Lung Cancer

Lung cancer is a complex disease and one of the most serious types of cancer. Understand the causes, symptoms and treatment options for this challenging disease.

What is Lung Cancer?

Lung cancer is a type of cancer that begins in the lungs, the organs responsible for breathing and oxygen exchange. It is one of the most common cancers worldwide and is the leading cause of cancer-related deaths among men and women.

Lung cancer often starts in the cells lining the air passages of the lungs but can also develop in other parts of the lungs, such as the bronchioles, bronchi, or alveoli. There are two main types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), each with different characteristics and treatment approaches.

Causes

The primary cause of lung cancer is exposure to carcinogens (cancer-causing substances), particularly those found in tobacco smoke. However, other factors may also increase the risk of developing lung cancer:

• Tobacco Smoke: Tobacco smoke, including cigarette smoke, cigar smoke, and pipe smoke, is the leading cause of lung cancer. Smoking tobacco is responsible for the majority of lung cancer cases worldwide, and long-term smokers are at significantly higher risk of developing the disease than nonsmokers.
• Second-hand Smoke: Exposure to second-hand smoke, also known as passive smoking or environmental tobacco smoke, increases the risk of lung cancer among nonsmokers. Second-hand smoke contains many of the same carcinogens found in mainstream smoke and can cause lung cancer and other health problems.
• Occupational Exposure: Exposure to carcinogens and hazardous substances in the workplace, such as asbestos, radon, arsenic, diesel exhaust, uranium, chromium, nickel, or certain chemicals used in mining, construction, manufacturing, or agriculture, may increase the risk of lung cancer.
• Radon Gas: Radon is a naturally occurring radioactive gas that can seep into homes and buildings from the soil or rock beneath them. Prolonged exposure to high levels of radon gas is a significant risk factor for lung cancer, particularly among individuals who smoke.
• Air Pollution: Exposure to outdoor air pollution, such as particulate matter, nitrogen oxides, sulphur dioxide, ozone, or vehicle emissions, may increase the risk of lung cancer, especially in urban or industrial areas with high levels of pollution.
• Family History: A family history of lung cancer may increase the risk of developing the disease, particularly among first-degree relatives (such as parents, siblings, or children) of individuals with lung cancer.
• Genetic Factors: Certain genetic factors or inherited predispositions may increase the risk of lung cancer, although the specific genes involved and their exact roles are still being studied.
• Radiation Therapy: Previous radiation therapy to the chest area, such as for the treatment of Hodgkin lymphoma, breast cancer, or other cancers, may increase the risk of lung cancer later in life.
• Lung Diseases: Certain preexisting lung diseases, such as chronic obstructive pulmonary disease (COPD), emphysema, pulmonary fibrosis, or tuberculosis (TB), may increase the risk of developing lung cancer.

Symptoms

Lung cancer may cause symptoms, but they are often nonspecific and may be similar to symptoms of other respiratory conditions. Common symptoms of lung cancer may include:

• Persistent Cough: A persistent or chronic cough that does not go away or worsens over time, particularly if it produces blood or bloody sputum (haemoptysis).
• Shortness of Breath: Shortness of breath or difficulty breathing, which may occur with or without exertion and may worsen over time.
• Chest Pain: Chest pain or discomfort that may be sharp, dull, or aching in nature, and may be felt in the chest, back, shoulder, or arm.
• Wheezing: Wheezing or a whistling sound when breathing, particularly if it occurs in association with coughing or exertion.
• Hoarseness: Hoarseness or changes in voice quality, such as a raspy or deep voice, that persists for more than a few weeks.
• Unexplained Weight Loss: Unexplained weight loss, loss of appetite, or wasting (cachexia) that occurs without dieting or intentional changes in eating habits.
• Fatigue: Persistent fatigue, weakness, or lack of energy that is not relieved by rest and interferes with daily activities.
• Respiratory Infections: Recurrent or persistent respiratory infections, such as bronchitis or pneumonia, that do not respond to usual treatments.
• Coughing Up Blood: Coughing up blood or bloody sputum (haemoptysis), which may be streaked with blood or may be more significant in quantity.
• Swelling of the Face or Neck: Swelling of the face, neck, or upper chest, particularly if it occurs on one side and is associated with venous congestion or obstruction (superior vena cava syndrome).

It is important to note that these symptoms can also be caused by other conditions, such as respiratory infections, allergies, asthma, or chronic lung diseases, and experiencing one or more of these symptoms does not necessarily mean that a person has lung cancer. However, if symptoms persist or worsen over time, it is important to see a doctor for evaluation and diagnosis.

Diagnosis and Evaluation

If lung cancer is suspected based on symptoms, physical examination, or imaging findings, diagnostic tests and evaluations may be performed, which may include:

• Chest X-ray: A chest X-ray may be performed to create images of the lungs and chest cavity and detect abnormalities, such as masses, nodules, or infiltrates, that may indicate the presence of lung cancer.
• Computed Tomography (CT) Scan: CT scan uses multiple X-ray images to create detailed cross-sectional images of the lungs and chest area, allowing for a more precise evaluation of lung tumours, lymph nodes, or metastases.
• Sputum Cytology: Sputum cytology involves examining a sample of sputum (mucus coughed up from the lungs) under a microscope to detect abnormal cells that may indicate the presence of lung cancer.
• Bronchoscopy: Bronchoscopy is a procedure that uses a flexible tube with a camera (bronchoscope) to examine the airways and collect tissue samples (biopsy) from the lungs for microscopic examination. Bronchoscopy may also be used to visualize and biopsy suspicious lung lesions or masses.
• Needle Biopsy: Needle biopsy, also known as fine-needle aspiration (FNA) or core needle biopsy, involves using a thin needle to extract tissue samples from lung lesions or lymph nodes for microscopic examination.
• Thoracentesis: Thoracentesis is a procedure that involves removing fluid from the pleural space (the space between the lungs and the chest wall) using a needle and syringe. Thoracentesis may be performed to evaluate pleural effusions (fluid buildup) or to obtain fluid samples for analysis.
• Positron Emission Tomography (PET) Scan: PET scan uses a radioactive tracer to create images of metabolic activity in the body and may be used to evaluate the extent of the disease, detect metastases, or assess treatment response.
• Biopsy and Pathologic Evaluation: If lung cancer is suspected based on imaging studies or biopsy results, a biopsy may be performed to obtain tissue samples from the lungs or other affected areas for microscopic examination. Pathologic examination helps determine the type, stage, grade, and molecular characteristics of the cancer, which are important factors for treatment planning and prognosis.

Staging and Evaluation

Once a diagnosis of lung cancer is confirmed, further staging and evaluation may be performed to determine the extent of the disease and guide treatment decisions. Staging may include:

• Computed Tomography (CT) Scan: CT scan of the chest, abdomen, and pelvis may be performed to evaluate for metastases, detect involvement of adjacent organs or lymph nodes, or assess treatment response.
• Magnetic Resonance Imaging (MRI): MRI of the brain or spine may be performed to evaluate for metastases or detect involvement of the central nervous system.
• Bone Scan: Bone scan may be performed to evaluate for metastases to the bones or detect bone involvement.
• Endobronchial Ultrasound (EBUS): EBUS is a procedure that uses ultrasound imaging to evaluate mediastinal lymph nodes (lymph nodes in the chest) for metastases or lymph node involvement.
• Mediastinoscopy: Mediastinoscopy is a surgical procedure that involves using a thin tube (mediastinoscope) to visualize and biopsy lymph nodes in the mediastinum (the area between the lungs) for microscopic examination.
• Lung Function Tests: Lung function tests, such as spirometry or pulmonary function tests (PFTs), may be performed to assess lung function and determine baseline respiratory function before treatment.

Treatment and Management

Treatment for lung cancer depends on various factors, including the type, stage, histologic subtype, molecular characteristics, extent of the disease, and the patient’s age, overall health, and preferences. Treatment options may include:

• Surgery: Surgical removal of the tumour and surrounding tissues (lobectomy, pneumonectomy, or segmentectomy) is the primary treatment for early-stage lung cancer. Surgery may be curative for localized disease and may be combined with other treatments such as chemotherapy or radiation therapy.
• Radiation Therapy: Radiation therapy uses high-energy beams of radiation to destroy cancer cells or shrink tumours and may be used as a primary treatment for early-stage lung cancer, as adjuvant therapy (after surgery) to reduce the risk of recurrence, or as palliative therapy to relieve symptoms or control advanced disease.
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells or inhibit their growth and may be used alone or in combination with surgery, radiation therapy, or targeted therapy for both early-stage and advanced-stage lung cancer. Chemotherapy may be administered intravenously or orally and may be given in cycles or continuously, depending on the treatment regimen.
• Targeted Therapy: Targeted therapy drugs that target specific molecular pathways or genetic mutations involved in lung cancer growth and progression may be used to block tumour growth, prevent angiogenesis (formation of new blood vessels), or overcome resistance to chemotherapy. Targeted therapy drugs may include EGFR inhibitors, ALK inhibitors, ROS1 inhibitors, or other molecularly targeted agents.
• Immunotherapy: Immunotherapy drugs such as immune checkpoint inhibitors or monoclonal antibodies may be used to stimulate the immune system to recognize and attack cancer cells. Immunotherapy may be used in certain cases of lung cancer to enhance treatment response, improve survival, or induce durable remissions.
• Palliative Care: Palliative care focuses on providing relief from symptoms, pain, and stress associated with cancer and its treatment, and may be provided concurrently with curative or life-prolonging therapies. Palliative care aims to improve quality of life, relieve suffering, and support patients and their families throughout the cancer journey.
• Clinical Trials: Participation in clinical trials may offer access to novel treatments, experimental therapies, or investigational drugs that are being evaluated for safety and efficacy in the treatment of lung cancer. Clinical trials help advance scientific knowledge and may provide potential benefits to participants.

Follow-Up and Monitoring

After treatment for lung cancer, regular follow-up visits with your doctor, pulmonologist, medical oncologist, or radiation oncologist are essential to monitor treatment response, assess disease recurrence, and address any complications or side effects. Monitoring may include:

• Imaging Studies: Follow-up imaging studies such as CT scan, PET scan, or MRI may be ordered to evaluate for recurrence, detect metastases, or assess treatment response.
• Lung Function Tests: Periodic lung function tests, such as spirometry or pulmonary function tests (PFTs), may be performed to assess lung function and monitor for any changes or complications related to treatment.
• Symptom Assessment: Your doctor will ask about any changes in symptoms, such as cough, shortness of breath, chest pain, fatigue, or weight loss, during follow-up visits.
• Blood Tests: Periodic blood tests may be monitored to assess for signs of disease recurrence, evaluate treatment response, or detect any treatment-related side effects.
• Supportive Care: Supportive care services, such as nutritional counseling, respiratory therapy, pain management, or psychosocial support, may be offered to help manage symptoms, improve quality of life, and address the physical, emotional, and social needs of patients and their families.

Prevention and Risk Reduction

While the exact cause of lung cancer is not fully understood, several strategies may help reduce the risk of developing the disease:

• Tobacco Cessation: Quitting smoking and avoiding exposure to second-hand smoke are the most important steps to reduce the risk of lung cancer. Smoking cessation programs, nicotine replacement therapy, medications, counseling, or support groups may be helpful for individuals trying to quit smoking.
• Avoidance of Carcinogens: Avoiding exposure to carcinogens and hazardous substances in the workplace, such as asbestos, radon, diesel exhaust, or certain chemicals, may help reduce the risk of lung cancer. Employers should implement workplace safety measures to minimize occupational exposure to carcinogens and protect workers’ health.
• Radon Testing and Mitigation: Testing homes and buildings for radon gas and implementing radon mitigation measures, such as sealing cracks in the foundation or installing ventilation systems, can help reduce indoor radon levels and lower the risk of lung cancer.
• Air Quality Improvement: Supporting policies and initiatives to reduce air pollution, promote clean energy sources, improve indoor air quality, and mitigate environmental factors that contribute to lung cancer risk can help protect public health and prevent lung cancer.
• Lung Cancer Screening: Lung cancer screening with low-dose computed tomography (LDCT) may be recommended for individuals at high risk of developing lung cancer, such as current or former smokers, to detect lung cancer at an early stage when it is most treatable. Screening eligibility criteria and recommendations may vary based on age, smoking history, and other risk factors.
• Healthy Lifestyle Habits: Adopting a healthy lifestyle that includes regular physical activity, maintaining a healthy weight, eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, limiting alcohol consumption, and avoiding exposure to tobacco smoke or other carcinogens may help reduce the risk of lung cancer and improve overall health.

Conclusion

Lung cancer is a complex and challenging disease that affects millions of people worldwide and is associated with significant morbidity and mortality. While tobacco smoke remains the leading cause of lung cancer, other factors such as occupational exposure, environmental pollution, genetic predisposition, and lifestyle habits may also contribute to the risk of developing the disease.

Lung cancer often presents with nonspecific symptoms that may be overlooked or attributed to other respiratory conditions, highlighting the importance of early detection, screening, and awareness.

If diagnosed with lung cancer, treatment options may include surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or palliative care, depending on the type, stage, and molecular characteristics of the cancer.

Prevention strategies such as tobacco cessation, avoidance of carcinogens, radon testing, air quality improvement, lung cancer screening, and healthy lifestyle habits can help reduce the risk of lung cancer and improve outcomes. By raising awareness, promoting prevention efforts, supporting research, and providing comprehensive care, doctors, policymakers, advocacy organizations, and communities can work together to reduce the burden of lung cancer and improve the health and well-being of individuals affected by this disease.

Arranging To Visit A Private GP

To discuss any worrying symptoms that could be an indication of lung cancer make an appointment with one of our private GPs. Appointments are available to everyone and can often be booked for the same day. There is no need to be registered with our Buckinghamshire hospital, or live locally.

If you have insurance which covers a GP visit, we can in most cases invoice the insurer directly. Where you are paying directly, the cost for a 30 minute consultation is £125.

Any additional costs will always be discussed. They could apply if you are referred for an MRI scan, or to a consultant, or for other agreed decisions to support your health.

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