What do we know about Lung Cancer?

Overall, the most common symptoms include:

Shortness of breath with activity, a Persistent, cough, Coughing up blood, unexplained Weight loss, Chest pain and death

What Is Lung Cancer?

Lung cancer originates in the tissues of the lungs or the cells lining the airways (the bronchi). These cells begin as and look like lung cancer cells under the microscope, with the exception of changes that occur in the process of becoming cancerous.

If lung cancer spreads to other regions of the body, the cells are still lung cancer cells. For example, if lung cancer spreads to the brain, cells taken from the metastasis (growth) in the brain would be identifiable as cancerous lung cancer cells under the microscope. In contrast, some tumours begin in other parts of the body and spread (metastasize) to the lungs.

This is referred to as metastatic cancer to the lungs and not lung cancer. An example would be a breast cancer which spreads to the lungs. This would not be called lung cancer, but rather “breast cancer metastatic to the lungs.” 

Lung cancer is the leading cause of cancer deaths worldwide, with 1.8 million new cases being diagnosed yearly.

It is also the most fatal cancer in men, killing more men than prostate cancer, pancreatic cancer, and colon cancer combined. Overall, 27 percent of cancer deaths in the U.S. are due to lung cancer.

Before anyone dismisses these numbers as due to smoking alone, it’s important to point out that even if smoking were banned today, we would still have lung cancer. Lung cancer in never-smokers is the sixth leading cause of cancer deaths in the United States. In fact, the focus on smoking cessation as a way to treat lung cancer has, in some ways, overshadowed research looking into other causes.

How Does Lung Cancer Begin?

Lung cancer usually begins several years before it causes symptoms and is diagnosed. Cells in the lungs may become cancer cells after going through a series of mutations which transform them into cancer cells. Gene mutations - or changes in the DNA of the cells - may be inherited (as a hereditary predisposition) or acquired (damaged as the result of exposure to carcinogens (cancer-causing substances) in the environment. This accumulation of mutations is one of the reasons for a common finding with lung cancer: Many people develop lung cancer though they have never smoked, and some people smoke their whole life and never develop lung cancer.

Lung cancer begins - a tumour originates - when a mass of cancer cells becomes immortal in a way; cells dividing and multiplying out of control. Our normal cells are regulated by a series of checks and balances.

Who Gets Lung Cancer?

The average age for lung cancer is 70, and 80 percent of people who develop lung cancer have smoked, but:

Lung cancer occurs in non-smokers  - And while lung cancer in men who have smoked is decreasing, lung cancer in non-smokers is increasing. It’s estimated that 20 percent of women who develop lung cancer in the U.S. have never smoked, and that number increases to 50 percent worldwide.

Lung cancer occurs in young adults - It’s estimated that 13.4 percent of lung cancers occur in adults under the age of 40. While this number may seem small, when compared to the incidence of lung cancer overall, it is not. Calculating this out, around 21,000 young adults will die from lung cancer this year (again comparing this to 40,450 breast cancer deaths for women of all ages.) In addition, women are more likely than men to develop lung cancer at a young age, and lung cancer in young adults is increasing.

Types of Lung Cancer?

There are two primary types of lung cancer:

Non-small cell lung cancer is most common, being responsible for 80 to 85 percent of cancers.  This is the type of lung cancer more commonly found in non-smokers, women, and young adults.

Small cell lung cancer is responsible for around 15 percent of lung cancers. These lung cancers tend to be aggressive and may not be found until they have already spread (especially to the brain). They usually respond fairly well to chemotherapy but have a poor prognosis.

Non-small cell lung cancer is further broken down into three types:

Lung adenocarcinoma - Lung adenocarcinoma is responsible for half of non-small cell lung cancers and is currently the most common type of lung cancer. It is also the most common type of lung cancer found in women, young adults, and in people who do not smoke.

Squamous cell carcinoma of the lungs - Squamous cell lung cancer was once the most common type of lung cancer, but its incidence has decreased in recent years. Part of the thought is that the addition of filters to cigarettes created this shift. Squamous cell cancers tend to occur in or near the large airways - the first place exposed to smoke from a cigarette. Lung adenocarcinomas, in contrast, are usually found deeper in the lungs, where smoke from a filtered cigarette would settle.

Large cell lung cancer - Large cell carcinomas of the lungs tend to grow in the outer regions of the lungs. These are usually rapidly growing tumors that spread quickly.

Other, less common types of lung cancer include carcinoid tumours and neuroendocrine tumours.

Signs and Symptoms of Lung Cancer

Having an awareness of the early signs and symptoms of lung cancer is a must for everyone for two reasons:

There is not a screening test available for everyone, so the only way that most people have to find these cancers early—when  they are most treatable—is knowing the signs. Recent research tells us that the majority of people in the United States are not familiar with these symptoms.

Because lung cancer is common. As noted earlier, lung cancer is the leading cause of death in both men and women and anyone who has lungs is at risk.

Overall, the most common symptoms include:

shortness of breath with activity

a persistent cough

coughing up blood

unexplained weight loss

chest pain

Of note is that the types of lung cancer have been changing over the years, and with that, the most common symptoms. In the past, lung cancers such as squamous cell carcinoma and small cell lung cancer were most common. These cancers tend to grow near the large airways of the lungs and cause symptoms early on - commonly a cough and coughing up blood. Now, lung adenocarcinoma, a tumor which tends to grow in the outer regions of the lungs is most common. These cancers tend to grow for a long time before causing symptoms, which may include mild shortness of breath, subtle weight loss, and a general sense of being unwell.

Diagnosis and Staging

A combination of imaging studies, including CT, MRI, and PET scans may be used to diagnose lung cancer. In addition, a lung biopsy is usually needed to determine the type of lung cancer.

Careful staging - figuring out how extensive a lung cancer is - is important in designing a treatment regimen. Non-small cell lung cancer is broken down into five stages: stage 0 to stage IV. Small cell lung cancer is broken down into only two stages: limited stage and extensive stage.

How Does Lung Cancer Grow and Spread?

One of the differences between benign lung tumours and lung cancer, as noted, is that lung cancer cells have the ability to break off and spread to other regions of the body. This spread, in fact, is the cause of most cancer deaths. One of the differences between cancer cells and normal cells is that cancer cells lack “stickiness.” Normal cells produce substances that cause them to stay together. Without this stickiness, lung cancer cells can travel and grow in other regions, as well as invade nearby structures.

There are four primary ways in which lung cancers spread. It can “invade” tissues locally. Unlike benign tumours which may push up against nearby tissues, cancers actually penetrate nearby tissues. This is the reason for the name “cancer,” which is derived from the word crab; cancer can send crablike extensions into nearby tissues.

Lung cancer cells can also break away and spread through either the bloodstream or the lymphatic system to distant sites. In recent years, it’s also been found that lung cancer may travel and spread through the airways in the lungs.

Lung Cancer Treatments

Treatment options for lung cancer have improved significantly in recent years. These include:

Surgery - There are several types of lung cancer surgery which may be done, depending on the size and location of a tumor.

Radiation therapy - Radiation therapy may be given as an adjunct to surgery, to decrease pain or airway obstruction due to a cancer, or in high doses to a localized region in an attempt to cure cancer (stereotactic body radiotherapy.)

Chemotherapy - Chemotherapy usually uses a combination of medications to treat lung cancer.

Targeted therapies - Everyone with lung cancer should have molecular profiling (gene testing) done on their tumors. Targeted therapy drugs are currently available for people who bear tumours with several genetic mutations including EGFR mutations, ALK rearrangements, and ROS1 rearrangements. Contact your oncologist for an updated list of mutations.

Immunotherapy - In 2015, two immunotherapy drugs were approved for the treatment of lung cancer. In some cases, these drugs have resulted in long-term survival even for those with the advanced stages of lung cancer.

A relatively new type of cancer care is termed palliative care. Palliative care is care designed to address the full spectrum of medical needs for people with cancer, including physical, emotional, and spiritual support. Unlike hospice care, palliative care can be used for anyone, even if you have a cancer which is considered curable. Early studies have found that, in addition to improving the quality of life for people, this care may also improve survival.

Where in the Gambia?

For information, diagnose and treatments At EFSTH, MRC, number of NGO and Private Clinics. Also France De Gaulle Njie Foundation Web site, Email to azadehhassan@yahoo.co.uk, send text only to Dr Azadeh 002207774469/3774469.

Author: DR AZADEH Senior Lecturer at the University of the Gambia, senior Consultant in Obstetrics & Gynaecology, Clinical Director at Medicare Health Services.