Lung cancer is a killer in the Western world and its prevalence in the developing world is also of major concern. But all is not doom and gloom. By early diagnosis and treatment, and due to a more radical approach in treating these cancers surgically the survival rate in improving.
The long term survival of those diagnosed with lung cancer has improved significantly. This may be due to a multitude of factors but what is very clear is that early diagnosis is the key.
What are the lungs?
Lungs are part of the body system that enables us to breathe. The respiratory system encompasses the nose, mouth, the windpipe, the airways to each lung (the bronchus) and the lungs. The main aim is to bring oxygen into the blood stream which then provides it to all the living cells in the body.
What is lung cancer?
Lung cancer is when there is a malignant or cancerous growth in part of the lung or the bronchi. The growth will be uncontrolled and will destroy the lungs thereby reducing the amount of normal lung available to carry out its function. This leads to certain symptoms.
What are the causes of lung cancer?
|Smoking is the main cause of lung cancer. So stop now! Pic courtesy Getty images
In most people lung cancer is caused by smoking. Although non-smokers can also get lung cancer, 9 out of 10 diagnosed with it will be smokers.
The length of time that you have been smoking has a direct effect. The longer you have smoked the higher the risk. On a positive note if you stop smoking, the risk is reduced significantly. So stop smoking without delay.
Other causes can be exposure to radon gas, work exposure to asbestos, environmental factors such as pollution, family history of lung cancer and previous radiation exposure.
There is also good news in that it is thought that the incidence of lung cancer is lower in countries with high sunlight exposure, such as Sri Lanka.
How is lung cancer diagnosed?
If you have any of the symptoms given alongside or a combination of them please seek medical advice. Your general practitioner should be your first port of call. The doctor will take a thorough history and examine you. Then he or she will organise some routine investigations such as blood tests and a chest x-ray. If anything abnormal is found you will probably be referred to a chest physician for further tests.
What are the types of lung cancer?
The commonest type of lung cancer is that which spreads due to cancer in other parts of the body. This is called secondary lung cancer. For example tumours in the kidneys can spread to the lungs.
There is a further type called mesothelioma which is a type which affects the lining of lung (the pleura).
Lung cancer may also arise directly from the lung tissue itself, which is called primary lung cancer. There are two main types, small cell lung cancer and non small cell lung cancer.
What is the treatment?
Surgery, radiotherapy and chemotherapy alone or in combination can be used in the treatment of lung cancer. Treatment is dependent on a number of factors such as:
- Type of cancer
- Whether the cancer is contained just within the lung
- The extent of spread
- General health of the patient
As a general rule, small cell lung cancer is mostly treated with chemotherapy (and possible radiotherapy) and non small cell lung cancer with a combination of all treatment options.
What types of surgery?
There are three main types of surgical procedures.
Removal of a section of the lung, removal of a lobe of the lung and removal of a whole lung. The type of operation will be decided according to the extent of spread of the cancer. The operation may be followed by other forms of treatment. As this type of surgery is very difficult, it is only carried out in specialised centres, by specialist thoracic surgeons. In good hands especially the removal of a section of the lung and lobectomy can be carried out with a thoracoscope!
Before surgery the patient will have further tests carried out to make sure he or she is in a fit state for a major surgical procedure.
What is radiotherapy?
Radiotherapy involves giving a concentrated bean of x-rays to kill the tumour cells and slow their growth. The x-rays are given over a period of time which is determined by the specialist cancer doctor (oncologist).
What is chemotherapy?
Chemotherapy is when a combination of strong drugs is given via a vein into the blood stream. This medication will target tumour cells and kill them. Chemotherapy is used fo r many cancers and isn’t without its own risks. While on treatment you will need regular blood tests. The main risks of chemotherapy are being prone to infections, by having decreased immunity to ward off infections and problems with clotting of blood.
What are the long term
In general lung cancer has a poor prognosis mainly due to the late presentation of the symptoms and therefore the late diagnosis. The length of survival and the prognosis depends on the stage of the disease, that is the extent to which it has spread and the general condition of the patient. It also depends on the type of the cancer.
|Image courtesy isteroids.com
Overall, of all the people diagnosed with all types of lung cancer at all stages only about 25% survive for at least one year after diagnosis. These are numbers for the Western world where the risk of lung cancer is higher, and unfortunately there isn’t any clear data for Sri Lanka. But also remember statistics are averages based on large numbers of patients, and they cannot predict exactly what will happen to you as an individual. No two people respond to treatment alike. So do not lose hope.
Sri Lanka has the medical and surgical expertise and most of the equipment for diagnosis and management of lung cancer. This is available in the National Health Service in centres such as the Welisara Chest Hospital and the National Hospital Colombo. The main aim is to have this disease diagnosed early and treated early as this provides the best prognosis for long term survival.
It is also important that the right pathway of diagnosis and management is taken. See a family doctor if symptoms are present to rule out other conditions giving similar symptoms. Then the GP will refer to a specialist doctor in chest medicine who will carry out further tests and refer to the thoracic surgeons and or the oncologist for further care. And finally if you are still smoking, STOP!
What are the symptoms?
- Shortness of breath
- Night sweats
- Loss of weight
- Blood when coughing
- Pain on taking a breath
- Loss of appetite
- Worsening symptoms
Depending on the kind of cancer it is, there may be other symptoms. There are some which produce chemicals called hormones which may give symptoms such as swelling in legs, swelling of breast tissue in men, tiredness, lethargy and clots in legs so it is important to seek medical advice and explain your symptoms in detail to the doctor.
Also as the disease spreads there may be symptoms such as pain under the ribs, difficulties in swallowing, swelling of face and changes in the shape and nature of finger nails.
Bronchoscopy: This is where a flexible camera is passed through your mouth into the windpipe and beyond to look at the abnormality. During this procedure small samples of the abnormal areas maybe taken and sent to the lab for diagnosis.
CAT scan: This is carried out to get a clearer look as to the spread of the cancer. At the same time the rest of the body will be scanned to rule out the spread of the cancer to other parts of the body.
CAT scan of right
sided lung tumours
PET scan: This again gives further information regarding the extent of the spread of the cancer.
Biopsy: A biopsy is when a piece of the cancer tissue is removed by passing a thin needle through the skin and muscle into the lung. This may be done under a local anaesthetic.
Further specialised tests
Thoracoscopy: This test maybe carried out to diagnose fluid in the lungs, to look at the mediastinum or to take biopsies. This can be carried out under sedation or general anaesthesia and involves making two of three small cuts in the chest and introducing a flexible thin tube camera. Via this technique tissue samples can be taken or fluid drained which can then be sent for diagnosis. After the test a chest drain maybe placed in the cavity to drain further fluid.
Mediastinascopy: This is a test where the contents of the mediastinum are explored. The mediastinum is the area in the chest between the lungs which has major blood vessels, the heart and lymph nodes. For this test a general anaesthetic is required and a small cut is made at the base of the neck through which a flexible camera is introduced. You will need to stay overnight in the hospital.
Liver ultrasound: This is carried out to look for the spread of the tumour into the liver
All these tests are carried out to obtain the information required to treat the cancer appropriately. The type of lung cancer will also influence the treatment and management.