A Lung Cancer is when out-of-control cell growth occurs in one or both lungs. The cancer can arise in any part of the lung, but majority of it arises in the epithelial cells, which are the lining of the Bronchi and bronchioles i.e. the larger and the smaller airways of the lungs. Lung cancer is predominantly a disease of the elderly almost 70% of people diagnosed with lung cancer are over 65 years of age.
Lung Cancer is largely classified into two main types based on the cancer's appearance under a microscope viz. Small Cell Carcinoma which accounts for only 20% of the total lung cancers and Non small Cell Lung Cancer (NSCLC) which accounts for 80% of lung cancers.
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· Non-small cell lung cancer (NSCLC) :It is further classified into the following:
o Epidermoid carcinoma or Squamous cell carcinoma: It forms in the lining of the bronchial tubes and it usually starts from one of the larger breathing tubes and grows relatively slowly.
o Adenocarcinoma: It starts forming in the mucus-producing glands of the lungs. It is most common type of lung cancer that occurs in Women’s and Non-smokers.
o Large cell caracinoma: This kind of NSCLC initiates near the surface of the lung and it grows rapidly.
There are usually no signs or symptoms in lung cancer.
The main symptoms of lung cancer are listed below:
· A cough that doesn’t go away after two or three weeks
· A long-standing cough that gets worse
· Persistent chest infections
· Coughing up blood
· Persistent breathlessness
· Loss of appetite or unexplained weight loss
Surgery, radiotherapy and chemotherapy are all used to treat lung cancer. They can each be used alone or together. Your doctor will plan the best treatment for you. Some people with advanced non small cell lung cancer may have biological therapy.
Treatmentand type of lung cancer
The treatment for non small cell lung cancer is different from the treatment for small cell lung cancer.
Small cell lung cancer is mostly treated with chemotherapy. Surgery is only suitable if there is no sign that the cancer has spread to the lymph glands in the centre of the chest (the mediastinal lymph glands) and this is rare with small cell lung cancer. It has usually spread at the time of diagnosis. So chemotherapy is usually the main treatment. You may also have radiotherapy to treat this type of lung cancer.
Non small cell lung cancer can be treated with surgery, chemotherapy, radiotherapy or a combination of these, depending on the stage when the cancer is diagnosed. Some people with advanced lung cancer may have biological therapy.
Treatment by stage for small cell lung cancer
If you have early stage small cell lung cancer you are most likely to have chemotherapy and then radiotherapy to the lung. People who are fairly fit may have chemotherapy and radiotherapy at the same time (chemoradiation). It is quite common for this type of cancer to spread to the brain. So doctors often recommend radiotherapy to the brain for people whose lung cancer shrinks with chemotherapy treatment. You usually have radiotherapy to the brain at the end of the chemotherapy treatment. It aims to try to kill any cancer cells that may have already spread to the brain but are too small to show up on scans. Doctors call this prophylactic cranial irradiation or PCI.
For very early stage small cell lung cancer that has not spread to the lymph nodes in the centre of the chest (the mediastinal lymph nodes), you may have surgery to remove the part of the lung containing the tumour . The surgery is followed by chemotherapy and sometimes radiotherapy. But usually the cancer has already spread at the time of diagnosis and surgery is not then possible.
If you have small cell cancer that has spread to lymph nodes or other areas of the body you may have chemotherapy, radiotherapy or treatment to relieve symptoms. If chemotherapy works well to shrink the lung tumour down and you are fairly fit you may also have radiotherapy to the brain to kill any cancer cells that may have already spread there.
- Chemoembolization:Strong chemicals are used in chemotherapy that interferes with cell division process and damages DNA or proteins. The aim of these treatments is to rapidly divide the cells. The normal cells can be recovered from any chemical-induced damage whereas cancer cells cannot be recovered. The medicines in chemotherapy travel in a systematic way by passing from the complete body and destroying the original tumor cells that have spread in the whole body. Usually many therapies are combined that also includes many types of chemotherapy.
- Radiation Therapy :Radiation therapy may be employed as a treatment for both NSCLC and SCLC. Radiation therapy uses high-energy X-rays or other types of radiation to kill dividing cancer cells. Radiation therapy may be given as curative therapy, palliative therapy (using lower doses of radiation than with curative therapy), or as adjuvant therapy in combination with surgery or chemotherapy. Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy, yet in 10%-15% of people it leads to long-term remission and palliation of the cancer. Combining radiation therapy with chemotherapy can further prolong survival when chemotherapy is administered. External radiation therapy can generally be carried out on an outpatient basis, while internal radiation therapy requires a brief hospitalization.
- Targeted Therapy :Targeted therapy drugs more specifically target cancer cells, resulting in less damage to normal cells than general chemotherapeutic agents. Erlotinib and gefitinib target a protein called the epidermal growth factor receptor (EGFR) that is important in promoting the division of cells. This protein is found at abnormally high levels on the surface of some types of cancer cells, including many cases of non-small cell lung cancer.
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