“All you need to know about Lung Cancer”

— Get Well in India

Introduction

Lung cancer occurs when a cell in the lung becomes abnormal and begins to multiply. These abnormal cells eventually form a mass, or a tumor, and can spread to other parts of the body if not treated in the early stages.

Lung cancer surgery aims to remove the tumor formed by abnormal cells. If the tumor is too large for surgery at diagnosis, many lung cancer then patients are given radiation and/or chemotherapy to shrink the tumor before the surgery is performed.

In the lung cancer surgery, the portion of the lung containing the cancer and the adjacent lymph nodes  are surgically removed. Lymph nodes in the chest trap cancer cells as they leave the lungs and are the first site where lung cancer spreads. How much tissues in the lung are removed during a surgical procedure depends on many factors, such as the size and location of the tumor and your overall health and strength.

Head doctors

Dr. Rajesh Mistry

Dr. Rajesh Mistry

Cancer Specialist
Dr. Suresh Advani

Dr. Suresh Advani

Cancer Specialist
  • Anatomy

    The lungs in the chest are surrounded by the chest wall. The chest wall is made up of the ribs and the muscles between the ribs. The chest has two lungs (the right lung and the left lung).  

    Each lung is divided into lobes ( or sections):

    The left lung has 2 lobes. The heart sits in a groove (cardiac notch) in the lower lobe.

    The right lung has 3 lobes and is slightly larger than the left lung.

    The windpipe (trachea) is the tube-shaped airway in the neck and chest. It divides into 2 tubes or branches called the main bronchi. One bronchus goes to each lung. The area where each bronchus enters the lung is called the hilum.

    The pleura is a thin membrane that covers the lungs and lines the chest wall. It protects and cushions the lungs and produces a fluid that acts like a lubricant so the lungs can move smoothly in the chest cavity. The pleura is made up of 2 layers:

    Inner (visceral) pleura – the layer next to the lung

    Outer (parietal) pleura – the layer that lines the chest wall

    The area between the 2 layers is called the pleural space.

    The lungs produce a mixture of fats and proteins called lung or pulmonary surfactant. The surfactant coats the surfaces of the alveoli, making it easier for them to expand and deflate with each breath.

    Different groups of lymph nodes, which are part of the lymphatic system, drain fluid normally produced in the lung.

    What the lungs do?

    The main functions of the lungs are to transfer oxygen from the air to the blood and to release carbon dioxide from the blood to the air. Air enters the mouth or nose and travels through the windpipe, bronchi and bronchioles to the alveoli. The exchange of oxygen and carbon dioxide takes place in the alveoli. The alveoli absorb oxygen from the air and pass it into the blood, which circulates the oxygen around the body.

    Carbon dioxide, which is a waste product of the body’s cells, passes from the blood into the alveoli and is breathed out.

    The lungs also play a role in the body’s defence mechanism against harmful substances in the air, such as smoke, pollution, bacteria or viruses. These substances can enter through the nose and get trapped in the lungs. The lungs produce a thick, slippery fluid  called mucus, which can trap and destroy these substances from the air and it is removed by coughing or through nose.

  • Symptoms

    Symptoms can also vary according to the location of the tumor within the lung. As advancements are made from early stage to next stage, you may watch for the following symptoms;

    • Unstoppable cough
    • Acute chest pain
    • Coughing up blood
    • Feeling short of breath
    • Wheezing
    • Losing your voice (hoarseness)
    • Getting sick with pneumonia and bronchitis a lot
    • Swollen neck and face
    • Loss of appetite
    • Losing weight without any reason
    • Feeling tired
  • Diagnosis

    Screening can find some lung cancers, but most lung cancers are found due to visible symptoms as they cause trouble to you. The actual diagnosis of lung cancer is made by looking cells under a microscope.

    Your doctor will ask about your medical history to know your symptoms and might suggest some tests like x-rays, CT scan, MRI, ultrasounds, Positron emission tomography (PET) scan or a biopsy and other tests depending upon your symptoms. After reviewing the results, your surgeon will speak to you about the best option.

    Stages of lung cancer: The stage of a cancer describes its size and whether it has spread beyond its original site. The stage of the cancer helps the doctor to decide on the most appropriate treatment. Cancer is divided into four stages:

    • Stage 1 is small and localized
    • Stages 2 and 3 have spread into surrounding structures
    • Stage 4 has spread to other parts of the body.

Stages & Treatment Details

Surgery, radiation, chemotherapy, targeted drug therapy alone or in combination are used to treat lung cancer. Each of these types of treatments may cause different side effects.

Surgery: This is done in stage I and stage II where a surgery is performed to remove the tumor. For this procedure, the surgeon makes a small incision, or cut, in the chest and inserts a tube called a thoracoscope. The thoracoscope has a light and a tiny camera connected to a video monitor so that the surgeon can see inside the chest. A lung lobe can then be removed through the scope, without making a large incision in the chest.

Chemotherapy and Radiation: Chemotherapy drugs interfere with the ability of cancer cells to grow and spread, but they also damage healthy cells. Healthy cells can recover over time. Where the tumor cannot be surgically removed, doctors typically recommend chemotherapy in combination with high-dose radiation treatments.  Among the drugs most commonly used are cisplatin (Platinol) or carboplatin (Paraplatin) plus docetaxel (Taxotere), gemcitabine (Gemzar), paclitaxel (Taxol and others), vinorelbine (Navelbine and others), or pemetrexed (Alimta).

There are times when these treatments may not work or the lung cancer may come back. In such cases, doctors often prescribe a second chemotherapy. Common side effects are:

  • Fatigue
  • Nausea
  • Vomiting
  • Loss of appetite and weight loss
  • Skin changes in the area being treated, which can range from mild redness to blistering and peeling
  • Hair loss where the radiation enters the body

Targeted Therapies for Lung Cancer: Targeted therapies use drugs or other substances to block the growth and spread of cancer cells. These drugs are able to attack specific types of cancer cells. Targeted therapy is sometimes used to treat those cancer cells which have come back again or those which cannot be treated by chemotherapy. Common side effects of these drugs include:

  • High blood pressure
  • Fatigue
  • Bleeding
  • Low WBC count
  • Headaches
  • Mouth sores
  • Loss of appetite
  • Diarrhoea

After a surgery, your doctor keep an eye on your progress. Your dressings will be changed time to time and the surgical wound will be cleaned so that there is no infection.  The stitches or clips in the surgical would will stay in for about 10 days.

It’s normal to experience some pain for the first week or so. Your doctor will give you painkillers. Immediately after surgery you can’t eat or drink. You have fluids through a drip. You gradually build up what you drink and eat. Your physiotherapists will help you to move around as soon as possible. Within a few days you’ll be able to walk.  

Once you are eating and drinking, walking around the ward, climbing stairs, your surgical wound is healing well. If you feel very tired for several weeks and sometimes months after your surgery. You should try and do the following:

  • Avoid sitting for long hours
  • Walking around the house on an hourly basis
  • Building up to walking outside for fresh air

Your recovery will depends on how fit you were before surgery and your will power.

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