Lung Cancer

Lung Cancer is a malignant, cancerous or abnormal proliferation of the cells lining the air passages of the lungs. Based on microscopic diagnosis, the two main forms of lung cancer include small cell lung cancer and non-small cell lung cancer.

Small cell lung cancers (SCLC) are oat-shaped cancerous cells that mostly develop in the tissue layer below the epithelial lining of the lungs called the bronchial sub-mucosa, chiefly noticed in heavy smokers or those with a smoking past. Comprising 20-25% of reported cases, it rapidly multiplies and spreads to other body parts.

Squamous cell carcinoma, Adenocarcinoma and large cell carcinoma are together known as non-small cell carcinoma. In Squamous cell carcinoma, fish scales-like cancer cells that start in the bronchi, may persist in the chest without multiplying for longer times than other cancer forms. In Adenocarcinoma, cubical or column shaped cancer cells grow in the outer periphery of the lungs and underneath the bronchial tissue lining. It is the most prevalent lung cancer form accounting to 25-30% cases, with non-smokers being the most likely cases. This sub-form of Adenocarcinoma is known as Bronchoalveolar carcinoma. The Large cell carcinomas constitute 10-20% of the cases and are found commonly in the smaller bronchi.

Lung Cancer Causes:

The leading cause of lung cancer constituting 85-90% of reported cases is cigarette smoking, with cigar or pipe smoking also correlated to the disease. Other causes comprise of contact with radon, asbestos, nickel, chloromethyl ether, chromium, beryllium and arsenic –a derivative of copper and passive or second hand smoking.

The risks of developing lung cancer are high due to the factors like:

• Those who smoke, are over 50 years of age, have a past history of smoking or lung disease or family history of lung cancer.
• Having worked in industries that utilise materials like asbestos, nickel, chromium, beryllium, arsenic and chloromethyl ether. Those who have had contact with radon.
• Exposure to passive or second smoke.

Lung Cancer Symptoms:

Lung cancer in the initial stages is asymptomatic. However, symptoms start occurring when eventually the tumour enlarges; it exerts pressure and invades on the space of the close by structures and nerves known as metastasis.

If the cancer started and spread from the bronchi to the surrounding lymph nodes, the symptoms may comprise of:

• Coughing that may be accompanied by blood when the tumour grows causing a passage block.
• Presence of pneumonia.
• Experiencing chest pain and shortness or difficulty in breathing.
• Hoarse voice due to pressure exerted on the nerves and trouble in ingesting due to considerable blockage of the oesophagus.
• Due to the pressure exerted on the blood vessels, there is a swell-up of the facial, neck and upper parts of the body.
• Feeling exhaustion, loss of desire for food and decrease in weight.
• If the cancer has commenced and spread to the upper parts of the lung, then one may experience weakness along with radiating pain in the shoulder that is even felt in the arms, hands due to the pressure exerted on the nerves.
• If cancer has spread to the brain then the associated symptoms include headaches, weakness, marked behavioural alterations, speech difficulties and memory loss. If the cancerous cells have moved on to other body parts then there are symptoms of pain, jaundice, blood clotting and bone fractures.
• The tumour growths cause variations in hormone production known as Paraneoplastic syndrome that control body functions, leading to male breast augmentation, pain in the bones and joints, excessive production of corticosteroid hormones leading to Cushing’s syndrome. Overproduction of serotonin hormone leading to Carcinoid syndrome. There is notable excessive production of calcium known as Hypercalcemia.

Exams & Tests:

If in doubt, a thorough physical examination is undertaken by the doctor after noting down the medical past, will examine the areas of the neck, over the collarbones for swelling of the lymph nodes, unnatural abdominal swelling and indicators of lung accumulation. By palpating the doctor would be able to detect any swellings, and by using a stethoscope any lung accumulations, abnormal lung sounds or dullness can be identified.

Tests would comprise of the following:

• An X-ray to identify abnormal growths.
• A sputum test that involves taking the phlegm sample emitted from the lungs to be tested for cancer cells.
• A biopsy that involves the precision surgical removal of dubious tissue done employing procedures like bronchoscopy – the use of flexible delicate tube through the neck or percutanoeus needle that pierces the skin into the lung with the assistance of CT scanning or ultrasound to aid in navigation for removal of the sample.
• Spirometry or known as pulmonary function test to record rate and total volume of exhalation that are indicators of constriction or blocking in airways.
• Once the lung cancer has been diagnosed, detailed study is undertaken to evaluate the spread to determine the relevant treatment. These include a CAT, PET and bone scan.

Lung Cancer Treatment:

Due to the restricted effectuality of standardised treatment, lung cancer patients are hence persuaded to go in for clinical trials that are designed to unravel novel therapy techniques. Singular or combination of surgery, radiation therapy, laser therapy, Photodynamic therapy (PDT), oxygen therapy, Thoracentesis, Pleurodesis and chemotherapy are administered to treat the disease. Chemotherapy drugs are administered either orally or intravenously to treat even advanced forms of cancer.

The four forms of surgery include:

• Wedge resection – removal of a triangular piece of tissue that is the tumour itself and the encircled little amount of normal tissue. When a significantly larger sized tissue is removed, it is known as segmental resection.
• Lobectomy- the surgical removal of a complete lobe or part of the lung.
• Pneumonectomy- the surgical removal of one complete lung.
• Sleeve resection- the surgical removal of a section of bronchus.

Medications are used to relieve tingling, burning, mild, moderate and severe pain using anti-inflammatory drugs such as NSAIDs, narcotic pain suppressors, anti-depressants, anti-convulsants or anti-seizure medicines.

Additionally, to optimise treatment complementary therapy is also opted that include acupuncture, herbal medications, meditation, yoga, biofeedback, dietary and vitamin supplements and visualization.

Possible Complications:

Lung cancer can create complications like respiratory distress or heart problems like:

• Accumulation of fluid between the outer lung lining and the chest called Pleural effusion.
• Bloody cough.
• Prolapsed lung condition called pneumothorax.
• Airways restriction known as bronchial obstruction.
• Frequently occurring pneumonia.
• Fluid accumulation in between the heart and the pericardium surrounding it called pericardial effusion.
• The lung cancer metastasizes to major parts of the body.
• Death is most cases if detected in later stages.

Prevention:

Though there no sure shot way to avert lung cancer, one can decrease the chances by adopting the following steps:

• Avoiding or halting existent smoking habit or second-hand smoke. Halting or moderating the alcohol consumption to one drink in case of woman or two in case of men. If over 65 years of age, not exceeding greater than one drink in a day.
• Getting one’s residence tested for radon.
• Taking adequate precautionary measures at work place like wearing shielding gear, if exposed to toxic substances at work.
• Consuming ample amounts of fruits and vegetables into one’s daily diet.
• Exercising close to half an hour after proper consultation about the type and intensity. Slow or moderate forms of exercise are advisable. Activities such as walking, cycling and swimming are considered as idyllic options. Adding physical forms of exercise to daily life like taking the stairs rather than the lift, parking away from workplace and walking the extra way.

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