Lung Cancer: The Basics And More

Lung cancer is by far the leading cause of cancer death among both men and women all over the world, including India. Each year, more people die of lung cancer than of colon, breast and prostate cancers combined. Lung cancer can start in the cells lining the bronchi and parts of the lung. The tumour continues to grow and becomes large enough to be seen on imaging tests such as x-rays. At some point, cells from the cancer may break away from the original tumour and spread to other parts of the body. Lung cancer is often a life-threatening disease because it tends to spread even before it is detected by a chest x-ray. 

TYPES OF LUNG CANCER There are two major types of lung cancer: 
• Small Cell Lung Cancer (SCLC) • Non-Small Cell Lung Cancer (NSCLC) (80 per cent of all lung cancers) 

RISK FACTORS FOR LUNG CANCER INCLUDE THE FOLLOWING 
• Smoking cigarettes, pipes or cigars • Being exposed to second-hand smoke • Having a family history of lung cancer • History of Radiation therapy treatment for chest/breast 

• Being exposed to asbestos, chromium, nickel, arsenic, soot, or tar in the workplace 

• Air pollution • Being infected with the Human Immuno-deficiency Virus (HIV) 

• When smoking is combined with other risk factors, the risk of lung cancer increases. 

CAN NON-SMALL CELL LUNG CANCER BE PREVENTED? 
Not all lung cancers can be prevented, but there are some ways by which you can reduce your risk of getting lung cancer. The best way to reduce your risk of lung cancer is not to smoke and avoid second-hand smoke as well. If you stop smoking before a cancer develops, your damaged lung tissue gradually starts to repair itself. No matter what your age or how long you’ve smoked, quitting may lower your risk of lung cancer and help you live longer. People who stop smoking before age 50 cut their risk of dying in the next 15 years by half, compared with those who continue to smoke. 

CAN NON-SMALL CELL LUNG CANCER BE DIAGNOSED EARLY? 
Usually symptoms of lung cancer do not appear until the disease is already in an advanced, noncurable stage. Even when symptoms of lung cancer do appear, many people may mistake them for other problems, such as an infection or long term effects from smoking. This may delay the diagnosis and is a documented cause of delayed diagnosis in India. Some lung cancers are diagnosed early because they are found by an accident as a result of tests for other medical conditions. For example, lung cancer may be found by imaging tests (chest x-ray or chest CT scan), bronchoscopy (viewing the inside of lung airways through a flexible lighted tube), or sputum exam (microscopic examination of cells in coughed up phlegm) done for other reasons in patients with heart disease, pneumonia or other lung conditions. Some of these patients do very well and may be cured of lung cancer. 

WHO SHOULD BE SCREENED? 
Patients should be asked about their smoking history. Patients who meet all of the following criteria classify for lung cancer screening: 
• 45 to 74 years old 
• In fairly good health (discussed further down) 
• Have at least a 30 pack per year smoking history 
• Are either still smoking or have quit smoking within the last 15 years If you fit all of the criteria for lung cancer screening listed above, you and your doctor should start the screening process. Talk to your doctor about what to expect from the screening, including possible benefits and harms, as well as the limitations of screening. Symptoms may be caused by lung cancer or by other conditions. 

Check with your doctor if you have any of the following problems: 
• Chest discomfort or pain 
• A cough that doesn’t go away or worsens over time 
• Trouble in breathing 
• Wheezing • Blood in sputum (mucus coughed up from the lungs) 
• Hoarseness of voice 
• Loss of appetite 
• Weight loss for no known reason 
• Feeling very tired 

CANCER THAT PROGRESSES OR RECURS AFTER TREATMENT 
If cancer continues to grow during treatment (progresses) or comes back (recurs), further treatment will depend on the location and extent of the cancer, treatment options used, and on the person’s health and desire for further treatment. It is important to understand the goal of any further treatment - is to try to for cure of the cancer, to slow its growth or to help relieve symptoms. 

FOLLOW-UP CARE 
If you have completed treatment, your doctors will still want to watch you closely. It is very important to complete all of your follow-up appointments. During these visits, your doctors will ask about any problems you may be experiencing and may advise some lab tests or imaging tests. In recent times a PET scan has become the most reliable tool. In people with no signs of cancer remaining, many doctors recommend follow-up visits and CT scans every 6 to 12 months for the first two years after treatment and yearly visits and CT scans after this, although doctor visits might be more frequent at first. 

LIFESTYLE CHANGES AFTER NON-SMALL CELL LUNG CANCER 
You can’t change the fact that you have had cancer. What you can change is how you live the rest of your life. This can be a time to view your life in a new light.