Did you know?

• Lung cancer is the biggest cancer killer in the world – causing more deaths than breast and prostate cancer put together.
• Every 30 seconds, someone, somewhere in the world dies of lung cancer.
• 40% of smokers who start smoking in their early teens and continue to smoke will not live to claim their pension.
• Only 1 in every 10 people with lung cancer are alive 5 years after diagnosis.
• Recent studies indicate that women are more susceptible to developing lung cancer than men. Women smokers are twice as likely to develop lung cancer than male smokers. Even among non-smokers women’s risk of developing lung cancer is higher than men.
• Women also have a more difficult time overcoming nicotine addiction than men.

Understanding Lung Cancer

Lung cancer is a term used to describe a growth of abnormal cells inside the lung. These cells divide and grow at a much quicker rate than normal cells. The cancerous cells stick together to form a cluster and this abnormal cluster of cells is called a tumour. If the cancer cells first started growing in the lungs, the tumour is called a primary lung tumour. However, if the lung cancer cells break off and travel through the blood vessels they may latch on to and start to grow in other parts of the body e.g. the bones. This new cancer growth is called a metastasis or secondary tumour.

Types of Lung Cancer

There are a number of different types of lung cancer. The two most common are called:

• Non-small cell lung cancer (NSCLC), which is the most common type (around 75% of cases)
  
  
• Small cell lung cancer (SCLC)

These two types of lung cancer respond differently to different treatments, so the best treatment approach for you will depend on your type of lung cancer.

Non-small cell lung cancer

There are several different types of non-small cell lung cancer depending on the type of abnormal cell:

• Adenocarcinoma – is more common in women, particularly women smokers, and has a tendency to produce clumps of mucus/sputum in the smaller airways.
  
  
• Squamous carcinoma (also known as epidermoid carcinoma) – occurs most frequently in men and older people of both sexes but it is rare in non-smokers. It appears as an irregular growth of pearl-like cells with a firm texture and is more common in the larger central airways than in the outer lung. It may grow large enough to block the air travelling to a part of the lung causing it to collapse. This type of lung cancer is the most commonly removed by surgery.

Small Cell Lung Cancer

This is caused by small round cells that form fleshy lumps, usually in the larger airways and is very rare in non-smokers. This type of lung cancer cell divides and grows very quickly and has often spread to the lymph nodes and/or other organs in the body by the time it is diagnosed.

It is known to be more responsive to chemotherapy and radiotherapy than non-small cell lung cancers and may reoccur. You will attend regular check-ups after treatment is complete to ensure any reoccurrence is spotted quickly.

Other types of lung cancer

• Mesothelioma – is closely associated with a history of asbestos exposure usually either through working directly in the asbestos industry or working with asbestos products in the building trade. Generally, it affects older males and may take 35-40 years from the date of first exposure for the cancer to develop. This cancer cell type is usually found in the lining of the lungs and has a habit of producing fluid that may require draining from time to time to improve breathing.
  
  
• Carcinoid tumour – is a rare and benign tumour disease of the lung (1-2% of all lung cancers) This lung growth affects the organs and glands which produce many of the hormones (neuroendocrine) e.g. thyroid gland. It is more common in a younger age group and the majority of patients have no symptoms at diagnosis, however when symptoms do occur they can include flushing, diarrhoea, heart problems and wheezing. Surgery is usually curative but radiotherapy and chemotherapy can be used for controlling symptoms.

The diagnosis and treatment of lung cancer can be complicated. For country-specific information please follow your country’s link.

Staging

To determine the most appropriate treatment, cancers are ‘staged,’ which means classifying the severity of a patient’s disease.

Small cell lung cancer is classified as ‘limited’ (cancer only in one lung and in the lymph nodes in the same side) or ‘extensive’ (cancer has spread, either within the chest or elsewhere in the body).

Non-small cell lung cancer is staged as follows:

• Stage I: Cancer is present only in one part of the lung
• Stage II: Cancer has spread to the nearby lymph nodes or nearby tissues e.g. chest wall
• Stage III: Cancer has spread more extensively within the chest and, generally to the major lymph nodes
• Stage IV: Cancer has spread to other parts of the body, e.g. to the liver or bones

Treatments

Treatment depends on the size, type and stage of the tumour and on your own personal health. Your doctor will decide the most suitable treatment that has the least side-effects and works best for you.

In general, there are three types of treatment used in the management of lung cancer. These are surgery, radiotherapy (X-ray treatment) and chemotherapy (treatment using drugs).

When deciding on the type of treatment, doctors will make the following decisions about your lung cancer:

Is there is a chance of curing your cancer - that is, treating your cancer so it is highly unlikely that it will ever come back (curative treatment).

If this is not possible, then the doctor will try to shrink the tumour and stop it from re-growing for as long as possible. Hopefully by doing this, any symptoms that your cancer is causing will be reduced/delayed (palliative treatment).

The following factors are all taken into account when deciding what treatment approach will be right for you:

The lung tumour

Size of tumour: Bigger tumours are often more difficult to treat.

Position of tumour: If the tumour is very close to the windpipe, major blood vessels or another vital structure, curative treatment may be difficult.

Stage of the tumour: Doctors have to perform a variety of tests to decide the stage of your tumour. It may seem to you that these tests are delaying the start of treatment, but it is very important that the doctors give the treatment most suited to your tumour. Remember that everyone is treated as an individual, therefore no two people with lung cancer at the same stage, will be cared for in the same way.

Spread of cancer: If the cancer has spread to lymph glands in the mediastinum (the area in-between the lungs) or other structures outside of the chest then curative treatment may be difficult.

Type of lung cancer (e.g. small cell or non-small cell): Different types of lung cancer respond to different treatments.

Your health

Overall lung health: If there is damage to your lungs from other illnesses (e.g. Chronic obstructive pulmonary disease – COPD) then certain treatments may be ruled out as they could result in a worsening of breathlessness.

Presence of other illnesses: The presence of other illnesses may make the risks of certain treatments higher and this can help guide the decision on which therapy is best for you.

Current symptoms: Certain treatments require a reasonable level of fitness to reduce the risk of side-effects. If general fitness is poor then these treatments may not be advisable for you.

Acceptability of side-effects: There may be side-effects of treatment that would be unacceptable to some patients e.g. hair-loss. You should discuss possible side effects of therapy with your doctor before a decision on treatment is made.

Note: Age should not be a deciding factor when the above assessments are made.

Lung Cancer treatment options

Surgery: If the cancer has not spread widely (stages I and II), removing the tumour by surgery is the most common and effective form of treatment for non-small cell lung cancer. Surgery should be considered in all such patients and if surgery is not an option, patients should be offered an explanation as to why it is not possible. If the cancer has spread and surgery is not possible (this is more common in small cell lung cancer) then radiotherapy and chemotherapy are used (alone or in combination) to control symptoms by reducing the size of the tumour. In patients who develop collections of fluid within the chest, surgery can be used to control the fluid and improve breathlessness.

Chemotherapy is the general term for the treatment of cancer using drugs. The drugs that are used are designed to kill off cancer cells while causing less damage to normal cells. There are many different types of chemotherapy drugs which can be used on their own or, more commonly, in combinations. Patients with different types of lung cancer are likely to receive different combinations of chemotherapy drugs.

Radiotherapy is a general term for the treatment of cancer using x-rays. It is done by directing painless high-energy beams at the areas of the lung that need treatment. Radiotherapy works by killing cancerous cells and can be used either on its own or in combination with surgery and/or chemotherapy.

Newer Treatment Options

There have been encouraging advances made in recent years in the fight against lung cancer, and researchers are investigating potential new treatments or treatment strategies all the time. The following list is a brief sample of some the types of potential anti-cancer agents and technologies under investigation:

New Surgical Techniques

Video-assisted thoracoscopic surgery (VATS): a less invasive surgical technique that may be helpful for people with marginal lung function who cannot tolerate major surgery. VATS allows “keyhole” surgery, enabling the surgeon to perform the necessary surgery through a small incision with the aid of a video camera and television screen.

New Radiation Techniques

• Conformal 3-D radiation therapy is an important new technique that allows the dose of radiation to be increased with a reduction in the exposure time.
• The combination of both primary radiation therapy and chemotherapy is being examined and shows promise.
• Fractionation: the practise of varying the dose, duration and time between radiation treatments.
• Radiation modifiers can be used to change the cellular response to radiation. These agents appear to inhibit cancer cells from repairing the damage caused by a radiation treatment.
• Radiation sensitisers i.e. agents that make cells more sensitive to the effects of radiation.
• Brachytherapy – a technique used to deliver high doses of radiation from very short distances and involves the placement of a small radiation source in the airway next to a tumour.

Epidermal Growth Factor Receptor (EGFR) inhibitors

EGFR inhibitors are designed to stop the uncontrolled growth of cancer cells in certain types of tumour. EGFR inhibitors work by blocking one of the important signalling pathways involved in cancer cell growth in lung tumours. Clinical studies of these agents in advanced lung cancer have demonstrated that significant numbers of patients achieved either tumour shrinkage or stabilised disease and many patients experienced an improvement in their disease related symptoms.

New Chemotherapy Agents

Promising new chemotherapeutic agents are in clinical trials now, either alone, or in a variety of combinations. Timing and dosing of chemotherapeutic agents is under investigation, as are products that could enhance the effectiveness of the drugs or which can protect normal cells during chemotherapy.

Anti-angiogenic compounds

There are a variety of treatments under investigation that may inhibit the formation of tumour blood vessels. Solid tumours, such as lung cancer are able to grow and survive in the human body only by developing their own blood vessels to link into the body’s blood supply. By preventing the tumour from thus accessing the body’s blood supply – which brings nutrients and oxygen to the tumour cells, enabling them to survive and grow, and takes waste products away for processing elsewhere in the body – the tumour cells will eventually die.

Gene Therapy

Gene therapy for cancer uses genetic material as a therapeutic agent. The aim is to insert into cancer cells a regulator gene that has been lost or altered, or to try to block production of a gene whose function is to promote uncontrolled cell growth. For example, half of all NSCLC patients have abnormalities in their p53 gene – the gene responsible for killing abnormal cells. Whether it is this gene, or other genes involved with lung cancer, genetic therapy may hold promise for preventing and treating NSCLC.

Matrix Metalloprotease Inhibitors

Matrix metalloproteases (MMPs) are naturally-occurring enzymes which help to break down the structure between cells in order to make room for new, healthy tissue to grow. These enzymes are important in normal processes like new blood vessel development and wound healing. It is also believed, however, that MMPs can assist tumour cells as they invade surrounding healthy tissue and spread to more distant parts of the body and may help the development of new tumour blood vessels. By inhibiting the action of MMPs, it is hoped that tumour growth and spread may be slowed down.

Therapeutic Monoclonal Antibodies

Monoclonal antibodies are antibodies that are cloned, or artificially reproduced in a laboratory. They bind only to a certain protein that is a “match” for them. This means monoclonal antibodies can be designed to attach to certain tumour cells and destroy only them.