Frequently asked questions
A cancer originating in the lungs is called lung cancer. Lung cancer occurs due to an unrestrained growth of abnormal cells in the lung. These cells grow to form tumours, and disrupt the functioning of the lungs, which is to provide oxygen to the body.
Lung cancer is the most common type of cancer among males and females. It is also the most common cause of cancer-related deaths. The average 5-year survival rate of an early stage lung cancer is about 52% while that of a stage 4 lung cancer is only 4%. Lung cancer affects the proper functioning of the lungs. It interferes with the respiratory mechanism to create a host of symptoms.
Most often lung cancers do not show any symptoms, until they have spread and reached later stages. However, in some cases, people with early lung cancer do show some symptoms. It is extremely important to visit a doctor immediately when you first notice the symptoms, since early diagnosis of cancer is key to its successful treatment.
The most common symptoms of lung cancer are:
· Persistent cough
· Traces of blood in sputum
· Coughing up of blood or haemoptysis
· Chest pain that gets worse with coughing, laughing or deep breathing.
· Hoarseness of voice
· Unexplained weight loss
· Loss of appetite
· Shortness of breath
· Feeling tired or weak all the time
· Recurrent bouts of bronchitis and pneumonia
· Sudden onset of wheezing
If lung cancer has spread to other organs then, the following symptoms will be noticed.
· Extreme bone pain
· Depending on where to the cancer has spread, there will changes in the nervous system. Headaches, dizziness and seizures can start occurring.
· If the cancer has spread to the liver, then the patient will suffer from jaundice. The skin will become yellow in colour.
· If the cancer has spread to the lymph nodes, then lumps will start showing up in different parts of the body such as the neck.
There are three main types of lung cancer. They are Non-Small Cell Lung Cancer (NSCLC), Small Cell Lung Cancer (SCLC) and Metastatic Lung Cancer.
Non-Small Cell Lung Cancer (NSCLC):
Being the most common form of lung cancer, almost 85% of lung cancers belong to this category. The growth and spread of these cancers are slow in comparison to others. NSCLC has four major subtypes:
Adenocarcinoma: Accounting for almost 40 % of all lung cancer cases, adenocarcinoma is the most common form of lung cancer for both men and women. Adenocarcinoma occurs in the glandular cells that form the lining of the lungs.
Squamous Cell Carcinoma: This form begins in the squamous cells that form the lining of the bronchioles. This accounts for about 25% to 30% of lung cancers.
Large Cell Carcinoma: This can begin anywhere in the lungs and is regarded as a fast-growing NSCLC. Almost 10% of all lung cancers are of this type.
Large Cell Neuroendocrine Tumours: The fastest-growing form of all NSCLCs, they form only 2% of all lung cancers.
Small Cell Lung Cancer (SCLC):
This type of lung cancer grows and spreads far faster than NSCLC. The cells that make up the tumour are small in nature and hence the name.
Metastatic Lung Cancer:
This term applies to any form of lung cancer that has spread to other parts of the body, usually through the lymph nodes or the blood.
Some less-common types of lung cancers are Sarcomatoid carcinoma, Mesothelioma, Granular cell lung tumours, Carcinoid tumours etc.
Non-small cell lung cancers have four stages-
Stage 1 – in this case the tumour is in a single lung and has not spread to any lymph nodes or other distant organs.
Stage 2 - the cancer has spread to the adjacent lymph nodes but has not spread to any distant organs.
Stage 3 - this stage is subdivided to two other stages-
Stage 3a- cancer has not spread to the other lung but involves the lymph nodes in the same side. No spread to other organs.
Stage 3b- In this stage the cancer has spread to the opposite lung and has progressed further above the collar bone to the throat and neck.
Stage 4- this stage is subdivided into two other stages-
Stage 4a- the cancer has spread to other areas of the chest and to other organs as well
Stage 4b- the cancer has reached outside the chest and spread throughout the body
Small cell lung cancer has two stages:
Limited Stage: The cancer has affected only one of the lungs and nearby lymph nodes.
Extensive Stage: The cancer has spread to both lung and other areas of the chest and body.
The exact cause of lung cancer is still not clear. It is attributed to the genetic mutations that happen to the cells in the lungs. This results in their abnormal and uncontrolled multiplication. The result is a cancerous tumour. Though the cause is unknown, there are certain factors that increase the risk of getting lung cancer.
Smoking is the most important risk factor for lung cancer. More than 85% of lung cancer sufferers have a history of smoking. The more one smokes or the longer one smokes, more the risk. If smoking is combined with other risk factors, the chances of getting lung cancer become even higher. But if one stops smoking, there is a proportionate decline in the risk.
However, not every lung cancer patient is a smoker. There are a lot of other risk factors as well that can cause lung cancer. Some of the non-tobacco related causes of lung cancer are:
· Exposure to radon gas: This is one of the leading causes of lung cancer amongst non-smokers. Radon is a naturally occurring radioactive gas, usually found concentrated in houses built on land rich in natural uranium deposits.
· Second-hand smoking: Non-smokers who breath in tobacco smoke are equally exposed to nicotine and other chemicals, just as smokers are. Hence, they are equally at risk to getting lung cancer.
· Air pollution: Air pollution has long been associated with lung cancer. Both outdoors and indoor pollution can cause lung cancer.
· Family history: If anyone in a family has or has had lung cancer, then the chances of their close family members getting this disease is high.
· History of lung diseases: History of chronic lung diseases such as tuberculosis, cystic fibrosis etc. are established risk factors for lung cancer.
· Radiation therapy: If a person had radiation therapy to the breast or chest, then their risk of getting lung cancer increases.
· Metastatic cancer: Metastatic spread of other cancers to the lungs is another way non-smokers can get lung cancer.
One should also note that not everyone with exposure to risk factors gets lung cancer. Similarly, people never exposed to any of the risk factors get the disease. Risk factors are guidelines that can help in assessing the chances of getting the disease. People belonging to a high-risk group should undergo periodic screening tests for cancer. This helps in early detection and an early initiation of treatment if necessary.
The common methods of diagnosis of lung cancer are imaging tests like chest x-rays, CT and PET scan. Bronchoscopy, Sputum studies, and Biopsy are done for confirmation.
The type of treatment for lung cancer depends on several factors including:
· the type of lung cancer (non-small-cell or small-cell cancer)
· the position and size of the cancer
· the stage of cancer
· the overall health
Surgery is mostly used to treat non-small cell lung cancer. If the cancer is located near the heart, windpipe, food pipe and major blood vessels, then surgery might not be a viable solution. Surgery is not normally used to treat small cell lung cancer unless it is at a very early stage.
There are different types of lung surgery:
Wedge resection- it is the removal of a small section of the lung that contains the tumour along with a margin of the healthy tissue surrounding it.
Segmental resection -the removal of a segment of a lobe
Lobectomy- the removal of an entire lobe of one lung
Pneumonectomy- the removal of an entire lung
Radiotherapy uses radiation by x-rays or other radio-active rays to destroy cancer cells. In case the patient is not fit for undergoing the surgery, then an intensive course of radiotherapy, known as radical radiotherapy, is administered in non-small-cell lung cancer treatment. For very small tumours, a type of radiotherapy called stereotactic radiotherapy is instead of surgery. Palliative radiotherapy is used to control the symptoms and prevent the spread in situations where a cure is not possible. Prophylactic cranial irradiation (PCI) is done to prevent the spread of the cancer to the brain. External beam radiation therapy is more commonly used than internal radiation therapy in lung cancer.
Chemotherapy uses drugs to destroy cancer cells. The drugs are given orally or intravenously. Chemotherapy is done before surgery to shrink the tumour or after surgery to prevent the return of cancer. It is also given in combination with radiotherapy. Chemotherapy is also given as a palliative measure to relieve symptoms when a cure is not possible. Chemotherapy is usually done in cycles with appropriate intervals in between.
Other treatments available:
Biological therapy is a treatment that works by inhibiting the growth of cancer cells. Treatments like Radiofrequency ablation, Cryotherapy, and Photodynamic therapy uses heat, cold and lasers respectively to destroy tumours.
In India, cancer treatment costs a fraction of what it does in many countries around the world. Surgery costs depends on the type of surgery to be performed and the hospital where it will be performed.
Here’s a quick breakdown of other treatment costs:
• Cost of evaluation – Approx. 1,500 USD
· Chemotherapy – Approx. 1,300 to 1,500 USD per cycle
· Pre-operative investigations - 2500 USD
Apart from these, patients will also need to factor in additional costs such as travel fares, hotel stay costs for themselves and their travelling partner(s), medicines, food expenses etc.
Listen to expert doctors talking about treatment for Lung Cancer
Dr Prashanth, an expert oncology doctor explains in detail about lung cancer and the treatment options for the same