Lung Cancer — Symptoms, Diagnosis, Treatment

Overview

Lung cancer is a type of cancer that starts in the lungs. Your lungs are two spongy organs in your chest. They are responsible for taking in oxygen when you inhale and releasing carbon dioxide when you exhale. Lung cancer and smoking always, but not necessarily go hand in hand. Generally, people who smoke or are exposed to secondhand smoke have a higher risk of developing lung cancer. High levels of pollution, radiation and asbestos exposure may also increase the risk. According to the statistics, lung cancer claims more lives each year (both men and women) than do breast, ovarian, prostate and colon cancers combined. Based on the appearance of lung cancer cells, lung cancer is further divided into two major types.

Non-small cell lung cancer (NSCLC). It is an umbrella term for several types of lung cancers that share similar characteristics. These cancers may include adenocarcinoma, squamous cell carcinoma and large cell carcinoma.

Small cell lung cancer (SCLC). It occurs almost exclusively in heavy smokers and is considered less common than non-small cell lung cancer.

Symptoms

Most lung cancers do not cause any symptoms until they have spread, but some people with early lung cancer do experience symptoms. With early diagnosis, one may receive effective treatment. According to previous research, most of the symptoms felt are less likely to be caused by lung cancer itself.

In most cases, if the cancer doesn’t spread to other parts of the body, symptoms may include:

  1. Hoarseness
  2. Loss of appetite
  3. Shortness of breath
  4. New onset of wheezing
  5. Unexplained weight loss
  6. Extreme fatigue or weakness
  7. A recurrent cough that gets worse
  8. Coughing up blood or rust-colored sputum
  9. Chest pain that gets worse with deep breathing, coughing, or laughing
  10. Recurrent infections (e.g. bronchitis and pneumonia)

If lung cancer has already spread to other organs, affected people may suffer from:

  1. Spread to the Liver: Yellowed skin and eyes
  2. Spread to Bones: Bone pain (e.g. in the back or hips)
  3. Spread to the Brain: Nervous system changes (e.g. headache, dizziness, seizures, balance problems, weakness or numbness of an arm or leg)
  4. Spread to the Immune System: Swelling of lymph nodes (e.g. in the neck or above the collarbone)

In some cases, lung cancer can also cause syndromes of specific symptoms.

Horner syndrome

Cancers of the upper part of the lungs are sometimes called Pancoast tumors which can affect certain nerves to the eye and part of the face, leading to a group of symptoms called Horner syndrome: little or no sweating on the same side of the face, severe shoulder pain, a smaller pupil in the same eye, or drooping or weakness of one upper eyelid.

Superior vena cava syndrome

The superior vena cava (SVC) is a large vein carrying blood from the head and arms down to the heart. Tumors in the upper part of the right lung and the lymph nodes inside the chest can press on the SVC, which can cause the blood to back up in the veins. This may result in swelling in the face, neck, arms, and upper chest. It may also cause other symptoms such as headaches, dizziness, and a change in consciousness if it affects the brain.

Paraneoplastic syndromes

In this case, some lung cancers make hormone-like substances enter the bloodstream and cause problems with distant tissues and organs, the cancer has not spread to those places, though. Sometimes these syndromes may be considered the early symptoms of lung cancer. Since the symptoms affect other organs, the doctor may diagnose the patient with other diseases rather than lung cancer. Some common syndromes include:

  1. Cushing syndrome: Affected people may experience symptoms such as weakness, drowsiness, weight gain, easy bruising, fluid retention, high blood pressure, high blood sugar levels, or even diabetes.
  2. SIADH (syndrome of inappropriate anti-diuretic hormone): Symptoms of SIADH can include nausea, vomiting, fatigue, loss of appetite, muscle weakness or cramps, restlessness, and confusion. Left untreated, severe cases may lead to seizures and coma.
  3. Nervous system problems: SCLC can sometimes cause the body’s immune system to attack parts of the nervous system. It may cause problems such as a muscle disorder called Lambert-Eaton syndrome and a less common one called paraneoplastic cerebellar degeneration.

Complications

As lung cancer progresses, it may spread to other parts of your body, which may put you at a higher risk of developing complications.

Pleural effusion: In this condition, your major airways are blocked, resulting in the buildup of fluid around the lungs. If may compress the lungs, decrease lung function, and increase your risk of pneumonia.

Neuropathy: It is a disorder that affects the nerves, mainly of the hands and feet. Lung cancer itself or certain cancer treatments may cause neuropathy. Once you’ve got this, you may notice some symptoms such as pain, weakness, numbness and tingling.

Heart complications: If tumors spread or locate near the heart or major vessels, they can block the veins and arteries, upset the heart’s normal rhythm, cause a buildup of fluid around the heart and even swelling in upper parts of the body.

Esophagus complications: If the tumors grow near the esophagus, they may cause the patient to be troubled with swallowing or to experience more pain while swallowing food.

Pain in the ribs, chest muscles or other parts of the body: In most advanced stages of the disease, pain in the ribs and other areas of your body may occur. Normally, it can be controlled with meds and radiation.

Diagnosis

Some lung cancers can be found by screening, but most lung cancers are found because they are causing problems. If you suspect that you may have lung cancer, you should see a doctor who will check your medical history and look for some symptoms, and then will arrange for a series of tests for you. For example, the doctor may order some imaging tests such as Chest X-ray, CT scan, MRI scan, Bone scan or PET scan. Symptoms and the results of these tests may strongly suggest that a person has lung cancer. However, the actual diagnosis is made by looking at lung cells in the lab. The cells can be taken from lung secretions, fluid removed from the area around the lung, or from a suspicious area using a needle or surgery.

Sputum cytology

By taking this test, your sample of sputum is looked at in the lab. It proves to be helpful to find cancers starting in the major airways of the lung, such as squamous cell lung cancers. The best way to do this is to get early morning samples 3 days in a row. Moreover, if your doctor suspect you might have lung cancer, he/she may suggest further testing if no cancer cells are found in the sputum.

Needle biopsy

Needle biopsy includes fine needle aspiration biopsy, core biopsy and transthoracic needle biopsy. When it comes to the needle biopsy, both advantages and drawbacks are touched on. Doctors prefer this method because it doesn’t require a surgical incision. However, it does have some drawbacks. For example, in some cases, the amount of tissue removed might not be enough to both make a diagnosis and to perform further tests on the cancer cells.

Thoracentesis

If you have pleural effusions, doctors can remove some of the fluid to find out if it is caused by cancer spreading to the pleura. During the process, you skin will be anaesthetized, and a hollow needle is inserted between the ribs to drain the fluid which will be sent to the lab for cancer cells.

Endobronchial ultrasound

It can be applied to check the lymph nodes and other parts between the lungs if biopsies need to be taken in those areas.

Endoscopic esophageal ultrasound

To conduct this test, an ultrasound goes down into the esophagus to see if lung cancer cells are found in the nearby lymph nodes. Biopsies of the abnormal lymph nodes can be taken at the same time as the procedure.

Thoracoscopy

It can be done to see if cancer has spread to the areas between the lungs and the chest wall, or to the linings of these areas. It may take a sample of tumors on the outer parts of the lungs as well as nearby lymph nodes and fluid, and to assess whether a tumor is growing into nearby tissues or organs.

Treatment

There is a list of treatment options that you can choose from. To choose the best one, you and your doctor need to go through a group of vital factors. Basically, you have to take into consideration of your overall health, the type and stage of your cancer, and of course your preferences. For some patients, they may be afraid that the side effects of certain treatment may end up doing more damage to their bodies. In this case, they may choose not to undergo treatment.

Surgery

If your cancer is confined to the lungs, your doctors may conduct a surgery to remove the lung cancer, a margin of healthy tissue or even lymph nodes from your chest. Procedures include: wedge resection, segmental resection, lobectomy and pneumonectomy.

Radiation therapy and chemotherapy

If you have a larger lung cancer, your doctor may recommend radiation therapy and chemotherapy before a possible surgery so as to shrink the cancer. Radiation therapy uses high-powered energy beams from sources (e.g. X-rays and protons) to kill cancer cells, while chemotherapy uses drugs to kill cancer cells.

Radiosurgery

Radiosurgery (stereotactic body radiotherapy) is an intense radiation treatment that aims many beams of radiation from many angles at the cancer. If the patient with small lung cancers can’t undergo surgery, radiosurgery will be a good choice.

Targeted drug therapy

It proves effective in treating cases in which people’s cancer cells have certain genetic mutations. Part of the reasons could be that this therapy focuses on specific abnormalities present within cancer cells.

Immunotherapy

Immunotherapy is basically reserved for those with advanced lung cancers. By applying this method, people’s immune system is used to fight against cancer. One’s immune system may not attack the cancer itself because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

Palliative care

Sometimes, people with lung cancer will suffer from some side effects of the treatment while they are being treated. Palliative care (aka. supportive care) is a specialty area of medicine that involves working with a doctor to minimize the side effects.

Prevention

Even though not all lung cancers can be prevented, there are things you can do that might lower your risk of developing one.

Say no to tobacco

The most effective way to lower the risk of getting lung cancer is to stay away from tobacco, which means you’d better not smoke or not exposed to secondhand smoke.

Eat a healthy diet

You are recommended to keep a healthy diet in which lots of fruits and vegetables are included to reduce your risk of lung cancer.

Avoid radon exposure

Among all the causes for lung cancers, radon is an important one. You can reduce your exposure to radon by having your home tested and treated, if needed.

Avoid or limit exposure to cancer-causing agents

Whether you are at the workplace or elsewhere, it may also be helpful to avoid or limit your exposure to cancer-causing agents.

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Keywords: lung cancer, small cell lung cancer

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.