Everything You Need To Know About Lung Cancer

As Dave Pelzer emphasised, one can either see themselves as a victim of cancer or as a survivor of it — highlighting that it all comes down to one's mindset.

The latest data from the National Cancer Registry Programme (NCRP) highlights a bleak situation. Lung cancer is not just the most common cancer worldwide but also had an estimated 2.2 million new cases and a staggering 1.8 million deaths in 2020 alone.

Lung cancer, scientifically called bronchogenic carcinoma, is a rapidly spreading tumour of the connective tissues of the lungs or the airways (bronchioles) that supply air to the lungs.

Normally, cells divide to create more cells. However, mutations can cause cells to divide uncontrollably, forming tumours that disrupt organ function. This is what makes a tumour malignant or cancerous. The same is the case with lung cancer.

Metastasis is an important concept in cancer studies. It describes how cancer moves from its initial location to different areas of the body, significantly complicating treatment efforts.

Lung cancers may metastasise to the bones, heart, liver, and other organs.

To broadly understand, there are two types of lung cancer: primary and secondary.

• Primary lung cancer originates in the lungs.
• Secondary lung cancer originates in another part of the body and spreads to the lungs.

These types are distinct and require different treatment approaches.

The 2021 classification system by the World Health Organization (WHO) organises lung tumours into various categories. These categories include glandular precursor lesions, adenocarcinomas, adenosquamous carcinomas, squamous precursor lesions, squamous cell carcinomas, large cell carcinomas, sarcomatoid carcinomas, lung neuroendocrine neoplasms, tumours of the salivary gland type, neuroendocrine tumours, neuroendocrine carcinomas, and additional types of epithelial tumours.

To help you understand better, there are two main types of lung cancer based on its pathology: NSCLC (non-small cell lung cancer) and SCLC (small cell lung cancer).

NSCLC is the most common type, accounting for over 80% of cases. Squamous cell lung carcinoma that arises in the air passages, adenocarcinomas that occur in the outer layers of the lungs, and so on fall under NSCLC.

On the other hand, SCLC accounts for 15%-20% of the cases. This kind of lung cancer usually grows and spreads quicker than NSCLC. By the time it is identified in the majority of individuals with SCLC, the cancer has already extended beyond the lungs.

Like in other cancers, the prognosis and treatment’s success depend entirely on detection and intervention in the early stages. The staging depends on three factors — the size of the tumour, the extent of metastasis, and the involvement of the nearby lymph nodes. Lung cancer is staged as follows:

• Stage 0, or the in-situ stage, indicates that the cancer is confined to the surface lining of the lung or bronchus and has not extended beyond that area.
• Then comes Stage I, which means that the cancer is still contained within the lung and has not spread outside of it.
• This is followed by Stage II — the cancer has grown larger than Stage I and may involve nearby lymph nodes within the lung, or there are multiple tumours in the same lobe.
• In Stage III, cancer has advanced beyond Stage II, possibly involving nearby lymph nodes or other lung structures, or there are multiple tumours in different lobes of the same lung. 
• Lastly, in Stage IV, the cancer has metastasised to the alternate lung, the fluid surrounding either the lung or the heart, or to remote organs within the body.

Lung cancer progresses slowly and stealthily. Sometimes, the symptoms are chronic, yet too ordinary and not specific enough to prioritise. Hence, they often get overlooked until patients start to feel breathless and visit a doctor.

It all starts with an annoyingly persistent cough that won’t go away and worsens. If there’s blood in the cough or the spit looks rusty, that’s a concern.

Eventually, chest pain can occur while coughing and with deep breaths, laughter, or physical activities. Watch out for constant shortness of breath or unusual fatigue accompanying the cough. These are early indicators. If left untreated, there can be hoarseness of voice, unexpected weight loss, and poor appetite. These are potential warning signals.

Metastatic lung cancers can show signs and symptoms irrelevant to the lungs and airways. These symptoms depend on where the tumour has lodged after travelling. For instance, if it spreads to the bones, it often leads to persistent back pain or discomfort in the hips.

Should cancer metastasise to the brain, patients might suffer from frequent headaches, numbness or weakness in the limbs, dizziness, balance problems, and even seizures. When it reaches the liver, jaundice may develop, characterised by yellowing of the eyes and skin.

It's best to understand the risk factors and causes to determine the preventive measures. Given the air pollution we are exposed to these days, there isn’t a sure-shot way to avoid and prevent lung cancer. Having said that, you can definitely avoid certain habits and situations that may eventually trigger lung cancer. 

Risk factors for lung cancer:

• Cigarettes, cigars, and pipe smoking
• Passive smoking
• Family history of lung diseases
• Environmental risk factors — working near mines or in factories/industrial plants, etc. 
• Beta-carotene supplementation if you are a heavy smoker
• According to studies, these are the protective factors for lung cancers:
• Quit smoking, vaping, and all other forms of tobacco/nicotine exposure. 
• Use protective gear — wear masks and filters at workplaces with risk factors.
• Reduce exposure to radon (a radioactive gas emitted from water, soil, etc). Get your house checked for radon exposure.
• Along with prevention, it is important to eat healthy, exercise daily (physical activities that set your heart and lungs racing), manage stress, and get your periodic lung cancer screening done (in case you are vulnerable) to stay off the lung cancer radar.

Lung cancers are tricky as they begin as minor respiratory issues. Latest advancements in medicine today make it possible to have a variety of screening and imaging tests for detecting lung cancers. But before that, if you have been smoking relentlessly, have a lung-unfriendly work environment, or have a family history of lung diseases, then it’s time to take action.

The treatment protocols for lung cancer patients depend on the stage of the disease. They are extensive and patient-specific and include surgery and several therapies.

The first signs of lung cancer include a mild to moderate chronic cough that worsens with time and may be accompanied by mild chest pain, breathlessness, and fatigue.

Lung cancer usually starts with mutations in the lung cells. These cells divide uncontrollably, forming tumours that disrupt the healthy lung tissues and airways. 

Yes, lung cancer can be cured if it is diagnosed very early with no metastasis of the tumour from the lung region and when the patient is otherwise healthy.