Nine Types Of Standard Treatment Are Used:
Four types of surgery are used to treat lung cancer:
- Wedge resection: Surgery to remove a tumor and some of the normal tissue around it. When a slightly larger amount of tissue is taken, it is called a segmental resection.
- Lobectomy: Surgery to remove a whole lobe of the lung.
- Pneumonectomy: Surgery to remove one whole lung.
- Sleeve resection: Surgery to remove part of the bronchus.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Radiosurgery is a method of delivering radiation directly to the tumor with little damage to healthy tissue. It does not involve surgery and may be used to treat certain tumors in patients who cannot have surgery.
Gene Changes That May Lead To Lung Cancer
Scientists know how some of the risk factors for lung cancer can cause certain changes in the DNA of lung cells. These changes can lead to abnormal cell growth and, sometimes, cancer. DNA is the chemical in our cells that makes up our genes, which control how our cells function. DNA, which comes from both our parents, affects more than just how we look. It also can influence our risk for developing certain diseases, including some kinds of cancer.
Some genes help control when cells grow, divide to make new cells, and die:
- Genes that help cells grow, divide, or stay alive are called oncogenes
- Genes that help control cell division or cause cells to die at the right time are called tumor suppressor genes
Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes. Changes in many different genes are usually needed to cause lung cancer.
Agents Used For Pain Relief
There are many painkilling medications available. Research shows that aggressive pain relief can help patients better manage cancer treatment symptoms. For example, reducing pain in older people with cancer may markedly lower their fatigue levels, and improve other symptoms as well.
Opioids are the most potent painkillers. The correct dosing, timing, and use of these strong medications is very important for reaching acceptable pain relief and preventing a toxic response. Patients on opioid medications should be closely monitored to prevent abuse and addiction.
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How Does Asbestos Cause Lung Cancer
When a person inhales asbestos, microscopic fibers can become lodged in their lung tissue. Over many years, the fibers can cause enough genetic and cellular damage to cause lung cells to turn cancerous.
Asbestos-related lung cancer typically takes between 15 and 35 years to develop from initial exposure to onset of symptoms. Because of this long latency period, most cases diagnosed today were caused by occupational asbestos exposure that occurred decades ago when asbestos use was prevalent.
The most at-risk professions involve mining, construction, heavy industry, shipbuilding and firefighting. Veterans are also a high-risk group for asbestos-related lung cancer because of the militarys reliance on asbestos products.
According to an international study published in 2020, no substance causes more cases of lung cancer linked to occupation than asbestos. The study found that asbestos is responsible for 37.5% of all occupational lung cancer cases.
Risk factors for asbestos lung cancer include:
- Duration and intensity of asbestos exposure
- Overall health
Other Factors Determining Treatment Choices And Outcome
Staging factors are used to help determine treatment and outlook. The following suggest a more aggressive disease:
- The presence of respiratory symptoms
- A tumor larger than 3 cm
- High numbers of blood vessels in the tumor
Researchers are always looking for more accurate ways to determine lung cancer treatment and outlook, such as specific biomarkers and related blood vessel development within tumors. These markers might eventually help predict the cancer’s aggressiveness and determine the best treatment approach.
Using the TNM information, lung cancer is divided into stages, I through IV. Stages I through III are further divided into A or B . Each stage will usually have a different approach to treatment.
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How Do Doctors Diagnose Non
Doctors use many different tests to diagnose NSCLC and determine how advanced the cancer is.
These tests could include:
- Physical Exam Doctors might perform a general health check to look for lumps or any other signs of cancer. They may also ask about family history and health habits.
- Blood or Urine Tests Lab tests can help diagnose and monitor the disease.
- Chest X-Ray A simple X-ray can let doctors see the organs and bones inside the chest.
- CT Scan This imaging procedure combines a series of X-rays images taken at different angles to create pictures of areas inside the body.
- Sputum Cytology A pathologist analyzes a sample of sputum under a microscope to look for cancer cells.
- Thoracentesis This procedure uses a needle to remove fluid from the space between the lining of the chest and the lung. A pathologist examines the fluid to look for cancer cells.
If doctors suspect NSCLC, theyll perform a biopsy in order to make an official diagnosis. This procedure involves analyzing lung cells under a microscope.
There are different ways to collect cell samples, including the following:
What Are The Stages Of Small Cell Lung Cancer
Healthcare providers use a two-stage system to diagnose the spread of small cell lung cancer. This information also helps guide treatment. The two stages of small cell lung cancer are:
- Limited: Cancer is confined to one lung and nearby lymph nodes.
- Extensive: Cancer has spread to the other lung and lymph nodes. It also may have spread to bones, the brain and other organs.
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Side Effects Of Radiation Therapy
Radiation can have significant side effects when used as part of intensive treatments, such as hyperfractionated radiotherapy or radiotherapy in combination with chemotherapy. Among the most serious problems is severe inflammation in the esophagus or lungs . Infection is also a danger.
The use of targeted approaches, such as conformal radiotherapy, may help reduce these complications.
Types Of Chest Wall Tumors
Tumors found in the chest wall are also categorized by whether they are primary tumors or metastatic tumors . All metastatic tumors are malignant. In children, most chest wall tumors are primary, while they are more often metastatic in adults. Primary tumors start in the bones or muscles located in the chest wall.
Sarcomas â tumors that start in bone or muscle tissue, or more rarely in other types of tissue â are the most common type of primary tumor found in the chest wall.
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Genetic Syndromes Mutations And Susceptibility
The science looking at the genetics of non-small cell cancer is relatively young. Some of the mutations or alterations in signaling proteins in lung cancer that are detectable with genetic testing today include:
- RET mutations
- NTRK mutations
With regard to specific gene mutations, it’s been noted that women who have BRCA2 mutations and smoke have around twice the risk of developing lung cancer. People who have the uncommon Li-Fraumeni syndrome related to a mutation in the p53 gene also have an increased risk.
There are also regions on chromosomes that have been associated with susceptibility, including major susceptibility locus on chromosome 6 and another on chromosome 15. More recently, NF-kB2 genetic variations have been found to be significantly associated with non-small cell lung cancer risk, and in Japan, the GSTM1 null genotype is associated with an increased risk in never-smoking women.
What Is Small Cell Lung Cancer
Small cell lung cancer is fast-growing lung cancer that develops in the tissues of the lungs. By the time a person gets a diagnosis, small cell lung cancer has typically spread outside of the lungs. This cancer is also more likely than other types of lung cancer to come back after treatment. Small cell lung cancer is sometimes, but not often, called oat cell cancer because the small, oval-shaped cells look like oat grains under a microscope.
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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Patients May Want To Think About Taking Part In A Clinical Trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
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Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The type of lung cancer.
- Whether the cancer has mutations in certain genes, such as the epidermal growth factor receptor gene or the anaplastic lymphoma kinase gene.
- Whether there are signs and symptoms such as coughing or trouble breathing.
- The patients general health.
What Are The Lungs
lungs are two spongy organs located in the chest. They deliver oxygen to the bloodstream. When you take a breath in, air moves into the lungs, causing them to expand . The air comes very close to blood that is traveling in small vessels called capillaries. The lungs are designed to place blood in close contact with as much air as possible, so their tissues are very delicate. When you breathe out, you exhale substances that you don’t need, like carbon dioxide. The right lung has three sections, called lobes the left lung has two lobes.
You breathe in air through your mouth and nose. This air then travels down a tube, called the trachea. The trachea divides into smaller branches called bronchi, and the bronchi keep dividing and dividing like branches on a tree. As the branches get smaller, they are called bronchioles. At the end of the branches, there are little sacs of air called alveoli. The air comes into contact with blood in the alveoli. The lungs are exposed to whatever you breathe in, so any toxic chemicals or pollutants in the air you breathe can get into your body through your lungs.
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How Is Small Cell Lung Cancer Managed Or Treated
Treatment depends on many factors including your age, overall health and cancer stage. Treatment options include:
- Radiation therapy: External radiation therapy uses a machine to deliver strong X-ray beams directly to the tumor. In addition to killing cancer cells, this therapy can relieve symptoms.
- Chemotherapy: Your provider may combine chemotherapy drugs with other treatments to kill lingering cancer cells.
- Immunotherapy: This treatment engages your bodys immune system to fight and destroy cancer cells. Immune checkpoint inhibitors are a type of immunotherapy that treats advanced small cell lung cancer.
- Surgery: About one in 20 people with small cell lung cancer have a localized form that hasnt spread outside of the lung. For this select group, surgery can remove part or all of the diseased lung. Once cancer spreads, surgery is no longer an option.
Stage 0 Or Carcinoma In Situ
Stage 0 or carcinoma in situ are noninvasive cancers. Only a few layers of cancer cells are detected within one local area. The cancer has not grown through to the top lining in the lung and can be surgically removed. However, there is high risk for development of a second tumor.
- Surgery , often a limited procedure, where only part of a lobe is removed from the lung.
- In people who cannot be treated surgically, photodynamic therapy, cryotherapy, or brachytherapy are possible treatments.
Risk Factors And Preventing Non
According to the American Cancer Society, you are at increased risk of developing NSCLC if you:
- Smoke or have smoked in the past
- Have been exposed to secondhand smoke
- Have been around cancer-causing agents, such as radon, mustard gas, asbestos, uranium, arsenic, diesel, coal, or others
- Had radiation therapy to your chest
- Have a family history of lung cancer
- Had lung cancer
- Have been exposed to air pollution
- Have taken beta-carotene supplements while being a smoker
There may be certain measures you can take to lower your risk of NSCLC.
The first step is to avoid cigarette smoking or quit smoking right away. When you stop smoking before cancer develops, your damaged lung tissue starts to repair itself. Quitting smoking can lower your risk of lung cancer and help you live longer, regardless of how many years youve smoked.
How Is Lung Cancer Diagnosed
If you have symptoms of lung cancer, usually you will b referred for blood work and a chest x-ray and/or CT scan of the chest. Your provider may order sputum cytology, which looks at your phlegm for cancer cells. To see if the lung cancer has spread outside of the chest , you may have a CT scan of the abdomen and/or a PET-CT scan. To see if the lung cancer has spread to the brain, you may have an MRI or CT scan of the brain. Often times, your doctor will order tests called PFT’s to assess your lung capacity prior to considering surgery, radiation therapy, and some types of chemotherapy.
While all of these tests are important pieces of the puzzle, a biopsy is the only way to know for sure if you have cancer. A biopsy takes a sample of the suspicious area, which is then looked at under a microscope for any cancer cells. The biopsy is also necessary to determine the type of lung cancer and if there are cancer cells present in the lymph nodes.
A biopsy may be taken of the suspicious area in the lung and/or from lymph nodes near the lungs. Your provider will determine which areas should be biopsied and which biopsy method is best in your case. Biopsies are often done by a lung surgeon or a pulmonologist , who is trained in bronchoscopy. Possible methods for obtaining a biopsy include:
- What type of tissue it came from.
- What subtype of non-small cell lung cancer it is
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Combinations Of Chemotherapy With Surgery Radiation Therapy Or Both
Different combinations of treatments are considered, particularly for more aggressive or advanced cancers, different combinations of surgery, chemotherapy, and radiation therapy may be tried. These include:
- Chemotherapy following surgery . Evidence is now supporting the use of platinum-based chemotherapy after surgery in some people with lung cancers. Not all studies confirm survival benefits, however, trials are ongoing.
- Chemotherapy before surgery . Induction chemotherapy may be used to shrink tumors before surgery. Studies have been mixed as to whether there are any survival benefits in patients with advanced lung cancer.
- Combined and multi-modal Therapy. In more advanced cancers, investigators are researching very intensive treatments that use 2 or more combinations of chemotherapy, radiation, and surgery. For example, radiation plus chemotherapy may be helpful in people whose tumors are surgically removable. Such approaches are very toxic but appear to improve survival in selected people.
Severe inflammation in the esophagus is the most common severe side effect of the radiation and chemotherapy combination. There is also a very high risk of developing serious infections, including pneumonia.
Although people over 70 may suffer more from toxic effects than younger people, studies now suggest that they can achieve survival rates with combined treatments that are equal to those in younger people.
Staging Of Lung Cancer
After the initial diagnosis of NSCLC, accurate TNM staging of lung cancer is crucial for determining appropriate therapy. Most patients with stages I to II NSCLC benefit from surgical resection, whereas patients with more advanced disease are candidates for nonsurgical treatment. Conventional clinical staging is most often performed with computed tomography of the thorax and upper abdomen. Nevertheless, CT imaging has limited sensitivity for microscopic metastatic disease and is frequently unable to discriminate between mediastinal lymph nodes that are enlarged owing to malignancy and those that are enlarged owing to benign reactive hyperplasia. In contrast, positron emission tomography with fluorine 18labeled fluorodeoxyglucose has been shown to have greater sensitivity for the detection of metabolically active malignant disease and can lead to changes in initial staging and treatment plans for NSCLC when used in combination with conventional work-up.
Although PET or PET-CT imaging is more useful than other imaging modalities for determining the nodal stage of a lung cancer, PET findings of pathology are often confirmed by mediastinoscopy. Mediastinoscopy or thoracotomy has been considered the criterion standard for mediastinal staging of lung cancer, which is necessary to define optimal treatment.
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