Lung Cancer
Many of the patients I see are being investigated to see whether they may have a lung cancer. It is a difficult time for every person and their family. Here are a few of the frequently asked questions I get about lung cancer:
What are the types of lung cancer?
What are the common symptoms of lung cancer?
What are the risk factors for lung cancer?
What is cancer?
There are many types of cancers, from different cell types and different organs in the body. However all cancers have one thing in common – they occur when the genes in healthy cells becomes damaged causing the healthy cells to become abnormal cancer cells. Cancer cells
- grow faster than normal healthy cells
- damage surrounding normal health cells
- grow extra blood vessels
- invade beyond the limits of normal healthy cells
- do not decommission and die the way healthy cells do
The original site where the healthy cells change into cancer cells is called the “Primary site” or “Primary tumour”. As the cancer cells grow they can spread to other sites in the body. The process is called metastasizing and cancer cells that have spread to a different site in the body are called “metastases”.
WHAT ARE THE TYPES OF LUNG CANCER?
(1) Non small cell lung cancer
Make up 80% of all lung cancers. There are 3 general sub-types
(a) Adenocarcinoma – from gland forming cells
(b) Squamous Cell Carcinoma – from airway lining cells
(c) Large cell carcinoma – other cell types
(2) Small cell lung cancer
Make up 15% of all lung cancers. These are rapidly growing and spreading types of lung cancers
(3) Mesothelioma
A type of cancer from the lining of the lung (pleura). Often associated with asbestos exposure.
(4) Other
Tumours of the glands, nerves, bones or muscles within the chest. These are not strictly lung cancers.
How common is lung cancer?
- 12,203 (7,130 males + 5,073 females) new cases of lung cancer were diagnosed in 2016 in Australia
- 10% of all cancers diagnosed in Australia were lung cancers.
- 8,839 (5,122 males + 3,716 females) are thought to have died from lung cancer in 2016
Australian Institute of Health and Welfare 2016. Australian Cancer Incidence and Mortality (ACIM) books (/elf/go?url=http%3A//www.aihw.gov.au/acim-books/) : lung cancer. Canberra: AIHW. [Accessed January 2016].
What are the common symptoms of lung cancer?
Unfortunately lung cancers are often very advanced by the time people get symptoms.
Some common symptoms of lung cancer are:
- a new or changed cough that doesn’t improve over time
- coughing up blood
- wheezing or shortness of breath
- chest pain often that is related to taking a deep breath and/or shoulder pain
- hoarse voice
- trouble swallowing
- weight loss
- repeated chest infections
- swelling in the face or veins in the neck
These symptoms can be present in other conditions, so the first step if you have any of these symptoms is to take to your GP to get things checked out.
References:
- American Cancer Society. Non-small cell lung cancer, (accessed 28 May 2015).
- Understanding Lung Cancer. A guide for people with cancer, their families and friends. Cancer Council Australia 2016. ISBN 978 1925136 26 5
What are the risk factors for lung cancer?
The most common and important risk factors for lung cancer are
- Cigarette smoking. Smoking causes 9 out of 10 lung cancers. The risk is greater in people who’ve smoked more cigarettes and smoked for a long time.
- Second hand smoking – the over all lifetime risk of developing lung cancer from second hand smoke is ~0.5%.
- Asbestos exposure.
- Family History.
- Personal history of lung conditions e.g. pulmonary fibrosis, past radiation to the chest.
- Age >60 years although lung cancer can occur in younger people too.
How is lung cancer diagnosed?
The work up of lung cancer is always customised to each patient. I think that it is important to communicate with patients and families that whilst imaging findings in CT scans and chest x-rays can be concerning and worrying for cancer, ultimately a diagnosis can only be made for sure by a pathologist who has confirmed there are cancer cells seen on a biopsy under microscope.
Imaging tests often requested are
1. Chest x-ray (CXR)
Xray that can give an overview of larger tumours, fluid around the lung, however does not give detailed pictures
2. CT chest (aka CAT scan, computerised tomography)
Uses xrays to take pictures of the organs within the body and provide a cross-section picture that is more detailed than a CXR. These are often done with contrast dye through a drip in the arm to make the heart and the big blood vessels clearer.
3. PET scan (positron emission tomography scan)
s a whole body imaging tests that combines CT scan with radioactive dye that goes throughout the whole body to see if there are places where cells are too active. Cells that take up more radioactive dye are called “hot spots” and may represent spread of cancer cells if found in places away from the primary tumour.
Biopsy tests often requested are:
· Bronchscopy (aka bronch) – this is a small camera used to view inside the major airways. Small biopsy pincers and fluid can be placed down into the lungs using the camera to take samples for the pathologists to look for cancer cells.
· Linear EBUS (aka Endobronchial ultrasound) – uses a bronchoscopy with a special ultrasound on the end of the camera to take samples from the lymph glands within the chest.
· Radial EBUS - uses a bronchoscopy with a special ultrasound on the end of the camera to take samples from within the lung that cannot be seen by the camera alone
· CT guided core biopsy – you will lie in the CT scanner and a radiology specialist doctor will take samples of the abnormal area of lung with the help of the images. Usually this involves some local anaesthetic under the skin and a needle between the ribs, down into the lung tissue.
Other tests are sometimes needed and would be discussed by your specialist.
What are the treatment options?
Treatment is individualised to each patient based on the
1. Type of tumour found
2. Stage of the tumour
3. Past medical history of the patient
4. Wishes of each patient
Depending on these factors treatment may include one or combinations of
- Lung Surgery – this is generally only used for non-small cell lung cancers that are small in size and have not spread from the primary site in patients who are young and fit.
- Radical Radiation therapy – this is generally used for lung cancers that have not spread past the lymph nodes in the chest but where the lungs are not able to stand surgery
- Combination chemotherapy and radiation therapy – usually for cases where there has been spread of the lung cancer into the lymph glands in the chest but not to sites elsewhere in the body
- Palliative chemotherapy – chemotherapy designed to slow the progress of the cancer, but where the cancer has metastasised and is not able to be cured
- Palliative radiation therapy – radiation designed to alleviate pain from the cancer, but where the treatment will not make the cancer go away completely.
WHAT ARE THE RELIABLE WEBSITES TO USE?
http://www.cancer.org.au/about-cancer/types-of-cancer/lung-cancer.html