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17 / 10 / 2017
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Lung cancer

 
 

Lung cancer is a cancer normally found in smokers, but in areas where there is a lot of air pollution it is also present.

Lung cancer is the leading cause of cancer deaths, among both men and women. It claims more lives than colon, prostate and breast cancer combined.

Yet most of these deaths could have been prevented. That's because smoking accounts for about 85 percent to 90 percent of lung cancer cases. Although your risk of cancer increases with the length of time and number of cigarettes you smoke, quitting smoking, even after many years, can greatly reduce your chances of developing the disease.

Protecting yourself from exposure to other leading causes of lung cancer, such as asbestos, radon and secondhand smoke, also decreases your risk. Prevention is especially important because lung cancer usually isn't discovered until it's at an advanced stage when the outlook for recovery is less positive.

Treatment for lung cancer depends on the type of cancer, how advanced it is and your overall health. In some cases, surgical removal of the tumor may be an option. In others, chemotherapy, radiation or a combination of the two is likely to provide better results.

Signs and symptoms

Because lung cancer doesn't cause signs or symptoms in its earliest stages, it's often quite advanced by the time it's diagnosed. The most common warning sign is a cough, which occurs when a tumor irritates the lining of the airways or blocks the passage of air. In addition to a new cough, be alert for:

  • "Smoker's cough" that worsens
  • Coughing up blood, even a small amount
  • Chest pain
  • Shortness of breath
  • New onset of wheezing
  • Repeated bouts of pneumonia or bronchitis
  • Hoarseness that lasts more than 2 week

Lung cancer also may cause fatigue, loss of appetite and weight loss. If it has spread to other parts of your body (metastasized), you may have headaches or bone pain.

Although many of these symptoms might be attributed to other causes, talk to your doctor if you experience such problems. The earlier you discover and treat lung cancer, the better chance you have of lengthening your life and reducing symptoms.

Causes

Your lungs are two large, spongy organs shaped something like an upside-down butterfly. One lung is located on each side of your chest. They're separated by the mediastinum — the tissues and organs of your mid chest, which include your heart, esophagus and windpipe (trachea) as well as lymph nodes and major blood vessels such as the aorta. Each lung is divided into upper and lower sections called lobes. Your left lung has two lobes, and your right lung, which is larger and heavier, has three lobes.

Every time you inhale, air is carried through the windpipe to your lungs in two major airways called bronchi. Inside your lungs, the bronchi subdivide nearly 20 times into a million smaller airways (bronchioles), which finally end in clusters of tiny air sacs called alveoli. Within the air sacs, oxygen is absorbed into your bloodstream and carbon dioxide — a waste product of metabolism — is released.

How cancer forms
The lining of the airways and windpipe is made up of rectangular-shaped surface cells (columnar epithelium) and glands that produce mucus and other fluids. In healthy lungs, these cells divide in a controlled and orderly way. But sometimes this growth gets out of control — cells continue reproducing even when new cells aren't needed.

These abnormal cells primarily originate when the lungs are exposed to cancer-causing substances (carcinogens), such as those found in cigarette smoke, radon and asbestos.

At first only a small number of abnormal cells (precancerous lesions) may appear, but with repeated exposure to carcinogens over a number of years, these cells may increase and eventually become cancerous (malignant). And because cells in your lungs have easy access to a large number of blood and lymph vessels, tumors may be carried to other sites within your body, even before you have any symptoms.

Cigarette smoking accounts for the great majority of all lung cancers. Tobacco smoke contains more than 3,500 chemicals, at least 40 of which are known carcinogens. Cigarettes also contain at least 30 toxic metals, including nickel and cadmium, as well as radioactive compounds such as polonium 210.

Other risk factors for lung cancer include exposure to secondhand smoke, to asbestos and other industrial carcinogens, and to high concentrations of radon — an odorless gas that's released into the air from the breakdown of uranium in the soil and water. Smokers exposed to asbestos and radon are far more likely to develop cancer than are nonsmokers.

Primary lung cancer is uncommon in nonsmokers, but cancer of the breast, colon, prostate, testicle, kidney, thyroid, bone or other organs may spread to the lungs. In that case, however, the cancer is still referred to by the name of the organ in which it originated, rather than being called lung cancer.

Types of lung cancer
Lung cancer is commonly divided into two groups: small cell and non-small cell. Each grows and spreads in different ways and is treated differently. Small cell lung cancer, for example, spreads aggressively and responds best to chemotherapy and radiation. It occurs almost exclusively in smokers.

Non-small cell lung cancer, which is more common, accounts for almost 75 percent of lung cancers. If caught early when it's confined to a small area, it often can be removed surgically. There are three major categories of non-small cell lung cancer:

  • Squamous cell carcinoma. This cancer forms in cells lining your airways. It's the most common type of lung cancer in men.

  • Adenocarcinoma. This type of cancer usually begins in the mucous-producing cells of the lung. It's the most common type of lung cancer in women and in people who have never smoked.

  • Large cell carcinoma. This type of cancer originates in the peripheral part of the lungs.

Risk factors

Smoking remains the greatest risk factor for lung cancer, accounting for as many as 9 out of every 10 cases of the disease. Your risk increases with the number of cigarettes you smoke each day and the number of years you have smoked. Your risk is also greater if you start smoking early in life — even if you later quit. Smoking filtered, low-tar or low-nicotine tobacco offers no additional protection because most people who smoke these cigarettes inhale more deeply, which also increases the risk. The good news is that it's never too late to quit smoking. Quitting — at any age — can lower your risk of developing lung cancer.

Other risk factors include:

  • Sex. Current or former women smokers are at greater risk of lung cancer than are men who have smoked an equal amount. Although the exact reasons for this are unknown, some experts speculate that women may have a greater susceptibility to the cancer-causing substances found in tobacco. Others believe that estrogen may play a role. Women also are known to inhale more than men do, and they are less likely to quit.

  • Exposure to secondhand smoke. Even if you don't smoke yourself, you're at high risk of lung cancer if you're exposed to the smoke of others. Daily exposure to secondhand smoke may increase your chances of developing lung cancer by as much as 30 percent. The Environmental Protection Agency has determined that secondhand smoke causes at least 3,000 lung cancer deaths a year.

  • Exposure to radon gas. Second only to smoking as a cause of lung cancer, radon comes from the natural (radioactive) breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Although unsafe levels of radon can accumulate in any building, the greatest exposure risk most people face is at home. The Surgeon General and the Environmental Protection Agency recommend that all homeowners check for the presence of radon. The best tests are those that take 3 to 6 months.

  • Exposure to asbestos and other chemicals. Workplace exposure to asbestos and other cancer-causing agents — such as vinyl chloride, nickel chromates and coal products — also can increase your risk of developing lung cancer, especially if you're a smoker.

  • Race. Lung cancer is much more prevalent among African Americans than it is among whites. African American men are two to four times more likely to develop lung cancer than are their white counterparts. They also develop the disease at an earlier age and are less likely to survive. Doctors don't think there's a genetic reason for this disparity. Rather, it is more likely to be related to inequities in health care and to environmental factors.

Screening and diagnosis

Screening for lung cancer is controversial. The American Cancer Society currently doesn't recommend screening tests for lung cancer, even in high-risk individuals. But some doctors believe that smokers, especially those 50 years or older, should have an annual chest X-ray, although having annual chest X-rays has never been shown to be of particular benefit.

Complicating matters further is a study that appeared in the March 2003 issue of Radiology. It found that a new type of computerized tomography (CT) scan might detect lung cancer at a much earlier stage in high-risk people than conventional CT scans do. But the type of imaging — called a spiral CT scan — also has serious drawbacks. In the study 1,049 of the 1,520 people screened had lumps called noncalcified lung nodules. These people needed to undergo the further expense, stress and — including possible surgery — of additional testing. Yet in more than 95 percent of cases, the nodules turned out not to be cancerous.

Canadian researchers think they may have found a way to reduce the number of unnecessary procedures that result from CT screening, however. Many long-time smokers who develop lung cancer have abnormal cells in their sputum. Performing a sputum analysis first may help decide just who is most likely to benefit from screening.

Looking ahead
Researchers are optimistic that better screening tests for lung cancer may become available. The results of a study that appeared in a 2001 issue of Cancer Research show that smokers with high levels of certain compounds in their blood are much more likely to develop lung cancer than smokers with lower levels of the compounds. Researchers who conducted the study say that a simple blood test may one day help identify smokers at high risk of lung cancer, although no such test currently exists.

Diagnosis
A standard chest X-ray can reveal an abnormal mass or nodule in your lungs. And a CT scan may show very small lesions and whether cancer has spread to other areas. But as with all types of cancer, lung cancer can be definitively diagnosed only by looking at a tissue sample (biopsy) under a microscope. The sample may be removed using one of the following techniques:

  • Bronchoscopy. In this test, a flexible tube called a bronchoscope is passed into your airway. The bronchoscope allows your doctor to look inside your lungs as well as to take a tissue sample for examination in the laboratory.

  • Mediastinoscopy. In this test, an instrument passed through a small incision at the base of your neck allows your doctor to take a biopsy of lymph nodes in your chest. This helps determine how far the cancer has spread and whether surgery is a reasonable option for removing the tumor.

  • Transthoracic needle biopsy. Using an X-ray or CT scan for guidance, your doctor takes a small needle and places it into a mass in your lung, removing a small piece for study.

  • Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.

  • Thoracentesis. If you have fluid in your chest cavity, your doctor can remove a sample by inserting a thin needle into your chest between the ribs. The fluid is then examined in the laboratory for presence of cancer cells. When large amounts of fluid are present, thoracentesis can improve your breathing.

  • Video thoracoscopy. In this procedure, your doctor inserts a tube (endoscope) through a small incision between your ribs and partially collapses one of your lungs. This creates a space through which a pen-sized instrument with a video device is passed between the ribs and through your chest wall. Your doctor then can perform biopsies of nodules or masses while watching the procedure on a video screen. Your lung will expand again after the procedure.

Staging
Staging is a system of classifying information about cancer, including where and to what extent the cancer has spread. In many cases, Roman numerals are used to describe stages, with 0 being the least advanced and IV the most advanced. Your doctor uses this information to determine what treatment you need and to evaluate how your cancer might progress.

Non-small cell lung cancer
Non-small cell lung cancer is staged according to the size of the tumor, the level of lymph node involvement and the extent to which the cancer has spread. Stages of non-small cell lung cancer include:

  • Stage 0. At this stage, cancer is limited to the lining of the air passages and hasn't invaded lung tissue. Stage 0 cancers almost always are found during bronchoscopy, which is likely to have been performed to assess an abnormality on a chest X-ray. If found and treated promptly, cancers at this stage usually can be eliminated.
  • Stage I. Cancer at this stage has spread to layers of lung tissue but not to the lymph nodes.
  • Stage II. This stage cancer has invaded neighboring lymph nodes or spread to the chest wall.
  • Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes beyond the lung area.
  • Stage IIIB. The cancer has spread locally to areas such as the heart, blood vessels, trachea and esophagus — all within the chest.
  • Stage IV. The cancer has spread to other parts of the body, such as the liver, bones or brain.

Small cell lung cancer
Small cell lung cancer is staged differently from non-small cell types. Rather than using numbers, it's classified as either limited or extensive:

  • Limited. Cancer is confined to one lung and to its neighboring lymph nodes.
  • Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have invaded both lungs, more remote lymph nodes or other organs.

Complications

Your lungs are abundantly supplied with blood and lymph — a fluid that helps return water and proteins from your tissues to your blood. Lung cancer spreads easily to other parts of your body through your bloodstream and lymph system.

Small cell cancer, in particular, is a fast-growing tumor that quickly spreads to other organs. At the time of diagnosis, this type of cancer has already spread in more than two-thirds of people with the condition. Without treatment, the tumor will continue to grow and may prove fatal within a matter of months.

This kind of cancer responds very well to chemotherapy and radiation therapy — better than do non-small cell lung cancers. But even when there is a positive response to treatment, relapses usually occur within two years. Unfortunately, at that point the cancer usually isn't as responsive to further therapy.

In addition, some non-small cell lung cancers — even those identified at any early stage — may spread undetectably (micrometastasis) to lymph nodes and other organs. As a result, cancer can reappear months and even years after treatment.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.

In no event will the DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.
 
 
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Dr. Eddy Bettermann M.D.

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