Lung Cancer - Diagnosis and Treatment
The cell is the basic unit of life, and the human body has a delicate mechanism of checks and balances on cell growth such that old cells die and are continuously replaced by new cells. Cancer develops when this system is disrupted so that there is an uncontrolled division and proliferation of cells that eventually form a mass known as a tumor.
Lung cancer is the cancer of the lungs that usually starts in the spongy walls of the lungs’ airways called bronchi or bronchioles or the air sacs called alveoli. Lung cancer is considered the most common cancer-related cause of death among American men and women and also worldwide. However, it could be easily prevented by not smoking and also avoiding other people’s secondhand smoke. Like any other cancer, early detection plays a crucial role in successful Lung cancer treatment. The other factors that determine the treatment of Lung cancer include size, location and extent of cancer spread. Common treatments include surgery, chemotherapy, and radiation therapy.
Lung cancers are broadly classified into two categories based upon the microscopic appearance of the tumor cells, precisely the size of the cells:
a) Small cell lung cancers (SCLC) and
b) Non-small cell lung cancers (NSCLC).
The growth and spread of both these cancers are different from each other and hence require different treatment. SCLC comprise about 20% of all lung cancers, and they grow very rapidly. SCLC have a strong correlation to cigarette smoking, with only 1% of these tumors occurring in nonsmokers. They metastasize, i.e. spread to other parts of the body rapidly and are most often discovered after they have spread extensively.
Non-small cell lung cancers (NSCLC) are the most common lung cancers, accounting for rest of the 80% of all lung cancers. NSCLC has three main types based on the type of cells found in the tumor:
• Adenocarcinomas are the most common type of NSCLC in the US making up to 40% of lung cancer cases. However, it is to be noted that adenocarcinomas are not only related to smoking like other lung cancers, but they could also be found in non-smokers -- especially women. Most adenocarcinomas occur in the outer, or peripheral areas of the lungs.
• Squamous cell carcinomas usually arise in the central chest area in the bronchi. This lung cancer most often stays within the lung, spreads to lymph nodes, and grows quite large, forming a cavity.
• Large cell carcinomas, which account for nearly 10 percent of NSCLC tumors have a high tendency to metastasize to the lymph nodes and distant sites.
1. Smoking: Smoking and tobacco use have a high correlation with incidence of lung cancer. Tobacco smoke contains over 4,000 chemical compounds, many of which have been shown to be cancer-causing or carcinogenic. Even passive smokers, i.e. people who don’t smoke but are exposed to tobacco smoke for long duration are at high risk of developing lung cancer
2. Exposure to radon gas: Radon gas is a natural radioactive gas released by some soil and rocks with an estimated 12% of lung-cancer deaths attributable to radon gas, or about 21,000 lung-cancer-related deaths annually in the US.
3. Chemicals and workplace risks: Chemicals like Asbestos can persist for a lifetime in lung tissue following exposure. Many cancers including cancer of the pleura of the lung are associated with exposure to asbestos. There are many such substances or chemicals at a workplace or in the environment that can significantly increase a person’s risk of developing lung cancer including exposure to nickel, and chromium.
4. Air pollution: Breathing polluted air with high-level of chemical gases also carry a risk of lung cancer similar to that of passive smoking.
5. Previous lung disease
6. A family history of lung cancer: Genetic predisposition could also put some individuals at higher risk of lung cancer. This is the reason why doctors recommend screenings for those who have a family history of the disease or over the age of 50. Early detection is key to successful Lung cancer.
7. Previous radiotherapy treatment
8. Lowered immunity
1. Persistent cough: A persistent cough that refuses to go away. There could also be a change in a cough you have had for a long time like your cough might be more painful, or have a different sound or it may be bringing up coloured mucus or phlegm.
2. Shortness of breath: Getting out of breath doing the things you used to do without a problem earlier could also be an early sign of lung cancer.
3. Coughing up blood: Coughing up rust coloured phlegm (sputum) or sputum with flecks of red in it.
4. Pain in the chest or shoulder
5. Loss of appetite
6. Losing weight
7. Feeling exhausted all the time
8. Long-running chest infection that doesn’t get better with treatment.
9. Hormone-related symptoms: Certain lung cancer cells produce hormones resulting in symptoms that don’t seem directly related to the lung cancer. Doctors call them paraneoplastic syndrome. These include pins and needles or numbness in the fingers or toes, muscle weakness, drowsiness, breast swelling in men, and blood clots.
Diagnosis of Lung cancer
If you're a chain smoker or have other risks for lung cancer, your doctor would suggest certain screening tests like X-ray, or a CT scan to know more about the disease as part of your Lung cancer treatment in India. If the screening shows you may have lung cancer, the doctor will likely ask for diagnostic tests that can pinpoint the type and stage of the disease and how far it has spread to other places in the body.
The procedures to collect tissue to diagnose and accordingly plan Lung cancer in India are listed below:
1. Biopsy: Biopsy involves removal of a small amount of tissue for examination under a microscope. This procedure is helpful to determine the kind of lung cancer one has and to also figure out the subtype of NSCLC and to do additional molecular testing.
2. Needle aspiration/core biopsy: Biopsy is an essential part of Lung cancer treatment, and there are different methods to do a biopsy. After numbing the skin, an interventional radiologist takes a sample of the lung tumor for testing. This can be done with the help of a needle depending on how large of a sample is needed. Usually, a core biopsy provides a larger amount of tissue than a needle aspiration.
3. Bronchoscopy: In bronchoscopy, a thin, flexible tube with a light on the end is passed through the mouth or nose, down to the main windpipe, and into the breathing passages of the lungs. This tube allows the doctor see inside the lungs. There are tiny tools inside the tube that can take samples of fluid or tissue so the pathologist can examine them before starting your Lung cancer treatment.
4. Thoracentesis: This diagnostic test as part of your Lung cancer treatment in India involves numbing the skin on the chest to insert a needle into the space between the lung and the chest-wall where fluid can collect. This fluid is then checked for cancer cells by the pathologist.
5. Thoracoscopy: Before starting the treatment, diagnostic tests give exact information about the cancer to the doctor, who then determines the course of your Lung cancer. Through a small cut in the chest wall, a surgeon inserts a special instrument and a small video camera to examine the inside of the chest.
6. Mediastinoscopy: This procedure involves examination of a sample of the lymph nodes in the centre of the chest.
7. Thoracotomy: A surgeon makes an incision in the chest, examines the lung directly, and takes tissue samples for testing.
If you have been diagnosed with lung cancer, your doctor will discuss a treatment plan. The Lung cancer treatment is based on a number of factors, such as patient’s overall health, the type and stage of his/her cancer, and also individual preferences.
Following are the main treatment options that lung cancer patients undergo:
Surgery is the primary option for Lung cancer treatment for patients with early-stage cancer who are in good general health. During surgery, the surgeon removes the entire lobe in which the tumor is located and some bit of healthy tissue too. Different surgical procedures to remove lung cancer include:
• Wedge resection: It involves removal of a small section of lung that contains the tumor along with a margin of healthy tissue
• Segmental resection involves removing a larger portion of lung, but not an entire lobe
• As part of a patient’s Lung cancer, Lobectomy is performed to remove the entire lobe of the lung
• Pneumonectomy to remove an entire lung
It is important to note that Surgery is an option if your cancer is confined to the lungs. In case of larger lung cancer, oncologists usually recommend chemotherapy or radiation therapy before surgery in order to shrink the cancer. Similarly, if there are chances that some cancer cells couldn't be removed by surgery or that your cancer may recur, your doctor may recommend chemotherapy or radiation therapy post-surgery too.
These days there are many advanced surgical techniques such as minimally invasive surgery and video-assisted thoracoscopic surgery (VATS) that may reduce the amount of time you need to spend in the hospital after lung cancer surgery and help you return to your normal activities sooner.
Radiation therapy, or radiotherapy uses high-energy beams such as X-rays and protons to kill cancer cells. For patients having locally advanced lung cancer, radiation therapy may be used before and after surgery. It's often combined with chemotherapy treatments. If surgery isn't an option for you, combined chemotherapy and radiation therapy may be your primary Lung cancer surgery.
When it comes to advanced lung cancers; basically, those that have spread to other areas of the body, radiation therapy can be helpful in relieving symptoms, such as shortness of breath and pain. Many individuals who have a small localized lung cancer, but who don't qualify for a surgery are treated with a radiation treatment called as stereotactic body radiation therapy (SBRT). People who can't undergo surgery include older generation, patients with chronic heart disease, or those receiving a blood-thinning drug that puts them at risk of surgical bleeding.
When compared with standard radiation therapy techniques, newer and precisely targeted Lung cancer surgery may be more effectual with fewer side effects. Many Indian hospitals offer cutting-edge technology for radiation planning and treatment including intensity-modulated radiation therapy, volumetric modulated arc therapy, image-guided radiation therapy and proton therapy. Lung Cancer treatment in India is amongst the most advanced in the world with high success ratio.
Chemotherapy is the third option for Lung cancer treatment that uses medicines to kill cancer cells. Usually, one or more chemotherapy drugs may be given intravenously or orally. A combination of drugs is given in a series of treatment cycles with breaks in between so that you can recover.
Therefore, Chemotherapy sterilizes microscopic disease after surgery. It is also a possibility that it will slow tumor growth and relieve symptoms in patients who cannot have surgery. Chemotherapy, as a Lung cancer, is also used before surgery to shrink cancer and make it easier to remove.
For people with advanced lung cancer, this therapy could be used to relieve pain and other symptoms.
Targeted drug therapy
As part of your Lung cancer treatment, doctors may prescribe targeted drug therapy that focuses on specific abnormalities present in cancer cells. Thus, by blocking these abnormalities and running targeted drug treatments the cancer cells can be terminated.
Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.
Immunotherapy helps your immune system to fight cancer. Often you will find that our body's strength; the disease-fighting immune system may not attack your cancer. It is because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.
Immunotherapy Lung cancer surgery in India is generally reserved for people with advanced lung cancer.
The Lung cancer treatment in India is amongst the world’s most advanced and also the cheapest. The cost of Lung cancer treatment in India starts from USD 8,000 which is very low compared to treatment cost in the countries like the US, UK or Singapore.
There are many good hospitals for Lung cancer in India that provide International level of healthcare and hospitality to patients complemented by high standard of medical facilities and technology. From Max Healthcare, Manipal Hospitals, Fortis Healthcare, to BLK, Nanavati Hospital, Wockhardt, and Columbia Asia, these hospitals offer the best infrastructure and world-class facilities for Lung cancer treatment at an affordable cost.
The best Oncologists in India have wide experience in various cancer surgeries including Lung cancer treatment with positive results.
top Lung Cancer Specialist in India
Dr Sudipto Pakrasi
A renowned ophthalmologist, with a career spanning three decades, Dr Sudipto Prakasi currently leads the Opthalmology division at Medanta – Medicity, Gurgaon as the Chairman. Dr Prakasi complView Details