Lung
cancer is the most common cause of cancer -related death in Australia
and one of the most common cancers among New Zealanders. Each year,
medical advances are offering powerful new weapons to fight this disease
more effectively.
It's probably no surprise to learn that smoking causes about 90 percent of all primary lung cancers, meaning those that originate in the lungs. But this disease can also result from exposure to air pollution or industrial toxins such as asbestos. Breathing in such poisons for year causes genetic mutations that make cells in the lungs multiply uncontrollably and form a tumour, also called a carcinoma. This can grow into nearby blood vessels and lymph nodes, then spread ( metastatise) to other sites in the body, most commonly to the bones, brain and liver. Other types of cancer can also move into the lugs from elsewhere in the body; this is called secondary lung cancer.
Lung tumours can grow undetected for years. Eventually symptoms develop and 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 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 typically is sizable when discovered. Small cell lung cancer (also called oat cell cancer) is aggressive and has metastatised by the time it's diagnosed.
Once the type of lung cancer you have is identified, its stage will be determined based on the size of the tumour, whether it has spread to any lymph nodes or travelled to other parts of the body. There are four stages (1-4) for non-small cell lung cancer, and two (limited and extensive) for small cell cancer. For both types, the earlier the stage, the better your long-term outlook (see table above).
LIKELY FIRST STEPS
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STAGE SPREAD OUTLOOK
Non-small cell cancer
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1 Tumour is limited to the lung. Five-year survival is 70%
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2 Cancer has spread to lymph nodes Five-year survival is 39-55%
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3 Cancer has spread to diaphragm, chest wall Five-year survival is 5-35%
or to lymph nodes in chest.
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4 Cancer has spread throughout the body Five-year survival is less than5%
What is happening
It's probably no surprise to learn that smoking causes about 90 percent of all primary lung cancers, meaning those that originate in the lungs. But this disease can also result from exposure to air pollution or industrial toxins such as asbestos. Breathing in such poisons for year causes genetic mutations that make cells in the lungs multiply uncontrollably and form a tumour, also called a carcinoma. This can grow into nearby blood vessels and lymph nodes, then spread ( metastatise) to other sites in the body, most commonly to the bones, brain and liver. Other types of cancer can also move into the lugs from elsewhere in the body; this is called secondary lung cancer.
Lung tumours can grow undetected for years. Eventually symptoms develop and 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 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 typically is sizable when discovered. Small cell lung cancer (also called oat cell cancer) is aggressive and has metastatised by the time it's diagnosed.
Once the type of lung cancer you have is identified, its stage will be determined based on the size of the tumour, whether it has spread to any lymph nodes or travelled to other parts of the body. There are four stages (1-4) for non-small cell lung cancer, and two (limited and extensive) for small cell cancer. For both types, the earlier the stage, the better your long-term outlook (see table above).
- For early non-small cell cancer, surgery to remove the affected part of the lung.
- Radiation and/or chemotherapy for inoperable and more advanced tumours.
- In some cases, clinical trials to test new and hopefully more effective treatments.
QUESTIONS TO ASK
- Is surgery possible? How will it affect by breathing?
- What are the potential complications of the treatment you're proposing?
- Are there any clinical trials that might be appropriate for me?
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STAGE SPREAD OUTLOOK
Non-small cell cancer
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1 Tumour is limited to the lung. Five-year survival is 70%
-----------------------------------------------------------------------------------------------------------------------------------------
2 Cancer has spread to lymph nodes Five-year survival is 39-55%
-----------------------------------------------------------------------------------------------------------------------------------------
3 Cancer has spread to diaphragm, chest wall Five-year survival is 5-35%
or to lymph nodes in chest.
------------------------------------------------------------------------------------------------------------------------------------------
4 Cancer has spread throughout the body Five-year survival is less than5%
Small cell lung cancer
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Limited Cancer in one lung and nearby lymph nodes. Two-year survival is about 20%.
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Extensive Cancer has spread to other parts of the body. Two-year survival is less than 4%
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Treatment Options
If you have early-stage non-small cell cancer and good lung function, your treatment is likely to begin with surgery Some stage 1 and 2 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, localised small cell centers can be eliminated with surgery as well. Several surgical procedures are used (see illustration on shortly).
Newer techinques help control symptoms. Laser therapy uses intense light to destroy cancer cells. If the tumour is small, you may be a candidate for a developing technique that is called photodytherapy (PDT). In PDT a photo sensitiser drug called porfimer sodium is injected into you. This drug stays longer in the cancer cells than in normal cells to they can then be targeted and destoryed. Both of these procedures are used to eradicate tumours that are blocking an airway.
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Limited Cancer in one lung and nearby lymph nodes. Two-year survival is about 20%.
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Extensive Cancer has spread to other parts of the body. Two-year survival is less than 4%
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Treatment Options
MEDICATIONS
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Chemotherapy Before or after surgery and/or radiation.
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Chemotherapy Before or after surgery and/or radiation.
PROCEDURES
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Surgery To remove part or all of lung.
------------------------------------------------------------------------------------------------------------------------------------------------------- Laser therapy Intense light that destroys cancer cells.
---------------------------------------------------------------------------------------------------------------------------------------------
Photodynamic surgery Light-sensitive drugs kill small tumours.
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Radiation surgery In addition to or in place of surgery.
LIFESTYLE CHANGES
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Stop smoking Cuts risk of recurrence; improve health.
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Get support To help with emotional issues, depression.
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Improve diet Eat small protein- and kilojoule-packed meals.
TAKING CONTROL
Preliminary studies say that it's possible. Researchers have found that people with mutations in the p53 gene have an increased risk for lung cancer if they smoke. This gene is called a tumour-suppressor because it's needed to repair DNA damage, or if there's too much damage, to trigger cells 'commit suicide'. When this process goes awry, cancer can occur.
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 of these.
Procedures---------------------------------------------------------------------------------------------------------------------------------------------
Surgery To remove part or all of lung.
------------------------------------------------------------------------------------------------------------------------------------------------------- Laser therapy Intense light that destroys cancer cells.
---------------------------------------------------------------------------------------------------------------------------------------------
Photodynamic surgery Light-sensitive drugs kill small tumours.
---------------------------------------------------------------------------------------------------------------------------------------------
Radiation surgery In addition to or in place of surgery.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Stop smoking Cuts risk of recurrence; improve health.
----------------------------------------------------------------------------------------------------------------------------------------------
Get support To help with emotional issues, depression.
----------------------------------------------------------------------------------------------------------------------------------------------
Improve diet Eat small protein- and kilojoule-packed meals.
TAKING CONTROL
- Seek help early. If you have any symptoms, such as an unrelenting cough, blood in your sputum or unexplained weight loss, seek help. Lung cancer can usually only be cured if caught early enough.
- Go to a big center. When choosing where to go for treatment, choose a larger center that is more likely to have all the resources you might need. Researchers who analysed lung cancer patient's records from 76 hospitals found that the more lung surgeries performed at a hospital, the longer patients survived.
- Get relief from pain. If you have pain that isn't well controlled, don't hestitate to talk to 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.
Preliminary studies say that it's possible. Researchers have found that people with mutations in the p53 gene have an increased risk for lung cancer if they smoke. This gene is called a tumour-suppressor because it's needed to repair DNA damage, or if there's too much damage, to trigger cells 'commit suicide'. When this process goes awry, cancer can occur.
Treatments
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 of these.
If you have early-stage non-small cell cancer and good lung function, your treatment is likely to begin with surgery Some stage 1 and 2 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, localised small cell centers can be eliminated with surgery as well. Several surgical procedures are used (see illustration on shortly).
Newer techinques help control symptoms. Laser therapy uses intense light to destroy cancer cells. If the tumour is small, you may be a candidate for a developing technique that is called photodytherapy (PDT). In PDT a photo sensitiser drug called porfimer sodium is injected into you. This drug stays longer in the cancer cells than in normal cells to they can then be targeted and destoryed. Both of these procedures are used to eradicate tumours that are blocking an airway.
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