What is Lung Cancer?Lung cancer is the most common cancer that affects humans; being the top cause of worldwide cancer deaths (“Lung Cancer”, 2017). It is developed when abnormal cells within one or both lungs start to develop and reproduce at an uncontrollable rate, creating bundles called tumors. These tumors can spread to other areas of the respiratory system and vital organs, targeting and destroying the cells of the nearby tissue. Types of lung cancer Lung cancer is divided into four different divisions; small cell lung cancer (SCLC), lung adenocarcinoma (NSCLC), squamous cell lung cancer (NSCLC), and large cell lung cancer (NSCLC).
Small cell lung cancer makes up around 15-20% of all lung cancer cases and develops at a faster rate than NSCLC lung cancers (“Lung Cancer: Causes, Stages, Life Expectancy, and More”, 2017). It starts in the bronchi of the lungs and occurs most often in people who smoke. The tumor cells are much smaller in size compared to regular cells and have a flat shape (“Types of Lung Cancer”, 2017). Lung adenocarcinoma is a type of non-small cell lung cancer that develops at a very slow rate compared to other lung cancers, about 40% of lung cancer cases are lung adenocarcinoma. It is found in the smaller passages of the respiratory system such as the bronchioles and develops within the cells of glands like most other cancers. Women are far more likely than men to be diagnosed with this type of cancer as well as non-smokers (“Types of Lung Cancer”, 2017). Squamous cell lung cancer makes up 30% of cases, also a non-small cell lung cancer.
This NSCLC targets the squamous cells found in the lining of airways, the cells resemble scales. It affects the main airways into the lungs and the left and right bronchi. Furthermore, it can be spread towards the liver, spine, and brain being a strong result of smoking habits, including second-hand smoke (“Types of Lung Cancer”, 2017). Large cell lung cancer is a lesser common type of lung cancer, making up 10% of all cases. Its cells are only classified as large in size and is most commonly diagnosed in men. With advances of technology, the specifics of this type of cancer have been observed uncovering that most large cell lung cancers can be further identified as either squamous or adenocarcinoma (“Types of Lung Cancer”, 2017). Stages of lung cancer The stages of lung cancer are used to specify which treatments would work best for the type of cancer and also accurately locate the cancer tumor during diagnosis. There are five different stages used to assess the type of cancer; stage 0, stage I, stage II, stage III, and stage IV.
Stage 0 describes cancer as stationary within the lungs and no damage to surrounding tissues. In stage I, the tumor is very small in size and has not yet traveled to the lymph nodes. IA is used to identify tumors less than 3 cm in diameter and IB is used to identify tumors between 3cm and 5cm in diameter. Stage II also has two substages; IIA and IIB. With IIA the tumor is either greater than 5 cm in diameter and has not spread to lymph nodes or less than 5 cm in diameter and has spread to lymph nodes.
IIB is where the tumor is between 5 cm and 7 cm in diameter and has spread to lymph nodes, or larger than 7 cm and has translated to nearby areas such the diaphragm. Stage III is the last stage to be subdivided into IIIA and IIIB, these tumors are very difficult to get rid of. In IIIA the tumor has reached the heart and invaded the lymph nodes, or it has spread to lymph nodes located along the middle of the lungs. Stage IIIB is where the tumor spreads to the heart and many inner lymph nodes or lymph nodes outside of the lungs and the heart or bronchi. The last stage is IV, where cancer can spread into the bloodstream, the surrounding fluid of the lungs and heart, and the opposite lung (“Lung Cancer Staging”, 2017).
CausesLung cancer is caused by exposure to a number of different substances such as uranium, nickel, radon, petroleum products and cadmium, however, the largest cause of lung cancer is smoking. Smoking makes up 90% of all lung cancer cases, the increased exposure to carcinogens is what causes the abnormalities in cells (“Lung Cancer: Causes, Stages, Life Expectancy, and More”, 2017). With every 15 cigarettes that a person smokes, one cancerous DNA mutation can develop. Longer exposure to carcinogens and usage of multiple methods of smoking further increases the risk of developing lung cancer. When the smoke enters the airways it targets the lining tissue cells and damages the genetic coding within. The substances within the smoke that affect cells the most are nitrosamines, benzopyrene, benzene, and polonium-120. Benzopyrene and chromium work together to increase their bondage to the cell DNA, and other ingredients within smoke such as nickel prevent the repairing of DNA (“How smoking causes cancer”, 2017).
Symptoms and Syndromes An individual with lung cancer will experience a variety of different symptoms and syndromes depending on the severity of their cancer. The symptoms of lung cancer are usually seen during the later stages of development but are not specific to the cancer as they are commonly seen in other disorders. Symptoms include the coughing up of blood, infections such as pneumonia or bronchitis, chest and back pains, weight loss, hoarseness, jaundice, and the swelling of neck veins or the face (“Signs & Symptoms”, 2017). The syndromes that are experienced are more specific to this type of cancer, they include Horner Syndrome, Superior Vena Cava Syndrome, and Paraneoplastic Syndromes. Horner syndrome includes a group of syndromes that follow lung cancer located along the top of the lungs. With Horner Syndrome, the individual will experience the absence of sweat and a smaller pupil size on the same side as the tumor, severe shoulder pain, and a lazy eyelid. Superior Vena Cava Syndrome occurs when the tumor is located in lymph nodes located near the superior vena cava, placing pressure against it causing a backup of blood. Someone with this condition will have symptoms such as swelled body parts, dizziness, and headaches.
Paraneoplastic Syndromes develop when hormones created by the cancer enter the bloodstream and reach other parts of the body affecting them first, the cancer does not actually spread to the other body parts. Some of the most common syndromes are blood clots, nervous system problems, gynecomastia, and hypercalcemia (“Signs and Symptoms of Lung Cancer | American Cancer Society”, 2017). DiagnosisThe diagnosis of lung cancer uses the medical history of the patient along with many tests like imaging tests, biopsies, and laboratory tests to determine the chances, severity, and location(s) of the cancer. The medical history is examined first to decide whether or not the patient will need additional tests and screenings to further determine their diagnosis. The doctor will ask them a series of questions regarding their family history of lung cancer, any severe illnesses they may have or had had, and if they have been in harmful environments that have jeopardized their health.
Afterward, they will examine any symptoms the patient expresses such as shortness of breath, swollen veins, or swollen lymph nodes and if the symptoms seem severe enough, they will be taken for additional testing (“Medical History”, 2018). Imaging tests are usually done first after a medical history exam and are used to determine areas in the body that may hold the cancer, see if the cancer has spread to other sections in the body and if treatments given to the patient are working effectively. Common examples of imaging tests are chest X-rays, bone scan, magnetic resonance imaging, or a computed tomography. These scanning can identify possible tumors within the body, but do not properly determine if they have lung cancer (“Imaging Tests”, 2018). Another test that is used for the diagnosis of lung cancer is a biopsy, where samples are taken from the patient and examined by a pathologist to identify cancer. Many different methods can be used to extract the cells, some examples being a bronchoscopy and mediastinoscopy. In a bronchoscopy, a camera and light attached to a tube are moved down the patient’s trachea towards the lungs to look for unusual areas.
If an unusual area is identified, tools will be passed down the tube to collect samples of cells. In a mediastinoscopy, a tube with a lens and light attached is entered into the trachea from an incision in the neck and used to collect cells from the lymph nodes (“Biopsies”, 2018). The last test that can be used to diagnose lung cancer is a laboratory test, a patient can get sputum cytology and/or blood tests done. For a sputum cytology, the patient is required to cough up phlegm over a period of about three days. A pathologist with closely examine the phlegm for any cancer cells that may be located along the airways. Blood tests are done to check the overall health of the patient, helping to decide if they can undergo surgery. Doctors will look see if there are low numbers of red blood cells, white blood cells, and platelets in the blood (“Laboratory Tests”, 2018). Treatments The appropriate treatment for the patient’s cancer varies on a number of different factors including the stage of the cancer, symptoms, health of the patient, and how comfortable they feel with the treatment.
These factors also decide if the patient will only need one of the treatments or a combination of many; it is common for patients to receive radiation or chemotherapy after surgery. There are four main treatments for lung cancer:Surgery: Surgery is only completed if the cancer is stationary, it is most successful in non-small cell lung cancer patients. A thoracic surgeon initiates the surgery, its goal is to remove the tumor and all surrounding tissue that may hold cancer cells. The surgeon may also take out the lymph nodes of the patient for further examination of possible cancer spread. During the surgery, an entire lobe, half a lobe, or small portion of the lung can get removed regardless of the tumor size. Removing an entire lobe is the most effective type of surgery as the risk of cancer spreading elsewhere is greatly reduced.
After surgery, a patient will often experience back and chest pains and get recommended for one month of physical therapy to help relieve muscle pains and regain strength (“Surgery”, 2018). Angiogenesis inhibitors: Angiogenesis inhibitors are used to lessen blood flow to cancer cells to decrease and maybe stop the rate at which the cancer cells reproduce. They work by attaching onto the vascular endothelial growth factor (VEGF) proteins of the tumor preventing it to attach onto the VEGF receptors of blood vessels, therefore reducing blood flow to the tumor. Examples of angiogenesis inhibitors are Ramucirumab and Bevacizumab, and common side effects of these drugs include high blood pressure, fatigue, inflammation of mucous membranes located in the mouth, and headaches (“Angiogenesis Inhibitors”, 2018).
Chemotherapy: Chemotherapy works best for small cell lung cancer and uses drugs to kill the cancer cells by identifying and targeting all cells that rapidly reproduce. As a result, side effects of receiving chemotherapy are created as the drugs also kill other functioning cells in the patient’s body. Chemotherapy is taken in as one or many drugs, and enter the body through either a vein, under the skin, in a muscle, or orally. Chemotherapy takes as little as a few weeks to complete or can become a regular occurrence for the patient, it is taken in cycles of 1 to 3 days with periods of rests in between. Common side effects that follow chemotherapy are hair loss, fatigue due to a loss of red blood cells, diarrhea or constipation, and decreased appetite. To help cope with these side effects the patient can take supplements to increase appetite, medication to control diarrhea/constipation, and blood transfusions (“Chemotherapy”, 2018).
Radiation therapy: Radiation therapy uses rays of energy targeted at the tumor to stop the growth of cancer cells, similar to chemotherapy, killing them. However, unlike chemotherapy only cells that are hit by the rays of radiation are killed, leaving the rest of the cells in the body unaffected. The direction at which the rays are entering the body and hitting the tumor must be carefully created to avoid vital organs, as all cells in the ray’s path are affected. Radiation therapy can also be given by implants placed near the tumor that is removed over a certain period of time.
The radioactive effects of the implants affect the tumor and some surrounding tissue, however far fewer cells are damaged in this process when compared to the rays of radiation. Common side effects of getting radiation therapy done are: itchy, dry and burned skin, hair loss, shortness of breath and difficulty breathing (“Radiation Therapy”, 2018). Lifestyle Changes There are a number of different lifestyle changes that someone with lung cancer will have to do in order to keep the results of the treatment and prevent their lung cancer condition from worsening. Three major changes revolve around exercise, diet, and healthy choices. Out of all the symptoms that come along with lung cancer, the common ones that everybody will experience are fatigue and shortness of breath. In most cases resting to try and relive the fatigue that the patient is feeling is not going to help muscle and bone movement and can make them feel weak and even more tired.
Creating an everyday exercise plan that is compatible with their abilities is proven to help restore strength in their body, decrease fatigue, and improve breathing (“Lifestyle Changes After Lung Carcinoid Tumor”, 2018). Keeping a balanced and healthy diet is very important in controlling the patient’s weight gain from treatments, their nausea, and the number of nutrients they sound be receiving. As a result, rather than eating three meals a day, a dietitian can recommend the patient to eat many small portioned meals every few hours.
A healthy diet with nutrient and vitamin-rich foods is ideal, the patient could discuss the best meal plan for them with their dietitian (“Lifestyle Changes After Lung Carcinoid Tumor”, 2018). The last lifestyle change is making healthy choices. The best healthy choice for the patient to do is to quit smoking if they do smoke. It is well known that cancer is the largest cause of lung cancer, quitting this bad habit will stop carcinogens from entering your body and decrease the amount the mutating cells in your body.
Continuing this habit will only add on the cancer in their body, making the treatments they received ineffective. Another healthy choice is to figure out methods that help to decrease the stress levels of the patient. High-stress levels are going to weaken the immune system, reducing your body’s strength to fight against the cancer cells (Oxygen, 2018).