Lung Cancer: Types, Symptoms, and Treatment Options

Lung Cancer: Types, Symptoms, and Treatment Options

In Western industrialized countries, the number of lung cancer cases has been increasing for years. Although the trend has been declining for men since the 1980s, women are showing new sad record numbers every year. Lung cancer is now the third most common form of cancer in both sexes. In Germany, more than 50,000 people develop lung cancer every year. Its proportion of deaths is even more frightening: lung cancer is the most common cause of cancer death in men and the third most common in women.

Smoking as a risk factor

These figures are all the more tragic given that lung cancer is one of the few malignant tumours for which the leading risk factor has long been known: around 90 per cent of lung cancer patients are smokers.

If you consider that, according to a study, every third 15-year-old smokes, with Germany being one of the sad leaders in an international comparison, there is a high probability that the number of lung cancer patients will not decrease in the future either.


What is lung cancer?

Strictly speaking, lung cancer is a generic term for various malignant tumour diseases in the lungs and bronchial system. By far, the most common form (90 per cent) is bronchial carcinoma, which is often equated with lung cancer and is discussed here below. Metastases, i.e. daughter tumours of other types of cancer, can be washed into the lungs via the blood and settle there. Malignant tumours of the lungs and pleura are rare.

Depending on how the tissue appears under the microscope, a distinction is made between small cells (25 per cent) and non-small cell bronchial carcinoma. The latter is further divided into different forms, including squamous cell carcinoma, which originates from the covering tissue and is the most common at about 45 per cent, and adenocarcinoma, which, unlike all other forms, is not dependent on smoking.

Small cell bronchial carcinoma spreads secondary tumours very early and, therefore, has a poorer prognosis. In addition to the microscopic findings of the cell tissue, the tumour stage is also essential for prognosis and therapy, i.e. how extensive the cancer is and how far it has already spread to surrounding structures and in the body at the time of diagnosis.

What are the causes of lung cancer?

Bronchial carcinoma mainly develops as a result of tobacco smoking. Cigarette smoke contains around 4,000 substances, 40 of which are carcinogenic, as well as benzo(a)pyrene, which damages a gene P-53 on chromosome 9 that is responsible for fighting cancer. Not only is active smoking unhealthy, but passive smoking also increases the risk of cancer. If a non-smoker spends a cosy evening surrounded by smokers in a closed room, e.g. a pub, the body is as stressed as if it had smoked 4 to 9 cigarettes.

The risk of developing the disease increases with the number of cigarettes, the inhalation depth, the duration of smoking and age. The tar and nicotine concentration also play a role. It is assumed that after 40 pack years (i.e. one pack of cigarettes a day for 40 years), the cancer risk is 30 times higher. However, there is good news: If smokers manage to break free from their nicotine addiction, the probability of developing lung cancer gradually approaches that of non-smokers.


Airborne toxins as a cause of lung cancer

In addition to smoking, other toxins in the air we breathe can cause lung cancer, especially if we are exposed to them for a long time. These include asbestos, arsenic, chromium, cadmium, nickel, polycyclic aromatic hydrocarbons, mustard gas, uranium, radon, etc. For example, blast furnace workers, gas workers, roofers and asphalt cookers are at risk, especially if they disregard occupational health and safety regulations. The combination of these pollutants with active smoking is hazardous.

However, it has not yet been clarified why some smokers develop cancer while others are spared despite decades of nicotine addiction. A clear hereditary cause could be found just as little as a diet-related cause. However, the scientists assume that there are connections.

Lung cancer: symptoms and signs

How is lung cancer manifested? What is treacherous is that lung cancer usually does not cause any symptoms for a very long time. Lung cancer is, therefore, often discovered either by chance during an X-ray examination or only when it is already advanced and, therefore, difficult to cure. In contrast to other types of cancer, no screening test is currently offered that would be suitable for early detection screening.

When symptoms occur, they are usually indistinguishable from other lung diseases, at least initially. The following  symptoms  should prompt a visit to the doctor, especially if they occur in combination or over a long period of time:

Further symptoms can occur if lung cancer spreads and metastases settle in other organs. The spine, brain, adrenal glands and liver are particularly commonly affected, which can lead to  back painheadaches , dizziness, behavioral changes, abdominal pain or  nausea  .

How is the diagnosis made?

The examinations not only find the tumor, but also determine its type and stage in order to decide on treatment. First, the doctor will ask about your medical history, especially smoking habits and occupational risks.

The physical examination will be followed by x-rays of the lungs and various blood tests. In order to be able to assess the tumor tissue, a lungoscopy may be carried out, during which cell and tissue samples can also be taken.

Computed tomography of the chest, upper abdomen and brain can be used to determine the extent of cancer and detect secondary tumors. Skeletal scintigraphy can be used to specifically look for settlements in the bone, and if necessary, this can be followed by a bone marrow biopsy. There are also a number of other examinations that are used depending on the case and before a planned operation.


What therapy is there?

Treatment depends on the type and spread of the tumor. As far as possible, attempts are made to achieve a cure. However, this is only possible if all tumor tissue, including metastases and affected  lymph nodes,  can be removed. Only then can a recurrence be prevented. Depending on the type of cancer, stage and condition of the patient, surgery, chemotherapy, radiation therapy or a combination of these are used.

  • Surgery: The right and left lungs consist of three and two lobes, respectively, which are composed of a total of ten and nine lung segments. Depending on the size of the tumour, a segment (partial lung resection) or a lobe (lobectomy) is removed, or more rarely, the entire left or right lung (pneumectomy). A lung function test is carried out to determine whether the remaining breathing activity is sufficient. Non-small cell forms are particularly suitable for surgery.
  • Chemotherapy: Cytostatic drugs are usually given in several cycles. They are cell toxins that primarily attack cancer cells but do not spare the body’s healthy cells. This is why there are often severe side effects. Small cell carcinomas are particularly sensitive to this.
  • Radiation therapy: X-rays in specific doses damage cells. Small cell lung cancer can be reduced in size; if the skull is irradiated, it may be possible to prevent metastases from spreading.

Recently, scientists have found some new approaches at the molecular biological level in which cancer cells are targeted during therapy. Initial research results give hope that new treatment options will also emerge for lung cancer in the future.

What is the course and prognosis?

Overall, lung cancer is currently one of the most prognostically unfavourable types of cancer – 5 years after diagnosis, on average, only 13 to 14 per cent of patients are still alive. However, the prognosis depends heavily on the tumour’s type, size, and spread, the response to therapy, and the age and general condition of the patient.

Squamous cell carcinoma has the relatively best prognosis at an early stage, while small cell lung carcinoma has the worst. If left untreated, it can even lead to death within a few weeks. Regular check-ups are essential after the end of the treatment so that even a recurring tumour can be recognized and treated at an early stage. And in any case, the person concerned should consistently avoid cigarettes.

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