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Lung Cancer

What is lung cancer?

Malignant tumors which develop as a result of uncontrolled growth and proliferation of abnormal cells in one or both of the lungs.

Lung cancer is classified into small cell (oat cell) lung cancer and non-small cell lung cancer.

Non-small cell lung cancer: Non-small lung cancer has many subtypes. Each subtype has different cancer cells. Each cancer cell grows differently and spreads in different ways. Types of non-small cell lung cancer are determined by the type of cells in the cancer tissue and the appearance of the cells when examined under a microscope. Small cell lung cancers comprise roughly 15% of all lung cancers. Lung cancer is often seen in smoking patients. Its spread to the body through the lymphatic system and blood is faster compared to other types of lung cancer.

Squamous cell carcinoma: This cancer type originates from squamous cells that appear thin and flattened like herringbone. It is also called epidermoid carcinoma.

Adenocarcinoma: It arises from cells with glandular (secretory) features.

Large cell carcinoma: It is cancer in which large and abnormal cells are seen when viewed under the microscope.

Adenosquamous carcinoma: Cancer that begins in cells that appear flattened under the microscope and also exhibits glandular features.

Pleomorphic, sarcomatoid, or sarcomatoid carcinoma: It is a group of cancers that progress with different types of cancer cells under the microscope.

Carcinoid tumor: It is a slow growing, neuroendocrine (starting from cells that secrete hormones as a result of nervous stimulation) cancer.

What are the symptoms of lung cancer?

The symptoms of lung cancer may vary depending on the location. A mass located in the upper part of lung may cause pain in arm and shoulder, hoarseness, blepharoptosis by compressing some nerves. These symptoms can be neglected since they can be seen in many diseases. Any upper respiratory tract infection, lung infection, musculoskeletal pain can cause these complaints. If the duration of these symptoms exceeds a few weeks, a doctor should be consulted immediately. Some of the symptoms of lung cancer are as follows:

 

  • Persistent shortness of breath, wheezing
  • Persistent and progressively worsening cough
  • Hemoptysis
  • Loss of appetite and weight loss
  • Chest pain
  • Hoarseness
  • Dysphagia

 

The most common symptom of lung cancer is persistent cough. In addition, chest pain, shortness of breath, fever, hoarseness, swelling in the face and neck, shoulder and arm pain, back pain, difficulty in swallowing and bloody sputum are also symptoms of lung cancer. In a quarter of lung cancer patients, hemoptysis accompanying cough is observed. Head and bone pain, faigue and weakness are also common symptoms of lung cancer.

The symptoms of lung cancer sometimes are quite insidious. In almost a quarter of patients, cancer presents without any symptoms. Most people find out they have lung cancer when they have a chest X-ray for another disease. Thus, routine controls are of vital importance in determining the early-stage lung cancer. Lung cancer, diagnosed in the early stages has a very high chance of being treated successfully. Today, with the advances in imaging techniques such as low-dose spiral computed tomography, lung cancer can now be detected at an early stage.

How is lung cancer diagnosed?

For the diagnosis of lung cancer, firstly, it is necessary to reach a mass determined on x-ray. Diseases of the person, status of tobacco use (cigarette, pipe, cigar, etc.) , environmental or occupational exposure to substances and whether there is cancer in other family members are asked. If lung cancer is suspected, sputum examination (sputum cytology; examination of the material coming out of the mucous membrane of the lungs with a deep cough under a microscope) may also be requested by the doctor. This technique is a simple and useful test for diagnose of lung cancer. To be sure of cancer, the doctor may need to examine the lung tissue. This examination is to determine the type of cancer (non-small cell or small cell) and the extent to which it has spread (metastasized) or the stage of the cancer. Then, to determine how to reach the mass a computerized tomography is taken. The most appropriate way of reaching the mass is determined by using fine needle biopsy or bronchoscopy. Lung cancer is diagnosed by examining the biopsy. If the disease has spread to other organs, the diagnosis can be carried out by taking samples from those organs. After diagnosis, lung cancer stages are determined.

Since lung cancer is a type that cannot be evaluated in cancer screening programs, it can rarely be detected in the early stage, that is, before it spreads from the lung to the lymphatics or other organs. The probability of detecting the disease at an early stage is around 15%. The 5-year survival rate is 50% in cases that have not spread to the lymph nodes. However, when cancer is diagnosed in these patient groups, this rate falls below 15% because the disease has spread to nearby organs other than the lung. Early diagnosis of lung cancer occurs in routine tests or examinations for another health problem.

Imaging methods in lung cancer

Chest x-ray: After the detailed history and physical examination of the patients, a two-way chest X-ray is taken as the first step for diagnosis. In some cases, damage to the lungs due to the tumor can be detected with this imaging method. However, since chest X-ray does not always give a clear response, any small change to be seen on the film should be detected by lung tomography.

Computed tomography (CT): Computed tomography gives information about the size, shape and location of the tumor. It shows lymph nodes that have become enlarged due to disseminated lung cancer. With the diagnosis of early-stage lung cancer, it shows the condition of the liver, adrenal glands, brain and other internal organs where lung cancer can spread.

Magnetic Resonance Imaging (MRI): This technique allows visualization of the lung by dividing the lung into sections by means of computer together with magnetic and radio waves. There is no radiation hazard since x-rays are not used in MRI examination.

Positron Emission Tomography (PET): The procedure is performed using a low-dose radioactive substance bound to a sugar molecule that collects in cancerous tissues. Rather than diagnosing of cancer, it is applied in determining whether the tumor has spread in patients diagnosed with cancer, and in planning the treatment by staging lung cancer.

Bone Scintigraphy: Thanks to the radioactive substance given to the patient through the vein, it is determined whether the cancer cells show any spread to the bones. It is a method that is routinely applied especially in small cell lung cancer and in cases where bone metastasis is suspected in non-small cell lung cancers.

Biopsy methods in lung cancer
Lung cancer may progress locally in the lungs or may spread (metastasized) to other parts of the body, including the lymph nodes, bone, and brain. For this reason, in order to determine the lugn cancer and its type, a tissue sample is taken from lung. The tissue sample taken by biopsy is examined under microscope. Doing a biopsy on the tissue seen in the lung and believed to be cancer does not cause the tumor to spread and the disease to worsen.

The methods used to take this tissue sample are as follows:
Bronchoscopy in Lung Cancer: The airways are examined and small tissue samples are taken through a thin lighted tube inserted orally into the bronchus and trachea.

Needle Aspiration in Lung Cancer: For the mass in the lung, a sample is taken from the cancerous tissue by entering the needle through the chest wall. This sample is examined under the microscope.

Thoracentesis Application in Lung Cancer: A sample is taken from the fluids covering the lungs with a needle to determine the cancer cells.

Thoracotomy Application in Lung Cancer: This method, used for the diagnosis of lung cancer, is the opening of the rib cage with a surgery. It is performed in case all other methods are not suitable or if success cannot be achieved with all methods.

Sputum Cytology in Lung Cancer: It is the method of examining the material coming out of the mucosa in the lungs with a deep cough under the microscope. The sputum sample taken from the patients is examined under a microscope to determine the cancer cells.

In case the patient is diagnosed with lung cancer as a result of the examinations, the samples taken from the patient are subjected to a series of tests in order to determine the stage and spread of the cancer and to determine the best treatment method. The treatment of lung cancer is personalized, according to the stage of the cancer and the results of these tests.

How is lung cancer treated?

As in all other cancers, lung cancer treatment varies depending on many factors such as the general health status of the disease, the stage of the disease and the type of cancer. At many stages, different treatment combinations and personalized treatments are performed. For this reason in the treatment of lung cancer, choice of full-fledged hospital and specialist doctor are very important.

A small number of cancer cells that are likely to be left behind after lung cancer surgery are eliminated by the adjuvant treatment method. This treatment method is planned according to the patient's diagnosis report, age and general health status. After the surgery of lung cancer, patients can receive only chemotherapy or only radiotherapy or both chemotherapy and radiotherapy as adjuvant treatment. Sometimes, in early stage patients, post-operative adjuvant treatment may not be required.

Treatment methods in lung cancer

Surgery in lung cancer

The surgery of lung cancer is one of the methods of lung cancer treatment. The type of surgery depends on the location of cancer in the lung. This is an operation in order to take the small sample in the lung. While surgical removal of the entire lobe is called lobectomy, removal of either the right or left lung is called pneumonectomy. Due to their location, size and general health status of the patient some tumors cannot be operated.

Chemotherapy in lung cancer

Chemotherapy treatment in lung cancer is the elimination of cancer cells with drugs. In general, chemotherapy consists of 2 drugs. Chemotherapy can only be performed by nurses with fully trained in this field. The number of times that chemotherapy is delivered is expressed as a "cure" and is usually repeated every 21-28 days. In fully equipped outpatient centers, chemotherapy in lung cancer is usually administered in the form of intravenous fluids or oral pills. In some cases, depending on the negativity of the patient's condition or the nature of the drugs given, chemotherapy is given as an inpatient. After each chemotherapy cycle, patients are checked in the medical oncology clinic. In these controls, patients are examined, their complaints are listened to, the side effects of drugs are questioned, and some blood tests are requested to investigate whether they cause any harm to other organs in the body. Before each cycle, blood count should be done and this count should be shown to authorized nurses giving chemotherapy.

The characteristics of the tumor in the pathology report determine whether a patient will receive chemotherapy after surgery, and if so, how many cycle she/he will receive. However, in making these decision, the age and general condition of the patient also play an important role. As they cannot tolerate side effects, chemotherapy is not suitable for patients whose general condition is poor enough to spend more than 12 hours in a day. If patients who are scheduled for chemotherapy have had surgery, it is preferable to start chemotherapy within 3 weeks after surgery. Patients receiving the first chemotherapy should have their blood and general condition checked in the medical oncology clinic approximately one week after chemotherapy. In this control, the general conditions of the patients, the way they tolerate the treatment and their blood tests are examined, and their complaints, if any, are listened to. In the subsequent cycles, the blood controls and general conditions of the patient are examined before each treatment. The dose of the drug is adjusted if necessary, by evaluating the side effects of chemotherapy.

Smart drugs and smart molecule therapy

It is a form of treatment with oral pill-form drugs given to suitable patients after extensive pathological examination of the type of non-squamous cell lung cancers of non-small cell lung cancers in recent years. For small cell and squamous cell lung cancers, smart drug therapy is not suitable. In treatment guidelines around the world, if the pathology reports are appropriate, smart therapies are used as the first-line treatment of small and non-squamous cell lung cancers in advanced-stage patients. Advanced pathological examinations performed on these patients are called EGFR mutation test and ALK fusion test. In non-smokers, the rate of positive determination of these tests is higher. However, even in smokers, the rate of one of the two tests being positive is around 20%. This is the possibility that one out of every five patients will benefit from these treatments, which should never be ignored.

Radiotherapy in lung cancer

Radiotherapy is the use of high-energy rays to kill cancer cells. It is applied to a limited area and affects cancer cells in that area. Radiotherapy can be given before surgery to shrink a tumor or after an intervention to eliminate a cancer cell. Clinicians usually use radiotherapy as the first alternative in patients with locally advanced cancer that cannot be operated with chemotherapy but not spread to a distant site (metastasis). Radiotherapy can also be used to relieve symptoms such as shortness of breath or pain in patients with advanced stages.

Vaccine therapy in lung cancer

In the treatment of lung cancer, especially in recent years, serious developments can be mentioned. One of the most important of these developments regarding the patients with stage four lung cancer, is immunotherapy, also known as vaccine for lung cancer. Immunotherapy means that the patient fights cancer cells by using his own immune system. Therefore, it has fewer side effects than other chemotherapy drugs. Until a few years ago, other chemotherapy drugs were tried for patients with stage 4 lung cancer, and vaccine of lung cancer was used when successful results were not obtained. Today, patients with stage 4 lung cancer in America and Europe can be treated with this cancer vaccine right from the start.

Some tests are required from the patient to be able to use vaccine of cancer lung. It is determined whether the patient is a candidate for this vaccine according to the type of lung cancer. If the patient is a candidate for the vaccine, lung cancer vaccine treatment can be started from the first moment of diagnosis. Although the vaccine does not have typical side effects such as nausea and vomiting, it can cause temporary inflammation in the intestines and thyroid gland.

Since the lung cancer vaccine is currently used only in the fourth stage patient groups, it can affect life expectancy. All treatments are applied to prolong the life of the patient in stage 4.

Why should I be treated at Memorial Health Group for lung cancer?

In the treatment of lung cancer, many different treatment methods can be used individually or together. In the treatment of lung cancer, procedures performed through the trachea such as radiation oncology (radiotherapy), medical oncology (chemotherapy, immunotherapy, smart drug), interventional bronchoscopy, robotic, open or closed (VATS) surgeries of thoracic surgery can be applied. All of the treatment methods listed above, which are necessary in the treatment of lung cancer, are successfully applied in Memorial Health Group. It should be noted that the treatment of lung cancer requires a team effort. In the treatment of lung cancer, Memorial Health Group acts with this notion. The aim is to apply the most modern and best treatment to patients by evaluating the patient-specific treatment method by the council formed by specialist doctors.

What should be considered after lung cancer treatment?

After lung cancer treatment, patients should pay attention to 3 important issues.

  • Post-treatment follow-up should not be neglected.
  • Smoking should be stopped. If smoking has been stopped, it should not be started again.
  • Very sugary foods should be avoided.
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