Lung cancer treatment
Lung carcinoma is one most common cancer types. The main risk factor is smoking. Symptoms such as persistent cough, bloody sputum, wheezing, and shortness of breath often appear when the tumour is already advanced. Lung cancer treatment includes surgery, chemotherapy, radiotherapy including proton beams, target therapy, immunotherapy, intervention chemotherapy, and ablation.
Lung cancer is malignant growths that arise from the pulmonary tissue, in most cases from the cells in the lungs' air sacs and the cells that line the airways (bronchi). Depending on the location, doctors distinguish two forms of the disease: central and peripheral, which differ in primary symptoms.
The central form develops in large bronchi (main, partial and segmental). Symptoms appear already in the early stages due to a decrease in the lumen of the organs.
Peripheral lung cancer is localised in small bronchi (bronchioles) and the lung parenchyma (lung tissue, alveoli). This form can last long without specific symptoms due to the absence of nerve endings in the lung tissue. Symptoms only appear when the tumour begins to press on the neighbouring organs and structures, causing concern for the patient.
Lung cancer is divided into non-small (NSCLC) and small cell lung cancer (SCLC). This division is based on the type of the cells and can be confirmed after histological examination. NSCLC accounts for 85% of all cases and includes:
- Adenocarcinoma comes up from cells producing mucus.
- Squamous cell carcinoma appears in the squamous cell (they are lining the airways from the inside).
- Large cell carcinoma (undifferentiated) can develop from any part of the lungs, and it's usually hard to diagnose.
Lung carcinoma is one of the most frequently detected and dangerous types of oncology. In terms of prevalence, it ranks second after skin cancer, and the level of adverse outcomes is first. In addition, it is the second most common cancer in men and the third in women (after breast and colon cancer). That is why it is crucial to understand the causes of tumour development, symptoms, diagnosis and treatment methods.
Risk factors of lung neoplasm
Genetic damage of cells is the leading cause of lung cancer. Depending on the gene involved, they are responsible for various tasks, including regulating the growth and differentiation of cells. If changes, so-called mutations, suddenly occur in genes, a repair system in the body typically intervenes and repairs the damage. However, sometimes the system fails. Then damaged cells can multiply uncontrollably, and cancer develops. This process is typical for all malignancies, and lung cancer is no exception.
Experts assume that several factors play a role in the development of lung cancer. These are primarily harmful substances that get into the lungs with the air we breathe. For example, the following factors increase the risk of lung cancer:
- Smoking is a bad habit that, in 90% of cases, becomes the main reason for developing a deadly disease. The reason is hidden in resins, nicotine and other carcinogenic substances that a person inhales together with smoke. It should also be understood that passive smokers are also at risk of developing lung cancer. The appearance of oncology is affected by the number of cigarettes smoked, their composition, and the patient's smoking history.
- Chemical substances such as asbestos, arsenic, radon, cadmium, nickel, and chromium pose the greatest danger to the human body. People who systematically inhale toxic fumes or come in contact with these substances risk developing cancer.
- Ecology. Frequent inhalation of fine dust increases the risk of developing lung cancer.
- Contact with chloromethyl ether and other harmful substances.
- Radioactive exposure.
- Chronic lung diseases: pneumonia, bronchitis, bronchiectasis, tuberculosis.
Gender also matters. Women with such a bad habit as smoking get pulmonary malignancy more often. And residents of rural areas suffer from the disease less often than people living in megacities.
Lung cancer symptoms
Lung cancer usually develops silently. Many of those affected do not notice any signs or symptoms at first. Unspecific manifestation often only appears in the advanced stage:
- Bloody sputum (hemoptysis) is a symptom characteristic of half of the patients. Outwardly it looks like red streaks of blood in the mucus coughed up from the respiratory tract.
- More than half of patients complain of chest pain. It is most often felt on the side of the appearance of the tumour, although in 10% of cases, it can appear on the opposite side.
- Cough is a reflex symptom of lung cancer, found in most patients. In the early stages, it is dry and unproductive. With the development of malignant processes, mucus and mucous-purulent sputum appear.
- Shortness of breath (dyspnea). Its severity depends on many factors (the size of the neoplasm, the degree of pressure on neighbouring structures, veins, bronchi). About half of patients complain about this symptom, and in 10%, it manifests itself in the early stages of the disease.
- Worsening of the general condition: fatigue, weakness, unexplained increase in temperature, etc.
- Inflammation: obstructive pneumonitis (Inflammation of lung tissue with a decrease in the bronchial lumen) develops against the background of organ decline, proceeds quickly and often recurs.
- Unexplained weight loss is a prevalent sign of any cancer.
Secondary signs of lung cancer result from inflammatory processes, metastases development, and other organs' involvement. Such features are revealed in the later stages when the tumour is clearly expressed and the inflammatory process has spread widely.
Diagnostic tests for lung tumours
Diagnosis of lung oncology at the first stage of the disease is difficult. As a result, the diagnosis may not always adequately reflect the development of the process, or the doctor may make an incorrect conclusion. However, using a full range of innovative methods makes it possible to detect neoplasms in the first stages, which increases the chances of successful treatment until the patient fully recovers.
A standard test for suspected lung cancer includes X-ray images that can quickly identify tumours larger than half a centimetre in diameter and located at the edge of the lungs.
The bronchi can be viewed directly with the bronchoscope (thin, flexible tube with a mirror), so the examination is called bronchoscopy. The oncologist inserts it through the patient's nose or mouth into the trachea and further into the bronchi. A doctor can also take tissue samples or mucous membrane swabs from the lung tissue (tissue biopsy).
Computed tomography of the chest detects small or poorly defined lung tumours. For example, this procedure makes neoplasms visible from 0.3 centimetres. Modern clinics worldwide are equipped with high-resolution CT scan that is better than traditional one. With the help of the ultrasound examination of the abdomen, the doctor can determine whether a tumour has already spread to other organs (metastasis). The liver, kidneys, adrenal glands, spleen and lymph nodes are examined.
If lung cancer is diagnosed, further examinations follow. Above all, they should show how far the malignancy has spread, whether lymph nodes are affected and whether metastases have formed in other parts of the body:
- Pulmonary function tests provide information about how well the lungs are functioning. They determine whether there will still be enough functional lung tissue left after removing a lung lobe or an entire lung.
- Magnetic resonance imaging can detect brain, spinal cord and skeletal metastases. The procedure uses a strong magnetic field and radio waves, so the patient is not exposed to X-rays.
- Positron emission tomography (PET-CT) makes metabolic activities in the tissue visible. A weakly radioactive substance shows which body region's metabolic processes are taking place.
- Tests for gene changes in the tumour. Tissue or liquid biopsies are followed by genetic testing for specific genetic characteristics of lung cancer.
Depending on the biopsy results, lung cancer is finally divided into one of four stages. Stage I is a localised tumour with no lymph node involvement and no distant metastases. Stages II and III include tumours that are more widespread and have varying degrees of lymph node involvement. Distant metastases are already present in stage IV.
Lung cancer treatment methods
In practice, oncologists use combined treatment, choosing a more suitable strategy for each patient:
Chemotherapy uses drugs that slower cell growth, so-called cytostatics. They act primarily against fast-growing cells and thus against cancer cells. Several chemotherapeutic agents are available for treating lung tumours according to individual requirements.
There are also more specific types of chemotherapy (targeted chemotherapy):
- Transpulmonary chemoembolisation (TPCE) - the doctor uses tiny beads to block the blood supply to the lung cancer and destroy it with chemo drugs.
- Transpulmonary chemoperfusion (TPCP) - antitumour drugs are injected directly into the artery feeding the malignant neoplasm.
Immunotherapy activates your immune system to recognise the tumour as "foreign" and fight it. Immunotherapeutic drugs such as Opdivo (Nivolumab) and Keytruda (Pembrolizumab) show effective lung cancer treatment, especially NSCLC.
Targeted therapies are currently only used in advanced (metastatic) non-small cell lung cancer. However, new active ingredients exist to fight the tumour in a more targeted manner. In this case, the active drugs block specific tumour-growth mechanisms.
Radiation therapy is an option for non-small cell lung cancer in stages I and II as the sole therapy when surgery is not an option and in select stage III patients. Otherwise, it is more effective with chemotherapy in patients with stage III and small cell lung cancer. Proton therapy - is a more precise type of radiation therapy (compared with conventional radiotherapy). Proton beams have a targeted effect on the malignant cells in the lung without damaging healthy tissues.
Surgical treatment can be an option when the tumour has not exceeded a certain size and has not yet formed distant metastases. In that case, an operation is sought to remove the tumour tissue and the lymph nodes affected by tumour cells. Lobectomy (lung lobe removal) is the most common operation. However, if the tumour is massive, it may be necessary to remove an entire lung (pneumonectomy). Nowadays, experienced surgeons perform minimally invasive operations, which significantly reduce the postoperative recovery period:
- Video-assisted thoracoscopic surgery (VATS). The use of a thoracoscope (a device for providing video on screen) and needed surgery instruments through the tiny incisions in the body.
- Robot-assisted thoracic surgery (RATS). Another method of minimally invasive operation is even more precise because of the robotic system.
Ablation therapy (RFA, MWA, Ethanol) - is the method of lung cancer treatment based on the use of microwaves (microwave ablation), radio waves (radiofrequency ablation, RFA), or alcohol (ethanol ablation).
A correctly chosen combination of treatment methods with timely diagnosis ensures a significant improvement in the condition.
Recovery from lung tumour
The lung cancer prognosis of a patient depends primarily on timely diagnosis. On the one hand, the cancer stage at the time of diagnosis is decisive. The chances of recovery and life expectancy are generally better in the early stages of lung malignancy than in the more advanced. On the other hand, the type of bronchial carcinoma also influences life expectancy. Small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC) progress differently and have different chances of recovery.
60 to 70% of patients with stage I lung tumours are alive five years after diagnosis with proper treatment. However, if the diagnosis and treatment are not carried out until stage IV, the 5-year survival rate is less than 5%.
Is lung nodule cancer?
Lung nodules are a widespread formation. It is a mass of tissue in the lung, which is usually not malignant (benign). But also, lung nodules can become cancerous and lead to lung cancer.
How is lung cancer treated?
Treatment for lung cancer includes surgery (video or robot-assisted thoracoscopic surgery), chemotherapy (including transarterial chemoembolisation and chemoperfusion), radiotherapy, target medications, immunotherapy, ablation (RFA, MWA, Ethanol) and proton therapy.
How successful is chemotherapy for lung cancer?
Oncologists widely use chemotherapy to treat lung cancer, giving good results. But the best indicators in treatment are provided by complex chemotherapy with surgery and radiation therapy. Nowadays, more advanced chemotherpay options are available like chemoembolisation or regional high-dose chemotherapy.
How fast does lung cancer spread?
Lung cancer is an aggressive form of malignancy. However, the spreading depends on the type of lung cancer. Small cell lung cancer (SCLC), compared to non-small cell lung cancer (NSCLC), proliferates faster and is more dangerous. There are researches which show that lung tumours double in about five months.
Does lung cancer spread to the brain?
Brain metastases are a widespread complication of lung cancer. Statistics show that up to 40% of patients have metastases of the brain and nervous system in the latest stage of lung cancer.
Where can I get Lung cancer treatment?
What are the best clinics for Lung cancer treatment?
Who are the best doctors for Lung cancer?
Prof. Dr. med. Christian Brandts from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Gernot Rohde from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Hubert Serve from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Wolf O. Bechstein from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Michael von Bergwelt from University Hospital Ludwig-Maximilians Munich