Lung Cancer

Lung cancer is one of the most common cancers in the world and the main cause of cancer-related
death in men and women. In addition to smoking cigarettes, which is by far the most well-known cause
of cellular breakdown in the lungs, a family history of cellular breakdown in the lungs and certain
ecological factors are also risk factors. Similarly to all cancers, it develops at the level of the cells
through abnormal cells that multiply rapidly. Typically, lung cancer starts in the lungs and then may
spread (metastasizes) to other organs or bones. Lung cancers that begin in the lungs are called primary
lung cancers.
Lung cancer generally falls into two types:

Non-Small Cell Lung Cancer

The majority of lung cancer cases are NSCLCs, which make up 80-85% of
the cases. If diagnosed in the early stages, most of them can also be
treated well. The further more subdivisions are as follows:

a. Squamous cell lung carcinoma: The majority of cases of NSCLC
begin in cells that line the passages of the respiratory tract. This is
known as squamous cell carcinoma. The major percentage of all cases of
NSCLC usually begin in these cells.
b. Adenocarcinomas: They are the ones that usually form in the outer
part of the lungs, rather than any other parts. Other sub-type of
adenocarcinomas is:
Adenocarcinoma in situ (AIS): This rare form of adenocarcinoma
occurs in the tiny air sacs in the lungs. In most cases, it isn’t aggressive
and does not require immediate medical attention.
c. Adenosquamous carcinoma: This type of cancer, in general, is
developed in a mixture of squamous cells and mucus-producing cells.
d. Large cell carcinoma: Large cell carcinoma is a fast-growing group
of non-small cell lung cancer. It cannot be classified under other cancer
types.

Small-Cell Lung Cancer

Compared to NSCLC, small-cell lung cancer is way more aggressive. It
makes up about 15 to 20 percent of all other lung cancers. Small-cell
lung cancer is less likely to be cured than non-small cell lung cancer,
despite the fact that it often responds to chemotherapy better in the
beginning.

Symptoms Of Lung Cancer

Symptoms can be divided into 2 stages; early symptoms and late symptoms.

Early Symptoms Of Lung Cancer

If you are in the early stage of lung cancer, you won’t be able to see any
of the usual symptoms. But when early symptoms occur, they can show
signs like shortness of breath. Sometimes unexpected symptoms, such
as back pain may occur. If the tumors are causing pressure in the lungs or
spreading to the spinal cord and ribs, you’ll start to have a severe back
pain.

  • chest pain that worsens when breathe deeply, laugh, or cough
  • a lingering or worsening cough
  • coughing up phlegm or blood
  • Hoarseness or change in voice
  • wheezing
  • weakness and fatigue
  • loss of appetite and weight loss
  • Respiratory infections such as pneumonia or bronchitis that recur
    frequently

Late Symptoms Of Lung Cancer

Depending on the positions of newly formed tumors, late symptoms of
lung cancer can hence be declared. Late-stage symptoms vary from
person to person. It is not compulsion to experience every symptom for
those with late-stage lung cancer. Late-stage symptoms might include:

  • lumps in the neck or collarbone
  • pain in bone especially in the back, ribs, or hips
  • shoulder pain
  • swelling of the face and upper body
  • headaches
  • dizziness
  • balance issues
  • numbness in arms or legs
  • yellowing of skin and eyes (jaundice)
  • One eyelid droops and the pupils shrink
  • lack of perspiration that occur in only one side of the face
    Additionally, there are some lung cancer tumors that can sometimes
    release a substance similar to hormones. This leads to a wide variety of
    symptoms known as paraneoplastic syndrome which shows signs such
    as:
  • muscle weakness
  • high blood pressure
  • high blood sugar
  • nausea and vomiting
  • Confusion
  • seizures

Causes Of Lung Cancer

  • Smoking is the number one risk factor for lung cancer.
  • Approximately 80% to 90% of lung cancer cases are caused by smoking.
  • Other tobacco products like cigars or pipes can also lead to lung cancer.
  • Tobacco smoke contains over 7,000 toxic chemicals, with about 70 of them known to cause cancer.
  • Smokers are 15 to 30 times more likely to develop lung cancer compared to non-smokers.
  • Smoking increases the likelihood of dying from lung cancer.
  • Lung tissue is damaged by smoke from the moment it is inhaled, increasing the risk of lung cancer.
  • Heavy smokers are usually associated with small-cell lung cancer.
  • Quitting smoking reduces the risk of lung cancer compared to continuing to smoke.
  • However, the risk for former smokers is still higher than for those who never smoked.
  • Quitting smoking at any age can help lower the risk of lung cancer.

Lung Cancer Staging

During the diagnostic process, other tests are utilized to determine how far the cancer has spread
through the lungs, lymph nodes, and the rest of the body. It is known as staging. Based on the type and
lung cancer staging, doctors can determine the best treatment that is needed.

Non-Small Cell Lung Cancer (NSCLC) Stages

  • Stage 1: Cancer cells are found in the lung, but they have not spread
    outside the lung.
  • Stage 2: Now, cancer cells can be found in the lung and which have
    started spreading to nearby lymph nodes.
  • Stage 3: Cancer cells are found in the lung and lymph nodes in the
    middle of the chest. It can be categorized into 2 stages.
    o Stage 3A: Cancer cells have spread in lymph nodes, but only on the
    same side of the chest where cancer grows first.
    o Stage 3B: In this phase, cancer cells are now spreading to lymph
    nodes on the opposite side of the chest or to lymph nodes just above the
    collarbone.
  • Stage 4: Cancer cells have spread to both lungs, into the area
    around the lungs, or to the distant organs like liver, bone, brain etc.

Small-Cell Lung Cancer (SCLC) Stages

In general, there are two stages of SCLC; (i) limited and (ii) extensive.

  • In the limited stage, cancer cells are found in either one lung or
    nearby lymph nodes on the same side as of the chest.
  • In the extensive stage, cancer cells have vastly spread:
    o throughout one lung
    o to the opposite lung
  • o to lymph nodes on the opposite side
  • o to fluid around the lung
  • o to bone marrow
  • o to distant organs

Treatment Of Lung Cancer

Treatment will depend on various factors, such as:

  • the type of cancer
  • the location and stage of the cancer
  • the patient’s health status
  • their treatment preferences
    Here are some of the treatment options for lung cancer in Nepal:
  • Surgery: to get rid of a part or all of a lung
  • Chemotherapy in Nepal: drug treatment that can kill cancer cells
    and shrink tumors
  • Radiation therapy in Nepal: use of high energy rays to kill cancerous
    cells
  • Radiofrequency ablation in Nepal: treatment where a thin needle is
    inserted and used to destroy cancer cells by the healthcare professional
    using an electric current.
  • Targeted therapy in Nepal: drug treatment that targets a specific
    behavior to prevent tumor growth
  • Immunotherapy in Nepal: drug treatment that use body’s immune
    system to fight against cancer cells
  • Palliative therapy in Nepal: includes pain relief, oxygen therapy, and
    other help that a person may need to manage the symptoms
    To treat the non-small cell lung cancer (NSCLC), you might have to
    choose many different methods, for each individual. To move further
    with the treatment plan, details of the patient’s health and the stage of
    lung cancer should be known previously.
    Treatment options for non-small cell lung cancer (NSCLC) according to
    the stage include:

Stage 1 NSCLC: Surgery is the first treatment given to remove a portion
of the lung. Chemotherapy can also be recommended in the case of high
risk of recurrence. Cancer caught at this stage also has a higher chance
of proper cure.
Stage 2 NSCLC: Surgery is performed to remove a part or all of the lung
followed by chemotherapy.
Stage 3 NSCLC: Combination of surgery, chemotherapy, and radiation
therapy is given.
Stage 4 NSCLC: Options include surgery, radiation, chemotherapy,
targeted therapy, and immunotherapy that varies from patient to patient
.
Treatment options for SCLC can be chemotherapy, and radiation therapy.
In most cases, it will be impossible to perform surgery due to the
advanced stage of the cancer.

When to Visit a Cancer Doctor in Nepal?

When you observe the above-mentioned symptoms and have a strong
feeling about cancer, it would be a right time to visit an oncologist in
Nepal. You can either go for a surgical oncologist or a medical
oncologist in the first phase. Your cancer specialist helps you to choose
the suitable treatment option. As per the top medical oncologist Dr.
Sudip Shrestha, it is very important to reach out to your cancer doctor as
soon as possible. The best cancer doctor is hence important for you in
each and every step of your cancer treatment.

Dr.Sudip Shrestha
Founder & Executive Chairman Sr. Consultant Medical Oncologist Nepal Cancer Hospital & Research Center

Designation: Founder and Chairman, Senior Consultant Medical Oncologist

Qualification: MBBS, MD, Post Graduate Training in Medical Oncology

Department: Medical Oncology

Special interest: Chemotherapy, Immunotherapy, Targeted Therapy, Precision Medicine

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