The lungs can be found in the chest and this vital organ allows us to breathe. Air that’s breathed in from our nose goes down our windpipe and into the lungs. Then, it spreads through tubes known as bronchi. The oxygen is absorbed into the blood and sent to the rest of the body to allow the body to function normally.
Lung cancer occurs when there is uncontrolled growth of abnormal cells, normally from the cells that line the bronchi. These abnormal cells don’t function like normal lung cells and as they grow, they may become bigger and they may start to interfere with the normal lung functions. These abnormal cells can spread to other parts of the body.
People who smoke have the greatest risk of lung cancer. The risk of lung cancer increases with the length of time and number of cigarettes you’ve smoked. If you quit smoking, even after smoking for many years, you can significantly reduce your chances of developing lung cancer.
There are 2 main types of lung cancer:
- Non-small cell lung cancer (NSCLC): The most common type of lung cancer. Grows slower than small cell lung cancer and is normally confined to the lung for a longer time.
- Small cell lung cancer (SCLC): This type makes up about 10-15% of all lung cancer. Grows more rapidly and spreads much faster to other organ.
WHAT ARE THE SYMPTOMS?
- A persistent cough that doesn’t go away or worsen
- Presence of blood in sputum
- Increasing breathlessness
- Pain in the chest (may feel worse with deep breathing or coughing)
- Change in the voice or a persistent hoarse voice
- Recurrent lung infection
- Loss of appetite
- Unexplained weight loss
- A lump or swelling in the neck (due to cancer that’s spread to the lymph nodes)
- Pain in bones or headache or weakness of the arms or legs (due to the lung cancer spreading
WHAT ARE THE TREATMENTS?
Treatment that you’ll receive will depend on several factors including:
- Type of lung cancer you have
- Size and position of the cancer
- Stage of the cancer
- Overall health
- Lobectomy: Where one or more large parts of the lung (called lobes) are removed. Your doctors will suggest this operation if the cancer is just in one section of one lung.
- Pneumonectomy: Where the entire lung is removed. This is used when the cancer is located in the middle of the lung or has spread throughout the lung.
- Wedge resection or segmentectomy: Where a small piece of the lung is removed. This procedure is only suitable for a small number of patients, as it is only used if your doctors think your cancer is small and limited to one area of the lung. This is usually very early-stage non-small-cell lung cancer.
Chemotherapy uses powerful cancer-killing medication to treat cancer. There are several different ways that chemotherapy can be used to treat lung cancer. For example, it can be:
- Given before surgery to shrink a tumour, which can increase the chance of successful surgery (this is usually only done as part of a clinical trial)
- Given after surgery to prevent the cancer returning
- Used to relieve symptoms and slow the spread of cancer when a cure isn’t possible
- Combined with radiotherapy
Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days, then having a break for a few weeks to let your body recover from the effects of the treatment. The number of cycles of chemotherapy you need will depend on the type and the grade of your lung cancer. Most people require four to six courses of treatment over three to six months.
Chemotherapy for lung cancer involves taking a combination of different medications. The medications are usually delivered through a drip into a vein (intravenously), or into a tube connected to one of the blood vessels in your chest. Some people may be given capsules or tablets to swallow instead.
Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancer cells. There are a number of ways it can be used to treat people with lung cancer. An intensive course of radiotherapy, known as radical radiotherapy, can be used to try to cure non-small-cell lung cancer if the person isn’t healthy enough for surgery. For very small tumors, a special type of radiotherapy called stereotactic radiotherapy may be used instead of surgery.
Radiotherapy can also be used to control the symptoms and slow the spread of cancer when a cure isn’t possible (this is known as palliative radiotherapy). A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also sometimes used during the treatment of small-cell lung cancer. PCI involves treating the whole brain with a low dose of radiation. It’s used as a preventative measure because there’s a risk that small-cell lung cancer will spread to your brain.
- History taking and Physical examination: Questions will be asked about your general health and the type of symptoms you experienced. You may be asked to breathe into a device called a spirometer. This device measures how much air you breathe.
- Blood test: To rule out some possible causes of your symptoms. For instance, a chest infection.
- Chest X-ray: Normally, the first test used to diagnose lung cancer. Mostly, lung tumours show up as a white-grey mass on X-ray.
- CT scan: This is normally the next scan after a chest X-ray. X-rays and a computer are used to create detailed images of the inside of your body. You’ll be injected with a contrast medium before the scan. This helps to make the lungs show up more clearly.
- PET scan: Essential test to investigate the cancer, as this is not only going to show the tumor, precisely indicate the stage, but also will warn you and your doctor if there happen to be any metastasis in other parts of your body. Being a very sensitive and accurate, this scan can indicate even tiny metastasis and very early stages of cancer.
- Bronchoscopy: A bronchoscopy is a procedure that allows a doctor to remove a small sample of cells from inside your lungs. During a bronchoscopy, a thin tube called a bronchoscope is used to examine your lungs and take a sample of cells (biopsy). The bronchoscope is passed through your mouth or nose, down your throat and into the airways of your lungs. The procedure may be uncomfortable, but you’ll be given a mild sedative beforehand to help you relax and a local anesthetic to make your throat numb. The procedure is very quick and only takes a few minutes.
- EBUS-TBNA (Endobronchial Ultrasound-Guided Transbronchial Needle Aspirate): Endobronchial ultrasound-guided transbronchial needle aspiration is a special technique used to take samples of body tissue from inside the chest. It is also known as EBUS TBNA for short. The procedure is carried out using a special kind of bronchoscope. This is a thin flexible kind of ‘telescope’ which passes through the mouth and into the airways. The bronchoscope (often shortened to ‘scope’) allows doctors to see inside the lungs and carry out the procedure. Endobronchial means from inside or within the bronchus.The bronchi (the term for two bronchus) are large tube-like airways. They take air from the windpipe (trachea) to the smaller airways, called the bronchioles. During the procedure ultrasound probe is used to help the doctor doing the test see the structures just outside the airways. This gives the test the first part of its name. The scope also contains a very fine needle. This needle is used to take samples of body tissue by pushing through the bronchus to the tissue on the other side. The needle holds the sample of tissue; this is called aspiration. Transbronchial means across the bronchus, giving the name transbronchial needle aspiration. It may be used to ‘Stage’ cancer by taking tissue samples from the lymph nodes.
- CT-guided biopsy: A percutaneous needle biopsy involves removing a sample from a suspected tumor to test it at a laboratory for cancerous cells. The doctor carrying out the biopsy will use a CT scanner to guide a needle to the site of a suspected tumour through the skin. A local anesthetic is used to numb the surrounding skin, and the needle is passed through your skin and into your lungs. The needle will then be used to remove a sample of tissue for testing.
The key determinant of which technique is chosen is really the location of the growth. If the growth is central and close to the airways, bronchoscopy with/without EBUS-TBNA is better. If the growth is peripheral and closer to the chest wall, a CT-guided biopsy is better.