A Family Doctor's Tale - LUNG CANCER

DOC I HAVE LUNG CANCER

Lung cancer is the most common cancer in Singapore men. Smoking (active and passive) contributes to this cancer as does inhalation of asbestos and other toxic chemicals. While the incidence of men smoking has decreased there is alarmingly more  women who are smoking.
A lung cancer patient of mine recounts his regret in long term smoking which led to his condition with the breathlessness, loss of weight, heart failure and weakness. Lung cancer can be hard to treat especially if they are fast spreading. He eventually succumbed to his illness.

Lung Cancer is the uncontrolled growth of abnormal cells in one or both lungs. The cells lining air passages grow and divide until an  abnormal mass or tumor is formed. The cells then grow and spread to the rest of the body.

There are 2 main types of Lung Cancer:
1. small cell lung cancer (SCLC) has the most aggressive clinical course of any type of pulmonary tumor, with median survival from diagnosis of only 2 to 4 months.
2. non-small cell lung cancer.
a.Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.
b.Large cell carcinoma: Cancer that may begin in several types of large cells.
Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
c.Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.

These types are diagnosed based on how the cells look under a microscope.

The Non-small cell Lung cancer  may take up to 10-30 years to develop. Thus it is often seen in middle aged and elderly persons. Once developed Lung cancers tend to spread quickly because the lungs are richly supplied by blood and lymph
vessels. In the travel through the lymph vessels, it can cause enlarged lymph nodes. If it enter the blood , the cancer cells can spread to the liver, bone, brain or other parts of the body.

Causes are related to:
1. Cigarette smoking is the main cause of lung cancer.
2. Cigar and pipe smoking is also a source of lung cancer though less than those who smoke cigarettes.
3. Passive smoking in a family where one member smokes has been to increase the risk of lung cancer by 35%
4. Industrial hazards such as chemicals and smoke emitted at workplace also increase the risk of lung cancer. Examples are asbestos, coal gas, chromates, uranium.
5.Being treated with radiation therapy to the breast or chest.

Symptoms:
1. Persistent cough which does not improve
2. shortness of breath and wheezing due to the pressure of the tumor pressing on the airways.
3.Production of blood stained sputum
4. chest pain especially together with a chronic cough
5.Sudden unexplained loss of weight
6. Loss of appetite
7. General weakness and tiredness
8.Recurrent chest infections and fever
9. hoarseness of voice

1. History and Medical examination especially history of smoking and exposure to chemicals
2. Chest X-ray to check for lung shadows
3. Sputum cytology- sometimes the cancer cells may be detected in the sputum
4. Bronchoscopy- a bronchoscope is passed into bronchi to study the airway while the patient is under general anesthesia. Suspicious growth can be taken for biopsy(examination under microscope for cancer cells)
5.CT Scan and MRI produce 3D images of the lung
6.Ultrasound or another imaging procedure is used to locate the abnormal tissue or fluid in the lung.
7.Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope (a thin, lighted tube) is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. This procedure may be used to remove parts of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.

AS usual the treatment consists of Surgery, Radiotherapy and chemotherapy.The choice of treatment depends on the size, extent and the type lung cancer and the general health of the patient.

Part or whole of the lung can be removed in the treatment of lung cancer. After surgery the patient may required assisted ventilation for a short period. Physical activity may be limited for a while. If the remaining lung is in good condition, the patient may be able to live a normal life.

Chemotherapy:
Certain type of lung cancer are sensitive to chemotherapy. It is used in combination with surgery and radiotherapy.

Radiotherapy:
Radiation may be used in conjunction with surgery or to relieve pressure symptoms or pain caused by the lung cancer.

The prognosis (chance of recovery)  depend on the following:

The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
The type of lung cancer.
Whether there are symptoms such as coughing or trouble breathing.
The patient’s general health.

For most patients with non-small cell lung cancer, current treatments do not cure the cancer.

Compared with other cell types of lung cancer, SCLC has a greater tendency to be widely disseminated by the time of diagnosis but is much more responsive to chemotherapy and radiation therapy.

Because patients with small cell lung cancer tend to develop distant metastases, localized forms of treatment, such as surgical resection or radiation therapy, rarely produce long-term survival. With incorporation of current chemotherapy regimens into the treatment program, however, survival is unequivocally prolonged.