What are cancer?

Cancer is a class of diseases in which a group of cells display uncontrolled growth, invasion that intrudes upon and destroys adjacent tissues, and sometimes metastasis, or spreading to other locations in the body via lymph or blood. These three malignant properties of cancers differentiate them from benign tumors, which do not invade or metastasize. More dangerous, or malignant, tumors form when two things occur: a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis. When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat. In 2007, cancer claimed the lives of about 7.6 million people in the world. Physicians and researchers who specialize in the study, diagnosis, treatment, and prevention of cancer are called oncologists.

Definition of lung cancer: Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope. Symptoms of Lung Cancer : Lung cancer is a disease that consists of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas, derived from epithelial cells. Lung cancer, the most common cause of cancer-related death in men and women, is responsible for 1.3 million deaths worldwide annually, as of 2004.[1] The most common symptoms are shortness of breath, coughing (including coughing up blood), and weight loss.[2] The main types of lung cancer are small-cell lung carcinoma and non-small-cell lung carcinoma. Non-small-cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small-cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation.[3] The most common cause of lung cancer is long-term exposure to tobacco smoke.[4] Nonsmokers account for 15% of lung cancer cases,[5] and these cases are often attributed to a combination of genetic factors,[6][7] radon gas,[8] asbestos,[9] and air pollution[10][11][12] including secondhand smoke.[13][14] Lung cancer may be seen on chest radiograph and computed tomography (CT scan). The diagnosis is confirmed with a biopsy. This is usually performed by bronchoscopy or CT-guided biopsy. Treatment and prognosis depend on the histological type of cancer, the stage (degree of spread), and the patient's performance status. Possible treatments include surgery, chemotherapy, and radiotherapy. Survival depends on stage, overall health, and other factors, but overall only 14% of people diagnosed with lung cancer survive five years after the diagnosis

Early Symptom of Lung Cancer: Cancerous Lesions

The site of the cancerous lesions is the place where the symptoms of lung cancer can occur. Most often, invasion of the lung tissues cause breathing difficulty, which may cause shortness of breath, coughing, chest pain, wheezing and coughing up blood. There may be other related symptoms, if the cancer has spread beyond the bronchia. For example, if the cancer has invaded the esophagus, it may cause complicated swallowing. Cancer that has invaded the nerve tissues may cause paralysis of the vocal chords, or hoarseness. The frequent early symptoms of lung cancer are:

Constant pain in the chest or elsewhere, (possibly from the cancer spreading to a bone). Excessive fatigue. Deteriorating breathlessness. Chronic cough. Weight loss &loss of appetite Hoarseness Wheezing Pyrexia of unknown origin Chest pain Dyspnea

The above symptoms also being the symptoms of many other lung problems, to determine the cause, it is always worthwhile to see a physician. Once you entered the doctors cabin, he will put forth frequent questions about your medical history, along with questions about your accidental or incidental exposure to hazardous chemicals.

Physical Examination for an Early Symptom of Lung Cancer

After inception of the early symptom of the lung cancer, your physician will subject you for physical examination. You may be asked to give a sample of sputum for the occurrence of cancer cells, if you are suffering from unrelenting cough with sputum (mucus). Other than this, for easy location of the abnormal spots in your lung, your doctor will order a specialized X-ray including CT scan or simple chest X-ray. In order to examine your lungs along with airways, your health care professional may use bronchoscope, and will take sample, or biopsy, of the tumor by means of the bronchoscope itself.

Through either nostrils or mouth, the bronchoscope will be inserted into ones lung. After finding the early symptom of the lung cancer, this is one of the several ways in which the doctor collects the biopsy sample. In order to recognize lung cancers of smaller size, most of the physicians are most likely use a modern CT scan in smokers, which can be treated and cured easily than the large sized lung cancer. To spot small sized cancers, the method called helical-low dose CT scan has been used extensively. If the cancer spreads to other parts of the body, various other symptoms may occur. That is, if there is metastasis. With the following possible symptoms for each area, Lung cancer can spread to the liver, the brain, or the bones: Brain: headaches, seizures, nausea, vomiting, weakness Liver: stomach pain (especially the right side), jaundice Bones: bone pain An MRI, a bone scans and CT scan are the common tests to find out the metastasis stage of your lung cancer after observing the early symptom of lung cancer.

Sings of Lung cancer Signs of lung cancer are not found at the early stages of lung cancer. At the initial stages itself, however, it is better to identify the lung cancer. Some of the signs of lung cancer are chronic cough, coughing up blood, wheezing, and chest pain, bouts of pneumonia or bronchitis and reason less fever. It is best to consult your doctor if you experience these signs of lung cancer and check whether you have lung cancer or not. You are likely to get lung cancer if you experience the following sings of lung cancer: asbestos fibers, smoking, passive smoking, and air pollution. In the other diseases also the signs of the lung cancer may be found, so it is better to find the reason for these signs and start the treatment for these symptoms. Another thing that plays an important role in getting these symptoms is the environment in which you live. By inspecting the sputum or by chest x-ray and CT scans, diagnosis of cancer can be done. With the help of bronchoscope sometimes biopsy sample is taken and tested for lung cancer.

Statistics for Signs of Lung Cancer

Statistics reveal that only about 15% of the lung cancer cases are detected at an early stage in order to eliminate the cancer. The important thing you must remember is that, for years together, cancerous cells grow in your body despite of giving any sings of cancers. Probably you may be already in the advanced stage of lung cancer if you get to find the symptoms and see the symptoms. One of the signs of lung cancer is affect of vocal cord due to the hoarseness. Sometimes difficulty in swallowing is experienced if the esophagus is affected by the cancer. Some patients may experience pain in the shoulder also.

Sign of Lung Cancer: Neurological Disorders

Another sign of lung cancer is pain in the bones where it is in the metastasis stage. From your bones it would have spread to the bones. At the time of the metastasis stage, if the cancer is extended to the brain then your might suffer signs in some parts of the body that are of neurological nature such as blurred vision, stroke, headaches and sometimes loss of sensation or numbness. Cancer cells can produce a hormone called adrenocorticotrophic which leads to the production of more cortisol hormone by the adrenal glands. You can also find increased level of calcium in the bloodstream after testing your blood. These are also the signs of lung cancer. Such signs can be classified as paraneoplastic symptoms.

Depression as a Sign of Lung Cancer

In persons affected by the lung cancer, signs like depression are also found. Such signs are of psychological nature. In lung cancer patients, general signs like weight loss or weakness or fatigue are also found. If you experience any of these symptoms, it is always better to consult your doctor so that in case of cancer in order to eliminate it, you get treatment at the early stages itself. Otherwise there is no point in going for treatment at a difficult where you will be treating cancer to extend your life.

Sign and Symptom of Lung Cancer

Sign and symptom of lung cancer are normally useful in patients who attend the hospital for cure towards the effective prediction of the severity of the problem. It is confusing to find that about twenty to twenty five per cent of patients who get affected by lung cancer often show no specific sign and symptom of lung cancer. In such group of patients, most of the times, both the patient and the clinician may not think about the potential of lung cancer. Hence, apparently, it is to be understood that the sign and symptom of lung cancer need not always be revealed. Whenever a person coughs, one unnecessarily jump into the conclusion that he or she is being affected by lung cancer, but at the same time, when the cough is observed to be existing for significantly a long period, then one should employ this as sign and symptom of lung cancer in that patient clinically.

Sign and Symptom of Lung Cancer: Differential Diagnosis

Experienced clinician who effectively deals with sign and symptom of lung cancer will however view TB as criteria for differential diagnosis in patients revealing emaciation and chronic cough in a low-pitched scale. Specifically, when the patient brings out some blood during such coughing activities, the clinical suspicion will often get strengthened. Similarly, the lung cancer may be suspected, if the patient exhibits sign and symptom like persistent chest pain or pain at shoulders or if the patient exhibits breathing activity but with difficulties. If there is hoarseness or pain in bones as happens in case of successive spread of lung cancer over bones, again one has to exclude lung cancer. Hence, so as to make an effective diagnosis, the sign and symptom of lung cancer need to be analyzed largely. It is considered to be indirect sign and symptom of the lung cancer when cancer in lung tissues may be accompanied by paraneoplastic symptoms and calcium is elevated in serum of these patients. For not only the thoracic specialist but also to the patient with variable levels of lung cancer the sign and symptom of lung cancer may often be of confusing types. Hence, even the specialist has to repeatedly acquire additional knowledge on the recent kinds of simple signs and symptoms that can elicit doubts on the presence of lung cancer in the affected patients.

How to rule out Signs and Symptoms of Lung Cancer?

In order to assist in ruling out the occurrences of lung cancer in people, this may require constant going through of various research findings made in different type of medical experts. Currently to acquire up-to-date information on sign and symptom of pulmonary cancer, even the human doctors are consulting concerned veterinarians. Relentless body pain in a generalized form and feeling of depression for a very prolonged time and feeling of tiredness for a stretched period also are to be considered as the Sign and symptom of lung cancer. Hence, it is to be understood that the sign and symptom of lung cancer are associated with the persistence for a long time. However, in the sign and symptom of lung cancer, sudden breathless episode is also included.

The etiology, or the root cause of lung cancer, is not always evident. Although tobacco smoking is the primary etiological factor, scientists agree that many lung cancers have no single cause, but are instead the result of a combination of several causes that may include exposure to radon, asbestos, environmental tobacco smoke, and exposures to other hazardous materials. Don't just assume that your lung cancer was caused by smoking alone. Lung cancer is also a significant health problem among patients who have never smoked (referred to as "never smokers"). You could have been exposed to carcinogens decades ago, and many people with lung cancer cannot easily remember these exposures. Call us at 1-800-998-9729 and we may be able to help you identify where you came into contact with hazardous materials that could have increased your risk for lung cancer.

Other Causes of Lung Cancer

Radon : A gaseous decay product of radium-226 and uranium-238, radon can result in the damage of respiratory epithelium through alpha particle emissions. Uranium miners face an increased risk of lung cancer, probably due to radon-induced radiation. Many members of the armed forces came into contact with depleted uranium and radon during military service, as did employees of defense contractors. See our pages on radon as a cause of lung cancer, and uranium as a cause of lung cancer

Secondhand smoke. Also referred to as environmental tobacco smoke (ETS), secondhand smoke has been identified as a significant risk factor for lung cancer in the case of never smokers. Experts estimate that 15 to 35 percent of lung cancer cases among never smokers are associated with ETS. More on secondhand smoke as a cause of lung cancer. Between smoking and secondhand smoke, the Centers for Disease Control estimate that 87% of US lung cancer cases are caused by tobacco.

Asbestos.

:Asbestos is known to be a cause of lung cancer and other types of cancer. The asbestos fibers can become airborne and get in your lungs. Often the cancer doesnt show up until decades after exposure. Asbestos as a cause of lung cancer. If you have lung cancer and were exposed to asbestos, even decades ago, you may be eligible for compensation

Pesticides, especially the mixture called Agent Orange. Agent Orange was sprayed from airplanes during the Vietnam War and became airborne, entering the lungs of ground troops. The Department of Veterans Affairs has acknowledged that Agent Orange is carcinogenic and provides benefits for qualified cancer patients with a history of exposure. See our page on Agent Orange as a cause of lung cancer. Heavy metals. These include cadmium, chromium, and arsenic. Heavy metals are in many products and waste streams. Arsenic has been identified as a causative factor for lung cancer when it contaminates drinking water, as seen in specific areas of Chile and Taiwan. The United States lowered permissible arsenic levels in drinking water several years ago due to health concerns. See our page on heavy metals as a cause of lung cancer.

Air pollutants present, for instance, in smoke from burning coal and vapors from cooking oil have been associated with lung cancer. There are hundreds of chemical constituents in smoke and combustion products. Even the experts dont know all of the carcinogenic ones, but it is clear that there is a connection. See our page on hydrocarbons as a cause of lung cancer.

Where Were You Exposed to Carcinogens?

Workplace Exposures Several types of occupational exposures have been identified as factors that increase the risk of lung cancer among smokers and never smokers. Electricians, painters, plumbers, steamfitters, pipefitters, and many other jobs brought workers into close contact with asbestos insulation, cements, ceiling tiles, brakes, and other materials. Carcinogens in these materials include asbestos, beryllium, heavy metals, and hydrocarbons. Military Service Exposure Thousands of veterans have contracted lung cancer after being exposed to asbestos. Often the cancer doesn't show up until decades after exposure. Members of all branches of the military were exposed to the same materials as civilian workers were. Exposure to beryllium and depleted uranium was especially common among servicemen because those metals were used in defense systems. Agent orange, the herbicide, was used extensively in the Vietnam War. Home Exposure Radon accumulates in the basements of buildings in some areas of the country, and asbestos was used widely in home construction for decades. Both radon and asbestos are known causes of lung cancer and pose risks for people who live in homes with those materials. Pesticides, especially the mixture called Agent Orange. Agent Orange was sprayed from airplanes during the Vietnam War and became airborne, entering the lungs of ground troops. The Department of Veterans Affairs has acknowledged that Agent Orange is carcinogenic and provides benefits for qualified cancer patients with a history of exposure. See our page on Agent Orange as a cause of lung cancer. Heavy metals. These include cadmium, chromium, and arsenic. Heavy metals are in many products and waste streams. Arsenic has been identified as a causative factor for lung cancer when it contaminates drinking water, as seen in specific areas of Chile and Taiwan. The United States lowered permissible arsenic levels in drinking water several years ago due to health concerns. See our page on heavy metals as a cause of lung cancer. Air pollutants present, for instance, in smoke from burning coal and vapors from cooking oil have been associated with lung cancer. There are hundreds of chemical constituents in smoke and combustion products. Even the experts dont know all of the carcinogenic ones, but it is clear that there is a connection. See our page on hydrocarbons as a cause of lung cancer.

Where Were You Exposed to Carcinogens?

Workplace Exposures Several types of occupational exposures have been identified as factors that increase the risk of lung cancer among smokers and never smokers. Electricians, painters, plumbers, steamfitters, pipefitters, and many other jobs brought workers into close contact with asbestos insulation, cements, ceiling tiles, brakes, and other materials. Carcinogens in these materials include asbestos, beryllium, heavy metals, and hydrocarbons. Military Service Exposure Thousands of veterans have contracted lung cancer after being exposed to asbestos. Often the cancer doesn't show up until decades after exposure. Members of all branches of the military were exposed to the same materials as civilian workers were. Exposure to beryllium and depleted uranium was especially common among servicemen because those metals were used in defense systems. Agent orange, the herbicide, was used extensively in the Vietnam War. Home Exposure Radon accumulates in the basements of buildings in some areas of the country, and asbestos was used widely in home construction for decades. Both radon and asbestos are known causes of lung cancer and pose risks for people who live in homes with those materials.

There are a number of different treatment options for lung cancer. Standard treatment options include surgical resection, chemotherapy, and radiation therapy. Newer lung cancer treatment approaches include photodynamic therapy, electrocautery, cryosurgery, laser surgery, targeted therapy and internal radiation. Each lung cancer treatment has its own specific ability to fight cancer and its own set of side effects and possible complications. Therefore while there are many options, lung cancer treatment needs to be performed judiciously and only after very careful consideration of a number of factors.

Treatment Guidelines for Non-Small Cell Lung Cancer Stage Stage 0 Stage IA Stage IB Stage IIA Stage IIB Stage IIIA Stage IIIB Standard Treatment Surgical resection Surgical resection Surgical resection Surgical resection Surgical resection Surgery then chemotherapy Chemotherapy and radiation Chemotherapy and radiation Chemo therapy Radiation therapy (palliative) Surgical resection (palliative) Alternate Theraphy, clinical trials, for symptom control, or palliation Endoscopic surgery, laser therapy, electrosurgery, cryosurgery Chemotherapy (adjuvant), radiation therapy Chemotherapy (adjuvant), radiation therapy Chemotherapy (adjuvant), radiation therapy (primary or adjuvant) Chemotherapy (adjuvant), radiation therapy (primary or adjuvant)

Neoadjuvant chemotherapy and radiation

Stage IV

Combination therapy, internal radiation, targeted therapy, laser therapy

Treatment of non-small cell lung cancer

For occult and stage 0 NSCLC, surgery is generally curative without the need for radiation or chemotherapy. This is because these stages do not represent invasive lung cancerthe lung cancer is completely contained within the primary tumor. Therefore when the tumor is surgically removed, the cancer is gone for good. Obviously the success rate in this case, as with all stages, depends on the quality and accuracy of the lung cancer staging. If cancer cells have migrated away from the tumor, these stages no longer apply and additional treatment is necessary. Surgery is indicated for stages I, II, and III of NSCLC. It may also be used for palliation in stage 4. Palliative therapy, it should be mentioned, is intended to relieve symptoms and improve quality of life with no real goal of cure or cancer remission. For stages I and II of NSCLC, surgery is the primary treatment of choice. (See page on staging of lung cancer.) The surgery that is used to treat the lung cancer is tailored to the patient based on the extent of the disease. Since the lung is essential for respiration and for life, preserving as much functional lung tissue as possible is a primary concern to thoracic surgeons. Surgeons consider how well the patient will be able to breathe after a portion of lung is removed. At the same time, a sufficient amount of tumor and surrounding lung must be removed in order to assure that the cancer has been eliminated. Pulmonary function tests (breathing tests) are performed before cancer surgery to assess the patients overall lung capacity. An estimate is made of the level of lung function that would exist after the proposed surgery. If the patient will be left with too little lung capacity, either a less aggressive surgery will be performed or the surgery will not be done at all and alternate treatment will be given. Since people with lung cancer often have other lung diseases such as emphysema, lung capacity is a very important issue. There are five lobes of lung, three on the right side of the chest and two on the left. Within these lobes, the lung is further subdivided into segments according to how the bronchi and bronchioles supply them with air. This organization is important when planning lung resection surgery.

There are several approaches available to thoracic surgeons. A wedge resection preserves the most lung tissue but provides the least room for error (meaning there is a reasonable chance of the cancer recurring). A wedge resection is suited to small primary tumors, usually of the Stage 0 and I variety. A segmental resection is a bit more aggressive, taking more lung tissue. However, the segmental resection is often well suited to stage I and II disease. Again, the risk of missing cancer cells is weighed against the resulting lung capacity. A lobectomy is a procedure in which one of the five lobes is completely removed. The largest lung cancer resection surgery, a pneumonectomy (or hemi-pneumonectomy), is when an entire lung is removed, either the left or the right lung. In general, lobectomy and pneumonectomy are used to treat stage II NSCLC in patients with excellent reserve capacity of the lungs. There are a number of chemotherapeutic regimens that can be used to treat NSCLC. These are usually reserved 1) for higher stages of lung cancer (stages III and IV) or 2) as adjuvant therapy, that is, to be used after surgery or 3) as neoadjuvant therapy, which is treatment before surgery. Neoadjuvant therapy is done to make the tumor smaller so that surgery will be easier or more effective. Adjuvant therapy is performed to kill cancer cells that may have been missed in the surgery or spread from the primary tumor. The standard of care in the treatment of NSCLC is to use a platinum-based chemotherapeutic agent, especially in advanced disease (stages III and especially IV). Most studies have shown that two agents are better than one. Three agents used in combination do not provide much additional benefit but do cause a number of additional, unpleasant side effects. Therefore chemotherapy regimens usually include two drugs. Often this combination regimen includes a platinum drug like cisplatin along with either an older (etoposide) or newer (docetaxel, gemcitabine, pemetrexed (Alimta) or vinorelbine) chemotherapeutic drug. Non-small cell lung cancer tumors are not very sensitive to most chemotherapy regimens, unfortunately. Chemotherapy alone is not considered a curative treatment for NSCLC. Often chemotherapy is combined with radiation therapyan approach that is sometimes referred to as chemoradiation therapy. When the two treatment modalities are combined, the rates of disease clearance and survival are better than with either treatment alone. Otherwise chemotherapy is combined with surgery (either as neoadjuvant or adjuvant)

Radiation therapy alone is sometimes used for stage I and II NSCLC when surgery is not possible due to too little lung capacity. If that stage I or II tumor is resectable, surgery would be used rather than radiation therapy.

In stage IIIA NSCLC, surgery is still considered first line therapy. When surgery is possible, it is usually combined with adjuvant chemotherapy. If surgery is not possible in stage IIIA disease, chemoradiation therapy is used. Some specific stage IIIA tumors, like Pancoast tumors or tumors that have invaded the chest wall, have special treatment approaches. In stage IIIB, chemoradiation therapy is considered first line. Radiation therapy alone may be used if patients are concerned with the toxic effects of chemotherapy; however outcomes are better if both treatment modalities are used. In this stage of NSCLC, surgery is not considered a curative intervention or effective treatment and is rarely performed. Radiation therapy may be used for palliation of symptoms when tumor invades certain tissues and causes troublesome symptoms. Chemotherapy is really the only treatment modality used in stage IV NSCLC. Radiation therapy and surgery are used to relieve symptoms rather than change the course of the disease or improve survival. Treatment for stage IV disease most likely will include a platinum-based chemotherapeutic agent and a non-platinum chemotherapeutic drug. When three drugs are used, the third is not technically a chemotherapeutic agent but rather targeted therapy. Targeted therapy includes drugs, antibodies or other proteins that target and disrupt specific proteins within the cancer cell. These disrupted proteins are critical for the cancer cells survival so the treated cell dies or stops multiplying. The use of targeted therapy in stage IV disease along with two other chemotherapeutic drugs may improve overall survival.

Treatment of small cell lung cancer

The treatment options in SCLC are less complex than NSCLC, mostly because studies have repeatedly shown that treatment outcomes are not affected by detailed staging. In other words, placing SCLC in four different stages does not influence treatment choices or outcomes to any appreciable degree. Thus treatment of SCLC is based mainly on two different stages, limited and extensive.

Treatment Guidelines for Small Cell Lung Cancer Stage Standard Treatment Radiation Therapy Chemotherapy (single drug or combination) Alternate Theraphy

Limited

Surgery Radiation therapy to the brain prophylactically Surgery (palliative)

Radiation Therapy Extensive Chemotherapy (combination of drugs)

Fortunately SCLC is very sensitive to radiation therapy. Radiotherapy is the treatment modality used in virtually all cases of limited SCLC disease. Radiation therapy is more effective and causes fewer side effects in limited disease because, by definition, limited disease can be treated through a single, external radiation port. In extensive SCLC disease, radiation therapy may be reserved for patients that have not responded to chemotherapy. This is because in extensive disease, radiation would need to been applied to large areas of the body. As a palliative intervention in extensive SCLC (and sometimes limited SCLC), certain organs like that brain may be irradiated prophylactically (in case there is spread). Chemotherapy is used to treat both limited and extensive SCLC. In limited disease, patients have been successfully treated with a single chemotherapeutic drug (when combined with radiation). In most cases though, two drugs are used rather than one. These two drugs are commonly a platinum drug and etoposide. In extensive SCLC, two chemotherapeutic drugs are used. The specific chemotherapeutic agents used in extensive SCLC vary. In both NSCLC and SCLC, it may be possible to enroll in a clinical trial of lung cancer treatments. These trials usually compare new therapies against older ones to see if outcomes can be improved. Targeted therapies, radiosensitizers, internal radiation sources, and newer combination treatment regimens are just some of the treatment tools being tested in research and clinical studies. These new treatments may improve survival or may lead to future breakthroughs.