Lung Cancer

Lung cancer is the third most common cancer in the U.S. It’s caused by harmful cells in your lungs growing unchecked. Treatments include surgery, chemotherapy, immunotherapy, radiation and targeted drugs. Screening is recommended if you’re at high risk. Advances in treatments have caused a significant decline in lung cancer deaths in recent years.

What is Lung Cancer?
Lung cancer is a condition characterized by the uncontrolled growth of cells in the lungs. Normally, cells divide in a regulated manner to produce more cells only when they are needed. However, sometimes these cells undergo changes, or mutations, that cause them to multiply uncontrollably. This unregulated cell division results in the formation of masses or tumors, which can interfere with the normal functioning of the lungs. These abnormal cells can also invade nearby tissues and spread to other parts of the body in a process known as metastasis. This is a simplified explanation, and the actual process involves a complex interplay of genetic and environmental factors. It’s important to note that not all lung tumors are cancerous; tumors can also be benign, meaning they do not spread to other parts of the body.
Lung cancer refers to malignancies that originate in the lungs, typically in the bronchi, bronchioles, or alveoli. These structures are the airways and small air sacs responsible for oxygen exchange. However, it’s important to distinguish between primary lung cancer and metastatic lung cancer. Primary lung cancer begins in the lungs, while metastatic lung cancer starts elsewhere in the body and later spreads to the lungs. In the case of metastatic lung cancer, the cancer is named after its place of origin. For instance, if breast cancer spreads to the lungs, it’s still referred to as breast cancer, but it is said to have metastasized to the lungs.

What are the different forms of lung cancer?
Lung cancers primarily fall into two main categories: Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC).
1. Non-Small Cell Lung Cancer (NSCLC) is the most common type, accounting for over 80% of all lung cancer cases. It includes several subtypes, with adenocarcinoma and squamous cell carcinoma being the most common. Adenosquamous carcinoma and sarcomatoid carcinoma are rarer types of NSCLC.
2. Small Cell Lung Cancer (SCLC), on the other hand, typically grows faster and is more challenging to treat than NSCLC. It often presents as a small lung tumor that has already spread to other parts of the body. Variants of SCLC include small cell carcinoma, also known as oat cell carcinoma, and combined small cell carcinoma.

What are the stages of lung cancer?
Cancer staging is typically based on the size of the initial tumor, its penetration into surrounding tissues, and whether it has spread to lymph nodes or other organs. Each type of cancer has its own specific guidelines for staging.

When it comes to lung cancer, each stage can encompass various combinations of tumor size and spread. For example, a Stage III cancer could have a smaller primary tumor than a Stage II cancer, but other factors may categorize it as a more advanced stage. Here’s a general overview of lung cancer stages:
· Stage 0 (in-situ): The cancer is located in the top lining of the lung or bronchus and has not spread to other parts of the lung or outside of the lung.
· Stage I: The cancer has not spread outside the lung.
· Stage II: The cancer is larger than in Stage I, has spread to lymph nodes inside the lung, or there is more than one tumor in the same lobe of the lung.
· Stage III: The cancer is larger than in Stage II, has spread to nearby lymph nodes or structures, or there is more than one tumor in a different lobe of the same lung.
· Stage IV: The cancer has spread to the other lung, the fluid around the lung, the fluid around the heart, or distant organs.
This is a simplified explanation, and the actual process involves a complex interplay of factors. It’s important to note that the staging of cancer is crucial in determining the appropriate treatment plan.

Incidence Rates of Cancer
In 2020, the global age-standardized incidence rate of lung cancer was 22.4 per 100,000 population. This indicates that approximately 22.4 individuals out of every 100,000 were diagnosed with lung cancer. It’s crucial to recognize that this is an average figure, and the actual incidence rate can vary significantly based on factors such as geographical location, lifestyle habits, and genetic predisposition. Furthermore, there were more than 2.2 million new cases of lung cancer worldwide in 2020. This highlights the substantial impact of lung cancer on global health and its role in causing numerous fatalities.
Most lung cancers don’t cause symptoms until they’re advanced. However, recognizing early signs can lead to earlier diagnosis and more successful treatment. Although these symptoms often result from non-cancerous conditions, it’s critical to consult a doctor if they persist to ensure any issues can be addressed promptly.
Common symptoms include:
· Persistent or worsening cough
· Blood or rust-colored spit when coughing
· Chest pain aggravated by deep breaths, coughing, or laughing.
· Hoarseness
· Decreased appetite.
· Unintended weight loss
· Difficulty breathing
· Chronic fatigue
· Recurring infections like bronchitis or pneumonia
· Wheezing that starts suddenly.
If lung cancer spreads, it may cause:
1. Bone pain, often in the back or hips
2. Neurological issues such as headaches, limb weakness or numbness, dizziness, balance problems, or seizures due to brain metastasis
3. Jaundice, indicated by yellowing skin and eyes, when it spreads to the liver.
4. Enlarged lymph nodes in the neck or above the collarbone.
Certain lung cancers also lead to syndromes characterized by specific symptom clusters.
Lung cancer arises when mutations in lung cells impair the mechanisms that regulate cell division and death, leading to uncontrolled cell proliferation. These mutations can accumulate due to various factors, with tobacco smoke being the most significant risk factor. Other contributors include exposure to radon, asbestos, certain metals, radiation, and air pollution, as well as genetic predispositions. Regular cell processes like senescence and apoptosis normally prevent such uncontrolled growth, but in cancer cells, these processes are disrupted, allowing tumors to form, and potentially spread (metastasize) throughout the body.
Lung cancer risk factors encompass several elements:
· Tobacco Smoking: This is the primary risk factor, accounting for approximately 90% of lung cancers. This includes cigarettes, cigars, and pipes.
· Secondhand Smoke Exposure: Being exposed to secondhand smoke also increases the risk of lung cancer.
· Radon Exposure: Radon, a naturally occurring radioactive gas, can accumulate in homes or buildings through cracks or holes, leading to increased risk.
· Asbestos Exposure: Individuals working with asbestos, such as in mines, mills, textile plants, places where insulation is used, and shipyards, are at a higher risk.
· Exposure to Other Carcinogens: Exposure to radioactive ores, arsenic, diesel fumes, and certain chemicals can also increase the risk.
· Air Pollution: This is another risk factor for lung cancer.
· Family History of Lung Cancer: A family history of lung cancer can increase one’s risk.
These factors increase the risk of developing lung cancer, not everyone exposed to these risk factors will develop the disease. Diagnosis and Test
The process of diagnosing lung cancer involves several tests:
· Chest X-ray: This can reveal larger tumors that are more than 1cm wide.
· CT Scan: A Computerized Tomography (CT) scan uses x-ray beams to create a cross-sectional image of your body. It can detect smaller tumors and provide information about the tumor and lymph nodes.
· PET Scan: A Positron Emission Tomography (PET) scan is used to stage lung cancer after a diagnosis has been made.
· Lung Function Test: A test known as spirometry may be conducted to assess how well your lungs are functioning.
· Biopsy: If a tumor is suspected after a CT scan or X-ray, a small sample of tissue will be taken. There are different types of biopsies, including bronchoscopy, CT-guided core biopsy, and endobronchial ultrasound.
· Sputum Cytology: The sputum (mucus) from your lungs will be examined under a microscope to check for abnormal cells.
These tests collectively help in confirming the diagnosis of lung cancer, determining its stage, and planning the appropriate treatment strategy.
Traditional Treatments for Lung Cancer:
· Surgical Resection: This traditional treatment involves the removal of the tumor through surgery. However, it can cause significant trauma and carries high risk. Many lung cancer patients’ deaths are attributed to complications from surgery.
· Radiation and Chemotherapy: These treatments kill cancer cells but can also damage normal cells, leading to a weakened immune system and toxic side effects such as reduced leukocyte and platelet counts, hair loss, and vomiting. They may not be suitable for advanced cancer patients.
New Technology Options for Lung Cancer Patients - Minimally Invasive Therapy:
· Interventional Therapy: This involves making a 1–2-millimeter incision and directly administering anticancer drugs to the tumor, resulting in fewer side effects. The drug concentration is 2-8 times higher than that of systemic chemotherapy, allowing for more accurate targeting of cancer cells.
· Cryotherapy: This therapy reduces the risks and complications from surgery. It involves minimal bleeding and allows for quick recovery. It causes minimal damage to normal tissues and can be performed repeatedly to prevent recurrence of lung cancer.
· Microwave Ablation: This efficient procedure can ablate a tumor with a 6cm diameter in about 10 minutes, with high safety, few toxic side effects, and a low recurrence rate.
· Particle Implantation: This involves implanting 125I seeds that emit y-ray within the tumor, accurately targeting the cancer cells. The radiation of seeds to the tumor lasts for 180 days, with high accuracy and minimal invasiveness.
· TCM & Western Medicine: This combination can help control the tumor and extend survival time for patients who are not suitable for radiotherapy and chemotherapy.
Remember, treatments for lung cancer are varied, but the most effective treatment plan is one that is tailored to the patient’s individual conditions.
The prognosis for lung cancer can vary significantly based on several factors, including the type of lung cancer and the stage at which it is diagnosed. Here are some general statistics:
· For localized non-small cell lung cancer (NSCLC), the 5-year relative survival rate is 65%.
· For regional NSCLC, the 5-year relative survival rate is 37%.
· For distant NSCLC, the 5-year relative survival rate is 9%.
· For localized small cell lung cancer (SCLC), the 5-year relative survival rate is 30%.
· For regional SCLC, the 5-year relative survival rate is 18%.
· For distant SCLC, the 5-year relative survival rate is 3%.
These figures represent averages, and individual prognosis can vary based on a variety of factors including overall health, response to treatment, and more. Always consult with a healthcare provider for the most accurate information.
Caring for Someone with Lung Cancer: What to Know
When caring for someone with lung cancer, caregivers play a vital role in providing medical, practical, and emotional support. The guidance from the Irish Cancer Society encompasses these key responsibilities:
Medical Tasks:
· Managing medications
· Helping manage side effects.
· Attending medical appointments
· Coordinating with healthcare providers
· Keeping emergency contacts ready
· Assisting with personal care and palliative needs
Daily Assistance:
· Handling groceries and cooking
· Keeping living spaces tidy
· Providing transport for appointments
· Managing laundry and bills
Emotional Support:
· Offering a supportive presence
· Allowing for the expression of feelings
· Respecting the varying emotional responses to cancer
Caregiver Self-Care:
· Joining support groups
· Considering professional counseling
· Staying active and maintaining a healthy lifestyle
Caregivers must balance their duties with personal care to prevent burnout. Dealing with the emotional burdens and potential stigma associated with lung cancer adds complexity to the role, making self-care and seeking support essential. In summary, caregiving demands a balance of attentive care and personal resilience.

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