Lung Cancer: What are the Symptoms and Treatment?

What Causes Lung cancer?

• Smoking is the leading cause of lung cancer.
• Lung cancer in Non-smokers can occur because of any of the following reasons:
• Exposure to radon, secondhand smoke, exposures to asbestos, air pollution, etc.
• Studies have found that lung cancer can be caused by different DNA mutations such as:
  • In NSCLC- Changes in the p16 tumor suppressor gene and to the K-RAS oncogene.
  • In SCLC- Changes in RB1 tumor suppressor gene
  • In both NSCLC and SCLC-Changes in the TP53 tumor suppression gene and to chromosome 3

What are the Risk Factors?

• Smoking
• Family history
• Radiation exposure
• Exposure to radon, asbestos, or other carcinogens (such as arsenic, vinyl chloride, diesel exhaust).
• Secondhand smoke (breathing in the smoke of others)
• Air pollution

Signs and symptoms

• Coughing up blood
• Persistent cough
• Breathing problems
• Chest pain
• Hoarseness
• Headache
• Loss of appetite
• Unexplained weight loss
• Chest infections

What are the Complications?

Shortness of breath, weakened immune system, lung infections, metastatic complications, Pain in different parts of the body, fluid in the chest. ¹

Diagnosis: How to diagnose Lung cancer?

• Medical history – Check for symptoms and other risk factors.
• Physical examination – 
• Diagnostic tests – The tests performed are:
  • Chest x-ray
  • CT scan : Series of x-ray images taken at different angles
  • PET scan : A procedure that uses radioactive glucose to find malignant tumor cells in the body.
  • MRI : A procedure that uses a magnet, radio waves, and a computer to make detailed pictures of areas inside the body.
  • Sputum cytology – Patient’s sputum is checked for the presence of cancerous cells
  • Thoracentesis -Fluid is drained from the chest to check for cancer cells
  • Lung biopsy – Removal of a small amount of lung tissue for examination under a microscope to look for precancerous cells or cancer cells.
    • Different types of biopsies can be performed such as –
      1. Fine needle aspiration (FNA) biopsy (thin needle used to collect lung tissue)
      2. Core needle biopsy (larger needle used to collect lung tissue)
  • Bronchoscopy – A procedure to look into lungs and in air passages, with the help of a bronchoscope.
  • Endobronchial ultrasound – A procedure in which high-energy sound waves (ultrasound) are used to form a picture of lungs called a sonogram.
  • Endoscopic esophageal ultrasound
  • Mediastinoscopy and mediastinotomy – used to look at mediastinum (the area between the lungs) and collects samples to check in the laboratory.
  • Thoracoscopy – look into the pleural cavity
  • Lung function tests – Tests to check the functionality of lungs ( to know how much lung can safely be removed).
  • Genetic testing
    • Test for specific proteins – PD-L1 protein
• Other tests include complete blood count, blood chemistry tests.

Treatment: How is Lung cancer treated?

• Surgery :
  • Pneumonectomy: Surgery to remove an entire lung.
  • Lobectomy: The lungs are made up of 2 or 3 lobes. Lobe containing cancer cells is removed.
  • Segmentectomy or wedge resection: only part of a lobe is removed.
  • Sleeve resection: 
• Radiofrequency Ablation (RFA) – Use radio waves to heat the tumor and kill cancer cells.
• Radiotherapy
  • Recommended to reduce risk of a cancer recurrence after surgery.
  • 1. External radiation therapy uses a machine outside the body to send radiation toward cancer.
  • 2. Internal radiation therapy uses a radioactive substance that is placed directly into or near cancer.

• Chemotherapy – Chemotherapy uses anti-cancer drugs to kill and stop the growth of cancer cells
• Medications- Chemotherapeutic drugs, when used in combinations act more efficiently.
  • Platinum compound : Cisplatin, carboplatin,
  • Topoisomerase -2 inhibitors : Etoposide (VP-16)
  • Antimetabolites: 5-FU (fluorouracil), Pemetrexed
  • Taxanes (docetaxel, paclitaxel). 
  • Gemcitabine (Gemzar)
  • Vinorelbine (Navelbine)
• Targeted therapy – identify and attack specific cancer cells without harming normal cells.
  • Angiogenesis inhibitor – Bevacizumab and Ramucirumab – binds to vascular endothelial growth factor (VEGF) – signals growth of new blood vessels ( slows the spread of cancer)
  • KRAS inhibitor– Sotorasib
  • EGFR inhibitors – Erlotinib (Tarceva), Gefitinib (Iressa), Osimertinib, Amivantamab, Necitumumab
• Immunotherapy
  • Immune checkpoint inhibitor–
    • The immunotherapy drug pembrolizumab (Keytruda) ( PD-1 protein inhibitor) is approved to treat tumors that have either high microsatellite instability (MSI-high) or dMMR, regardless of the tumor’s location in the body.
    • Nivolumab 
  • PD-L1 inhibitor – Atezolizumab, Durvalumab.
  • CTLA-4 inhibitor – Ipilimumab

Prevention: Can we prevent it?

Prevention of Lung cancer –

• Stop or avoid smoking
• Healthy weight
• Physical activity
• Avoid exposure to carcinogens
• Avoid exposure to radon
• Avoid secondhand smoke

Living with Lung cancer –

• Follow-up care ( doctor visits and tests)
• Survivorship care plan
• Avoid smoking
• Staying at a healthy weight
• Regular physical activities
• Palliative care

When to see a doctor? :

It is wise to consult with a pulmonologist immediately if observed any symptoms. The typical consultation fee for a pulmonologist ranges from Rs. 500 to Rs. 2000 in India.

Consult Oncosurgeons

• Consult an Oncologist at Hinduja Hospital Mumbai
• Dr Ch Uday- Oncologist at Aster Hospital
• Dr. Abhishek Puri- oncologist at Fortis Hospital
• Dr. Aditi Chaturvedi- oncologist at Max Hospital
• Dr. Aditi P- Oncologist at Aster Hospital
• Dr. Aditya Joshipura- oncologist at HCG Hospital
• Dr. Akshat Malik- oncologist at Max Hospital
• Dr. Akshay Shah- oncologist at Fortis Hospital
• Dr. Akshay Tiwari- oncologist at Max Hospital
• Dr. Alok Narang- oncologist at Max Hospital
• Dr. Amal Roy Chaudhoory- oncologist at Fortis Hospital
• Dr. Amit Agarwal- oncologist at Fortis Hospital
• Dr. Amit Bhargava- oncologist at Fortis Hospital
• Dr. Amit Chakraborty – oncologist at Nanavati Hospital Mumbai
• Dr. Amit Ghanekar- oncologist at Fortis Hospital

Types of Cancers

• 
  Myelodysplastic neoplasms: a rare blood disorders
• 
  Myeloproliferative Neoplasm: abnormal proliferation of blood cells
• 
  Cervical Cancer: abnormal growth of the tissues of the cervix
• 
  Vaginal Cancer: cancer of the female reproductive system
• 
  Ovarian cancer: cancer that begins in the ovaries

Cancer Specialists

• Dr. Nilesh Chordiya – oncologist at Nanavati Hospital Mumbai
• Dr. Nagraj G. Huilgol – oncologist at Nanavati Hospital Mumbai
• Dr. Pawan Gupta- oncologist at Max Hospital
• Dr. Rohit Nayyar- oncologist at Max Hospital
• Dr. Sandeep Batra- oncologist at Max Hospital
• Dr. Gagan Gautam- oncologist at Max Hospital
• Dr. Vimal Dassi- oncologist at Max Hospital
• Dr. Harit Chaturvedi- oncologist at Max Hospital
• Dr. Anil Kumar Anand- oncologist at Max Hospital
• Dr. Arun Goel- oncologist at Max Hospital
• Dr. Kanika Gupta- oncologist at Max Hospital
• Dr. Meenu Walia- oncologist at Max Hospital
• Dr. Akshat Malik- oncologist at Max Hospital
• Dr. Dinesh Singh- oncologist at Max Hospital
• Dr. Charu Garg- oncologist at Max Hospital
• Dr. Geeta Kadayaprath- oncologist at Max Hospital
• Dr. Pravas Chandra Mishra- oncologist at Max Hospital
• Dr. Rahul Naithani- oncologist at Max Hospital
• Dr. Nitesh Rohatgi- oncologist at Max Hospital
• Dr. Gagan Saini- oncologist at Max Hospital
• Dr. Gopal Sharma- oncologist at Max Hospital
• Dr. Akshay Tiwari- oncologist at Max Hospital
• Dr. Pankaj Kumar Arora- oncologist at Max Hospital
• Dr. Aditi Chaturvedi- oncologist at Max Hospital
• Dr. Bhuvan Chugh- oncologist at Max Hospital