Lung Cancer - The Facts

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LUNG CANCER - THE FACTS

  • Lung cancer is the biggest cancer killer in the world – causing more deaths than breast and prostate cancer put together.1
  • Every 30 seconds, someone, somewhere in the world dies of lung cancer.2
  • 40% of smokers who start smoking in their early teens and continue to smoke will not live to claim their pension.2
  • Only 15% of those people with lung cancer will be alive 5 years after diagnosis.3

What is lung cancer?

Lung cancer is a term used to describe a growth of abnormal cells inside the lung. These cells divide and grow at a much quicker rate than normal cells. The cancerous cells stick together to form a cluster and this abnormal cluster of cells is called a tumour. If the cancer cells first started growing in the lungs, the tumour is called a primary lung tumour. However, if the lung cancer cells break off and travel through the blood vessels they may latch on to and start to grow in other parts of the body e.g. the bones. This new cancer growth is called a metastasis or secondary tumour.

Types of Lung Cancer

There are a number of different types of lung cancer. The two most common are called:

  • Non-small cell lung cancer (NSCLC), which is the most common type (around 75% of cases) 2
  • Small cell lung cancer (SCLC)

These two types of lung cancer respond differently to different treatments, so the best treatment approach for you will depend on your type of lung cancer.

Non-small cell lung cancer

There are several different types of non-small cell lung cancer depending on the type of abnormal cell:

  • Adenocarcinoma - is more common in women, particularly women smokers, and has a tendency to produce clumps of mucus/sputum in the smaller airways.
  • Squamous carcinoma (also known as epidermoid carcinoma) - (also known as epidermoid carcinoma) – occurs most frequently in men and older people of both sexes but it is rare in non-smokers. It appears as an irregular growth of pearl-like cells with a firm texture and is more common in the larger central airways than in the outer lung. It may grow large enough to block the air travelling to a part of the lung causing it to collapse. This type of lung cancer is the most commonly removed by surgery.

Small Cell Lung Cancer

This is caused by small round cells that form fleshy lumps, usually in the larger airways and is very rare in non-smokers. This type of lung cancer cell divides and grows very quickly and has often spread to the lymph nodes and/or other organs in the body by the time it is diagnosed. It is known to be more responsive to chemotherapy and radiotherapy than non-small cell lung cancers and may reoccur. You will attend regular check-ups after treatment is complete to ensure any reoccurrence is spotted quickly.

Other types of lung cancer

  • Mesothelioma - is closely associated with a history of asbestos exposure usually either through working directly in the asbestos industry or working with asbestos products in the building trade. Generally, it affects older males and may take 35-40 years from the date of first exposure for the cancer to develop. This cancer cell type is usually found in the lining of the lungs and has a habit of producing fluid that may require draining from time to time to improve breathing.
  • Carcinoid tumour - is a rare and benign tumour disease of the lung (1-2% of all lung cancers).2 This lung growth affects the organs and glands which produce many of the hormones (neuroendocrine) e.g. thyroid gland. It is more common in a younger age group and the majority of patients have no symptoms at diagnosis, however when symptoms do occur they can include flushing, diarrhoea, heart problems and wheezing. Surgery is usually curative but radiotherapy and chemotherapy can be used for controlling symptoms.

Staging

To determine the most appropriate treatment, cancers are 'staged,' which means classifying the severity of a patient's disease:

Small cell lung cancer is classified as 'limited' (cancer only in one lung and in the lymph nodes in the same side) or 'extensive' (cancer has spread, either within the chest or elsewhere in the body).

Non-small cell lung cancer is staged as follows:

  • Stage I: Cancer is present only in one part of the lung
  • Stage II: Cancer has spread to the nearby lymph nodes or nearby tissues e.g. chest wall
  • Stage III: Cancer has spread more extensively within the chest and, generally to the major lymph nodes
  • Stage IV: Cancer has spread to other parts of the body, e.g. to the liver or bones

Treatments

Treatment depends on the size, type and stage of the tumour and on a patient's own personal health. In general, there are three types of treatment used in the management of lung cancer. These are surgery, radiotherapy (X-ray treatment) and chemotherapy (treatment using drugs). The following factors are all taken into account when deciding the most appropriate treatment approach:

  • Size of tumour: Bigger tumours are often more difficult to treat.
  • Position of tumour: If the tumour is very close to the windpipe, major blood vessels or another vital structure, curative treatment may be difficult.
  • Stage of the tumour: A variety of tests will be performed to decide tumour stage.
  • Spread of cancer: If the cancer has spread to lymph glands in the mediastinum (the area in-between the lungs) or other structures outside of the chest then curative treatment may be difficult.
  • Type of lung cancer (e.g. small cell or non-small cell): Different types of lung cancer respond to different treatments.

Current Lung Cancer treatment options

Surgery: If the cancer has not spread widely (stages I and II), removing the tumour by surgery is the most common and effective form of treatment for non-small cell lung cancer. Surgery should be considered in all such patients and if surgery is not an option, patients should be offered an explanation as to why it is not possible. If the cancer has spread and surgery is not possible then radiotherapy and chemotherapy are used (alone or in combination) to control symptoms by reducing the size of the tumour. In patients who develop collections of fluid within the chest, surgery can be used to control the fluid and improve breathlessness.

Chemotherapy is the general term for the treatment of cancer using drugs. The drugs that are used are designed to kill off cancer cells while causing less damage to normal cells. There are many different types of chemotherapy drugs which can be used on their own or, more commonly, in combinations. Patients with different types of lung cancer are likely to receive different combinations of chemotherapy drugs.

Radiotherapy is a general term for the treatment of cancer using x-rays. It is done by directing painless high-energy beams at the areas of the lung that need treatment. Radiotherapy works by killing cancerous cells and can be used either on its own or in combination with surgery and/or chemotherapy.

Newer Treatment Options

There have been encouraging advances made in recent years in the fight against lung cancer, and researchers are investigating potential new treatments or treatment strategies all the time. Some the types of potential anti-cancer agents and technologies under investigation include new surgical and radiation techniques, new chemotherapy agents, and the novel agents e.g. epidermal growth factor receptor (EGFR) inhibitors, anti-angiogenic compounds and gene therapy.

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For more information please contact http://www.lungcancercoalition.org.

References

  1. Ferlay, J. et al. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide IARC CancerBase No. 5. Version 2.0, IARCPress, Lyon, 2004
  2. The Roy Castle Lung Cancer Foundation, 2004 (http://www.roycastle.org)
  3. Bepler G. Lung Cancer epidemiology and genetics. J Thorac Imaging 1999;14:228–34.

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