TREATMENT OF LUNG CANCER

Surgery is the first choice in the treatment of lung cancer. Today, closed (endoscopic) surgeries, which we call minimally invasive surgery, are performed.

What is Lung Cancer?

Cancer is the uncontrolled proliferation of cells in the body. Any type of cancer begins due to an error or mutation in the structure of the cell’s DNA, which carries its genetic material. Mutations in DNA occur with the aging process of the cell or due to environmental factors (smoking, inhalation of asbestos fibers, exposure to radon gas).

According to the data obtained from Turkey’s Lung Cancer Map Project, lung cancer is 75 per 100 thousand in men and 10 per 100 thousand in women, and the annual expected number of new patients is approximately 30 thousand.

Lung Cancer

Lung cancer is an important cause of death for both developed and developing countries. It is the most common cause of cancer-related deaths in both men and women worldwide, and is responsible for roughly 1/5 (19.4%) of all cancer deaths.

What are the Types of Lung Cancer?

Lung cancers are mainly divided into two groups: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). These two types of cancer have different growth rates, spread and treatments.

  • 51-year-old male patient with lung cancer

    Small cell lung cancer (SCLC): It is the fastest growing and most rapidly spreading (metastasis) type of lung cancers and is seen at a rate of 10-15%. Smoking is associated, with only 1% of these tumors occurring in non-smokers. Since it metastasizes very quickly, it is generally seen that it has spread throughout the body at the time of diagnosis. However, it responds well to chemotherapy.

    Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, constituting 85-90% of all patients. There are 3 types of NSCLC:

    Adenocancer: It is more common in women and non-smokers. It is the most common type of lung cancer in developed countries.

    Squamous (epidermoid or squamous) cell cancer: It is the most common type of lung cancer in our country. It is more common in men. It is closely related to smoking. The disease is often confined to the lung or spread to adjacent lymph nodes.

    Large cell cancer: It is the least common NSCLC and accounts for 10% of all lung cancers. It has a high tendency to spread to distant organs.

Hayat Sağlıklı Güzel -Burcu Esmersoy and Medical Aesthetics Specialist Dr. Nihat Dik

Prof. Dr. Gökhan Hacıibrahimoğlu gives information about Lung Cancer.

What Factors Increase Lung Cancer Risk?

  • Smoking: Smoking is responsible for 90% of lung cancer. It is known that there are more than 4000 chemicals and more than 70 cancer-causing substances in cigarette smoke. Passive exposure to cigarette smoke also increases the risk of lung cancer. Lung cancer can also occur in people who have never smoked. Non-smokers make up 10% of all lung cancer patients.In the case of smoking cessation, the probability of lung cancer decreases over time and approaches the level of never-smokers 10-20 years after quitting smoking.Asbestos. When inhaled with respiratory air, asbestos fibers damage the lung and mesothelioma, which is pleural cancer, develops. While asbestos exposure increases the probability of lung cancer 1.5-5.4 times, this risk is higher in smokers.Radon gas: In studies conducted in our country, the level of indoor radon gas was found below the limit values.Exposure to cancer-causing chemicals such as uranium, beryllium, vinyl chloride, nickel chromate, coal products, mustard gas, chlormethyl ethers, petroleum productsHaving a family history
    Air pollution
    Drinking water contains high levels of arsenic
    Radiation therapy to the lungs
    Scar (scar) left in the lung after some diseases
    Since contradictory results have been obtained in studies on diet so far, a clear opinion and recommendation has not yet been formed on this issue.

 

What are the Symptoms of Lung Cancer?

It takes several years for lung cancer complaints to occur and may not be noticed until the disease reaches an advanced stage. Unfortunately, patients usually do not have complaints in the early stages of the disease or existing complaints are ignored by the patients. Even if there are complaints such as cough and fatigue, these complaints are generally thought to be related to smoking. This is the most dangerous and insidious feature of the disease.

In patients diagnosed with lung cancer, symptoms vary depending on the location of the tumor in the lung, its size, place of spread, and extent of spread.

The most common ones due to the tumor itself and intrathoracic spread;

Cough
Chest, shoulder and back pain
Sputum
Bloody sputum (hemoptysis)
Shortness of breath
hoarseness
swallowing disorder
Neck and facial swelling
wheezing
Recurrent attacks of bronchitis or pneumonia

If lung cancer has spread beyond the rib cage, complaints may be related to other parts of the body. Other parts of the body where lung cancer commonly spreads include the other part of the lung, liver, lymph nodes, brain, adrenal glands, and bones. In such a case, some of the following complaints can be added to the above complaints.

Headache,
nausea, vomiting
Balance disorder, fainting, memory loss
Subcutaneous swellings
Bone or joint pain, bone fractures
general malaise
Bleeding, coagulation disorders
Loss of appetite, unexplained weight loss
cachexia (muscle wasting)
Tiredness

How is Lung Cancer Diagnosed?

Computed tomography is first performed in patients with suspected lung cancer based on examination and chest X-ray findings. It is decided how to reach the diseased area with computerized tomography. In most of the patients, it is taken from the tumoral tissue in the lungs for diagnosis. This procedure is called a biopsy. Biopsies can be done by various methods. In some cases, a needle may be advanced through the skin and into the lung, which is called a “needle biopsy”. Sometimes biopsy is obtained by a procedure called “bronchoscopy”. In this procedure, the airways of the lung are examined using a thin tube with a light at the end, and small pieces of tissue are removed. If there is fluid accumulation in the membrane around the lung, needle biopsies can be taken from here (thoracentesis, pleural biopsy). Another method is surgical removal of tissues (mediastinoscopy, video-guided thoracoscopic surgery, open lung biopsy). There are rumors among the public such as “They did a biopsy, it didn’t get better,” “His disease got worse”, sometimes by citing other people as an example. These are very wrong interpretations and can cause many patients to be afraid unnecessarily, to delay the diagnosis and therefore to lose their existing treatment opportunities.

It is very important that these tissue pieces are examined by a pathologist. Because knowing the exact lung cancer cell type is the most important information that guides the treatment. Other tests are usually done to have information about the spread of cancer in the body. These tests are brain magnetic resonance imaging (brain MRI), and PET-CT (positron emission tomography).

Akciğer kanseri tedavisinde ilk seçenek cerrahidir. Artık günümüzde minimal invaziv cerrahi dediğimiz kapalı (endoskopik) ameliyatlar uygulanmaktadır.

How is Lung Cancer Treated?

A treatment plan is made considering the type and stage of the tumor and the performance status of the patient. Accurate staging is essential for the correct treatment of lung cancer. In lung cancer, staging is based on whether the cancer is confined to the site, whether it has spread to lymph nodes (lymphatic glands at the edge of the airways) or to other distant organs.

NSCLC has 4 stages and is determined as follows:

Stage 1: The tumor is only in a small part of the lung and has not spread to any lymph nodes.

Stage 2: The disease has spread to the nearest lymph nodes or has jumped to the membrane around the rib cage, diaphragm, lung or heart without spreading to the lymph nodes.

Stage 3: The tumor has spread to the space called the mediastinum between the two lungs or to the lymph nodes there, or has spread to the lymph nodes with involvement of the pleura, rib cage or diaphragm.

Stage 4: The tumor has spread to distant organs or to the other lung, or it has caused fluid collection between the lung membranes or the heart membranes.

SCLC, on the other hand, is staged as “limited disease” and “widespread disease”:

Limited disease: At this stage, cancer is found on only one side of the rib cage, part of the lung, and adjacent lymph nodes.
Widespread disease: At this stage, the cancer has spread to the other half of the lung or to other parts of the body.

It is recommended that the system used in NSCLC staging recently should also be used in the staging of SCLC.

Types of Treatment

In the treatment of lung cancer, surgery, chemotherapy and radiotherapy methods can be applied alone or together. The treatments to be applied differ according to the stages in NSCLC. In patients with SCLC, if the disease is detected at a very early stage, there may be a chance for surgical treatment. However, in most of these patients, the disease is already in the widespread stage at the time of diagnosis and surgical treatment is not possible. The standard treatment is chemotherapy and radiotherapy in limited-stage patients, and chemotherapy alone in extensive-stage patients. Progress in survival was achieved with protective head irradiation in patients who received a complete response with these applications.

Surgical

In the early stages of NSCLC treatment (stages 1 and 2, and some stages 3), the recommended treatment is surgery (surgery). The surgery can be performed as removal of only a portion of the lung lobe (lobectomy, segmentectomy) or removal of the entire lung (pneumonectomy). In general, about 80-85% of patients with lung cancer who apply to a doctor have lost the chance to be treated with surgery. Therefore, surgery cannot be recommended for every patient. If you have been told by your doctor that you are in a position to have an operation and that you can handle this operation in terms of your general health, do not miss this chance. Because it will not be easy for you to get the same chance of recovery with the treatments to be done instead.

Radiotherapy

Radiation therapy is used to destroy cancerous cells and shrink tumors. Curative radiotherapy can be applied in patients with early stage NSCLC in whom surgical treatment cannot be applied or in patients for whom surgery is not possible medically. However, the results are not as good as surgical treatment. Radiotherapy can be added to the post-surgical treatment in Stage III cases who underwent surgical treatment.

Radiotherapy can be used in the treatment of symptoms related to compression and metastases seen in advanced lung cancer. At this stage, radiotherapy is not curative, but symptomatic.

In SCLC, radiotherapy is also used to prevent the spread of the tumor to the brain. This is called “protective brain teleportation”.

Chemotherapy

The purpose of chemotherapy is to stop the growth and proliferation of tumor cells without damaging the patient’s normal cells. During the treatment, besides the tumor cells, normal healthy cells are damaged. These undesirable side effects related to treatment are nausea-vomiting, diarrhea, neutropenia, hair loss, kidney and liver dysfunctions, skin rashes, sensitivity to sunlight, etc.

This treatment is aimed at helping control the growth and spread of the tumor. In NSCLC, chemotherapy is applied before surgery in stage III patients where resection is possible, in combination with radiotherapy in unresectable locally advanced stage (stage IIIA/B) patients, and alone in stage IV patients. In unresectable Stage III patients, a survival advantage was obtained with simultaneous chemotherapy and radiotherapy. In stage 4 patients, chemotherapy provided a survival advantage and an increase in quality of life compared to supportive treatment alone.

Mammography for breast cancer, a widely accepted screening tool for early-stage lung cancer as opposed to colonoscopy for colon cancer, was not available until recently. Today, early diagnosis can be made with computed tomography with reduced radiation dose. This screening method, which has been used in some countries, has a history of heavy smoking (30 pack years or more), continues to smoke or It is recommended for people aged 55-74 who have quit in the last 15 years. In a large study conducted in the USA, the probability of death from lung cancer with this screening test was reduced by 20% compared to those followed by chest radiography.

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