Lung cancer is characterized by the presence of cancerous cells in the lungs. Lung cancer is one of the leading causes of death worldwide.
It is mainly of 2 types:
- Non-small cell lung cancer (NSCLC) – 80% to 85%
- Small cell lung cancer (SCLC) – 10% to 15%
STAGES OF NON-SMALL CELL LUNG CANCER
Stage I: Cancer is confined only to the lung and has not spread to the lymph nodes.
Stage II: Cancer has extended in the lung and to nearby lymph nodes.
Stage III: Cancer has extended in the lung and the lymph nodes including the middle of the chest.
Stage IV: Most advanced stage of lung cancer. Cancer has spread to both lungs, to fluid in the area around the lungs, or to another part of the body.
Stages of Small Cell Lung Cancer
Limited stage: Cancer is found on one side of the chest, involving just one part of the lung and nearby lymph nodes.
Extensive stage: Cancer has extended to other parts of the chest or different organs of the body.
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 –
- Fine needle aspiration (FNA) biopsy (thin needle used to collect lung tissue)
- Core needle biopsy (larger needle used to collect lung tissue)
- Different types of biopsies can be performed such as –
- 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
- Immune checkpoint inhibitor–
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. 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. 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. Nikhil Agrawal- oncologist at Max Hospital
- Dr. Waseem Abbas- oncologist at Max Hospital
- Dr. Pankaj Kumar Arora- oncologist at Max Hospital
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