Lung Cancer: Symptoms, Stages and Treatment

Lung cancer: what is it?

Lung cancer usually begins in the middle of fifties or in the sixties. Smoking is responsible for 80% to 90% of lung cancers in the world. All the blood flows through this organ of our body to be oxygenated and the lungs are in close contact with some blood and lymph vessels. Doctors differentiated the lung cancer types regarding its characteristics and size; there are two main types, non-small cell lung cancer, and small cell lung cancer. Small cell can spread easier than non-small cell lung cancer; and, non-small cell is not that much aggressive as small cell lung cancer.

At this point, these two types are different. It is one of the main reasons for deaths of cancer in the USA; and, it has been observed that more and more people get affected by lung cancer today. Most of the patients are men but lung cancer in women has started to increase in recent decades. That is why not only men but also women should know about lung cancer; and, pay attention to their health.

What Causes Lung Cancer?

The key reason for lung cancer is smoking. Researchers believe that tobacco causes lung cancer deaths with a huge percent like %90. It is clear that smoking tobacco is very risky and this risk increases or decreases concerning some aspects such as age, lifestyle, how frequent smoking is and its amount. Besides tobacco, there are some other triggers for lung cancer such as radioactive, toxic materials. By the way, cannabis, chronic diseases affecting lungs like bronchi may result in this disease.

Lung Cancer Symptoms

Soma basic symptoms are listed below; but, the problem is that these are the common symptoms seen in other diseases. That is why people generally neglect them expecting that they recover soon. However, if those symptoms are permanent and you don’t feel okay for a long time; you should see a doctor soon. Because lung cancer is treatable in the early stages, it should not be too late for your health.

  • a cough that intensifies or does not go away
  • wheezing
  • chest pain that is constant and intensifies
  • blood in the mucus when we cough
  • bronchopulmonary infections, such as bronchitis or pneumonia, which do not recover or continue to reappear
  • weight loss
  • tired
  • hoarseness or other changes that affect the voice
  • difficulty swallowing

Diagnosis

Smoking tobacco is known to be the main reason for this disease. After you have read the symptoms and they are permanent, especially if you are suspicious about it, you should see a doctor for some tests. X-ray is useful to understand this disease and one of the key tests. Analysis of blood and bronchi can be helpful, too.

CT Scan and Magnetic Imaging

Doctors can use CT Scan and Magnetic Imaging beside X-Ray. If further investigation is still needed, a biopsy can be done.

What are the stages of lung cancer?

Lung cancer can firstly be categorized into 4 main stages for n0n-small cell lung cancer. The prognosis for stage I (the earliest stage) lung cancer is better than stage IV (the latest stage); because it is much easier to give treatment for stage 1 patients; the cancer cells are limited inside the lung and the tumor is so small.

These stages can be differentiated in this way;

stage I:  it is the best for patients to have treatment for lung cancer.
when the diameter of the tumor is maximum 3 cm and remains inside the lung;

stage II: when the tumor spreads to lymph nodes of the bronchi or those located at the level of the hilum;

stage III: when the tumor has metastasized to the lymph nodes of the mediastinum;

stage IV:  when the tumor has spread to the pleura, other lung or other organs. This is called metastasized lung cancer which has already spread to the rest of the body and other organs.

Small cell lung cancer, 2 subtypes exist; extensive and limited one. If the cancer cells exist in on lung or neighboring structures such as lymph nodes, it is at the limited stage. However, if small cell cancer cells have spread to other organs, opposite lung, entire lung; then, it is at the extensive stage. It should be noted out that small cell lung cancer cases are generally at the extensive stage when the patients learn that they have the tumor.

A detailed and clear explanation for stages of both cancer types:
READ 
Lung Cancer Stages and Types

Treatment for Lung Cancer

Lung cancer is the more alarming than the other cancer types because it is often discovered late because the early symptoms are not specific to this disease and may be signs of other common diseases such as coughing, headaches, pain in bones. The later you recognize you have this cancer, the better it is for your treatment. It is the leading cause of cancer deaths in the USA for men and women. Lung cancer is particularly dangerous because it can spread to the rest of the body more easily than other cancers. Lung cancer treatment is rather difficult because the modern methods are not perfect yet; there are some cases in which patients get their health back completely.

The doctors decide what treatment to direct at patients by looking at the tumor size and whether there is metastasis or not and the age of the patients; their health condition; the type of cancer and its stage. The first aim of treatment is to reduce the pain and the effect of disease’s symptoms on the patient; decrease the speed of cancer cells spread and keep health condition of the patient stable.

After the diagnosis, radiotherapy or chemotherapy can be chosen or they can perform a surgical operation to take the tumor out and clean it. But, this operation needs a removal of part of the lung or entire organ. (pneumonectomy; it is what the medical world calls this operation). Ultrasound treatment, MRI, and 3D ultrasound may target the tumor and reduce the effects when they are combined.

There are 3 main treatments for lung cancer cases. These are surgery, drug treatments, and radiotherapy.  Regarding the lung cancer cases, if it didn’t metastasize, the experts may advise a surgery for non-small cell lung cancer patients. For small cell lung cancer patients; chemotherapy is the key and the most effective treatment. But please, do not forget that what your doctors advise is always more important than the recommendation in this article; you should discuss and understand the process fully and make a final decision.

lungs and lung cancer
Lungs are the key organ for the respiratory system.

Treatment Types for Lung Cancer

Basically, there are two types of treatments; Systemic and Locoregional.

Systemic treatments

They do not directly attack the cancer cells; that is why its location is not important; because it circulates in our body to attack cancer cells. Chemotherapy, immunotherapy, targeted therapies are classified under this treatment type.

Locoregional treatments

They, unlike the systemic treatments, act on cancer cells directly; it does not circulate in our body. Surgery and radiotherapy are classified under this type of treatment.

Lung Cancer Surgery

If you read our previous article on “Lung cancer stages”; you have already learned about the stages of lung cancer for both of the types. Surgical operations are up to the stages and types of the cancer cells and they aim to clean the tumor by removing a part of the lung, which is defined as Lobectomy or entire lung, which is called Pneumonectomy.  So there are 2 types of operation for lung cancer surgery.  Before surgery, the doctors should express to you what waits for you; side effects; possible outcomes of the operation. They should evaluate the patients’ health condition; other diseases they may have, other operations in the past and etc. After consulting them, you should let the patient undergo surgery.

Lobectomy (Removal of a lobe)

As we have said before, removing a part or lobe of the affected lung is called as the lobectomy. If doctors believe that lobectomy can help the patient and let him recover, they may practice this operation for the affected lung or lungs. The doctors prefer this operation if the stage of lung cancer is one of those early stages.

Pneumectomy (Removal of a lung)

Unlike the operations in Lobectomy, this type of operation requires removing the enter lung because the experts aim to reduce the risk of metastases (cancer cells spread to other organs or structures). If cancer cells affect some other neighboring structures such as lymph nodes; they are also removed during the operation.

When the patients have surgical operations, the success of them count on the characteristics of the cancer cells the patients have; its size, type, stage and general health condition are the determinants after the operation.

Do you need Lung Cancer Surgery?

The point in having a surgical operation is the removal of a part of the lung or the entire lung to clean the cancer cells. If the extent of the cancer is large and it has metastasized to other organs; doctors do not practice it. Because the aim of the surgery is to clean all the affected structures, which means that it should not metastasize.

Among lung cancer treatments, surgery plays a vital role for non-small cell lung cancer; however, it is not practicable for all stages. The practitioners prefer operations when the stage is 1, 2 and sometimes stage 3A; but, it is rarely advised for stage 3B. Surgery is practicable for small cell lung cancer, only when it has not spread to other organs. If the cancerous cells have spread to some other structures in the body; then, the doctors use other treatment techniques such as targeted therapies, immunotherapies, and radiotherapy.

In conclusion, the final decision to have a surgical operation is directed by the cancer type, stage, and its metastases. If the patients have surgery, some side effects may be seen after the practice.

Side Effects of Surgery

After the operation, patients may experience some side effects listed as following. If the patients experience these side effects severely and are really weak; they should let the doctors know about this situation and follow them.

  • pneumothorax:  air or gas exists in the pleural cavity; between your lung and chest wall. It is a serious side effect because it can make pressure on the lung and can collapse it. If your chest hurts severely; you have a serious pain and you experience shortness of breath; you may have the pneumothorax and should contact your doctor immediately.
  • pleural effusion: much fluid builds up around the lung. It may cause coughs, fever and chest pain. That is why you should contact your doctor and let them treat it.
  • bleeding: some bleeding may be experienced; if the surgery site bleeds after the operation; the patients should cover it with a bandage which is both clean and dry.
  • infection: it is possible to have some infections; although doctors try hard to decrease infection risk; it is seen in some cases after the surgery.
  • pain: the patients may have pain regarding the extent of the surgery.
  • phlebitis: it is inflammation, and generally appears with bruising.
  • fatigue: the patients may experience this up to 1 month; it is something usual.
  • haemothorax: blood may collect in the surgery site; you should let the doctors know what extent it is.
  • Swelling: it is also seen much and one of the common side effects.
  • Bruising: surgery site may bruise, it is normal.
  • Dysfunction of an organ: the patients may experience loss of function in some organs; they are generally temporal losses, but you should contact your doctors.

Radiotherapy for Lung Cancer

Radiotherapy is different from other treatment techniques because it is practicable for all cancer diseases; and, it can be given as a supportive treatment to the patients, especially with chemotherapy. It attacks cancerous cells and kills them with the high energy; this energy spreads to the targeted site. Radiotherapy is very useful for the inoperable cancer cases such as tumors in the brain, metastasized cancer cells. For lung cancer treatment, radiotherapy aims to attack the tumor and the structures around it to act on cancerous cells.

Use and Limitations of Radiation Therapy

Doctors advise radiotherapy combined with chemotherapy; patients of Stage 3B and 3A,
inoperable Stage 1A and 1B; if the tumor still exists after surgery or chemotherapy; or when it invades the lining of the lung at stage 2; if the cancerous cells metastasized; small cell lung cancers which haven’t metastasized yet (with chemotherapy). As you can see from these treatment techniques, radiotherapy plays a vital role in different stages of lung cancer.

Techniques of Radiotherapy

There are several main radiotherapy techniques to act on cancerous cells but the leading one is conformational radiotherapy which can attack cancerous tissues and after the evaluation of the targeted tumor. It can arrange the dose of radiation and distribute it to the tumor and reduces the risk of healthy structures to expose to radiation and keep them stable. It benefits from some software and imagination techniques; and, it also concerns about your breathing and take it into account during the practice; it is what makes conformational radiotherapy the leading technique.

Today, if the targeted tumor is not large, endobronchial brachytherapy has made it possible to direct the radiation to the center of that tumor and so, there is no need to have any surgical operations to clean it out. Endobronchial brachytherapy requires locating a bit of radioactive material to the tumor on purpose with a wire.

Side Effects of Radiation Therapy

After the practice of radiation therapy, the patients may experience some side effects for a while; these symptoms are up to the general health condition of the patient, tumor’s type and size. The side effects are; nausea, difficulty in or pain in swallowing, loss of hair, loss of appetite. Practitioners and doctors work hard to reduce the effects of them and keep the patients comfortable after the practice. If these side effects hurt a lot and make the patient uncomfortable, the doctor should know about it, especially when these side effects seem to be permanent.

Chemotherapy for lung cancer

Chemotherapy aims to attack cancerous cells by delivering toxic drugs and to kill them. It is able to prevent cells from duplicating and destruct the cell frame’s fibers, which causes cancerous cells to lose their power and decrease the spread speed of cells. Patients can take Chemotherapy medicines by orally or by venous route and undergo these treatments once three or four weeks to give healthy cells the opportunity to recover; these practices are repeated; the doctors can decide how many times the patients get these drugs by taking into account treatment progress and outcomes.

Use and Limitations of Chemotherapy

Chemotherapy may be needed before or after the surgery; the doctors sometimes combine them and apply an integrated treatment. If the chemotherapy is preoperative, the patients take the drugs before the surgery; however, if it is postoperative, the patients take drugs after the surgery as you guess.

When it comes to non-small cell lung cancer, chemotherapy drugs are not that much effective for malignant cells; however, postoperative or preoperative chemotherapy can be given. Chemotherapy is advised for Stages 1B; as postoperative in stage 2; as a part of treatment 3A; integrated with radiotherapy in stage 3B and 4.

For small cell lung cancer, chemotherapy is systematic because it is common to assume an extension of cancer to other organs even if this extension is not localized precisely. It is usually indicated:

As it is in non-small cell lung cancer, chemotherapy again plays a vital role in small cell lung cancer treatment. For both types of small cell cancer, chemotherapy is practiced regularly because small cell lung cancer cells are more aggressive than non-small one, that is why there is a risk of metastases.

Chemotherapy Drugs

The frequently prescribed drug for chemotherapy is cisplatin by injection. It is also possible to see a treatment of a combination of cisplatin or carboplatin with other chemotherapy drugs such as;

Drugs Name

injection

capsule

Etoposide

yes

yes

Paclitaxel

yes

no

Vinorelbine

yes

yes

Docetaxel

yes

no

Pemetrexed

yes

no

Gemcitabine

yes

no

Side Effects of Chemotherapy

Loss of hair, vomiting, diarrhea, loss of weight, loss of appetite, fatigue, anemia, headaches, muscle pain;  These effects depend on what drug the patient will take. Doctors are aware of the drugs’ side effects and will let you know about them.

Targeted therapies for lung cancer

Targeted therapies are differentiated from chemotherapy in a way that they do not act on all cells; they target the cancerous cells and destroy them; at this point, targeted therapies offer fewer side effects than chemotherapies. Chemotherapies can cover most of the patients, and can be given to them; however, doctors can practice targeted therapies for certain types of mutations; otherwise, it cannot be beneficial for patients. Experts apply a test to see the type and characteristics of the cell through analysis of the tumor sample, blood sample, liquid biopsy or etc. After understanding the characteristics, they decide whether targeted therapies for lung cancer treatment are okay or not.

The Major Targeted Therapies

There are six main targeted therapies; the doctor can advise different one regarding the characteristics of the tumor and the patient’s health condition.

NAME

FORM

Afatinib

Tablet

Erlotinib

Tablet

Ceritinib

Tablet

Bevacizumab

Injection

Crizotinib

Tablet

Gefitinib

Tablet

 Use and Limitations of Targeted Therapies

Especially stage 4 non-small cell lung cancer needs targeted therapies; doctors utilize this treatment for further stages of lung cancer and these therapies are generally combined with chemotherapy. The treatment technique has some determinants such as the tumor’s size, type, stage and the patient’s characteristics.

Side Effects of Targeted Therapies

Traditional chemotherapy is practiced once three or four weeks because it acts on all cells unlike the targeted therapies; these therapies has less toxic and just act on cancerous cells. That is why it has fewer side effects.

Immunotherapy for Lung Cancer

Immunotherapy is practiced especially for non-small cell lung cancer rather than small cell cancers. Its main goal is to destroy the cancerous cells by supporting and reconstructing the immune system; when a patient’s immune system gets stronger; it can cope with the tumor. Immune system compounds know the structures of targeted tumor cells. These compound can act on cancerous cells or immune system’s cells. Most common immune system compounds are anti-PD1 and anti-PDL1. The first one, anti-PD1, acts on immune system cells; the second one, anti-PDL1, acts on the tumor’s cells.

Immunotherapies against Lung Cancer

PD-L1 plays an important role in cancer treatments because it can be utilized as a cancer biomarker as well as a target for the treatment. Restriction of PD-L1 can support antitumor to reconstruct its acts against the tumor. Immunotherapies have been practicable for the tumors whose characteristics correspond to Pembrolizumab (Keytruda) PDL1 (programmed cell death ligand-1) biomarker which has proved its efficiency. Immunotherapies can also be useful for the treatment in which chemotherapy or other treatment techniques like targeted therapies couldn’t help the patient to recover without taking PD-L1 of cancerous cells into account. These patients take nivolumab (Opdivo ®) and Pembrolizumab (Keytruda ®).

Side Effects of Immunotherapies

The most common side effects of Immunotherapy compounds are dry eyes, dizziness, headache, diarrhea, rash, anemia and etc. If these symptoms are permanent and they make you uncomfortable much; you should make a contact with your doctor and let him know about the process.

Treatments in Conclusion

As you can see, there are many variables in making a decision of what treatment will be given to the patients; doctors take into account the patients’ age, general health condition, size of the tumor, its’ extent, and type. After an evaluation in depth of these factors, doctors can give treatments to lung cancer patients. You shouldn’t forget that all of these treatment techniques have some side effects and the patients should know about them; lung cancer can be treated not only with drugs or therapies but also with supportive care of friends, family and the patients themselves.

Can people stop it to spread to the rest of the body?

People who have lung cancer should quit smoking as soon as possible and start to see their doctors in certain periods; because it can be stopped and cured regarding the stage it is in. It is not a contagious disease; which means it not a threat to people living around the patient.

How to Protect Yourself?

Everybody knows that the main reason for this disease is smoking tobacco. If people do not quit smoking, this can increase the chance to have lung cancer for them in the future. By the way, doctors and researchers advice that it is better for you to stay away from the places where people smoke a lot because passive smoking is a fact of today’s world.

 

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