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Lung cancer represents the negative result of abnormal cells growing in the lungs, organs that have the mission to take in oxygen and release carbon dioxide every time an individual inhales and exhales. After their growth or multiplication, these unhealthy cells invade the tissues and form a mass or tumor. Even though it begins in the lungs, this severe condition can also affect the respiratory system because the cancerous cells spread to different parts of the body. Lung cancer causes annually more deaths among both men and women than any other forms of cancer including ovarian, colon and breast cancer. Generally, it affects people over 40.The main cause for developing this condition is smoking but people who never touched a cigarette in their life can also face a risk of lung cancer. The early stages do not show alarming signs and symptoms but as the condition progresses, many people start to experience tiredness and weight loss, ache when breathing and persistent cough, sometimes with blood. There are two types of lung cancer, depending on the aspect of tumor cells: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Experts make a distinction between them taking into account the growth, spreading and treatment. Although SCLC is not the most common, it definitely represents a threat to the human life, especially to the life of heavy smokers because is more aggressive, growing and spreading faster than the first type. In certain cases, NSCLC and SCLC appear together in lung cancer tumors.
Smoking cigarettes represents the biggest factor that leads to lung cancer, more exactly in over 80% of all cases. Practically, the individual deliberately exposes himself to different toxic substances, which damage the lining of the lungs. The inhalation of tobacco smoke immediately alters the lung tissue and despite the body attempt to repair this harm, constant exposure to cancer-causing substances, also known as carcinogens, affects normal cells increasing the chances for lung cancer to develop. Therefore, the more an individual smokes, the more it increases the possibility of damaging the respiratory system’s vital organs.
Passive smoking is another cause of lung cancer. Sharing a personal or professional space with a smoker endangers a person’s health because she inevitably inhales the cigarette smoke and enables the development of lung cancer. Thus, the smoke does not have to enter directly into the lungs in order to provoke irremediable damage. Exposure to radon, a radioactive gas without color, smell or taste present in soils and rocks can damage people’s lungs by entering homes though gaps and openings in the foundation or pipes. This chemical element is sometimes present in building structures. Inhaling both smoke and radon at the same time significantly increases the risk of developing lung cancer. Radon gas dangerously affects many homes but is only detectable with test kits due to its odorless, tasteless and colorless characteristics.
Air pollution that usually comes from industries and vehicles negatively affects people’s health, not to mention that inhaling polluted air increases the chances of cancerous cells multiplying and forming a tumor. Researchers have linked certain substances and chemicals like asbestos, cadmium, silica, coal and arsenic to a higher risk of developing this dangerous type of cancer. Obviously, urban areas contain most of these harmful factors that can lead to the appearance of lung cancer.
Family history plays an important role in determining if one person can develop this severe condition because a small part of lung cancer cases is associated with genetic susceptibility. According to numerous studies, having a close relative with the disease increases the risk of dealing with lung cancer in the future. Already having an underlying lung disease, especially chronic obstructive pulmonary disease (COPD) as well as pulmonary fibrosis does not help, on the contrary, it increases the likelihood of lung cancer even if the person does not smoke.
Both types of lung cancer, namely NSCLC and SCLC, have the same symptoms. Although at the beginning people do not notice concerning manifestations of the disease, things take a major turn with the progression of lung cancer. In advanced stages, they experience recurrent cough, shortness of breath, headache, chest pain and infections including pneumonia and bronchitis, loss of appetite, unexpected and visible weight loss, wheezing, bone pain, lack of energy and weakness. Other symptoms of lung cancer, which are less common, involve finger clubbing, hoarse voice, swelling in the face or neck area, difficulty swallowing and high temperature. Making an appointment with the doctor becomes imperative when noticing these worrying signs, specifically for tobacco fiends.
These symptoms represent the negative consequence of not only the primary tumor, but also disturbances of body systems and other metastatic tumors, which can have different size and locations. Lung cancer generally spreads to the bones, liver and brain. Metastasis to the bones affects the femurs, the ribs and the pelvic bones and explains the backbone pain. Not all people with this dangerous condition feel backbone pain, but for those who do, the spinal cord suffers great damage leading to neurologic deterioration and interfering with the blood supply, causing urinary incontinence, weakness and loss of sensation in the upper and lower limbs. Metastatic lung cancer in the brain causes seizures, vision problems and weakness while metastasis in the liver explains the loss of appetite, implicitly weight loss.
In order to establish a diagnosis of lung cancer, doctors perform various procedures and tests, from medical history and physical examination, X-rays and MRI to bronchoscopy and biopsy. The first step is to ask the patient regarding his general health and concerning symptoms following a detailed physical examination with the purpose to determine clues of lung cancer, such as airway obstruction and lung infections. For more certainty and accuracy, the doctor will perform chest X-ray to identify the cause of the patient’s respiratory difficulties. Usually, this test shows nodules or a tumor, which obviously represents an abnormality that damages the lungs. Nevertheless, some abnormalities like calcium deposits and scarring do not present the same danger, although they have a similar appearance to cancerous tumors.
For this reason, resorting to MRI or computerized tomography (CT) scan will clarify any doubt because they provide a more detailed picture of the situation; more exactly, they can provide three dimensions of the lungs. This allows the doctor to assess the size of the tumor and the stage of lung cancer. Moreover, he is able to identity if the cancer has spread to other parts of the body, thus affecting vital organs and lymph nodes. If the doctor is positive concerning the existence of a tumor in the patient’s body after performing the tests mentioned above, he will continue with several diagnostic procedures, which include collection of sputum, bronchoscopy and biopsy.
After collecting the patient’s sputum, a pathologist will examine it under a microscope with close attention in order to confirm the doctor’s diagnosis, even if severe symptoms and X-rays already provide solid signs. If the tumor invades the airways, sputum cytology enables the visualization of cancerous cells. The efficiency of this procedure has a limit taking into account that tumor cells are not always present in the patient’s sputum, not to mention that injuries or inflammation may cause healthy cells to look similar to harmful ones.
Bronchoscopy consists in inspecting the airways with the help of a thin probe inserted through the patient’s mouth or nose in order to determine areas of tumor ideal for sampling, usually the central area of the lungs. An experienced surgeon or pulmonologist performs this procedure using a fiber optic bronchoscope for establishing an accurate diagnosis. This intervention is relatively safe for the patient but the appearance of rare complications is possible leading to heart arrhythmia, excessive bleeding and low oxygen levels in the blood. Anesthesia and sedative medication can also lead to complications.
Needle biopsy is another diagnostic procedure used when bronchoscopy becomes useless, namely when the tumor presents a peripheral location in the lung area. Before inserting a fine needle in the patient’s chest with the goal to reach the tumor, the surgeon uses a local anesthetic. After absorbing the cells into the syringe, he examines them under the microscope. The intervention comes along with a small risk of pneumothorax, which refers to air leaking from the lungs but this does not represent an alarming complication. Ultimately, blood tests can help the doctor discover abnormalities that accompany cancer, such as high levels of calcium. Researchers are constantly working in order to develop a blood test that can enable cancer diagnosis.
Before providing proper treatment for the patient, doctors need to determine not only the tumor size and spreading, but also the presence of metastasis in other organs of the body. Futhermore, this will help them estimate the patient’ prognosis. Using the tests presented above, they see positive results for abnormal blood chemistry as a clue in relation to metastasis affecting the patient’s bone or liver and decide the proper therapy for the specific stage of the lung cancer.
NSCLC is quite severe, reaching from stage 1 to stage 4 rapidly. In the first stage, the cancer affects solely the lung; in the next two stages, it takes control over the patient’s chest with bigger and more encroaching tumors. Ultimately, in the stage 4 the cancer has reached to other parts of the body including essential organs. SCLC has a limited stage, where it remains in the area of origin, namely in the chest and an extensive stage, where the cancer has managed to spread to different parts of the body.
The treatment for lung cancer demands the involvement of different specialists including a surgical oncologist, who can safely remove the tumor, a radiation oncologist, who can treat the cancer with medicines and therapy, pulmonary and palliative-care specialists, among others. Practically, this type of severe disease requires work team and taking difficult decisions that can immensely influence the patient’s life. The main options involve radiotherapy, chemotherapy and surgery. If the cancer is already in an advanced stage, doctors may recommend a combination of these.
For NSCLC in stage 1 and a patient with overall good health, doctors may perform surgery in order to remove the harmful cells followed by chemotherapy to eliminate possible cancerous cells still present in the body. If the patient’s health does not allow the surgery, radiotherapy represents the only solution for destroying the cancer cells. In certain cases, they opt for a combination between this and chemotherapy. If the cancer has reached a final stage and both surgery and radiotherapy are useless, chemotherapy remains the only hope for the patient.
For SCLC, doctors usually resort to chemotherapy, sometimes combined with radiotherapy. This does not cure the patient from lung cancer, but has the purpose to relive the painful symptoms and prolong his life. Surgery does not represent an option in this case because this type of cancer is silent and does not manifest with symptoms until it becomes too late. Shortly, it spreads though the body affecting other vital organs.