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Lung Cancer

Overview

Lung cancer is a disease of cancerous condition in lungs. Carcinomas of lung mainly derives from epithelial cells. Lung cancer can metastasize to liver, brain, kidney, etc and hence they are called carcinoma. Lung cancer is caused by mutation in normal working genes:- Epidermal growth factor  receptor (EGFR), which regulates cell proliferation, apoptosis, angiogenesis and also in other genes like CMET and NKX2-1. Two types of cancer can occur in lungs: 1.Non small cell carcinoma which includes squamous cell carcinoma, adenocarcinoma and large cell carcinoma. 2.Small cell lung carcinoma, also called oat cell carcinoma as the cells contain neuroscretory vesicles which releases hormones responsible for parneoplastic syndrome. Lung cancer is the leading cause of death in men than in women.


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Causes

Any cause for lung cancer is directly associated with mutation in the DNA of the tissue lining the bronchi of lungs.

Smoking is the leading cause for lung cancer. Passive smoking i.e inhaling smoke from someone who is smoking, also called second hand smoking, is the major cause of lung cancer in non-smokers. That's why smoking was banned in India on 2nd October 2008. The length of time a person smokes (as well as the rate of smoking) increases the person's chance of developing lung cancer. 10-15% of lung cancer cases are due to passive smoking. Passive smoking is much harmful than the direct smoking.

Radon gas is produced by Uranium which decays into radium. Radium is a radioactive substance and emits radon gas. The radioactive decay product ionizes the genetic material, causing mutation which turns into a cancerous condition.

Asbestos is the basic cause of cancer for many cancerous condition. This also causes certain mutation, which is responsible for developing cancerous condition.

Many virus like CMV (cytomegalovirus), SV40 (simian virus 40), can cause cancer by affecting the cycle of cell division and inhibit apoptosis, allowing uncontrolled cell division.


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Signs & Symptoms

Since it is a lung disease, a tumour in the airways like trachea,bronchi,etc in the lung can cause following symptoms:

  • Dyspnoea, a condition in which a patient has difficuity in breathing
  • Wheezing
  • Blood in cough (heamptysis), this blood is due to fragile surface of tumour as growth of blood vessels increases in the tumour which is coughed out.
  • Dysphonia (hoarseness in voice) due to compression on larynx
  • Chest pain or pain in the abdomen
  • Dysphagia, which is a condition due to compression on oesophagus.
  • Clubbing of nail fingers, this is very rare
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Prevention

90 percent of cases of lung cancer are caused due to cigarette smoking. Exposure to certain substances, such as asbestos, can also lead to the development of lung cancer. Exposure to second-hand smoke and other environmental factors may also be responsible.

The best means to prevent getting lung cancer is to quit smoking. Studies have shown that smokers who quit decrease their risk of lung cancer as compared to those who continue smoking. A good diet consisting of fruits and vegetables, rich in antioxidants and flavonoids helps protect cell's DNA and repair damaged cells.


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Treatments
Brain Prophylactic Radiation Modern Medicine

Brain Prophylactic Radiation is used for small cell lung carcinoma, which can also spread to the brain; prophylactic treatment is used in the early stages of cancer as they are too small to be detected by CT scan or MRI.

Chemotherapy Modern Medicine

Chemotherapy may be given alone, as an adjuvant to surgical therapy, or in combination with radiotherapy. This therapy is mainly for small cell lung carcinoma as it spreads more. It includes giving medicines that can inhibit the growth of proliferation of tumour cells, certain drugs target on the cell cycle. As most of the cancer drugs work by inhibiting the cell cycle of the dividing cell, so, the cells which are in non dividing stage and may enter into the dividing stage after sometime may not get affected by drugs. So, in this condition cells have to be in the dividing stage.

Photodynamic Therapy Modern Medicine

In this therapy there is a naturally occurring photosensitizing material, which can enter selectively into rapidly dividing active cells such as cancer cells, and when a doctor applies light on it then there is activation of this photosensitizing material and which can destroy the cancer cell. The material releases the toxin that destroys it. The drawbacks of PDT are that it is only useful in treating cancers that can be reached with a light source.

Radiation Therapy Modern Medicine

Radiation Therapy uses high-energy X rays to kill dividing cells. Radiation can be given externally to the cancer or it can be placed internally through placement of radioactive substances in sealed containers within the area of the body where the tumor is localized. This is called as Brachytherapy. This is usually done through a bronchoscope. Radiation therapy can be used in patients in which surgery is contraindicated or in those in which the cancer spreads to the lymph nodes. Radiation therapy causes some unpleasant side effects like nausea, vomiting, etc

Surgery Modern Medicine

Though there are many therapies that are used to treat lung cancer but none of them is proven to be fully advantageous to treat the disease in its advanced condition. Following treatments are used:


About 10-15% of lung cancers are removed surgically. There can be a wedge resection in which only a part of the affected lobe is removed. Lobectomy, in which there is removal of whole lobe of the lung, and pneumectomy, in which there is removal entire lung, is conducted.

The risks of surgery include complications due to bleeding, infection, and of general anesthesia. Surgery is more commonly performed with non small lung cell carcinoma as this type of cancer spreads less, so it is easily removed by surgery.

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