Lung Cancer

Lung cancer is a type of cancer that begins in the lungs. Lungs are a part of your respiratory system that help in respiration. Lung cancer is the number one killer among cancers in the United States, among both men and women. Each year it takes more lives than colon, prostate, ovarian and breast cancers combined. You are at a higher risk of developing lung cancer if you smoke. The risk of developing lung cancer increases significantly with the increase in duration and number of cigarettes you smoke. Quitting smoking, even after years of smoking, can considerably reduce the risk of lung cancer. 

Usually, an early stage lung cancer presents no signs and symptoms. Signs and symptoms are experienced once the cancer advances. The signs and symptoms are:

• Persistent cough
• Changes in chronic cough
• Blood in cough
• Shortness of breath
• Difficulty breathing and a whistling sound (wheezing)
• Loss of weight
• Hoarseness
• Headache
• Bone pain

When to see a Doctor

See your doctor if you have any signs and symptoms that concern you. Seek medical advice from your doctor if you are unable to quit smoking. You may be recommended counseling, medications and nicotine replacement therapy that help you quit smoking.

The exact cause of lung cancer is not known.

Majority of people with lung cancer are either smokers or have been exposed to secondhand smoke. However, people who don't smoke or have no exposure to secondhand smoke also develop lung cancer.  It is believed that smoking causes lung cancer by damaging cells lining the lungs. Inhalation of cigarette smoke, which contains carcinogen (chemical that cause cancer), immediately brings changes in the lung tissue. Initially, the damages are repaired. With frequent exposure, the damage of cells lining the lungs progresses to an extent that those cells act abnormally and develop cancer.

The lung cancer is categorized into two major types based on the appearance of lung cancer cells when viewed under microscope:

• Small cell lung cancer: It occurs less commonly and almost exclusively develops in heavy smokers.
• Non-small cell lung cancer: It is more common than small cell lung cancer. It includes several types of lung cancers with similar characteristics. Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma.

Making a diagnosis of lung cancer is done by performing several tests.

If you are suspected to have lung cancer, you may be referred to an oncologist (specialist in treating cancer), a pulmonologist (specialist in lung diseases), a radiation oncologist (doctor who uses radiation to treat cancer), a thoracic surgeon (surgeon who performs lung operations) or a palliative care specialist (doctor who treats signs and symptoms of cancer and cancer treatment).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information.

Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor. Some typical questions can be:

• What could be possible causes of my symptoms?
• What type of lung cancer do I have? Which stage of cancer do I have?
• Do I need any other tests?
• What are the treatment options and side effects of each treatment?
• Is my condition curable?
• Do I need genetic mutation test to determine my treatment options?
• Is smoking cessation beneficial?
• What can I do to relieve my symptoms?
• Am I eligible for clinical trial?
• Can you give me brochures or other material that provides information about lung cancer?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did you first notice the symptoms?
• Are your symptoms continuous or occasional?
• How severe are your symptoms?
• Does anything relieve or aggravate your symptoms?
• Do you wheeze while breathing?
• Have you been diagnosed with emphysema or chronic obstructive pulmonary disease?
• Do you have a cough that feels like you are clearing your throat?
• Have you been prescribed medications for shortness of breath?

Testing healthy people for lung cancer

If you are at increased risk of developing lung cancer, your doctor may recommend CT scans every year to look for lung cancer. Discuss with your doctor about the benefits and risks of lung cancer screening if you smoke or used to smoke and are older than 55. Studies have shown that lung cancer, when diagnosed early, can be treated more successfully. However, some studies have found that lung screening may reveal some other benign conditions which may require other invasive testing and make people unnecessarily worried. If you are suspected to have lung cancer, you doctor may order following tests:

• Imaging tests: An abnormal mass or nodule may be seen in X-ray image of your lung. CT scans can reveal small injury in your lungs which may not be identified on X-ray.
• Sputum cytology: If you have sputum producing cough, the sputum may be viewed under microscope to detect the presence of lung cancer cells.
• Tissue sample (biopsy): In biopsy, a sample of lung cells is removed from the affected site and tested further to determine the presence of cancer cells. Biopsy can be performed by:

1. Bronchoscopy: The abnormal regions of lungs are examined by lighted tube that's passed down your throat and into lungs.
2. Mediastinoscopy: The tissues from lymph nodes that lie behind your breastbone are collected by inserting surgical tools through an incision made at the base of your neck.
3. Needle Biopsy: Under the guidance of X-ray or CT images, needles are inserted through your chest wall to collect cells from the lungs.

Lung cancer staging

Lung cancer staging guides the treatment strategy. Staging tests may include CT scans, magnetic resonance imaging (MRI), positron emission tomography (PET) and bone scans. Stages of lung cancer are:

• Stage I: The tumor is smaller than 2 inches (5 centimeters) and confined to lung.
• Stage II: The tumor may be larger than 2 inches or smaller tumor that has spread to nearby areas, such as chest wall, the diaphragm or pleura (membrane around the lungs). Cancer may have spread to the nearby lymph nodes.
• Stage III: The tumor, at this stage, may have grown larger and invaded other neighboring organs. In this stage, the smaller cancer may spread to lymph nodes that are far from lungs.
• Stage IV: The cancer may have reached other lung or other distant organs of the body.
• Small cell lung cancer can be either limited or extensive. If it's limited, the cancer is confined to one lung only. Extensive small cell lung cancer means the cancer has spread beyond one lung.

Lung cancer treatment plan depends on your overall health, the type and stage of your cancer and your preference. Options include one or more treatments, including surgery, chemotherapy, radiation therapy or targeted drug therapy. If you believe that treatment poses more risk than benefit, you may choose not to take any treatment. In this case, your doctor may provide supportive care to relieve your symptoms, such as pain or shortness of breath.

• Surgery: Your surgeon removes the cancerous portion of your lung and a small portion of healthy tissue. Some of the procedures for removing lung cancer are:

1. Wedge resection: The section of lung containing cancer is removed along with a margin of health tissue.
2. Segmental resection: A larger portion, but not an entire lobe, of lung is removed.
3. Lobectomy: Entire lobe of one lung is removed.
4. Pneumonectomy: An entire lung is removed.

During surgery, your surgeon may remove lymph nodes from your chest to check whether they have signs of cancer. The surgery, however, poses risks like bleeding and infection. You may experience short of breath after surgery. If a segment of your lung is removed, the remaining lung tissue will eventually expand making it easier to breathe. You may be referred to a respiratory therapist who can teach you some breathing exercises to aid in your recovery.

• Chemotherapy: It uses drugs to destroy tumors. Chemotherapy, either alone or in combination, can be given intravenously (through a vein in your arm) or orally. Chemotherapy is often given after surgery to kill the remaining cancer cells. However, chemotherapy may be given before surgery to shrink the cancer cells so that they can be removed easily. The combination of chemotherapy is given over period of weeks or months, with breaks in between to let you recover.
• Radiation therapy: It uses ionizing radiations like X-rays to kill cancer cells. Radiations can be directed to your lungs either from a source outside your body (external beam radiation) or inside your body near the cancer (brachytherapy). It is generally used as first treatment if the lung cancer can't be removed by a surgery. It can also be used after surgery to kill the remaining cancer cells. In people with advanced lung cancer, radiation therapy may be given to relieve pain and other symptoms. Stereotactic body radiotherapy may be a treatment option for people small lung cancers. In this therapy, the radiations are aimed at lung cancer from different angles. It usually requires one or few treatments. In few cases, stereotactic body radiotherapy may be opted instead of surgery.
• Targeted drug therapy: Certain drugs are used to target particular abnormalities in cancer cells. Afatinib, Bevacizumab, Ceritinib, Crizotinib, Erlotinib, Nivolumab, Ramucirumab are drugs that could be used to treat cancer. Few targeted therapies target certain genetic mutations. Before the initiation of therapy, laboratory analysis of susceptibility of cancer cells to the drugs is performed.
• Clinical trials: Clinical trials are research studies which determine whether new cancer treatment works. You may opt for clinical trial if lung cancer treatments are able to treat you. However, cure is not guaranteed. Discuss with your doctor before enrolling in clinical trial.
• Palliative care: Palliative or supportive care focuses to minimize signs and symptoms. You may be referred to palliative care team after your diagnosis and during your cancer treatment. A recent study suggests that people receiving supportive care live longer and claim to have improved mood and quality of life. Palliative doesn’t replace curative treatments but complements your cancer treatments.

You can't prevent lung cancer but minimize the risk of developing it. Here are some tips:

• If you smoke, quit and if you don’t, do not start. Talk to your children about potential hazards of smoking. If you can't quit, you may discuss it with your doctor. Your doctor may suggest nicotine replacement therapy, medication or support group. Avoid secondhand smoke.
• You may need to check radon level in your home. Contact your local department of public health for information on radon testing.
• Avoid exposure to carcinogens (cancer causing substances) or toxic chemicals at work.
• Choose healthy diets. Eat a diet rich in fruits and vegetables. It’s better to obtain vitamins and other nutrients from natural food sources.
• Avoid taking high doses of vitamin pills as they can be harmful. In a recent study, researchers, with hope of reducing the risk of lung cancer, gave beta carotene supplements to heavy smokers. But it increased their risk of developing lung cancer.
• Exercise regularly.

Alternative remedies can't cure your lung cancer but can relieve signs and symptoms.

Following therapies may be helpful:

• Acupuncture: Acupuncture doesn’t have any effect on cancer but may relieve pain and side effects associated with cancer treatment, such as nausea and vomiting. Acupuncture poses risk if you have low blood counts.
• Hypnosis: Hypnosis helps relax, reduce anxiety, nausea and pain in people with cancer. It is done by therapist who guides you through relaxation exercises and makes you think pleasing and positive thoughts.
• Massage: A massage therapist, with his or her hands, applies pressure to your skin and muscles. It helps relieve pain and anxiety. However, pressure shouldn’t be put near tumor or surgical wound. Avoid massage if your blood counts are low.
• Meditation: Meditation is simply a practice of concentration. Meditation can reduce stress and improve quality of life.
• Yoga: Yoga, gentle stretching movements along with deep breathing and meditation may help cancer patients sleep better. Yoga is usually safe when instructed by a trained instructor. Any moves that hurt or don’t feel right should be avoided.

Many people with lung cancer find it difficult to cope up with shortness of breath.

Treatments, such as supplemental oxygen, and medications, can make you feel comfortable. Being fearful and anxious makes it difficult to cope with shortness of breath.

• When you start to feel shortness of breath, try to relax or focus on something that helps you relax.
• Listening to music, meditating, praying or imagining your favorite place for vacation might help. Focus you mind on breathing when you experience shortness of breath.
• Cut off non-essential tasks to save energy since you get easily tired when you feel shortness of breath.
• Breathing with pursed lip and pacing your breathing with your activity can also help.

Diagnosis of cancer can be devastating and life altering.

• Learn enough about your cancer and treatment options.
• Discuss prognosis with your doctor.
• Talk to someone whom you are comfortable with or join a support group.

There are several risks and complications associated with lung cancer.

Risks

• Smoking: Your risk of developing lung cancer is proportional to years of smoking and number of cigarettes you have smoked. Quitting smoking at any age significantly reduce your risk of developing cancer.
• Exposure to secondhand smoke: Your risk of developing lung cancer increases if you are exposed to secondhand smoke
• Exposure to radon gas: Radon, a radioactive gas, is present in the air you breathe. Unsafe level of radon can be tested by radon testing kits. Remedies are available for unsafe level of radon.
• Exposure to asbestos and other carcinogens: Work place exposure of asbestos and carcinogens like arsenic, chromium and nickel can increase the chances of developing cancer especially if you are a smoker.
• Family history of lung cancer: You are at increased risk if you have a family history of lung cancer.

Complications

• Shortness of breath: If growth of cancer occurs in the major airways, you may experience shortness of breath. Accumulation of fluid in lung due to cancer makes it difficult for lungs to work properly.
• Coughing up blood: Hemoptysis (coughing up blood) are caused due to bleeding in the airways. Bleeding, sometimes, can be severe.
• Pain: Advanced lung cancer can spread to other areas of the body, such as a bone, thereby causing pain. Inform your doctor if you experience pain. Pain may initially be mild and intermittent, but can become constant over time. Medications, radiation therapy and other treatments can be used to reduce pain.
• Fluid in the chest (pleural effusion): Lung cancer can cause fluid accumulation in the space that surrounds the lung. Accumulation of fluid in the chest can cause shortness of breath.
• Metastasis: Lung cancer often spreads (metastasizes) to other parts of the body, such as the brain and the bones. The signs and symptoms depend on the organ that is affected. Cure is often impossible if the lung cancer has spread to other organs. Treatments are available to improve the quality of life.