on 2020-11-16 10:19:25
  • lung cancer

 

Worldwide, lung cancer remains the leading cause of cancer incidence and mortality, with 2.1 million new lung cancer cases and 1.8 million deaths predicted in 2018, representing close to 1 in 5 (18.4%) cancer deaths. In India, lung cancer constitutes 6.9 per cent of all new cancer cases and 9.3 per cent of all cancer related deaths in both sexes; it is the commonest cancer and cause of cancer related mortality in men, with the highest reported incidences from Mizoram in both males and females. The time trends of lung cancer show a significant rise in Delhi, Chennai and Bengaluru in both sexes. Lung cancer is rare below age 40, with rates increasing until age 80, after which the rate tapers off.

Four histologies account for approximately 90% of all epithelial lung cancers. Adenocarcinoma, squamous cell carcinoma and large cell carcinomas are classified under non-small cell lung cancers. Others type is small cell lung cancer. In India, non-small-cell lung cancer constitutes 75 - 80% of lung cancers. Small-cell lung carcinoma constitutes 20% of all lung cancers.

While in many Western countries adenocarcinoma has become the commonest lung cancer. In India it is still squamous cell carcinoma in both males and females.

RISK FACTORS

Increasing age is the most important risk factor for most cancers. Other risk factors for lung cancer include:

  • Current or history of tobacco use: cigarettes, pipes, and cigars.
  • Exposure to cancer-causing substances in secondhand smoke.
  • Occupational exposure to asbestos, arsenic, chromium, beryllium, nickel, and other agents.
  • Radiation exposure from any of the following:
    • Radiation therapy to the breast or chest.
    • Radon exposure in the home or workplace.
    • Medical imaging tests, such as computed tomography (CT) scans.
    • Atomic bomb radiation.
  • Living in an area with air pollution.
  • Family history of lung cancer.
  • Human immunodeficiency virus infection.
  • Beta carotene supplements in heavy smokers.

The single most important risk factor for the development of lung cancer is smoking. For smokers, the risk for lung cancer is on average tenfold higher than in lifetime nonsmokers (defined as a person who has smoked <100 cigarettes in his or her lifetime). The risk increases with the quantity of cigarettes, duration of smoking, and starting age.

 

Symptoms

Lung cancer typically doesn't cause signs and symptoms in its earliest stages. Signs and symptoms of lung cancer typically occur only when the disease is advanced.

Signs and symptoms of lung cancer may include:

  • A new cough that doesn't go away
  • Changes in a chronic cough or "smoker's cough"
  • Coughing up blood, even a small amount
  • Shortness of breath
  • Chest pain
  • Wheezing
  • Hoarseness
  • Losing weight without trying
  • Bone pain
  • Headache

 

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. The team consists of a medical oncologist, surgical oncologist and radiation oncologists along with nurses, physiotherapists and other technicians.

There are 5 basic ways to treat NSCLC:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted therapy
  • Immunotherapy

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health.

Surgery

The goal of surgery is to completely remove the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of healthy lung tissue.

The following types of surgery may be used for NSCLC:

  • Lobectomy.
  • A wedge resection.
  • Segmentectomy.
  • Pneumonectomy.

Adjuvant therapy

“Adjuvant therapy” is treatment that is given after surgery to lower the risk of the lung cancer returning. Adjuvant therapy may include radiation therapy, chemotherapy, targeted therapy, or immunotherapy.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. It has been shown to improve both the length and quality of life for people with lung cancer of all stages. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. For example, the PD-1 pathway may be critical in the immune system’s ability to control cancer growth. Blocking this pathway with PD-1 and PD-L1 antibodies has stopped or slowed the growth of NSCLC for some patients. The following drugs block this pathway:  

  • Atezolizumab
  • Nivolumab
  • Pembrolizumab

 

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, one may be able to lower one’s risk.

Smoking cessation

Based on solid evidence, long-term sustained smoking cessation results in decreased incidence of lung cancer and of second primary lung tumors. People who never smoke have the lowest risk of lung cancer. People who smoke can reduce their risk of lung cancer by stopping smoking, but their risk of lung cancer will still be higher than people who never smoked.

Exposure to secondhand smoke

Based on solid evidence, exposure to secondhand smoke is an established cause of lung cancer.

 

Diet

Research suggests that eating a low-fat, high-fibre diet, including at least five portions a day of fresh fruit and vegetables and plenty of whole grains, can reduce your risk of lung cancer, as well as other types of cancer and heart disease. Attempts to prevent lung cancer with vitamins or other treatments have not worked.

Exercise

There's strong evidence to suggest that regular exercise can lower the risk of developing lung cancer and other types of cancer. Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week.

Protect against harmful carcinogens at work

If you work in a job that is frequently around harmful carcinogens, such as at a construction site or in a nuclear plant, it is important to protect yourself against those carcinogens. Most employers will insist that you wear a mask or use a respirator.

Reducing or eliminating exposure to radon

Based on solid evidence, indoor exposure to radon increases lung cancer incidence and mortality, particularly among cigarette smokers. In homes with high radon concentrations, taking steps to prevent radon from entering homes by sealing the basement would be expected to result in a corresponding decrease in the risk of lung cancer.

 

 

 

 

 

 

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