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LUNG CANCER

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Under normal circumstances, the cells of your body die when they are old or damaged. But there are times when they overgrow and multiply inappropriately, leading to tumours and other complications. This condition is known as cancer. In lung cancer, abnormal cell division occurs in the lungs resulting in tumours and lumps. Typically, this cancer manifests itself through persistent cough, blood in the cough and shortness of breath. Your risk of lung cancer increases if you smoke or are exposed to a gas called radon and toxic substances such as asbestos or diesel.
The global prevalence of lung cancer is quite alarming. In 2018 alone, around 2.1 million new cases of this cancer were diagnosed worldwide, which accounts for 11.6 per cent of the world’s total cancer burden. Globally, the mortality rate is the highest in North America and Europe. In India, one in 68 males develops lung cancer. Lung cancer is one of the five most common cancer in India. More than 40% of patients are diagnosed with advanced lung cancer where cancer has been spread.

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Types

There are two types of lung cancer: Small-cell lung carcinoma (SCLC) and Non-small-cell lung carcinoma (NSCLC).


  • Small-cell lung carcinoma (SCLC)


In this type of lung cancer, the malignant cells appear small and round under a microscope. Though it affects a lesser number of people while compared to NSCLS, SCLC is more aggressive in terms of development. Smoking is a significant reason behind it. However, this form of lung cancer responds well to chemotherapy and radiation therapy.

  • Non-small-cell lung carcinoma (NSLC)


The cells of this form of lung cancer are larger than those of SCLC. NSLC, which is more common than SCLC, take time to develop. So, you may not experience symptoms at the initial stage. In fact, it may not even attack the nearby tissues or need immediate treatment. In this type of lung cancer also, smoking is one of the major culprits among others.

Stages

The stage of cancer tells us about the spread of the condition. This is crucial for deciding the treatment modality. While NSLC has four main stages, SCLC has two stages.


  • Stages of non-small cell lung cancer:



  • Stage 1: Cancer cells haven’t spread outside the lung.

  • Stage 2: Cancer cells are present in the lung and nearby lymph nodes.

  • Stage 3: Apart from the lungs, cancer cells have spread to the lymph nodes located in the middle of the chest.

  • Stage 3A: Malignant cells are present only on the lymph nodes of the chest area from where the cancer originates.

  • Stage 3B: Cancer cells are present in the lymph nodes of the chest area opposite to the point of origination or those above the collarbone.

  • Stage 4: Malignant cells are found in both the lungs or to distant organs.



  • Stages of small-cell lung cancer:



  • Limited stage: At this stage, malignant cells are found in only one lung or lymph nodes close to it.

  • Extensive stage: Cancer cells are found in both the lungs, the fluid around them, bone marrow and distant organs.

Symptoms

Whatever the form be, the manifestations of lung cancer usually remain the same. In most cases, the symptoms start showing up at a much later stage. Here are the red flags to watch out for:


  • Persistent cough

  • Blood in the cough

  • Chest pain that troubles you more while laughing, coughing, or breathing deeply

  • Hoarseness of voice

  • Shortness of breath

  • Wheezing

  • Weakness and fatigue

  • Loss of appetite

  • Unexplained weight loss

  • Respiratory infections such as pneumonia or bronchitis.

  • Lymph nodes in your neck or collarbone

  • Severe pain in your bones, particularly of the back, ribs, and neck

  • Numbness in your legs or arms

  • Dizziness

  • Body balance issues

  • Droopy eyelid (caused by the pressure exerted by a tumour on facial nerves)

  • Muscular fatigue

  • Nausea

  • Fluid retention

  • High blood pressure

  • High blood sugar

  • Seizures

Causes And Risk Factors

Almost anyone can get this condition. However, certain factors make you more vulnerable to lung cancer.


  • Active and passive smoking is the foremost reason for the development of lung cancer. Ultra-long or long cigarettes can put you at a greater risk of lung cancer.

  • Heavy exposure to metals such as asbestos, uranium, arsenic, radon, cadmium, chromium, nickel, soot, and tar may increase your risk of suffering from lung cancer.

  • Lung cancer can run in families as well. People with genetic mutation have a higher chance of getting lung cancer than heavy smokers with or without the inherited mutation.

  • There is an increased risk of suffering from lung cancer if you had any prior illness of the lungs or have sustained an injury in the organ.

  • Exposure to radiation therapy to the chest or breast or certain imaging tests like CT scan can increase your lung cancer risk.

  • Male population is highly prone to lung cancer.

Prevention

No form of cancer, including lung cancer, can be prevented. However, you can reduce your chance of falling prey to this condition.


  • Say no to smoking. Join smoking cessation programmes if needed.

  • Avoid second-hand smoke. Avoid areas where people smoke, such as bars and restaurants, and seek out smoke-free options.

  • Reduce your exposure to environmental toxins like radon, uranium, arsenic, nickel, etc. If your work demands you to come in close contact with these, wear a face mask.

  • Include a lot of fruits and vegetables in your meals.

  • Exercise regularly. Also, practising breathing techniques will improve your overall lung health.

Diagnosis

After reviewing your symptoms, if your doctor suspects lung cancer, he may recommend the following tests for a confirmatory diagnosis.


  • Imaging tests: Computed tomography (CT) and positron emission tomography (PET) scans are imaging studies that help your doctor spot lung tissues with cancer. He may also suggest a bone scan to identify cancerous growths. These tests are also required to figure out your body’s response to treatment.

  • Tissue sampling: If the imaging studies reveal a suspicious lesion, then your lung tissue needs to be sampled to identify cancerous cells. Tissue samples can be collected with needles or through minimally invasive procedures like bronchoscopy and mediastinoscopy.

  • Lab testing: Your doctor may also recommend sputum or blood tests to identify the type of lung cancer you have. These tests will also tell your doctor about the stage of cancer.

Treatment

The treatment of this condition may vary on the basis of location, stage and overall health status of an individual. Here are the treatment modalities that your oncologist may resort to:


  • Surgery


The aim of surgical intervention is to remove cancerous tissues in the lungs and surrounding areas. Your physician may have to remove one lung altogether or a segment of it, depending on your condition.

  • Chemotherapy


This is a potent intervention in which drugs are used to shrink or obliterate rapidly dividing cancerous cells. It works well for people with an advanced stage of this cancer. However, chemotherapy comes with its own set of side effects.

  • Radiation therapy


In this method, high-energy rays kill cancer cells and reduce the size of malignant tumours prior to surgical removal. It works best when the cancer cells or tumours are confined to one location.

  • Targeted therapy


This therapy targets a particular action of cancer cells and tries to fix it. For example, one targeted therapy may aim to stop cancer cells from multiplying.

  • Immunotherapy


Immunotherapy is a group of medications that use the body’s defence system to fight lung cancer. This therapy can be used alone or in combination with chemotherapy.

Lifestyle/management

There’s no diet or menu meant specifically for lung cancer. However, a balanced meal plan that nourishes your body well can help you combat the side effects of treatments. Also, in the course of your treatment, your nutritional needs and food tolerance may be altered. So, consult your physician and nutritionist for any change in diet that your body needs. Here are some dietary tips that will make you feel better if you follow them well:


  • Stick to small, frequent meals if you have lost appetite.

  • If you have lost a lot of weight, rely on low-sugar high-calorie foods and beverages.

  • High-fibre fruits and vegetables will be your go-to option if you are experiencing constipation.

  • Chemotherapy can wreak havoc with your digestive system. You can soothe it with mint and ginger tea.

Prognosis And Complications

Prognosis

The type and stage of lung cancer affect its prognosis. More than half of the patients are diagnosed in an advanced stage where cancer has spread. On an average, the 5-year survival rate for lung cancer is 15%. 

Complications

Treatments for lung cancer can lead to several complications. Smoking before surgery, weakened immune system, age, and obesity can lead to complications during surgery. The incidence of death within 60 days after surgery is very high. Respiratory complications like pneumonia and acute respiratory distress syndrome are responsible for deaths after surgery. Surgery can affect the patient's quality of life as they can become physically disabled. Radiotherapy can lead to pneumonia, fibrosis, and lung toxicity. Radiotherapy can also cause toxicity in the heart, digestive system, spinal cord and skin. 

Alternative Treatments

Complementary and alternative medicines that are used for the treatment of lung cancer are:


  • Acupuncture

  • Dietary supplements

  • Massage

  • Hypnosis

  • Meditation

  • Special diets

  • Megadose vitamins

  • Herbal preparations

  • Magnet therapy


These therapies have not been scientifically tested; hence, the patients must consult the doctor about the risks and benefits.

References

 


  1. Mathur Pet al. Cancer Statistics, 2020: Report from National Cancer Registry Programme, India. JCO Glob Oncol. 2020 Jul; 6:1063-1075.

  2. Lung cancer. MedlinePlus. Available at: https://medlineplus.gov/lungcancer.html. Accessed on Mar 23, 2020.

  3. NHS. Treatment – lung cancer [Internet] [Updated Aug 15, 2019]. Available at: https://www.nhs.uk/conditions/lung-cancer/treatment/. Accessed on Jul 30, 2021.

  4. Lung cancer. FDA. Available at: https://www.fda.gov/media/130344/download. Accessed on Mar 23, 2020.

  5. Spiro SG, et al. Complications of lung cancer treatment. Semin Respir Crit Care Med. 2008 Jun;29(3):302-17.

  6. How is lung cancer diagnosed and treated? CDC. Available at: https://www.cdc.gov/cancer/lung/basic_info/diagnosis_treatment.htm. Accessed on Mar 23, 2020.

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