Lung Cancer

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is lung cancer?

Breathing in such poisons for years causes genetic mutations that make cells in the lungs multiply uncontrollably and form a tumour, also called a carcinoma. It can grow into nearby blood vessels and lymph nodes, then spread (metastasize) to the bones, brain, liver, and other sites in the body. Other types of cancer can also move into the lungs from elsewhere in the body. This is secondary lung cancer.

Lung tumours can grow undetected for years. Eventual symptoms may include coughing, shortness of breath, bloody sputum, chest pain, loss of appetite, and recurring pneumonia. The two main types of lung cancer are non-small cell and small cell. Accounting for about 75% of the cases, non-small cell cancers are divided into three categories. Squamous cell carcinoma (or epidermoid carcinoma) usually starts in a major airway and can grow slowly or quickly. Adenocarcinoma can occur anywhere in the lung and varies in size and speed of growth. Large cell carcinoma is typically sizeable when discovered. Small cell lung cancer (also called oat cell cancer) is very aggressive and has metastasized by the time it’s diagnosed.

Once the type of lung cancer you have is identified, its stage is determined by the size of the tumour and whether it has spread to any lymph nodes or traveled to other parts of the body. There are four stages (I–IV) for non-small cell lung cancer, and two (limited and extensive) for small cell cancer. The earlier the stage for either type, the better your long-term outlook.

Treatment for lung cancer

With early-stage non-small cell cancer, the goal is to remove the tumour and cure the cancer. While treatment can’t cure cancer that has spread outside the lungs, it can control symptoms: This is called palliative care. With secondary lung cancer, you will be treated for the primary tumour and the lung tumour. The tools of lung cancer treatment are surgery, radiation therapy, chemotherapy, and clinical trials. Your doctor will recommend one or a combination.

Medications for lung cancer

With Stage I or II lung cancer, surgery to remove the growth may eliminate the need for chemotherapy (oral or intravenously administered cancer-cell killing drugs) to ensure a good chance at survival. At later stages, however, chemotherapy can help by eradicating microscopic nests of cancer in other parts of the body. Chemotherapy is the standard method for temporarily controlling small cell lung cancer, which is notorious for spreading. It may also be used to reduce symptoms in the advanced stages of non-small cell lung cancer. Typically, cisplatin (Platinol) or carboplatin (Paraplatin), both platinum compounds, are combined with other drugs, including etoposide (VePesid) and paclitaxel (Taxol). Chemotherapy often causes temporary nausea, fatigue, and hair loss, and can make you more prone to infections. Drugs can minimize these side effects.

Many people experience pain from lung cancer treatments or from the spread of the disease. If this occurs, ask your doctor for painkilling medications. If you can’t use or don’t want standard treatment, consider joining a clinical trial.

Lifestyle Changes

One good way to have an active hand in your own lung cancer treatment is to commit yourself to the following strategies:

• Quit smoking. It will make your treatment more effective, improve your overall health, and cut your risk of recurrence.
• Get support. When you have lung cancer, you’ll encounter emotional and practical issues that you shouldn’t try to deal with alone. Seek support from family, friends, a therapist, or a cancer support group.
• Don’t ignore depression. Lung cancer and the rigors of treatment can add up to depression. Talk with your doctor about treating it.
• Eat a nutrient-rich diet. You may not have a big appetite, so eat lots of small meals packed with protein and calories.

Related Procedures for Lung Cancer

If you have early-stage non-small cell cancer and good lung function, your treatment is likely to begin with surgery. Some Stage I and II lung tumours can be completely removed with surgery alone. For other tumours, surgery may be just the first step, followed by radiation, chemotherapy, or investigative treatments in clinical trials. In a few cases, localized small cell cancers can be eliminated with one of several surgical procedures.

Newer techniques help control symptoms. Laser therapy uses intense light to destroy cancer cells. If the tumour is small, you may be a candidate for photodynamic therapy (PDT). Your doctor will inject the light-sensitive drug porfimer sodium (Photofrin), which stays in the cancer cells. A laser activates it to kill the abnormal cells. Both procedures are used to eradicate tumours blocking an airway.

In addition to surgery, or in place of it, you may be given radiation therapy, which uses high-energy rays to kill cancer cells. Radiation serves several purposes. Before surgery, it can shrink your tumour. After surgery, it may aid in killing any cancer left in lymph nodes. If you have early-stage non-small cell cancer but can’t undergo surgery, radiation may even eliminate the tumour. For Stage III and IV small cell cancer and for cancer recurrence, radiation can shrink tumours and reduce symptoms such as pain, bleeding, and difficulty swallowing. When combined with chemotherapy, it lengthens survival in people with limited small cell lung cancer. Lung cancer that has spread to the brain may be treated with radiation. Try to find a facility that uses a CT scan to guide the procedure. It shields the unaffected lung from unnecessary radiation.

If a tumour obstructs a tube leading to the lungs (a bronchus), your doctor may suggest brachytherapy in which radioactive seeds are inserted directly into the tumour site for a few minutes. Laser therapy and photodynamic therapy are also options, but rarely cure such a cancer. When cancer has spread, the best treatment may be external-beam radiation, which uses several beams of radiation from outside the body. A newer technique, called 3-D conformal radiation therapy, provides a three-dimensional image of the tumour for the doctor to target. That makes it easier to avoid damaging normal tissue. Your doctor may order continuous hyperfractionated accelerated radiotherapy (CHART) for certain tumours, a regimen of two to three daily treatments that reduce the overall length of treatment. In one study, people with localized cancer who had CHART had a 24% lower death rate than those getting standard radiation.

Questions for Your Doctor

• Is surgery possible? How will it affect my breathing?
• What are the potential complications of the treatment you’re proposing?
• Would I benefit from receiving my treatment at a major cancer center or even in another country?

Living with Lung Cancer

If you’re living with lung cancer, here are a few quick tips to help you take control:

• Use a thoracic surgeon (one who specializes in chest procedures) if you’re scheduled for surgery. One study showed a much higher mortality rate when surgery is performed by general surgeons rather than by specialists.
• Look for high volume. If you’re having lung surgery, choose a hospital where many lung cancer surgeries are performed. Researchers who analyzed lung cancer patients’ records from 76 hospitals found that the more lung surgeries performed at a hospital, the longer patients survived.
• Get relief from pain. If your pain isn’t well controlled, don’t hesitate to talk with your doctor about more effective painkillers. Surveys show that 42% of people with cancer aren’t adequately treated for pain, although 95% could get relief.