Lung Cancer

Lung cancer is cancer that originates in the lungs, mostly in the cells lining the air passages. Generally, lung cancer is found to be related to tobacco smoking, however in recent years more cases have developed in non-smokers as well, especially women. Lung cancer generally has the highest mortality rate.

Types of lung cancer

Lung cancer is classified into two major groups depending on the main cells that form the cancer. There is a different in presentation, treatment, and prognosis among these two groups.

Small cell lung cancer makes up approximately 15% of all lung cancers. Typically beginning in the bronchi (air passages), it is fast-moving and aggressive and can quickly spread to other areas of the body. Nearly all cases of small-cell lung cancer result from tobacco smoking, as it is rare for non-smokers to develop this type of lung cancer.
Non-small cell lung cancer is the more common type of cancer, comprising approximately 85% of all cases of lung cancer. There are several types of non-small cell lung cancer, and each type has different kinds of cancer cells that grow and spread in different ways. These types include:
- Adenocarcinoma
- Squamous cell carcinoma
- Large call carcinoma

Risk factors

History or current use of tobacco (the most important reason)

Exposure to second-hand smoke
Increased exposure to asbestos or radon gas
Increased exposure to radiation
Highly-polluted air
Family history of lung cancer

Having one or more of these risk factors does not necessarily mean that a person will definitely develop lung cancer.

Symptoms of lung cancer

Persistent cough lasting several weeks
Chest pain
Coughing up blood or blood-stained sputum (hemoptysis)
Shortness of breath
Wheezing
High-pitched breathing sounds, indicating an airway obstruction
Hoarseness
Unexplained weight loss
Bone aches and fever

Diagnosis of lung cancer

Sputum cytology to examine mucus under a microscope
Bronchoscopy to examine the airways of the lungs
Endobronchial ultrasound (EBUS) to get images of the lungs and the surrounding areas to detect any tumors. The EBUS technique can also be used to obtain a biopsy of the lung tissue.
Transthoracic needle biopsy to remove a piece of lung tissue in order to examine under a microscope
CT/PET scans
MRI of the brain and bones (when required)
Pulmonary function tests (PFT) to monitor breathing and evaluate lung function

Treatment of lung cancer at KHCC

Treatment depends on the size of the tumor and the stage of the cancer, the type of tumor cells, and various genetic indicators. Treatment options are varied and may include surgery, radiotherapy, and/or chemotherapy.

Surgery

Surgery can be used to treat lung cancer as a first step when it is diagnosed at an early stage (stage I or II). Surgery may include resection the whole lung, part of the lung or segment from a part of the lung depending on the size and location of the tumor and the lung’s overall health status.

At KHCC, we use both open and minimally-invasive approachs to enter the chest cavity for lung resection. Minimally-invasive surgery is the opening of a small hole in the side of the chest and the utilization of a small camera and special instruments to complete the lung resection through this small hole.

Radiation:
Radiotherapy can be used in the treatment of lung cancer either as a primary treatment, after surgery, or for palliation to relieve symptoms caused by the tumor. Radiation therapy using Volumetric Modulated Arc Therapy (VMAT) combined with chemotherapy can be used in the treatment of small cell lung cancer and locally advanced non-small cell lung cancer. Stereotactic Body Radiation is used in treating early stage lung cancer when surgery is not an option.
Chemotherapy:
Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be administered through a vein in the arm (intravenously) according to a specific schedule for a specific number of cycles .Chemotherapy is used when cancer cannot be removed by surgery, or after surgery to kill any remaining cancer cells. It can be used alone or in combination with radiation therapy. It is used as the main treatment when the cancer has spread to other parts of the body.
Immunotherapy:
Immunotherapy mobilizes your immune system to fight cancer when cancer cells evade the immune system or hide elsewhere in the body. It is used when the tumor has spread outside the lungs and based on the result of specific test called (PD-L1).
Targeted therapy:
Oral medication can work on specific types of non-small cell lung cancer based on specific abnormalities present within cancer cells, referred to as “mutation” or “translocation of genetic material” (e.g. EGFR mutation or ALK translocation). By blocking these abnormalities, targeted drug treatments can cause cancer cells to die or stop growing. Targeted treatment is used in advanced cases or if the cancer has spread to other parts of the body.
Palliative care:
Patients with lung cancer often experience signs and symptoms of the cancer, as well as side effects of treatment. Supportive care, also known as palliative care, works hand-in-hand with doctors to minimize the impact of the patient’s symptoms.
Smoking cessation program:
Smoking cessation plays a vital role in managing cancer patients. Continuing to smoke following a cancer diagnosis contributes to a number of adverse outcomes, including tumor progression, the development of a second primary cancer and poor survival rates following chemotherapy or radiotherapy treatment. Many interventions are available to help patients quit smoking including counseling, nicotine replacement therapy and oral medications.

Screening

Smokers or former heavy smokers can have a special test (CT scan) to screen for lung cancer. This test can find lung cancer sooner and may help patients live longer. Speak to your healthcare provider to decide if this test is right for you.