Blog #8-Type of Cancer: Lung Cancer

Pick a cancer, describe symptoms, treatment, and prognosis.

Cancer: Lung Cancer

What is Lung Cancer?

Lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs; usually in the cells that line the air passages. The abnormal cells do not develop into healthy lung tissue, they divide rapidly and form tumors. As tumors become larger and more numerous, they undermine the lung’s ability to provide the bloodstream with oxygen. Tumors that remain in one place and do not appear to spread are known as “benign tumors”.

Malignant tumors, the more dangerous ones, spread to other parts of the body either through the bloodstream or the lymphatic system. Metastasis refers to cancer spreading beyond its site of origin to other parts of the body. When cancer spreads it is much harder to treat successfully.

Primary lung cancer originates in the lungs, while secondary lung cancer starts somewhere else in the body, metastasizes, and reaches the lungs. They are considered different types of cancers and are not treated in the same way.

Types of Lung Cancer:

Lung cancer can be broadly classified into two main types based on the cancer's appearance under a microscope: non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer (NSCLC) accounts for 80% of lung cancers, while small cell lung cancer accounts for the remaining 20%.

NSCLC can be further divided into four different types, each with different treatment options:

§  Squamous cell carcinoma or epidermoid carcinoma. As the most common type of NSCLC and the most common type of lung cancer in men, squamous cell carcinoma forms in the lining of the bronchial tubes.

§  Adenocarcinoma. As the most common type of lung cancer in women and in nonsmokers, adenocarcinoma forms in the mucus-producing glands of the lungs.

§  Bronchioalveolar carcinoma. This type of lung cancer is a rare type of adenocarcinoma that forms near the lungs' air sacs.

§  Large-cell undifferentiated carcinoma. A rapidly growing cancer, large-cell undifferentiated carcinomas form near the outer edges or surface of the lungs.

Small cell lung cancer (SCLC) is characterized by small cells that multiply quickly and form large tumors that travel throughout the body. Almost all cases of SCLC are due to smoking.

Symptoms of lung cancer:

Symptoms of lung cancer that are in the chest:

·         Coughing, especially if it persists or becomes intense

·         Pain in the chest, shoulder, or back unrelated to pain from coughing

·         A change in color or volume of sputum

·         Shortness of breath

·         Changes in the voice or being hoarse

·         Harsh sounds with each breath (stridor)

·         Recurrent lung problems, such as bronchitis or pneumonia

·         Coughing up phlegm or mucus, especially if it is tinged with blood

·         Coughing up blood

If the original lung cancer has spread, a person may feel symptoms in other places in the body. Common places for lung cancer to spread include other parts of the lungs, lymph nodes, bones, brain, liver, and adrenal glands.

Symptoms of lung cancer that may occur elsewhere in the body:

·         Loss of appetite or unexplained weight loss

·         Muscle wasting (also known as cachexia)

·         Fatigue

·         Headaches, bone or joint pain

·         Bone fractures not related to accidental injury

·         Neurological symptoms, such as unsteady gait or memory loss

·         Neck or facial swelling

·         General weakness

·         Bleeding

·         Blood clots

Prevention:

 There's no sure way to prevent lung cancer, but you can reduce your risk if you:

·         Don't smoke. If you've never smoked, don't start. Talk to your children about not smoking so that they can understand how to avoid this major risk factor for lung cancer. Begin conversations about the dangers of smoking with your children early so that they know how to react to peer pressure.

·         Stop smoking. Stop smoking now. Quitting reduces your risk of lung cancer, even if you've smoked for years. Talk to your doctor about strategies and stop-smoking aids that can help you quit. Options include nicotine replacement products, medications and support groups.

·         Avoid secondhand smoke. If you live or work with a smoker, urge him or her to quit. At the very least, ask him or her to smoke outside. Avoid areas where people smoke, such as bars and restaurants, and seek out smoke-free options.

·         Test your home for radon. Have the radon levels in your home checked, especially if you live in an area where radon is known to be a problem. High radon levels can be remedied to make your home safer. For information on radon testing, contact your local department of public health or a local chapter of the American Lung Association.

·         Avoid carcinogens at work. Take precautions to protect yourself from exposure to toxic chemicals at work. Follow your employer's precautions. For instance, if you're given a face mask for protection, always wear it. Ask your doctor what more you can do to protect yourself at work. Your risk of lung damage from workplace carcinogens increases if you smoke.

·         Eat a diet full of fruits and vegetables. Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Avoid taking large doses of vitamins in pill form, as they may be harmful. For instance, researchers hoping to reduce the risk of lung cancer in heavy smokers gave them beta carotene supplements. Results showed the supplements actually increased the risk of cancer in smokers.

·         Exercise most days of the week. If you don't exercise regularly, start out slowly. Try to exercise most days of the week.

Causes of Lung Cancer:

Smoking causes the majority of lung cancers — both in smokers and in people exposed to secondhand smoke. But lung cancer also occurs in people who never smoked and in those who never had prolonged exposure to secondhand smoke. In these cases, there may be no clear cause of lung cancer.

Treatment:

Surgery

A surgical oncologist is a doctor who specializes in treating cancer using surgery. For lung cancer, a thoracic surgeon is specially trained to perform lung cancer surgery. The goal of surgery is the complete removal of the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of normal lung tissue. A “negative margin” means that when the pathologist examines the lung, or piece of lung that has been removed by the surgeon, no cancer was found in the healthy tissue surrounding the tumor.

The following types of surgery may be used for lung cancer:

Lobectomy. The lungs have five lobes, three in the right lung and two in the left lung. For NSCLC, the removal of an entire lobe of the lung in a procedure called a lobectomy is often the most effective type of surgery, even when the lung tumor is very small.

A wedge. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of normal lung.

Segmentectomy. This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer developed.

Pneumonectomy. If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung.

Radiofrequency ablation. Radiofrequency ablation (RFA) is the use of a needle inserted into the tumor to destroy the cancer with an electrical current. It is sometimes used for a lung tumor that cannot be removed with the other types of surgery listed above.

The time it takes to recover from lung surgery depends on how much of the lung is removed and the health of the patient before surgery. Talk with your health care team about what to expect before your surgery, including recovery time and possible side effects.

Adjuvant therapy

Adjuvant therapy is treatment that is given after surgery to lower the risk of the lung cancer returning. Adjuvant therapy may include radiation therapy, chemotherapy, and possibly targeted therapy. Each therapy is described below. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. It also can decrease the risk of recurrence, though there is always some risk that the cancer will come back.

Along with staging, other tools can help determine prognosis and help you and your doctor make decisions about whether adjuvant therapy would be helpful in your treatment. In addition, ASCO provides several Decision Aids to help patients talk with their doctors about the risks and benefits of chemotherapy after surgery. Consider using one of the following decision aids to start a discussion with your doctor about adjuvant therapy: Stage IB, Stage II, or Stage III.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. If you need radiation therapy, you will be asked to see a specialist called a radiation oncologist, a doctor who specializes in giving radiation therapy to treat cancer. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks. When radiation treatment is given using implants, it is called internal radiation therapy, or brachytherapy. However, brachytherapy is rarely used for lung cancer.

Like surgery, radiation therapy cannot be used to treat widespread cancer. Radiation only destroys cancer cells directly in the path of the radiation beam. It also damages the normal cells in its path; for this reason, it cannot be used to treat large areas of the body.

Sometimes, CT scans are used to plan out exactly where to direct the radiation to lower the risk of damaging healthy parts of the body. This is called intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). It is not an option for all patients, but it may be used for patients with early disease and small tumors when surgery is not an option.

Patients with lung cancer who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, patients may also develop a sore throat and have difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation was directed. Most side effects go away soon after treatment is finished.

If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends. About 15% of patients develop this condition, called radiation pneumonitis. If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications, such as prednisone (multiple brand names). Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. Typically, the scarring does not cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath. For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of normal lung tissue exposed to radiation

 Prognosis:

Unfortunately, compared with some other types of cancer, the outlook for lung cancer is not very good. Overall, of all types of lung cancer, about 32 out of every 100 people (32%) will live for at least 1 year after they are diagnosed. Around 10 out of every 100 people (10%) will live for at least 5 years. And about 5 out of every 100 people (5%) will live for at least 10 years.