Health Tips

Lung Cancer

Cancer is a condition when the normal cells multiply or proliferate and undergo transformations that are out of control. These cells will develop into a growth or tumor that varies from the original tissues. Tumors are harmful as they take oxygen, nutrients, and would infiltrate adjacent tissues which later would result in damage and loss of normal function of the tissues. Lung cancer, sometimes also called primary lung cancer is a term used to describe cancer that first appears in the lungs.

Lung cancer starts in the lungs and can spread to lymph nodes or other body organs.The lungs may also be infiltrated with cancer that originated from other organs. If this happens, it is called metastases.

Lung cancer is now the third most common cancer in Malaysia and the leading cause of cancer deaths worldwide.

Types of Lung Cancer

Based on how lung cancer cells look under a microscope, it is divided into a few main types. Depending on the type of lung cancer you have, your doctor will decide on how to proceed with the treatment. The following are the main types of lung cancer:

• Non Small Cell Lung Cancer (NSCLC) which are lated being categorized into :

  • Adenocarcinoma

  • Squamous Cell Carcinoma

  • Large Cell Carcinoma

• Small Cell Lung Cancer (SCLC)

Causes of Lung Cancer

Smoking, including both active and passive smoking, is the leading causes in cases of lung cancer :

• More than 4000 chemical substances that have been linked to lung cancer are found in tobacco smoke.

• In comparison to non-smokers, smoking 20 cigarettes a day elevates risk by 20 to 25 times.

• Smokers who give up smoking have a lower risk of developing lung cancer. The risk of developing lung cancer is the same for smokers and non-smokers after quitting for 15 years.

• Lung cancer risk is also increased by smoking pipes, cigars, or vaping.

Lung cancer may also be caused by :

• Exposure to air pollution from vehicles, factories and others.

• Exposure to previous radiation therapy for another type of cancer.

• Exposure to radon.

• Exposure to asbestos.

• Occupational exposure to arsenic, chromium, nickel, aromatic hydrocarbon and ether.

• Lung diseases such as chronic obstructive pulmonary disease and tuberculosis.

Symptoms of Lung Cancer

In its early stages, lung cancer often exhibits no signs or symptoms or what we called asymptomatic. Lung cancer signs and symptoms often appear when the condition is advanced. Some of the symptoms include :

1. Cough that lasts for longer than two to three weeks.

2. Haemoptysis (coughing up blood).

3. Odynophagia (pain when swallowing).

4. Dysphagia (difficulty swallowing).

5. Discomfort or soreness when breathing or coughing.

6. Wheezing.

7. Breathlessness.

8. Persistent neck or shoulder or back pain.

9. Unintentional weight loss.

10. Low appetite.

11. Hoarseness of voice.

12. Fatigue.

Diagnosis of Lung Cancer

Various investigations are used to determine the diagnosis. Your doctor will first ask a few questions about your general health and current symptoms before possibly requesting blood work. Investigations may consist of :

1. Chest X-rays

Chest X-rays are typically the first test used to identify lung cancer. Important indicators in chest imaging, such as an apparent mass, a collapsed lung, and chest expansion, may indicate the presence of lung cancer and call for further investigations.

On a chest radiograph, lung cancer frequently appears as a white-gray mass, however this can also be the result of other diseases. As a result, more tests should be carried out later to confirm the diagnosis.

2. CT Scan

Following a chest X-ray, a computed tomography (CT) scan is frequently performed. A CT scan uses X-rays and a computer to produce precise images of the inside of your body.

You will be given an injection containing a special dye called a contrast medium, which boosts image quality, prior to the CT scan. This procedure is painless and takes between only 10 and 30 minutes.

3. PET - CT Scan

Positron Emission Tomography (PET) and CT scanning can be combined to perform a PET-CT scan if the CT scan reveals that the malignancy is in an early stage.

Active cancer cells can be located via PET-CT imaging. This would assist to pick diagnosis and course of treatment. Before the PET-CT scan, a moderately radioactive substance will be administered into you. It takes between 30 and 60 minutes and is painless.

4. Biopsy 

A biopsy is a procedure that requires taking a sample of abnormal cells. There are numerous approaches to performing biopsies.

Treatment of Lung Cancer

The ideal course of treatment for lung cancer depends on the type of cancer, the size and location of the tumor, and the stage of the cancer.

Surgery, radiotherapy, chemotherapy, and immunotherapy are the main modalities of treatments. However, there are also other modalities of treatments such as targeted therapy, radiofrequency ablation, or palliative care.

1. Surgery

Surgery for lung cancer involves removing the entire tumor as well as a portion of healthy tissue to stop the spread of cancer cells. Lung cancer surgery commonly comes in three different types which is :

• Lobectomy where one lobe of a lung is removed.

• Pneumonectomy where one whole lung is removed.

• Segmentectomy or wedge resection where only part of a lobe is removed.

2. Radiotherapy

High-energy radiation is used in radiation therapy to shrink tumours and kill cancer cells.

3. Chemotherapy

Chemotherapy is a type of cancer treatment that makes use out of powerful medication that can destroy cancer. Chemotherapy can be given :

• Preceding the surgery to reduce the rate of spread of cancer and shrink the tumor size.

• Following the surgery to eradicate any leftover cancer cells.

• In combination with radiotherapy.

Chemotherapy is typically administered for 3 to 6 months in cycles of 4 to 6. It may also be given in a combination of drugs for a greater result.

4. Immunotherapy

Several drugs direct the immune system to look for and destroy cancer cells. Both on its own or in combination with chemotherapy are options.

5. Targeted Therapy

Drugs called targeted therapies, sometimes known as biological therapies, are meant to stop the spread of advanced non-small cell lung cancer.

6. Radiofrequency

Heat is produced to kill cancer cells when a needle is guided to the tumor spot using a CT scanner. Early non-small cell lung tumors may benefit from its use.

7. Palliative Care

Palliative care aims to maximize quality of life by minimizing cancer signs and symptoms in cases where other modalities of therapies are not recommended or cancer is in an advanced stage and  cannot be completely cured.

Prevention of Lung Cancer

The majority of lung cancer patients appear at a late stage, and there is currently no cost-effective way to identify the disease at the early stage. Therefore, reducing exposure to tobacco smoke, whether it is active or passive smoke, is the most efficient way to avoid lung cancer. It is brilliant to stop smoking for those who are still smoking. Other than that, start to consume a nutritious, balanced diet and exercise regularly to maintain healthy.

Coping and Support

It might be overwhelming to receive a cancer diagnosis. You'll learn coping mechanisms for the anxiety and uncertainty that come with cancer over time. In the meanwhile, you might find it beneficial to :

• Discover enough about lung cancer to guide your treatment choices. Consult your physician to learn more about your lung cancer, your treatment options, and, if you'd like, your prognosis. You could feel more at ease choosing a course of therapy as you get more knowledge about lung cancer.

• Keep your loved ones close. You'll be able to manage your lung cancer better if you maintain your close ties. Friends and family can offer you the necessary help that you need. Additionally, they can offer emotional support when you're feeling overtaken by cancer.

• Find someone to talk to. Find someone who is willing to listen to you talk about your hopes and anxieties. It could be a friend or relative. A counselor, medical social worker, or cancer support group may also be beneficial.

Notes From DOC2US:

Although lung cancer can be fatal, those who obtain an early diagnosis frequently have a high chance of surviving.

People who are at a high risk of getting lung cancer might want to think about getting regular screenings. This can assist in identifying the early warning signs and allowing therapy prior to the cancer spreading.

Anyone who is worried about their chance of developing lung cancer should consult a healthcare professional for advice.

Written by Anas Fikri, MB BCh;
Medically reviewed by Nur Ariffin, MBBS UniSZA

References:

1. Centers for Disease Control and Prevention. Lung Cancer. https://www.cdc.gov/cancer/lung/basic_info/

2. MyHealth Kementerian Kesihatan Malaysia. Lung Cancer. http://www.myhealth.gov.my/en/lung-cancer/

3. Rajadurai P. et al. Lung cancer in Malaysia. 15(3): 317-323. 2020.

4. Kementerian Kesihatan Malaysia. Malaysia cancer statistics: data and figure Peninsular Malaysia 2006 (online) 2006 (cited 2009 Dec 17); (137 pages). http://www.moh.gov.my/opencms/export/sites/default/moh/report/Cancer/MalaysiaCancerStatistics-2006.pdf

Written by

DOC2US Editorial Team