Lung Cancer

Cancer that starts in the lungs, commonly caused by smoking.

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Lung Cancer

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Lung Cancer

Lung cancer often occurs in people inclined to smoke, and even in individuals without smoking or tobacco addiction, and is slowly becoming the top reason for cancer-related deaths in India and Asia.

Lungs are a pair of spongy organs in the chest that help inhale oxygen and release carbon dioxide. During inhalation, the air enters through the mouth and nose and reaches the lungs through the windpipe.

The windpipe called the trachea further divides into small tubules called bronchi, which further divide into smaller branches called bronchioles. The bronchioles further divide into tiny air sacs called the alveoli.

In lung cancer, the cell linings of these structures- the bronchi, the bronchioles or the alveoli, start to divide at a very high-speed leading to the formation of tumours which affects the normal breathing process.

Symptoms of Lung Cancer:

Coughing allows your body to expel irritants from the throat or airway by pushing air in and out of the lungs. It would be best to consult our cancer specialists to carry out the required tests to rule out cancer when the cough intensifies or worsens over time. Hemoptysis condition is associated with the discharge of blood or mucus while coughing and requires a thorough examination.
Dyspnea is shortness of breath with tightness in the chest. Large tumours or even cancerous spread cause blockages in major airways, called pleural effusion, leading to fluid accumulating in and around the lung region.

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Wheezing is a high-pitched whistling sound made while breathing in and out.
Hoarseness or change in the vocal sound caused due to the opening and closing of the vocal cords, producing vibrations.
Fever: This is another symptom that indicates that the body's defence systems are fighting cancer infection. If your body temperature is above normal and persists for long and does not get back to the optimum levels with treatment then it would be best to seek our consultant for medical evaluation.
Swelling or oedema: This symptom appears when tiny blood vessels or capillaries in your body are damaged along with pressure build-up, leading to fluid discharges. The kidneys, in turn, retain water and salt to compensate for the loss thus causing more swelling.
Enlarged lymph nodes - The cancer cells intercept the lymphatic functions, causing swelling in multiple body areas like neck, face and arms.

It is important to note that symptoms of lung cancer are similar to symptoms of other lung diseases and if you experience any of these associated symptoms, you should see your doctor for a medical evaluation.

Other symptoms of lung cancer

Other symptoms that exist in the case of lung cancer are:

Types of Lung Cancer

Based on the cell structure of the tumour lung cancer is classified into two types:

About 80 – 85% of lung cancers are non-small cell lung cancer abbreviated as NSCLC and differentiated as below:

These subtypes differ in tumour formation and characteristics but have similar treatment strategies and prognoses.

Adenocarcinoma: This form of cancer begins to form in the cells of the mucus-secreting glands that line the lungs, and eventually spreads to other organs as the disease progresses. Tumours take shape with the transformation process or uncontrollable growth of the glandular cells, and the cancerous tumour cells are called adenocarcinoma. form
Squamous cell carcinoma: The flat cells that line the inside of the airways or bronchi are called squamous cells, and carcinoma involving these cells is known as squamous cell carcinoma. They are typically present in individuals with smoking addiction and usually develop in the bronchi, which form the central part of the lungs.
Large cell carcinoma: This form of cancer belongs to the undifferentiated category, tends to develop and spread rapidly and emerges in any part of the lung. Treating large cell carcinoma can be very challenging and categorized into three types:
Neuroendocrine carcinoma
Adenosquamous carcinoma
Sarcomatoid carcinoma.
Small cell carcinoma: This form of cancer accounts for 10-15% of all lung cancers and is called fat cell carcinoma. By the time this cancer category is diagnosed in 70% of the cases, it might have spread to other areas in the body. They respond well to chemotherapy and radiation therapy with higher chances of making recurrence.

Prevention of Lung Cancer

Only a few categories of lung cancers can be prevented, however, you can take care of the following to reduce the risk.

Staging of Lung Cancer:

Lung cancer treatment depends on the “Stage” of the disease as treatment strategies vary according to the extent of disease spread. The following tests are mandatory for diagnosing and treating lung cancer.

All the above tests are available and performed on a routine basis at our centre.

What are the clinical tests done when Lung cancer is suspected?

Physical examination: Our doctor will check your vital signs like oxygen saturation levels, heart rate, and blood pressure, including auscultation for lung sounds and lymph node examination. This physical examination may indicate the presence of symptoms related to lung cancer.
X-Ray: A Chest X-Ray PA view or posteroanterior view or X-Ray view from the back to the front of the chest wall reveals the concerned areas in the lung. A lateral view or view from the side also is taken to verify the presence of tumour/cancer cells.
CT scan: Computerised Tomography scan is about scanning internal organs by taking pictures as the equipment moves around your body, providing a precise vision of the condition of internal organs. It helps determine the presence of tumours or cancers better than standard X-rays. CT scan of the chest, abdomen and brain may be done to investigate primary and metastatic lung tumours
Bronchoscopy: An endoscope, a thin-lighted tube inserted through the mouth into the lungs to examine the bronchus and lungs. This instrument can be used to perform a biopsy to collect cell samples for further examination. Collecting tissue samples in case of large tumours is comparatively easy and does not require hospitalization; this process can also be performed under sedation or using local anaesthesia.
EBUS – Endobronchial Ultrasound: This is a special type of endoscope consisting of an Ultrasound probe with a camera at its tip, which gives a clear vision of the airways and also guides consultants during the biopsy procedure to obtain tissue samples. Collecting tissue samples in case of large tumours is comparatively easy and does not require hospitalization; this process can also be performed under sedation or using local anaesthesia.
Sputum cytology: It is the thick mucus discharged during cough cycles, pathological studies of the mucus help diagnose malignant cells and confirm lung cancer. This test has limitations since there are chances that the mucus might contain non-cancerous cells due to inflammation that mimics cancer cells.
Magnetic Resonance Imaging: This technique uses magnetic radio waves and a computer to produce images of body structures. A movable bed passes through the magnetic scanner, enabling a detailed view of the tumour’s location. MRI poses a risk in examining individuals with heart pacemakers, metal implants, artificial heart valves and other surgical implants due to the action of magnetic forces. MRI of the brain is also taken since the brain is also affected in most lung cancer patients.
Positron emission tomography scan: Pet scan, a specialized imaging technique using short-lived radioactive drugs to produce three-dimensional coloured images, measures metabolic activity and tissue functions to determine the tumour type and growth. The radioactive drug accumulates in certain tissues and emits positrons, which encounter electrons, causing a reaction to produce gamma rays, wherein a scanner records these gamma rays and maps the concerned area.
Blood tests: This reveals the biochemical or metabolic abnormalities in the body that accompany cancer. In bone cancer, calcium levels are elevated as well as serum alkaline phosphatase levels and a spike in liver enzymes SGOT and SGPT signal liver damage.
Molecular testing: Molecular genetic testing looks for genetic mutations in the tumour. These mutations can be looked for in the epithelial growth factor receptor and the anaplastic lymphoma kinase genes. MAPK and PIK 3 are genes that mutate and specific therapies are given to these patients whose tumours have these gene alterations.
Lung biopsy: Imaging tests might help, but biopsy is the most significant test for cancer diagnosis, which also helps determine the type of cancer.

Which specialists are responsible for treating lung cancer?

Lung cancers are typically treated by a specialist team comprising a Thoracic Surgeon, Medical Oncologist, Pulmonologist, Interventional Radiologist and Pain/Palliative Care specialists.

Surgery: A surgical procedure called lobectomy may be required to remove the cancerous tissue from the lungs, which involves removing a part or segment of the lung or the entire lung, depending on severity. In addition to the removal of the damaged lung tissue, lymph nodes are harvested systematically to gain additional survival advantages.
Chemotherapy is a treatment given through the veins to eliminate cancer cells that may have escaped into the bloodstream and spread to other parts of the body, which is given during the following three treatment stages:
Neoadjuvant: Patients undergo chemotherapy prior to surgery or radiation to minimize the cancer spread.
Adjuvant: Patients undergo chemotherapy after surgery to eliminate the remaining cancer cells.
Palliative chemotherapy: Patients undergo chemo during the advanced phase ie. Stage IV to relieve them of symptoms and improve their condition.
Radiation therapy: Select patient groups undergo radiation therapy during adjuvant, neoadjuvant or definitive phases. In addition, in the case of patients where the disease has spread to the bone, it helps alleviate pain.
Targeted therapy: This therapy has revolutionized the treatment of advanced lung cancer, where drugs specifically “target’ cancer cells and relatively spare other cells, this has changed the perspective of lung cancer treatments.
Immunotherapy: Improvements in drugs have helped with the invention of immune-boosting drugs, which stimulate the body’s immune mechanisms to fight and kill cancer cells. It is an exciting concept that changes the perspective of lung cancer management.