LUNG CANCER

INTRODUCTION

WHAT IS LUNG CANCER?

Lung cancer is a type of cancer that begins in the lungs, which are two spongy organs in the chest
responsible for taking in oxygen and releasing carbon dioxide. It occurs when cells in the lungs grow
uncontrollably and form tumour’s, which can interfere with the normal function of the lungs and
potentially spread to other parts of the body (a process known as metastasis).

THERE ARE TWO MAIN TYPES OF LUNG CANCER:

.
NON-SMALL CELL LUNG CANCER (NSCLC):

This is the most common type, accounting for about 85% of cases. NSCLC includes several
subtypes, such as adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

SMALL CELL LUNG CANCER (SCLC):

This type is less common, making up about 10-15% of lung cancers. It tends to grow more
rapidly and spread more quickly than NSCLC

CAUSES OF LUNG CANCER

Lung cancer is a serious and often deadly disease characterized by the uncontrolled growth of
abnormal cells in one or both lungs. These abnormal cells can form tumors that interfere with the
lungs' essential functions, such as exchanging oxygen and carbon dioxide. The primary causes of
lung cancer include a combination of environmental, lifestyle, and genetic factors. Here’s a
detailed breakdown:

1. Tobacco Smoke

Cigarette Smoking:

The leading cause of lung cancer is cigarette smoking, responsible for about 85% of cases.
Tobacco smoke contains more than 7,000 chemicals, many of which are carcinogenic (cancer-
causing). Prolonged exposure to these chemicals damages the cells lining the lungs, leading to
mutations that can result in cancer.

Second hand Smoke:

Also known as passive or environmental tobacco smoke, exposure to second hand smoke
increases the risk of lung cancer in non-smokers. It contains similar carcinogens to those inhaled
directly by smokers.

Cigar and Pipe Smoking:

Although the risk is slightly lower compared to cigarette smoking, smoking cigars and pipes still
significantly increases the risk of lung cancer.
2. Radiation Exposure

Radon Gas:

Radon is a naturally occurring radioactive gas that can seep into homes through cracks in the
foundation. It is the second leading cause of lung cancer after smoking and is the leading cause
among non-smokers. Prolonged exposure to high levels of radon can damage lung cells and lead
to cancer.

3. Occupational Exposure to Carcinogens

Asbestos:

Occupational exposure to asbestos, a group of silicate minerals used in construction and

manufacturing, is strongly linked to lung cancer, particularly a type called mesothelioma. When
asbestos fibers are inhaled, they can cause significant lung damage over time.

Other Carcinogens:

Exposure to certain chemicals and substances at work, such as arsenic, diesel exhaust, silica, and
certain forms of chromium and nickel, can increase lung cancer risk. People working in mining,
construction, chemical processing, and manufacturing may be at higher risk.

4. Air Pollution

Outdoor Air Pollution:

Prolonged exposure to outdoor air pollution, particularly fine particulate matter (PM2.5),
increases the risk of lung cancer. Pollutants from vehicles, industrial processes, and burning
fossil fuels contribute to this risk.

Indoor Air Pollution:

In some regions, especially where wood or coal is used for cooking and heating, indoor air
pollution can significantly increase lung cancer risk. Inhalation of smoke from these sources can
damage lung tissue.
5. Genetic Factors

Family History:

A family history of lung cancer can increase an individual’s risk, suggesting a genetic
predisposition to the disease. Specific genetic mutations, such as those in the EGFR, KRAS, and
ALK genes, are associated with an increased risk of developing lung cancer.

Inherited Genetic Mutations:

While not as common as environmental causes, certain inherited genetic mutations can increase
susceptibility to lung cancer, even among non-smokers.

6. Previous Lung Diseases

Chronic Obstructive Pulmonary Disease (COPD):

Individuals with COPD, including chronic bronchitis and emphysema, are at a higher risk of
developing lung cancer. The chronic inflammation and damage to lung tissue contribute to this
risk.

Pulmonary Fibrosis:

This condition causes scarring of lung tissue, which increases the risk of lung cancer. The
mechanism is similar to that seen in COPD, with damaged lung tissue being more susceptible to
cancerous changes.
STAGING OF LUNG CANCER:

The staging of lung cancer is a way to describe how much cancer is in the body and where it
has spread. Staging helps guide treatment decisions and predict prognosis. The staging process is
different for Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC)

STAGING FOR NON-SMALL CELL LUNG CANCER (NSCLC)

NSCLC IS STAGED USING THE TNM SYSTEM, WHICH CONSIDERS THREE FACTORS:

1. T (Tumor):
The size and extent of the primary tumor.
2. N (Nodes):
Whether the cancer has spread to nearby lymph nodes.
3. M (Metastasis):
Whether the cancer has spread to other parts of the body.

BASED ON THE TNM CLASSIFICATION, NSCLC IS STAGED AS FOLLOWS:

Stage 0:

Cancer is only in the top layer of cells lining the airways and hasn't spread. Also known as
carcinoma in situ (CIS).

Stage I: The tumor is confined to the lung and has not spread to any lymph nodes. It is usually
less than 4 cm.

Stage II:

The tumor may be larger than in Stage I or may have spread to nearby lymph nodes or tissues
within the lung.

Stage III:
The cancer has spread to lymph nodes in the center of the chest (mediastinum), and possibly to
other local structures like the chest wall or diaphragm. It is further divided into:

Stage III A:

Cancer is in lymph nodes on the same side of the chest as the primary tumor.

Stage III B:

Cancer has spread to lymph nodes on the opposite side of the chest, or to the area above the
collarbone.

Stage IV:

The cancer has spread to other parts of the body, such as the other lung, brain, bones, or liver.
This stage is divided into:

Stage IV A:

Limited metastasis (to one or a few organs).

Stage IV B:

More extensive metastasis (to multiple areas).

STAGING FOR SMALL CELL LUNG CANCER (SCLC)

SCLC IS USUALLY CLASSIFIED INTO TWO STAGES:

Limited Stage: The cancer is confined to one side of the chest and may include nearby lymph
nodes. It can be treated with a single radiation field.

Extensive Stage: The cancer has spread widely throughout the lung, to the other lung, or to
distant organs (metastatic).
 SYMPTOMS OF LUNG CANCER

Lung cancer symptoms often vary depending on the type, location, and stage of the cancer.
In the early stages, lung cancer might not cause any symptoms, making it difficult to detect. As
the cancer progresses, symptoms become more noticeable. Here are some common symptoms:

RESPIRATORY SYMPTOMS:

1. Persistent Cough: A cough that doesn’t go away or worsens over time.

2. Coughing Up Blood (Haemoptysis): Even a small amount of blood in the sputum can be a sign
of lung cancer.

3. Shortness of Breath: Difficulty breathing or feeling out of breath with everyday activities.

4. Wheezing: A high-pitched sound when breathing.

5. Chest Pain: Pain that may worsen with deep breathing, coughing, or laughing. It may feel like
discomfort or a sharp pain in the chest.

6. Hoarseness: A change in the voice, often sounding raspy or strained.

7. Recurring Infections: Frequent episodes of bronchitis or pneumonia that do not respond to
treatment or keep coming back.

GENERAL SYMPTOMS:

1. Unexplained Weight Loss: Losing weight without trying.

2. Fatigue: Persistent tiredness or lack of energy.

3. Loss of Appetite: Reduced interest in eating.

4. Bone Pain: If the cancer has spread to the bones, there might be pain in the back or other
areas.

5. Headache or Neurological Symptoms: If the cancer spreads to the brain, it can cause
headaches, dizziness, or seizures.

ADVANCED SYMPTOMS:

1. Swelling in the Face, Neck, or Arms: Due to blockage of blood flow, particularly if the cancer
presses on the superior vena cava (a large vein that carries blood from the head and arms to the
heart).

2. Difficulty Swallowing: If the tumour is near the oesophagus.

3. Clubbing of Fingers: Changes in the shape of fingernails or the tips of the fingers.

4. Paraneoplastic Syndromes: A group of rare disorders triggered by an immune response to the

cancer, causing symptoms like high calcium levels, muscle weakness, or changes in the nervous
system.
TREATMENT FOR LUNG CANCER

▪ NSCLC
The treatment for Non-Small Cell Lung Cancer (NSCLC) depends on several factors, including
the stage of the cancer, the patient’s overall health, and specific characteristics of the tumour
(such as genetic mutations). Here are the main treatment options for NSCLC:

1. SURGERY:

Surgery is often the first line of treatment for early-stage NSCLC (Stage I and II) and
sometimes for Stage III, depending on the extent of the cancer.

Lobectomy: Removal of an entire lobe of the lung.

Pneumonectomy: Removal of the entire lung.

Segmentectomy or Wedge Resection: Removal of a small part of the lung, usually when the
tumour is small or if the patient cannot tolerate a larger surgery.

Sleeve Resection: Removal of a section of the bronchus (airway) and reattaching the
remaining ends
2. RADIATION THERAPY

Radiation therapy uses high-energy rays to kill cancer cells. It can be used alone or in
combination with other treatments:

External Beam Radiation Therapy (EBRT): The most common type, where radiation is
directed at the cancer from outside the body.

Stereotactic Body Radiotherapy (SBRT): A precise form of radiation that targets the tumour
with high doses, often used for early-stage cancers that cannot be surgically removed.

Brachytherapy: Rarely used in NSCLC, it involves placing radioactive material inside the body
near the cancer.

3. CHEMOTHERAPY

Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. It is often used in:

Adjuvant Chemotherapy: Given after surgery to eliminate any remaining cancer cells.
 Neoadjuvant Chemotherapy: Given before surgery to shrink the tumour for Advanced or
Metastatic NSCLC (Stage IV): Chemotherapy is used to control the cancer’s growth and relieve
symptoms.

4. TARGETED THERAPY

Targeted therapies are drugs that specifically target genetic mutations or proteins in cancer
cells that are helping the cancer grow. They are usually used for advanced or metastatic NSCLC,
particularly if the cancer has specific mutations such as:

ALK Rearrangements: Treated with ALK inhibitors (e.g., crizotinib, alectinib, lorlatinib).

ROS1 Rearrangements: Treated with ROS1 inhibitors (e.g., crizotinib, entrectinib).

BRAF Mutations: Treated with BRAF inhibitors (e.g., dabrafenib) and MEK inhibitors (e.g.,
trametinib).
5. IMMUNOTHERAPY

Immunotherapy helps the body’s immune system recognize and attack cancer cells. It is
often used for advanced NSCLC, either alone or in combination with chemotherapy.

Checkpoint Inhibitors: Drugs like pembrolizumab, nivolumab, and atezolizumab block

proteins that prevent the immune system from attacking cancer cells.

6. COMBINATION THERAPY

For some patients, a combination of treatments (e.g., surgery, chemotherapy, radiation,

and/or targeted therapy) may be used. The specific combination depends on the cancer's stage
and the patient’s overall health.
 ▪ SCLC
The treatment for Small Cell Lung Cancer (SCLC) depends on the stage of the disease (limited
or extensive) and the patient’s overall health. SCLC is an aggressive form of lung cancer that
tends to grow and spread rapidly, so treatment usually begins quickly after diagnosis.

1. Chemotherapy
Chemotherapy is the cornerstone of treatment for SCLC, as this type of cancer responds well to
it. It is used for both limited-stage and extensive-stage SCLC.

Common Chemotherapy Regimens: The most commonly used drugs include *etoposide
combined with a platinum-based drug like cisplatin or carboplatin.

For Limited-Stage SCLC: Chemotherapy is often combined with radiation therapy (concurrent
chemoradiation).

For Extensive-Stage SCLC: Chemotherapy is the primary treatment, sometimes combined with
immunotherapy.

2. Radiation Therapy
Radiation therapy uses high-energy rays to kill cancer cells. It is used in different ways
depending on the stage of the disease.
For Limited-Stage SCLC: Radiation therapy is typically given to the chest along with
chemotherapy. This combination is often referred to as concurrent chemoradiation.

For Extensive-Stage SCLC: Radiation may be used to shrink tumors that are causing symptoms
or to target metastases, especially in the brain or bones.

Prophylactic Cranial Irradiation (PCI): Given to prevent the spread of cancer to the brain,
especially in patients whose cancer has responded well to initial treatment. This is often
recommended because SCLC has a high tendency to metastasize to the brain.

CONCLUSION

Lung cancer, a leading cause of cancer-related deaths, is a complex disease with two main
types: Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC). NSCLC is more
common and typically slower-growing, while SCLC is aggressive and spreads quickly.

Early detection is crucial for improving survival rates, but lung cancer often presents with few
or no symptoms in its early stages, leading to late diagnosis. Treatment options vary based on
the type and stage of cancer and may include surgery, chemotherapy, radiation therapy,
targeted therapy, and immunotherapy.