including coughing up blood), chest pain, shortness of breath, and weight loss. These symptoms can also be caused by other, less serious conditions, so it is important to see a doctor for a proper diagnosis.
The main risk factor for lung cancer is tobacco consumption and nicotine exposure (smoking). Other risk factors include exposure to secondhand smoke, radon gas, asbestos, and other harmful chemicals.
Lung cancer is typically diagnosed through a combination of medical history, physical examination, and diagnostic tests such as imaging scans (e.g., CT scan, PET scan), bronchoscopy (examination of the airways with a flexible scope), and biopsy (removal of a sample of tissue for testing).
Treatment for lung cancer depends on the type and stage of the cancer, as well as the overall health of the patient. Options may include surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these treatments. In some cases, palliative care (care that focuses on relieving symptoms) may be the most appropriate option.
Lung cancer can often be prevented by avoiding risk factors such as smoking and exposure to secondhand smoke, radon gas, asbestos, and other harmful chemicals. It is also important to get regular screenings with annual Chest CT Scans.
The outlook for lung cancer depends on the stage of the cancer when it is diagnosed and the overall health of the patient. In some cases, the cancer can be cured if it is caught early and treated aggressively. However, in other cases, the cancer may be at a more advanced stage and may not be curable. In these cases, treatment may focus on prolonging survival and improving quality of life.
The prognosis for someone with lung cancer depends on the stage of the cancer at the time of diagnosis, as well as the overall health of the patient. In general, the prognosis is better for those with earlier stage cancers and those who are in good overall health.
A diagnosis of lung cancer can be overwhelming and can bring up a range of emotions. It is important to take care of your emotional and physical well-being during this time. Some things that may help include: talking to a therapist or counselor, joining a support group, getting regular exercise, and maintaining a healthy diet. It can also be helpful to lean on friends and family for support.
Yes, there are clinical trials for lung cancer. Clinical trials are research studies that involve testing new treatments or interventions in people. Participation in a clinical trial can provide access to the latest treatments and can also help contribute to the overall understanding of the disease. If you are interested in participating in a clinical trial, you should discuss this with your doctor.
About Dr. Sujata Vasani
Dr. Sujata Vasani is a Hemato-Oncologist with 18+ years of experience in her field. She currently has her own clinic at Kemps Corner and is an Honorary Consultant at these renowned hospitals – Saifee, Breach Candy, Bhatia, Cumballa, and Dalvi.
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