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Lung Cancer

Lung Cancer
Introduction:
Lung cancer is a condition resulting from the uncontrolled expansion of cells in the lungs. Normally, cells divide and replicate as part of their regular functions, but certain mutations can cause them to undergo excessive and abnormal growth. This uncontrollable cell division leads to the formation of masses or tumors in the lung tissue, hindering the proper functioning of the organs. Lung cancer specifically refers to cancers originating in the lungs, typically in the airways (bronchi or bronchioles) or small air sacs (alveoli). Cancers originating elsewhere and spreading to the lungs are usually named based on their primary site, referred to as metastatic cancer affecting the lungs by healthcare providers.

Figure 1:Lung Cancer

History:
About 150 years back, lung cancer was a very rare sickness. In 1878, the Institute of Pathology at Dresden University in Germany found that cancerous lung growths made up only one percent of all cancers seen during autopsies. By 1918, the amount had increased a lot to about 10%. And by 1927, it was over 14%. The big book about diseases, Springer Handbook of Special Pathology in 1930 said that cancer from lungs started to rise around the turn of century. This might have got even worse after World War I happened. Also it told us most cases happened with men but women were seeing this disease more and more over time too. Usually, the disease lasts about six months to two years after it’s found out. Most of these cases also included a long history of continuous coughing from bronchitis. Since 1987, lung cancer has become the main cause of death for women rather than breast cancer. Every year, 225,000 new cases of lung cancer happen in the United States. About 160,00 annual deaths come from them. In the 20th century, lung cancer was very rare. However, its big increase in later years is mostly because more and more men and women started smoking a lot.
Types of Lung Cancer:
There are many kinds of lung cancer. Mostly, they are either non-small cell lung cancer (NSCLC) or small-cell lung cancer (SCLC). Some people might have lumps that hold both kinds of cells.

Non-small cell lung cancer (NSCLC), making up around 80 to 85% of cases, has several types inside it. Most types of NSCLC respond well to early treatment.

1. Squamous cell lung carcinoma: In about 30% of cases, NSCLC starts in the cells that line pathways in our breathing system. These are called squamous cell carcinoma.
2. Adenocarcinomas: This kind usually develops in the outer part of your lungs.
3. Adenocarcinoma in situ (AIS): A rare type of cancer that starts in the small lung spaces doesn’t usually need strong treatment right away.
4. Adenosquamous carcinoma: This type of cancer comes from a mix of squamous cells and those that make mucus.
5. Large cell carcinoma: A quickly-increasing group of lung cancers that doesn’t match other specific types.

Small-cell lung cancer (SCLC) makes up about 15 to 20% of all lung cancers and is more serious than NSCLC. At first, SCLC does well when given medicine. Still, it is not likely to be fully cured like NSCLC.

Mesothelioma, linked to asbestos exposure, comes from cancerous tumors in cells that make hormones. It is strong, grows quickly and usually doesn’t get better with medical help.
Figure 2: Types of lung cancer

Causes:
Several factors can heighten the likelihood of developing lung cancer. The primary contributor is tobacco smoking, a well-established risk factor. Additionally, exposure to second-hand smoke, or passive smoking, poses a substantial threat. Occupational exposures to hazardous substances like asbestos, radon, arsenic, cadmium, nickel, diesel fumes, and soot are also significant risk factors. Individuals with a history of HIV infection face an elevated risk, and a family history of lung cancer can further contribute to susceptibility. Other considerations include a history of lung diseases such as fibrosis or emphysema, as well as advancing age, which is associated with an increased likelihood of developing lung cancer. Identifying and addressing these risk factors is crucial for preventive health measures and early detection.

Figure 3: Causes of lung cancer
symptoms
Lung cancer manifests through various symptoms, alerting individuals to potential health concerns. These signs may encompass;
 Shortness of breath
 Alterations in voice, such as hoarseness, and chest pain.
 Coughing or the presence of blood in their sputum. A persistent, unrelenting cough, lasting beyond the usual duration, is another notable symptom. Chronic chest infections that endure for more than three weeks or recur frequently should also raise concerns.
 Enlargement of fingertips
 Loss of appetite,
 Unexplained weight loss
 Persistent fatigue
Recognizing these symptoms is essential for timely medical evaluation and intervention to facilitate early detection and effective management of lung cancer.
Stages of lung cancer:
Cancer staging is a crucial aspect of understanding the extent and severity of the disease, aiding healthcare professionals and patients in determining appropriate treatment plans. The fundamental staging categories include localized, where the cancer is confined to a specific area; regional, signifying the spread to nearby tissues or lymph nodes; and distant, indicating the spread to other parts of the body. The TNM staging system, evaluating tumor size, lymph node involvement, and distant metastasis, provides a more detailed assessment.
 In the case of non-small cell lung cancer (NSCLC), stages are characterized by tumor size and spread:

1. Occult: Cancer not visible on imaging scans, but cancerous cells may appear in phlegm or mucus.
2. Stage 0: Abnormal cells found only in the top layers of airway lining cells.
3. Stage 1: Presence of a tumor in the lung, with a size of 4 centimeters or less and no spread to other body parts.
4. Stage 2: Tumor size up to 7 centimeters, with possible spread to nearby tissues and lymph nodes.
5. Stage 3: Cancer spreading to lymph nodes and other parts of the lung and surrounding areas.
6. Stage 4: Cancer has metastasized to distant body parts like bones or brain.

 For small-cell lung cancer (SCLC), staging includes limited and extensive categories:

1. Limited stage: Cancer affects only one side of the chest, possibly involving nearby lymph nodes. Around one-third of individuals discover SCLC in this stage.
2. Extensive stage: Cancer has spread beyond one side of the chest, potentially affecting the other lung or other body parts. Approximately two-thirds of SCLC cases are diagnosed in this advanced stage.

Diagnosis:
Diagnosing lung cancer typically involves a series of tests recommended by healthcare professionals when symptoms or screening results suggest potential issues. Various imaging tests, such as X-rays, CT scans, MRIs, or PET scans, can identify areas of lung tissue affected by cancer and detect any spread to bones or other organs. These scans also play a crucial role in monitoring the progress of treatment.
Tissue sampling through biopsy is another essential diagnostic step, involving the extraction of a small tissue sample for examination of cancer cells. This can be performed using a fine needle or a bronchoscope, a slender, illuminated device equipped with a camera that enters the lungs through the mouth or nose. In instances where lesions are less accessible, more invasive procedures like thoracoscopy or video-assisted thoracic surgery may be employed to remove lung tissue for examination.

Additionally, laboratory tests on pleural effusion (fluid around the lungs), sputum, and blood samples contribute valuable information in confirming the presence of cancer, identifying its type, and determining its stage. This comprehensive diagnostic approach aids healthcare professionals in formulating an accurate diagnosis and devising an appropriate course of action.
Treatment:
The choice of treatment for lung cancer is contingent upon several factors, including the cancer type, its location, stage, the individual’s overall health, and their personal preferences. All available treatment options come with potential side effects, necessitating consultation with a healthcare professional to determine the most suitable approach. It’s essential to weigh the pros and cons of each option in collaboration with a medical expert.

Treatment modalities may encompass:

1. Surgery: Removal of part or the entirety of a lung.
2. Chemotherapy: Drug treatment targeting cancer cells to induce cell death and shrink tumors.
3. Radiation therapy: Use of high-energy rays to eliminate cancerous cells.
4. Radiofrequency ablation: Insertion of a thin needle with an electric current to destroy cancer cells.
5. Targeted therapy: Focused intervention targeting specific behaviors to inhibit tumor growth.
6. Immunotherapy: Assistance to the body’s immune system in fighting cancer cells.
7. Palliative therapy: Comprehensive care, including pain relief, oxygen therapy, and support for symptom management.

The healthcare professional collaborates with the individual, adjusting the treatment plan as needed to address changing requirements and ensure the most effective and personalized care.

References:
1.Lung Cancer Faraz Siddiqui; Sarosh Vaqar; Abdul H. Siddiqui.
2.A Short History of Lung Cancer Hanspeter Witschi
3.Toxicological Sciences, Volume 64, Issue 1, November 2001, Pages 4–6, https://doi.org/10.1093/toxsci/64.1.4
4.https://www.cancer.org.au/cancer-information/types-of-cancer/lung-cancer
5.https://www.medicalnewstoday.com/articles/323701

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