Lung Cancer Symptoms, Risk Factors, Diagnosis and Treatment | Narayana Health

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All you need to know about Lung Cancer

(prevention and treatment.)



Symptoms of Lung Cancer

The formation of cancerous cells that originates from lungs is called lung cancer. Usually, lung cancer shows no symptoms at an early stage. Most significant symptoms are found in the advanced stages of lung cancer. Some of the common lung cancer symptoms are-

  • Chronic cough that worsens over time and fails to go away.
  • Blood in sputum
  • Chronic chest pain
  • Hoarseness (Change in the voice which sounds breathy and rough).
  • Difficulty in breathing.
  • Unexplained weight loss.
  • Constant feeling of tiredness and weakness.
  • Body and joint pain accompanied by headache.



Lung Cancer and Smoking

Risk Factors and symptoms of Lung Cancer

Smoking is considered as the highest risk factor to cause lung cancer in 9 out of 10 people. Pipe smoking and cigar are also considered dangerous apart from cigarettes. The possibilities of developing lung cancer depend on the frequency and duration of smoking. Most tobacco products consist of more than 7000 chemicals in them out of which 70 of those chemicals are known for causing lung cancer

Not all lung cancer patients are smokers, however, breathing cigarette or tobacco smoke as passive smokers is even more dangerous. Passive smokers inhale cigarette smoke along with other polluted smoke in the environment and this damages lung tissues immediately.

Chain smokers can reduce their chances of being affected by lung cancer by 50% if they quit smoking within 10 years from when they started.



Causes and Risk factors

Smoking is linked to about 90% of lung cancer deaths. Even smoking a few cigarettes a day increases the risk of lung cancer. Smoke from other people’s cigarettes (passive smoking) can also cause cancer.

However, frequent exposure to smoke causes severe damage to the lungs where self-repair fails to work. This begins to damage lung cells and increase the risk of lung cancer.

The risk can be lowered by giving up on smoking. Lung cancer can also be other factors like inhalation of hazardous gases with substances such as cadmium, uranium, few petroleum gases, nickel, arsenic and chromium.

Pre-existing lesion like pulmonary fibrosis is associated with sevenfold in increase in risk of lung cancer.

Although the genetic basis of lung cancer is still being elucidated, there is a clearly established familial risk.



Stages of Lung Cancer

Lung cancer stages and treatment

The treatment completely depends on the stages of lung cancer. Signs of lung cancer varies at different stages and the treatment is considered to be more effective when diagnosed at an early stage. Non- small cell lung cancer is considered to be the most common type of lung cancer and its stages are as follows-

Stage 1: The cancer is at the beginning stage where a small portion of the lung is infected without spreading outside the lungs.

Stage 2: Cancer has infected the lungs completely and spread to nearby lymph nodes.

Stage 3: In this stage, cancer spreads in lungs and lymph nodes present at the centre of the chest.

Stage 3A: Cancer spreads in all lymph nodes present on one side of the chest where it initially started.

Stage 3B: Cancer spreads in lymph nodes on the other side of the chest and gradually moves to the lymph nodes above the collar bone.

Stage 4: Cancer spreads in both lungs and area around the lungs and gradually moves to other organs.

Small cell lung cancer (SCLC) is another form of lung cancer and has two main stages-

Limited Stage: Cancer is found in a small portion in only one lung and in lymph nodes on the same side of the chest.

Extensive Stage: In this stage, cancer begins to spread to the entire lung and gradually moves to the other lung and lymph nodes around it. It also infects lung fluids, bone marrow and other organs. Most often people suffering from SCLC are diagnosed at an extensive stage.



Diagnosis and Treatment of Lung Cancer

Diagnosis- Once you show symptoms of lung cancer or if you've been considered at a higher risk for lung cancer, your doctor will recommend you to go through a number of tests to identify the presence of cancerous cells. Lung cancer can often be misdiagnosed and treated as tuberculosis if not properly investigated, Some of the tests to diagnose cancer are-

Imaging Test- During this process, an abnormal mass can be revealed through an X-ray image. A CT/PET-CT scan is recommended if the X-ray scan comes out clean. A clear picture of small lesions can be seen in a CT scan.

Biopsy- A tissue sample is taken out from the lungs through a biopsy to analyse the presence of cancer cells. A biopsy can be done by different methods and they are -

  • Bronchoscopy- The patient is sedated to pass a lighted tube down the throat to the lungs to get a closer view and to examine the condition of the lungs.
  • Mediastinoscopy- This procedure is done in the operation theatre with general anaesthesia where the doctor makes a small cut at the base of the neck to pass a lighted instrument to take a sample of lymph nodes with the help of surgical tools.
  • Image guided needle biopsy- A needle is passed through the chest wall and then passed through the infected lung tissue to obtain a sample of lymph nodes. This procedure is performed by looking at the imaging tests like CT Scan or ultrasound.

All samples collected during the biopsy is analysed by a pathologist to investigate further. Once the presence of cancer cells are found, the patient has to undergo a further test to know the stage of the cancer. In this process, a radioactive chemical is injected to highlight unusual areas of bone in the MRI- Brain, CT, and PET scan images. Depending on the stage of the cancer and pathology report, you may be asked to undergo molecular tests on biopsy sample, which will help in deciding the treatment plan.

Treatment- Once you have been diagnosed by lung cancer, a group of doctors coordinate together to discuss treatment methods and keep each other informed about important decisions taken during the treatment. The team includes -

  • A thoracic surgeon or surgical oncologist who is a specialist in lung and chest surgeries
  • A pulmonologist
  • A medical oncologist.
  • A radiation oncologist.

There are two major types sof lung caner- Non-small cell lung cancer (NSCLC) and Small Cell lung caner (SCLC). The treatment depends on the lung cancer type, stages and other health conditions. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, comprising 80% of lung cancer. The treatment depends on the lung cancer stages and other patient related and disease related characters. Some of the common treatment methods are -

Surgery- Performing surgery on lung cancer patients entirely depends on the stage of cancer and the health condition to withstand surgery. Surgery is reserved for patients who are diagnosed at an early stage. During the surgery, a portion of the infected lung or the entire lung is removed based on the severity of the infection.

Radiation therapy- Radiation treatment is performed with the help of powerful beams that are emitted from X-ray and protons to kill cancer cells. During the process, the affected area is targeted by radiation from a moving machine, while the patient lies down on a table. Radiation can be after surgery or during early stages of NSCLC or to painful sites to provide symptomatic relief. A combined treatment of radiation and chemotherapy is recommended for Stage III patients who are not candidates for surgery.

Chemotherapy- The treatment includes use of drugs to eradicate cancer cells. These drugs are induced either orally or through veins in your arms. The drugs are combined to provide a series of treatment for a few weeks or months. Chemotherapy is usually performed after surgery to eradicate any cancer cells left behind. Chemotherapy is also combined with the radiation process for treatment of Stage III cancer and is usually the only treatment option for Stage IV disease.

Targeted Drug Therapy- Patients suffering from Stage IV lung cancer due to a specific type of mutation in cancer cells (EGFR, ALK, ROS, MET etc) are recommended to undergo targeted drug therapy. The irregularity in the cell is blocked using drugs to kill cancer cells. With advancement in cancer research and medical science, these drugs have drastically improved the survical rate of advanced stage cancer.

Immunotherapy- Immunotherapy is a new tool in lung cancer armamentarium. These drugs are given through intravenous route. It makes way for the patient's immune system to fight against cancer cells by clearing the proteins covering the immune system. As of now, Immunotherapy drug is recommended only for patients suffering from advanced lung cancer.

Palliative Care- It is a specialized care to improve the quality of life for patients living with advanced stage cancer. It is supportive care that helps in relieving pain, treating vomiting, improving fatigue etc. It is given worth or without chemotherapy. It is also given to patients who are not fit for any cancer directed therapy or in patients where medical therapy fails.



Road to Recovery and Aftercare

Stay positive and have strong mental health to face challenges and pain during treatment and recovery. It is common to feel anxious and doubtful about the future and recovery is a slow process that takes time to heal.

Recovery time differs from one person to another. You have to analyse your mental and physical health to perform any regular activity that drains out your energy. Here are a few tips given below that can help you recover sooner with a positive attitude.

  • Quit smoking- Smoking worsens the condition in cancer and rapidly increase the chances of reoccurrence. Save your energy by not doing everything by yourself, ask for help from your loved ones and save your energy on things you want to do.
  • Follow healthy eating habits and stick to the lung cancer diet chart recommended by your nutritionist.
  • Avoid situations and scenarios that increase your stress level. Take it easy at work and do not overexert yourself.
  • Don't get lazy, maintain a healthy balance between taking rest and being active.
  • Always talk to your doctor about improvements and difficulties in recovery during follow-ups.
  • Go on walks, start with short distance and slower walks gradually increase the distance and pace without exhausting yourself.
  • Stay focused and feel more confident by setting small goals of recovery. Reward yourself with something you love once the goal is achieved.
  • Socialize with your family, friends and with people who can put a smile on your face.
  • Go on holidays, arrange parties with friends, indulge in hobbies you love, get back to work and take part in charity work.
  • After recovery, you will tend to look at life differently by prioritizing things to do in life. You will realize a healthy life is more important and will find ways to decrease stress levels in life.
  • Stop alcohol consumption.



Steps to Prevent Lung Cancer

Lung cancer cannot be prevented completely, however, there are some lung cancer prevention methods that can be followed to reduce the risk of being affected.

Stay away from smoke- Keeping yourself away from polluted smoke is the best choice to make. Educate people around you and create awareness in your children, talk to them about the risks involved in breathing smoke or polluted air.

Quit smoking- If you are a chain smoker or smoke casually, consider to quit smoking as soon as possible. If you cannot do it by yourself consult a lung doctor who can help you quit smoking by providing medication or nicotine replacement products.

Avoid being a passive smoker- Do not accompany your colleagues or friends to smoking zones if you are a non-smoker. Passive smoking is increasingly dangerous when compared to active smokers. Avoid smoking areas in public places like restaurants, bus stands, etc.

Check for radon exposure at home- Radon is a naturally erupted gas from earth and it can enter your house through cracks in the foundation. Follow precautionary methods during construction to avoid radon exposure. This is one of the important risk factors for the cause of lung cancer in non-smokers.

Stay away from toxic chemicals at work- If you work in a chemical factory, avoid inhalation of toxic chemicals by following the instructions provided by your company. Do not forget to use face masks for protection and have a regular lung check-up done by a doctor to know the condition of your lungs. If you have signs of lung cancer or considered to be at risk of being affected by lung cancer, look out for an alternative job.

Eat healthy food- A balanced diet with all the nutrients in it prevents our body from various diseases. By including fresh fruits and vegetables to your daily meal you can build a stronger immune system to fight dangerous infections. Avoid intake of supplements for vitamins and minerals instead consider to consume food with vitamins and minerals in its natural form.

Exercise regularly- By exercising every day the body gets stronger by strengthening the immune system. There are proven records that show treatments have shown quicker results due to exercising.



Lung Cancer FAQs: All your concerns addressed

A person affected by Lung Cancer usually has numerous questions running in their mind regarding treatments and chances of survival. Here is the list of frequently asked questions asked by lung cancer patients.

Q.  Do non-smokers get lung cancer?

  1. It is not common for non-smokers to be affected by lung cancer, but there are several causes apart from smoking that have been known to cause cancer of the lungs. Besides lung cancer, there are several lung disorders that might make lung operation a requirement for future well-being and it is best to consult with a pulmonologist or a specialist at a lung hospital to determine if you are a candidate who requires lung surgery, if you are affected by any of the symptoms that accompany lung disease.

Q.  Why would I need a lobectomy?

  1. Lobectomy or bi-lobectomy is most commonly performed if lung cancer is diagnosed at an early stage and a lung surgeon determines if the cancer can be completely removed through sectioning off of a lobe of the lung. It may also be performed in cases of severe infections such as tuberculosis and complicated fungal infections, or abscesses and scarring that may block airways.

Q.  How long does chemotherapy treatment take to cure lung cancer?

  1. Chemotherapy process is a systematic plan and varies from one patient to another depending on the stage of cancer. Speak to your doctor to get a clear picture of the process and do not hesitate to clear all your doubts.

Q.  Why is it required to undergo chemotherapy before surgery to remove lung cancer?

  1. Chemotherapy is not always required before surgery. Chemotherapy help in reducing the size of the tumour and this makes it easy for doctors to remove the tumour successfully.

Q.  What are the stages of lung cancer and why is it important to know the stage of lung cancer before treatment?

  1. The treatment method for lung cancer differs depending on the type and stage of lung cancer. The stage of cancer is defined depending on the areas infected.

Q.  Why do the reactions and results of lung cancer treatment differ for each person from the same chemotherapy drugs?

  1. It is a known fact that chemotherapy results will differ from one person to another depending on their metabolic rate. One person might have a weird feeling of nausea while the other can feel fatigued. This also depends on the dosage of the drug provided. The dosage of the drug differs at every stage. It is always important to remember that the recovery speed and the process during lung cancer treatment differs from person to person.

Q.  Does chemotherapy cause pain?

  1. As such chemotherapy does not cause pain. It is the cancer process itself which is linked to pain. As a matter of fact, chemotherapy is given to relieve pain and other symptoms.

Q.  Can you survive lung cancer?

  1. Yes, with proper treatment, necessary lobectomy and chemotherapy you can get cured of lung cancer but not cent per cent. The five-year survival rate states the percentage of people who live at least 5 years after the cancer is detected. The five-year survival rate among all types of lung cancer patients is 19%.

Q.  What are the early signs of lung cancer?

  1. Most lung cancers do not cause any symptoms until they spread but here are few common symptoms which shouldn't be avoided:
  • Loss of appetite
  • Feeling weakness
  • Unexpected weight loss
  • Shortness of breath
  • Chest pain
  • A consistent cough or coughing up blood
  • Bronchitis or Pneumonia which keeps coming back
  • Hoarseness

Q.  How do you get lung cancer?

  1. Majority of lung cancers is caused by smoking tobacco. Lung cancer can happen to both - active smokers and in people exposed to secondhand smoke. But lung cancer also occurs in people who are neither active nor passive smoker.
  2. Smoking damages the lung cells when you inhale cigarette smoke which is filled with carcinogens, cancer-causing elements.

Q.  What are the 4 types of lung cancer?

  1. Based on the appearance of lung cancer cells under the microscope, doctors distinguish lung cancer into two major categories:
  2. Small cell lung cancer (SCLC): It is less common types of lung cancer which occurs exclusively in heavy smokers or chain smokers.
  3. Non-small cell lung cancer (NSCLC): It is an umbrella term for several types of lung cancers. This type of lung cancer includes adenocarcinoma, squamous cell carcinoma and large cell carcinoma.

Q.  How do you test yourself for lung cancer?

  1. As with all disease, earlier identification leads to greater cures. The 5 year survival rate for those diagnosed early is 55 out of every 100. Apart from looking out the early and consistent symptoms of lung cancer, your doctor might ask you to do the following recommended tests:
  • Low dose CT Scan (low dose computed tomography scan)
  • Nasal swabs
  • Blood tests

Q.  Is lung cancer curable if caught early?

  1. There are technologies like Imaging tests, Sputum cytology, and Tissue sample (biopsy) for early detection of lung cancer and to find tumours when they are still in a surgically curable stage. Most people when diagnosed with lung cancer are diagnosed at a developed stage when the options for treatment are relatively few. There is, however, a period of time before symptoms develop, the pre-clinical phase of lung cancer. During this period, there's a possibility of screening an individual and detecting the disease at an early enough stage that a surgical or a local procedure could cure cancer. Cancer in it's earliest stages is the most treatable.

Q.  Where does lung cancer spread first?

  1. Metastasis refers to the spread of cancer cells from the primary location (the organ in which cancer began) to other secondary locations of a human body. Statistically, 40% of newly diagnosed patients with lung cancer already have metastases to other parts of the body.
  2. Lung cancer can spread to nearly any region of the body like Lymph Nodes, Bones, Brain, Liver, Adrenal Glands. Occasionally it cal also spread to the eye, the skin, the stomach, small and large intestines, the pancreas, the kidney, and even the breast.

Q.  How does lung cancer patient die?

  1. Death is inevitable but you can expect the following during the later stages of lunch cancer. 30% pf people suffer and die due to Tumor burden from metastases, which means that the amount of cancer tissue present spread to other body parts and caused death. Sometimes, infections like pneumonia and sepsis begin in the bloodstream and spread through the entire body leading to death.
  2. Pulmonary haemorrhage (bleeding into the lungs), Pulmonary Embolism (blood clots in the legs) that break off and travel to the lungs, and most commonly respiratory failure are some of the immediate cause of death among .ung cancer patients.

Q.  Are nodules found on the lungs always cancerous?

  1. No. The majority of nodules (suspicious spots or masses) on the lungs are not always cancerous. To detect lung cancer, a thorough lung cancer diagnosis is always recommended. Advancement in technology has led the experts to create a program that evaluates lung nodules and returns a diagnosis in just a few days.

Q.  Are there any side-effects of the lung cancer treatment that I can expect?

  1. Lung cancer and its treatment cause some side-effects that may impact your quality of life. They may include pain, fatigue, depression, weight-loss, anxiety, etc. Integrated approaches such as alternative therapies and supplements always come as a rescue, such as mind-body medicine, oncology rehabilitation, and spiritual support. Such treatments allow patients to continue treatment and reduce lung cancer symptoms.

Q.  How diet affects lung cancer risk?

  1. Some studies recommend that eating a healthy diet can lower your risk, along with giving you many other benefits for the rest of our body. But more evidence is still needed in support. So, always ask your doctor before starting with any supplement based on lung cancer stages.