Lung Cancer
What is lung? Where is it located?
The lung is a part of the respiratory organ where we inhale oxygen into it and exhale carbon dioxide. The respiratory system is made up of the trachea, bronchus, lung, diaphragm and chest wall. We breathe in and out every 12-18 times per minute. It is located and well protected within the thoracic cage and occupies a major position of it. Lung cancer is emerging as one of the common cancers in India.
What causes lung cancer?
Development of lung cancer cannot be attributed to any single fact. There are certain risk factors which increase the chance of developing lung cancer. Risk factors include:
- Smoking is a major risk factor.
- Passive smoking (breathing in other people’s smoke)
- A family history of lung cancer
- A personal history of the head and neck cancers
- A history of radiation to the chest wall in breast cancer and Hodgkins
diseases - Industrial pollutants
- Air pollution
- Certain hereditary conditions
What are the symptoms of lung cancers?
The presence of lung cancer depends on the site of the tumour. A doctor should be consulted if any of the following occur:
- Cough persisting for two weeks or longer
- Blood (either bright red or very dark) in the sputum
- Chest pain
- Shortness of breath
- Weight loss for no reason
- Feeling very tired
- Body pain in case of metastasis
- In Southeast Asia, owing to the higher incidence of lung cancer, screening strategies are employed. By this, all patients above the age of 55 years, who were smokers in the past and current smokers are advised to have a low dose of CT chest and based on the clinical relevance they are treated and followed up accordingly. In India, while a formal screening programme does not exist, it is advisable for adults above the age of 55 years, especially those with the history of smoking, industrial workers, family history of lung cancer, to get themselves tested with the low dose CT chest by visiting
family physician.
What Investigations will I be subjected to?
The best investigations to diagnose lung cancer is Bronchoscopic Biopsy if the lesion is central or a CT Guided Biopsy if it is in the periphery. Whole body PET CT scan survey will give us detailed information about size, relationship to the surrounding structures,
mediastinal lymph node status and any metastasis elsewhere. Ver rarely tumour market chromogranin B will be done if the lung cancer is neuroendocrine type. Other ancillary tests like pulmonary function test, DLCO, Echo, ECG Perfusion lung scan, etc., will be done to assess the lung reserve, anaesthetictness for surgery and chemotherapy based on the stage of cancer.
Are there different types of lung cancer?
Yes, there are different types of lung cancer depending on the type of cell/tissue from which the cancer is arising. Non-small cell type and small cell type lung cancer carcinoma is the most common type of lung cancer. Neuroendocrine, sarcoma are some of the less common types of lung cancers. The treatment depends on the type of cancer.
How to stage cancer?
Accurate staging of the cancer is based on histopathology and is possible after surgery. Lung cancer can be broadly classified into operable and inoperable locally advanced – when cancer appears large and or/ invading other surrounding organs, which enlarged lymph nodes. Metastatic – when cancer has spread far from the lung e.g. to the bone, brain, liver or adrenal gland.
Now that I have been diagnosed to have lung cancer, how will I be treated?
Different types of treatment are available for patients with lung cancer. Following types of standard treatment are used:
- Surgery
- Chemotherapy
- Radiotherapy
- Immunotherapy
Surgery is the recommended treatment for early stage lung cancer and in some cases of locally advanced lung cancers after giving chemoradiation. Some patients may be given chemotherapy or immunotherapy after surgery to kill any cancer cells that are left.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells either by killing the cells or stoping them from dividing. Immunotherapy is anticancer systemic therapy involving stimulation of the patient’s immune system against tumour cells by drugs which activate the cytotoxic T cells causing cell kill with minimal normal cell kill and side effects. Targeted therapy uses drugs or substances to identify and attack specific cancer cells without harming normal cells. Radiation therapy involves the use of radiation beams to kill cancer cells. Most newer treatment plans are able to do the same without causing much side effects.
Which kind of surgery is done for lung cancer?
The type of surgery depends on the location and extent of the disease and these include:
Segmentectomy where a portion of the lung is removed from a single lobe. Lobectomy, where a complete lobe is removed. In Pneumonectomy, the whole portion of the lung is removed either on right or left side. Sleeve resections where lung parenchymal preserving surgery is performed. Systematic mediastinal lymph node dissection.
Are there any alternatives besides surgery?
Till date, surgery is the best-recommended treatment for early lung cancer; Radiotherapy may be given to those who are unwilling or who are medically unfit for surgery.
How do I prepare myself for surgery?
The preparation is generally similar to any major surgery. If you are a smoker it is absolutely essential to stop smoking. Breathing exercises using the incentive spirometer and football bladder should be started. Follow the anaesthetist’s advice regarding the continuation of medications if you are on any. A high protein diet is preferred to improve nutrition.
How major is surgery? What are the possible complications?
Lobectomies with lymphadenectomy and other lung surgeries are deemed as major surgeries with a risk of complications and a very small risk of death. This means that if 100 people are operated, less than one of them have a chance of death. The surgery is done by minimally invasive technology where it is done by one or two or three holes technique through laparoscope/ thoracoscope or robotic and the patient can go home within 3-5 days. The complications of lung surgeries: Air leak Bleeding from the stump site or from the chest wall. Atelectasis (lung infection) Wound infection
