Lung Cancer Diagnosis & Treatment
What are the Lung Cancer Treatments?
Lung cancer, considered one of the most common cancers worldwide, is commonly caused by tobacco smoke or other air-borne pollutants. There is, however, a rising trend of even non-smokers being afflicted by the disease.
The approach to lung cancer treatment is dependent on a variety of factors including the type, severity and stage of the cancer, as well as the condition of the patient. There had been many advances in medical treatment for lung cancer in recent years, including treatment for lung cancer (stage 4) which have been diagnosed at a late stage (where the cancer cells have spread). Patients are advised to seek professional medical help at a lung cancer treatment centre as soon as possible.
Depending on the stage and where the cancer is located, your oncologist may recommend any or a combination of the following treatments:
Lung Cancer Treatment: Surgery
Early stage lung cancer (stage 1 or stage 2) which have not spread to organs beyond the lungs may be potentially cured by surgery. With lung cancer surgery, tumours and the lymph nodes nearby will be removed.
Possible surgical procedures for lung cancer patients include:
- Lobectomy: Surgery to remove a section of the lung
- Pneumonectomy: Surgery to remove the entire lung
Lung Cancer Treatment: Radiation Therapy
Radiation therapy (also known as radiotherapy) is a treatment that shrinks or destroys lung tumours with high-energy rays. This damages molecules within the cancer cells which results in destruction of the abnormal cells. Lung cancers which are considered to be advanced but have not spread to other parts of the body (locally advanced), and where lung cancer surgery is not possible, radiotherapy in combination with chemotherapy may be recommended. In suitable cases, this may be followed by immunotherapy.
Lung Cancer Treatment: Chemotherapy
Chemotherapy refers to lung cancer treatment using specially developed medication. They are usually given via injection or drip. Chemotherapy works by preventing division of cells. As a result, the cancer cannot continue to grow and gets destroyed.
Lung Cancer Treatment: Targeted Therapy
Targeted therapy, as the term implies, refers to drugs that block specific cancer-inducing process that promotes the growth and spread of lung cancer. This form of treatment only works for patients whose cancer cells express certain specific abnormalities. The advantage of this form of treatment is that it destroys cancerous cells while sparing other healthy cells.
Lung Cancer Treatment: Immunotherapy
Immunotherapy is a new form of lung cancer treatment that activates your immune system to recognize and kill cancer cells. It may be used alone or in combination with chemotherapy, in appropriate patients.
Are there any Side Effects of Lung Cancer Treatment?
Side Effects of Lung Cancer Treatment: Surgery
Potential side effects and complications of lung cancer surgery include post-operative pain, infection, bleeding.
Side Effects of Lung Cancer Treatment: Radiation Therapy
Possible side effects of radiation therapy for lung cancer include the following:
- Nausea
- Tiredness
- Pain on swallowing
- Breathlessness
- Skin pigmentation
Side Effects of Lung Cancer Treatment: Chemotherapy
Possible side effects of chemotherapy for lung cancer include:
- Drop in blood counts (transient)
- Lowered immunity
- Nausea and vomiting
- Diarrhoea or constipation
- Tiredness
- Loss of appetite
- Hair loss
- Skin and nail changes
- Numbness and tingling
- Body aches
Side Effects of Lung Cancer Treatment: Targeted Therapy
Targeted therapy causes less severe side effects compared to other forms of lung cancer treatment. Side effects of targeted therapy may include:
- Nausea and vomiting
- Diarrhoea or constipation
- Bloated feeling
- Mouth ulcers
- Rash and other skin changes
- Vision problems
Side Effects of Lung Cancer Treatment: Immunotherapy
Immunotherapy typically has lesser side effects compared to chemotherapy. However, there are sometimes less predictable and more serious side effects which your doctor or specialist for lung cancer will discuss with you. Some of the side effects of immunotherapy may include:
- Diarrhoea
- Nausea or vomiting
- Rash, dry and itchy skin
- Headaches
- Tiredness
- Hormonal imbalances
- Rarely, organ inflammation
What is Lung Cancer?
Lung cancer occurs when abnormal cells located in the lungs start to grow uncontrollably. As these cancerous cells grow, they may interfere with the function of normal cells in the lungs and may affect your ability to breathe. In advanced stages, the cancerous cells may spread to lymph glands around the airways and other parts of the lungs and body, including the bones, brain and liver.
There are two major types of lung cancer: small cell lung cancer (SCLC), which makes up about 10-15% of all lung cancer cases, and non-small cell lung cancer (NSCLC). Lung cancer is often caused by cigarette smoking. Exposure to other environmental pollutants may also have a causative role.
What are the Signs and Symptoms of Lung Cancer?
Many patients with lung cancer will not notice any symptoms until the cancer has spread. But depending on the location of the cancer, some patients may develop early warning symptoms and signs. If you or a family member experiences any of these, it is important to visit a lung cancer specialist early so that you can be screened, diagnosed and treated where needed. The outcome of treatment is likely to be better if the cancer is diagnosed earlier.
The most common symptoms
of lung cancer are:
- A cough that does not go away or gets worse over time
- Coughing up blood or sputum (spit or phlegm) stained with blood
- Chest pain, which may be made worse with deep breathing or coughing
- Hoarseness of voice
- Breathlessness
- Infections such as bronchitis and pneumonia that won’t go away or keep coming back
- New occurrence of wheezing
In more advanced stages where the cancer has spread to other organs, patients may also experience the following symptoms:
- Loss of weight and appetite
- Persistent or worsening headache, dizziness, weakness or unsteadiness
- Bone aches
- ‘Lumps’ in the neck
Screening for Lung Cancer
The goal of lung cancer screening is to detect cancer at its earliest and most treatable stage. The need for specific screening tests is based on your age, gender, a history of smoking. If you feel that you may have a high risk of developing lung cancer but show no signs or symptoms of the cancer, you may consider consulting a specialist.
If indicated, the doctor may arrange for a low-dose computed tomography (LDCT) scanning of the chest. This is an imaging which allows visualization of any tumours in the lungs but has less radiation than a standard scan.
What are the Types of Lung Cancer?
There are two major types of lung cancer:
- Non-Small Cell Lung Cancer (NSCLC): These account for most of the lung cancers diagnosed. They tend to be slower growing tumours and include Adenocarcinoma (the commonest cell type) and squamous cell carcinoma.
- Small Cell Lung Cancer (SCLC): These cancers usually affect patients who have a history of smoking. These cancers are aggressive and will require treatment urgently.
What are the Causes and Risk Factors of Lung Cancer?
A risk factor is anything that may increase your likelihood of developing a disease such as cancer. Several risk factors may make you more likely to develop lung cancer:
- Lifestyle habits, particularly smoking of tobacco products
- Exposure to radon (a radioactive gas)
- Exposure to asbestos
- Exposure to other cancer-causing agents in the workplace: radioactive ores such as uranium, inhaled chemicals or minerals such as arsenic, beryllium, cadmium, silica, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas, and chloromethyl ethers
- Diesel exhaust from vehicles
- Air pollution
- Arsenic in drinking water
- Previous radiation therapy to the lungs
How is Lung Cancer Diagnosed?
If a specialist or medical oncologist suspects the presence of lung cancer, specific imaging scans and biopsy will be needed to confirm (or rule out) the diagnosis of lung cancer.
Radiological Imaging for diagnosis and assessment may include:
- Chest XR
- CT (Computed Tomography) scan or PET (Positron Emission Tomography) scan
- Bone scan
- MRI (Magnetic Resonance Imaging) of the brain
Tests to diagnose lung cancer include:
Tissue testing is needed to confirm a diagnosis of lung cancer. There are different ways to obtain tissue for analysis:
- Pleurocentesis: If there is fluid around the lungs, this fluid can be extracted using a needle and sent to the laboratory for testing.
- Bronchoscopy: A scope is inserted through the nose or mouth into the airways to obtain tissue, which is then examined for cancer cells in the laboratory.
- Transthoracic Needle Aspiration Biopsy: A biopsy needle is inserted directly into the lung tumour to extract cells / tissue under CT scan guidance.
- Open biopsy: If the tumour is in an area that is difficult to reach by needle, biopsy is performed via a limited surgery.
What are the Stages of Lung Cancer?
The stage of lung cancer indicates how far the cancer has spread to other parts of the body. Staging helps cancer specialists decide the right course of treatment for each patient. Regardless of the stages of lung cancer, early detection and diagnosis can significantly improve the outcome for patients.
Non-Small Cell Lung Cancer (NSCLC):
- Stage 1: Cancer is confined to the lung
- Stage 2: Cancer is found in the lung and adjacent lymph nodes
- Stage 3: Cancer is found in the lung and lymph nodes in the middle of the chest (mediastinum)
- Stage 4: Cancer has spread other parts of the lungs or to organs outside the lungs
Small Cell Lung Cancer (SCLC):
- Limited stage: During this stage, the cancer is found on one side of the chest. It may be in one part of the lung or affect lymph nodes nearby.
- Extensive stage: At this stage, the cancer cells have spread to other regions of the chest or other parts of the body.
