Want to know more about lung cancer? Let's talk about it in detail!

Have you ever been worried about something like a persistent cough? Sometimes we think it's something minor, but it can be a sign of a serious illness. Today we're going to talk about a disease that many people fear, but it's very important to be aware of. That is lung cancer, or `(Lung Cancer)`. Simply put, lung cancer is a disease that occurs when the cells inside your lungs start dividing uncontrollably. The cells in our body divide normally and make new cells all the time. That's what helps our body grow and repair tissues. But sometimes, certain changes `(mutations)` occur in these cells. Then these cells start dividing even when they shouldn't. These uncontrolled dividing cells come together and form `(tumors). Because of these tumors, organs like our lungs can't function properly. Lung cancer is the name given to cancers that start in the lungs. Most often, these start in the lungs, in places like the bronchi or bronchioles or the small air sacs called alveoli. Sometimes, cancer that starts in other places can spread to the lungs. Doctors then call it 'cancer that's metastatic to your lungs'. This means that the cancer is named after where it started.

What are the main types of lung cancer?

Although there are several types of cancer that affect the lungs, when we talk about 'lung cancer' we usually refer to two main types. These are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).

Non-small cell lung cancer (NSCLC)

This is the most common type of lung cancer. More than 80% of lung cancer patients have this type. There are several main types of this type. For example, `(Adenocarcinoma)` and `(Squamous cell carcinoma)` can be mentioned. `(Adenosquamous carcinoma)` and `(Sarcomatoid carcinoma)` are also two types that fall under `(NSCLC)`, but are slightly less common.

Small cell lung cancer (SCLC)

This type of `(SCLC)` grows faster than `(NSCLC)` and is also a little harder to treat. It is often found as a small tumor in the lungs, but by then it may have spread to other parts of the body. The specific types of `(SCLC)` are `(Small cell carcinoma)` (also called `(oat cell carcinoma)`) and `(Combined small cell carcinoma)`.

Other types of cancer that can occur in the lungs

In addition to these two main types, there are other types of cancer that start in or around the lungs. Examples include lymphomas, sarcomas, and pleural mesothelioma. These are treated differently and are not usually called lung cancer.

What are the stages of lung cancer?

When cancer is diagnosed, doctors next look at the stage it is in. This is determined by the size of the original tumor, how far it has spread to nearby tissues, and whether it has spread to lymph nodes or other organs. Each type of cancer has a different staging system.

Stages of lung cancer

Each stage can have different combinations of size and spread. For example, a cancer in stage III may be smaller than one in stage II. However, it is considered more advanced due to other factors. The common stages of lung cancer are:

• Stage 0 (Stage 0 - In-situ): The cancer is only in the uppermost layer of the lung or bronchi. It has not spread to other parts of the lung or outside the lung.
• Stage I: The cancer has not spread outside the lungs.
• Stage II: The cancer is larger than stage I, has spread to lymph nodes within the lung, or there is more than one tumor in the same lobe of the lung.
• Stage III: The cancer is larger than stage II, has spread to nearby lymph nodes or surrounding structures, or there is more than one tumor in another lobe of the same lung.
• Stage IV: The cancer has spread to the other lung, the fluid around the lung , the fluid around the heart , or distant organs.

Limited and Extensive Stages - for Small Cell Carcinoma (SCLC)

Although doctors now use the same stages ``I`` through ``IV`` for ``SCLC``, you may also hear the terms ``limited stage`` or ``extensive stage``. This depends on whether the cancer is confined to an area that can be treated with a ``single radiation field``.

• Limited stage SCLC is confined to one lung. Sometimes it may have spread to lymph nodes in the middle of the chest or to lymph nodes on the same side above the collarbone.
• Extensive stage SCLC cancer may have spread throughout one lung, or it may have spread to the other lung, to lymph nodes on the opposite side of the lung, or to other parts of the body.

What is metastatic lung cancer?

Metastatic lung cancer is cancer that starts in one lung and spreads to the other lung or other parts of the body. Treating these types of metastatic cancers is more difficult than treating cancers that are localized.

How common is lung cancer?

In countries like the United States, lung cancer is the third most common type of cancer. According to health systems in those countries, more than two hundred thousand new lung cancer cases are reported every year. This can be considered a major health problem in Sri Lanka as well.

What are the symptoms of lung cancer?

Often, the symptoms of lung cancer are similar to those of other, less serious diseases. Many people do not have any symptoms until the disease is very advanced. However, some people may have symptoms early on. Even if they do have symptoms, they may only have one or more of the following:

• A cough that won't go away and gets worse.
• Difficulty or shortness of breath (dyspnea).
• Chest pain or discomfort.
• Wheezing is a whistling sound coming from the chest.
• Coughing up blood (hemoptysis) .
• Voice becoming hoarse.
• Food is tasteless .
• Becoming thin for no reason.
• Feeling extremely tired for no reason.
• Shoulder pain .
• Swelling of the face, neck, arms, or upper chest (Superior vena cava syndrome).
• The pupil of one eye is dilated, the eyelid is drooping, and sweating on that side is reduced or absent (Horner's syndrome).

What are the first symptoms of lung cancer?

A persistent cough or pneumonia that doesn't go away despite treatment can sometimes be an early sign of lung cancer. But they can also be caused by other, less serious conditions. The most common early symptoms are a persistent or worsening cough, shortness of breath, chest pain, hoarseness, or unexplained weight loss. Depending on where your lung cancer starts, some of these symptoms may occur in the early stages (stage I or II). But they often appear after the cancer has progressed to an advanced stage. That's why it's important to get screened for lung cancer if you're at risk.

How long can lung cancer be present without being known?

Cancer can grow in your body for years without you even realizing it. Lung cancer often doesn't show symptoms in the early stages.

What are the causes of lung cancer?

Lung cancer occurs when cells that don't really need to divide keep dividing. As I said before, cell division is a normal process. But every cell has a switch called ``senescence'' that says, ''Enough, don't divide anymore'', or a way to die when it needs to (apoptosis). This switch is activated when a cell divides too much, or when it has too many changes (mutations). Cancer cells are normal cells in our bodies that have ``mutations'' that have removed that switch. Then the cells continue to divide uncontrollably, interfering with our normal cells. These cancer cells can get into the blood or lymphatic system, travel to other parts of the body, and spread the damage. We don't know exactly why some people develop these changes and develop cancer, while others don't. However, certain factors, such as using tobacco products, can damage your cells and increase your risk of developing lung cancer.

Risk factors for lung cancer

Although there are many factors that increase the risk of lung cancer, the single biggest risk factor is the use of any form of tobacco, such as cigarettes, cigars, and pipes. Experts say that 80% of lung cancer deaths are related to smoking. Other risk factors include:

• Exposure to secondhand smoke. This means that you are exposed to secondhand smoke when you are around someone who is smoking, even if you are not smoking.
• Exposure to harmful substances such as air pollution, radon, asbestos, uranium, diesel fumes, silica, and coal products.
• Having previously received radiation treatments to the chest (for example, for breast cancer or lymphoma).
• A family history of lung cancer (hereditary predisposition).

Does vaping cause lung cancer?

When you vape (use a device that inhales a mixture of nicotine and flavorings), you can inhale a number of things, including substances that are known to cause cancer. Because vaping is still new, we don't know all of its long-term effects. But experts believe it can cause lung damage.

Can non-smokers get lung cancer?

Although smoking is the main risk factor for lung cancer, about 20% of people diagnosed with the disease have never smoked. That's why it's important to talk to a doctor if you have any suspicious symptoms.

How is lung cancer diagnosed?

Diagnosing lung cancer is a multi-step process. When you first see a doctor, they will ask about your symptoms, ask about your medical history, and do a physical exam (such as listening to your heart and lungs). Because the symptoms of lung cancer are similar to those of other common diseases, your doctor may first order blood tests and a chest X-ray. If your doctor suspects you may have lung cancer, the next steps will be to do other imaging tests, such as a CT scan, and a biopsy. This may include a PET/CT scan to see if the cancer has spread, and to examine the cancer tissue from the biopsy to determine the best treatment.

Can a chest X-ray show lung cancer?

X-rays are not as good as CT scans for showing lung tumors, especially in the early stages. Tumors may be too small to be seen on an X-ray, or they may be hidden by other structures in the body (such as the ribs). An X-ray cannot tell for sure if you have lung cancer – it can only show the doctor if there is anything suspicious that needs to be examined further.

What tests are used to diagnose lung cancer?

Tests your doctor may order include blood tests, imaging tests, and fluid or tissue biopsies.

Blood tests

Blood tests alone cannot diagnose cancer, but they can help your doctor see how your organs and other parts of your body are working.

Imaging tests

Chest X-rays and CT scans give your doctor pictures of changes in your lungs. A PET/CT scan is usually done if something suspicious is found on a CT scan, or after cancer has been diagnosed to see if it has spread.

Biopsy

There are several methods your doctor can use to get a better look at what's going on inside your chest. In these methods, your doctor can take a sample of tissue or fluid (biopsy). They can look at it under a microscope to see if there are cancer cells and what type of cancer it is. These samples can also be tested for genetic changes (mutations) that could affect your treatment. Methods used to detect lung cancer early or find out more about its spread include:

• Needle biopsy: In this, the doctor uses a needle to take a sample of fluid or tissue.
• Bronchoscopy, Thoracoscopy, or Video-assisted thoracic surgery (VATS): A doctor uses these procedures to look at parts of the lungs and take tissue samples.
• Thoracentesis: A doctor uses this procedure to take a sample of the fluid around your lungs and test it.
• Endobronchial ultrasound or Endoscopic esophageal ultrasound: A doctor uses these methods to look at lymph nodes and perform biopsies.
• Mediastinoscopy or mediastinotomy: A doctor uses these procedures to look at the area between the lungs (the mediastinum) and take samples.

Molecular tests

As part of the biopsy, your doctor will test your tissue sample for gene changes (mutations) that can be targeted with special drugs. This is part of your treatment plan. In NSCLC, the genes that may have mutations that can be targeted are:

• `(KRAS)`
• `(EGFR)`
• `(ALK)`
• `(ROS1)`
• `(BRAF)`
• `(RET)`
• `(MET)`
• `(HER2)`
• `(NTRK)`

How is lung cancer treated?

The goal of lung cancer treatment is to get rid of the cancer from your body or control its growth. These treatments can remove cancer cells, destroy them, stop them from dividing, or teach your immune system to fight them. Some therapies are also used to reduce symptoms and relieve pain. The treatment you get will depend on the type of lung cancer you have, where it is, how far it has spread, and many other factors.

What are the medications/treatments used for lung cancer?

Lung cancer treatments include surgery, radiofrequency ablation (RFA), radiation therapy, chemotherapy, targeted drug therapy, and immunotherapy.

Surgery

Surgery is available for non-small cell lung cancer (NSCLC) that has not spread and for single-cell lung cancer (SCLC). Your surgeon will remove the cancer and some healthy tissue around it to make sure no cancer cells are left. Sometimes, to give the best chance of the cancer not coming back, a resection is needed to remove all or part of your lung.

Radiofrequency ablation (RFA)

For non-small cell lung cancer (NSCLC) tumors near the outer edges of the lungs, a treatment called radiofrequency ablation (RFA) is sometimes used. RFA uses high-energy radio waves to heat and destroy cancer cells.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It can be done alone or as an adjunct to surgery to make surgery more successful. Radiation therapy is also used as palliative care - to shrink tumors and reduce pain. It is used for both NSCLC and SCLC.

Chemotherapy

Chemotherapy is a combination of drugs that are often used to stop the growth of cancer cells. It may be given before or after surgery, or in combination with other drugs, such as immunotherapy. Chemotherapy for lung cancer is usually given intravenously (IV).

Targeted drug therapy

Some people with non-small cell lung cancer (NSCLC) have specific changes (mutations) in their lung cancer cells that help the cancer grow. Special drugs target these mutations and try to control or kill the cancer cells. Other drugs, called angiogenesis inhibitors, can stop the formation of new blood vessels that cancer cells need to grow.

Immunotherapy

Our bodies usually recognize and destroy damaged or unhealthy cells. But cancer cells can hide from the immune system and remain undetected. Immunotherapy works by exposing cancer cells to your immune system. Your own body can then fight the cancer.

Palliative care

Some lung cancer treatments are used to relieve symptoms such as pain and difficulty breathing. These include treatments that shrink or remove tumors that are blocking the airways, and methods that remove fluid around the lungs and stop it from building up again.

What are the side effects of the treatments?

Side effects of lung cancer treatment depend on the type of treatment you receive. Your doctor can tell you what side effects to expect and what complications to watch out for with your specific treatment.

Chemotherapy

• Nausea, vomiting.
• Diarrhea.
• Hair loss.
• Fatigue.
• Mouth sores.
• Loss of sensation, weakness, or numbness (neuropathy).

Immunotherapy

• Fatigue.
• Itchy rash.
• Diarrhea.
• Nausea, vomiting.
• Joint pain.
• Additional side effects may occur due to complications (e.g., pneumonitis, colitis, hepatitis).

Radiation therapy

• Difficulty breathing.
• Cough.
• Pain.
• Fatigue.
• Difficulty swallowing.
• Dry, itchy, or red skin.
• Nausea, vomiting.

Surgery

• Difficulty breathing.
• Chest wall pain.
• Cough.
• Fatigue.

How to manage symptoms and side effects?

Your doctor may prescribe medications to help you manage your symptoms or the side effects of your treatment. A palliative care specialist or dietitian can help you manage your pain or other symptoms and improve your quality of life while you are receiving treatment.

What should I expect if I have lung cancer?

What to expect after being diagnosed with lung cancer depends on many factors. For some people with early-stage cancer, doctors will remove the cancer and then continue to have follow-up screenings for several years. For many others, this is a process that changes over time. This means that you may try one treatment until it works, then switch to another treatment when it no longer works.

Does lung cancer spread quickly?

How quickly lung cancer spreads depends on its type. Of the main types, small cell lung cancer (SCLC) tends to spread more quickly than non-small cell lung cancer (NSCLC). By the time lung cancer is found, it may have already spread to the lymph nodes or other organs.

Can lung cancer be cured?

Some types of lung cancer, if caught before it has spread, can be considered cured. But experts don't often use the word "cured" to describe a cancer. They more commonly use the words "remission" or "no evidence of disease (NED)." If you've been in remission or "NED" for five or more years, you can be considered cured. However, there's always a small chance that cancer cells will come back.

What is the survival rate of lung cancer?

The survival rate for lung cancer depends largely on how far the cancer has spread when it is diagnosed, how well it responds to treatment, your overall health, and other factors. For example, for small tumors that have not spread to lymph nodes, the survival rate is 90% for tumors smaller than 1 centimeter, 85% for tumors between 1 and 2 centimeters, and 80% for tumors between 2 and 3 centimeters. The relative five-year survival rate for lung cancer diagnosed at any stage is 22.9%. The five-year relative survival rates by stage of the cancer are as follows:

• For localized cancer in one lung: 61.2% (64% for NSCLC, 29% for SCLC)
• For cancer that has spread to the lymph nodes (regional): 33.5% (37% for `(NSCLC)`, 18% for `(SCLC)`)
• For distant cancers: 7% (26% for NSCLC, 3% for SCLC)

But remember, these statistics do not accurately reflect your specific diagnosis and treatment.Due to advances in diagnosis and treatment, lung cancer mortality rates have been rapidly decreasing in recent years.

What are relative survival rates?

Your doctor may use what are called five-year survival rates to explain how your lung cancer might affect your health five years after diagnosis. These numbers compare the survival rate of someone with lung cancer to that of someone in the general population of the same age.

How to prevent lung cancer?

Because we don't know exactly what causes most cancers, the only way to prevent them is to reduce your risk. Here are some ways you can reduce your risk:

• Not smoking, or if you do, quitting. Your risk of lung cancer begins to decrease within five years of quitting.
• Avoiding second-hand smoke and other substances that can harm your lungs.
• Eat a healthy diet and maintain a healthy weight. Some studies suggest that eating fruits and vegetables (two to six and a half cups a day) may help reduce the risk of cancer.
• If you are at high risk, get screened for lung cancer.

Lung cancer screening

Screening tests can increase your chances of detecting cancer in its early stages. If you meet all of these requirements, you are eligible for lung cancer screening:

• If you are between 50 and 80 years old.
• If you are currently a smoker, or if you quit smoking 15 years ago.
• If you have a 20 pack-year smoking history (the number of packs of cigarettes you smoke per day multiplied by the number of years you have smoked),

Ask your doctor about the benefits and risks of getting this test done once a year.

How do I take care of myself?

Self-care is an important part of cancer care. Here are some ways you can take care of yourself, whether you're undergoing treatment or recovering:

• If possible, bring a friend or family member with you to see your doctor. They can help you remember the information and options the doctor gives you.
• Plan ahead for how you will feel in the days following treatment. This may include asking for extra help, preparing meals in advance, or making sure you have a light schedule.
• Even if you are not feeling well, ask your doctor about getting proper nutrition.
• Drink plenty of water to keep your body hydrated.
• Exercise if possible and as recommended by your doctor.
• Keep important phone numbers handy. You may be seeing several doctors, so it's helpful to know who to call if you have a problem.
• Consider joining a support group, either locally or online. Being with people who have been through the same thing can help you gain perspective and know what to expect.

Once you have completed treatment, support and self-care can play an important role going forward. Don't hesitate to ask for help or guidance. Be sure to follow up as your doctor recommends.

When should I see a doctor? / What questions should I ask my doctor?

If you have any symptoms that worry you, see your doctor. If you smoke or have smoked in the past, ask your doctor about screening for lung cancer. Some questions you can ask your doctor include:

• What are my treatment options?
• What is the best way to take care of myself at home?
• What will the treatment be like?
• What are my next steps?
• What are the important numbers to call if you have questions or in an emergency?
• What side effects should I talk to you about?
• When should I go to the Emergency Department (ETU) ?

A diagnosis of lung cancer can bring a variety of emotions. Sometimes the amount of new information can be overwhelming. It's important to remember that statistics cannot predict how your treatment will go or what decisions will be right for your specific situation.

With the help of trusted friends or a support group, you can get help to consider your options and express your wishes. Cancer treatment is often a process, and taking care of yourself is one of the most important parts of it.

Finally, things to remember

Lung cancer is a serious disease. However, if detected early and treated properly, the chances of recovery are high. It is important to avoid smoking, follow a healthy lifestyle, and have regular medical screenings if you have risk factors. If you have any concerns about any of the symptoms, don't hesitate to seek medical advice. Remember, you are not alone, and there are many people who can help you on this journey.

---

` Lung Cancer, Lung Cancer, Cancer Symptoms, Cancer Causes, Cancer Treatment, Smoking, NSCLC, SCLC, Lung Health