Lung cancer, like other cancers, occurs when cells divide and grow uncontrollably, leading to the formation of a mass or tumor. This abnormal growth easily invades the surrounding tissues and organs, can spread to distant parts of the body, or can regrow after removal, and is referred to as a malignant tumor or cancer.
Who Gets Lung Cancer?
The development of cancer can take years.
Smoking is the most common risk factor that causes the development of lung cancer. Exposure to cigarette smoke (or its components) causes many people to have permanent abnormal changes in their lungs. These changes often lead to the development of a cancerous tumor in the lungs.
However, 25% of all lung cancer cases worldwide are diagnosed in people who have never smoked. In these cases, the underlying cause is not well understood.
Two out of three people diagnosed with lung cancer are over the age of 65.
The most common age at diagnosis is 70.
How Common is Lung Cancer?
In Turkey, the incidence rate of lung cancer has been determined as 60.4 per 100,000 in males and 9.3 per 100,000 in females. The prevalence of lung cancer has been found to be higher in western regions compared to other regions.
What Are the Stages of Lung Cancer?
Staging cancer allows the physician to make treatment decisions and helps the patient understand their own condition by predicting the expected outcomes. Staging can be simply explained as follows:
Localized: Cancer is confined to the lungs.
Regional: Cancer has spread to the lymph nodes in the chest.
Metastatic: Cancer has spread to other parts of the body (or metastasized).
What Are the Types of Lung Cancer?
Most lung cancers start in the membrane (pleura) that surrounds the bronchi. Bronchi are the air passages that branch off from the trachea, which is our windpipe. Lung cancer often develops beneath the membrane that surrounds the bronchi, outside the lungs. These tumors consist of two main types: small cell lung cancer and non-small cell lung cancer, each of which grows and spreads in different ways.
Non-small cell lung cancer is much more common and usually grows and spreads more slowly than small cell lung cancer.
Small cell lung cancer accounts for about 15% of all lung cancers. This type of lung cancer grows rapidly and can quickly spread to other parts of the body after diagnosis.
What Are the Symptoms of Lung Cancer?
Symptoms of lung cancer usually appear as the disease progresses. However, early symptoms that may be observed in some individuals include:
Persistent cough that doesn’t go away
Hoarseness
Coughing up blood or bloody phlegm
Weakness
Wheezing
Recurrent or persistent infections
Chest pain that worsens with coughing or laughing
Advanced lung cancer symptoms include cough, shortness of breath, chest pain, fatigue, and/or unintended weight loss. If the cancer spreads to other areas, symptoms such as bone pain, headaches, muscle weakness, and/or drooping eyelid may occur.
How is Lung Cancer Diagnosed and Managed?
Suspicions of lung cancer usually arise when there is an abnormal finding in chest imaging or when the disease has progressed enough to cause symptoms such as cough, shortness of breath, chest pain, fatigue, and/or weight loss.
Diagnosis requires a biopsy or the removal of cells or tissues from a suspicious mass. Biopsies can be performed through a bronchoscope (called bronchoscopy) or by inserting a needle into the lung tumor through the skin. If these approaches are unsuccessful, surgery may be necessary for a definitive diagnosis.
Biopsy is important in determining whether it is cancer and what type of lung cancer it is.
Lung Cancer Screening
Lung cancer screening involves low-dose chest CT imaging of healthy individuals who are at high risk of developing lung cancer but do not show any cancer symptoms. When performed with high quality, this screening has been found to reduce the number of deaths from lung cancer to an acceptable extent.
How is Lung Cancer Treated?
All relevant information about the patient, including their health condition, the type of tumor, and the extent of its spread, is gathered to design the most appropriate treatment.
Treating lung cancer is challenging. The cell type and stage of cancer determine the survival rate. Cancers diagnosed at a localized stage can be treated. Unfortunately, in most people, the disease is diagnosed when it has spread outside the chest or to the lymph nodes. Additionally, the lungs are delicate organs and may not tolerate certain treatment modalities well. All these factors explain why lung cancer has one of the lowest survival rates among cancer types. The overall two-year survival rate for those diagnosed with lung cancer is 25%. The five-year survival rate drops to 15%.
It is important to discuss the goals of lung cancer treatment with your doctor. Some treatments can be used to control cancer, while others are used to improve quality of life or reduce symptoms. These treatments can be administered alone or in combination.
Chemotherapy and Targeted Therapies:
Chemotherapy involves the use of drugs designed to kill rapidly growing cells, such as cancer cells. Chemotherapy can be administered directly through a vein or taken orally as a pill.
Targeted Drugs:
A newer class of drugs designed to target specific vulnerabilities in cancer cells or supportive tissues like blood vessels.
Chemotherapy affects both normal and cancer cells. Your doctors will try to minimize side effects while effectively treating the cancer. Side effects largely depend on the specific type of drug and dosage administered. They can vary from person to person and may be temporary. Common side effects of chemotherapy include nausea and vomiting, fatigue, hair loss, and mouth sores. Your doctor can suggest ways to manage any side effects and improve symptoms that may arise during and after treatment.
Radiation Therapy
Radiation therapy is a high-energy form of X-ray that kills cancer cells. It can be used as a primary treatment or in conjunction with chemotherapy (with or without surgery). It often plays a significant role in advanced cancer patients by relieving pain, unblocking airways, alleviating shortness of breath, or reducing cough.
Radiation therapy is a “targeted” treatment, meaning it is designed to minimize damage to normal cells while maximizing its effect on cancer cells. Radiation for treating lung cancer is mostly delivered from a machine (external radiation). Occasionally, radiation can be delivered internally using tubes that place radioactive seeds directly near the tumor.
The side effects of radiation therapy mainly depend on the treated area of the body and the radiation dose. Common side effects of radiation therapy to the chest include dry throat, difficulty swallowing, fatigue, skin.
Radiation therapy encompasses a specialized area of innovation known as high-tech approach, sometimes referred to as ‘radiosurgery’. It serves as an effective alternative for selected patients with small tumors who either do not desire or are not suitable for surgery due to safety concerns. Radiotherapy employs highly focused radiation at very high doses, specifically targeting small lung tumors.
Surgery
Surgery is still considered the ‘gold standard’ in the treatment of early-stage lung cancer. Removing the tumor along with the surrounding lung tissue offers the best chance of treatment for those with localized disease. Surgery should be performed by thoracic surgeons specializing in the treatment of lung cancer and other chest malignancies. Your surgeon will determine whether a tumor is removable. Some tumors cannot be removed due to their proximity to vital structures or invasion.
Surgery may not be the optimal choice for patients with multiple medical problems or weak lung function. This situation requires a multidisciplinary approach.
What Types of Surgeries Are Used to Treat Lung Cancer?
The extent of lung tissue removal and the surgical approach depend on the tumor’s location in the lung, size, the patient’s body type/weight, and previous chest surgeries. Minimal invasive approaches are considered for resection. Trained thoracic surgeons routinely perform video-assisted thoracic surgery (VATS) and VATS lobectomy, as well as robotic surgery. Surgical resection of lung cancer is typically performed as follows:
Limited resection: An operation that removes only a small portion of the lung is called segmental or wedge resection.
Lobectomy: The lungs consist of three lobes on the right and two lobes on the left. The removal of these lobes is known as lobectomy. It is the most common surgery for lung cancer.
Pneumonectomy: The complete removal of the entire lung is called pneumonectomy.
The recovery after thoracic surgery depends on the size of the procedure, whether it is performed minimally invasively, and the patient’s age and overall fitness. Many patients return home within three to four days after surgery. Patients who undergo minimal invasive surgery can typically return to work three weeks after the operation.
Pain Management
Pain can be a significant issue for individuals undergoing cancer treatment. Various treatments and the cancer itself can cause pain. Effective pain management helps maintain or improve the patient’s quality of life and reduces the risk of pain-related depression.
Smoking Cessation
Smoking is a significant cause of lung cancer, but quitting smoking can be a challenging process for chronic smokers. Since smoking habits vary from person to person, there is no universally applicable ‘best’ method for quitting. Successful smoking cessation programs employ multiple methods rather than relying on a single approach.
