Lung cancer

While prostate cancer in men and breast cancer in women are the most common in the world and in our country, lung cancer, which is rapidly spreading, is observed as the second type of cancer. Lung cancer, the most obvious cause of which is shown to be smoking, can manifest itself especially with shortness of breath, wheezing, sudden weight loss or various pains. This cancer, which ranks first among the most frightening types of cancer, is successfully treated with developing medical and technological opportunities and its life span can be extended.

What is Lung Cancer?

The most important task of the tissues and cells in the lungs is to provide oxygen to the body and to remove the carbon dioxide formed during vital activities from the body. Lung cancer occurs with the uncontrolled proliferation of tissues and cells in the lungs. There are two types of lung cancer, small cell (oat cell) lung cancer and non-small cell lung cancer.

There are many types of non-small cell lung cancer, and the type of cancer cells of each type is different. Each cancer cell spreads in different ways and grows differently. The types of non-small cell lung cancer are determined by the appearance and type of cells in the cancer tissue when examined under a microscope. Small cell lung cancers comprise 15% of all lung cancers, mostly seen in smokers. Its spread to the body through the lymphatic system and blood is faster than other types of lung cancer.

Squamous cell carcinoma: Caused by squamous cells that appear thin and flattened like herringbone, this is also called epidermoid carcinoma.

Adenocarcinoma: It originates from cells with glandular (secretory) characteristics.

Large cell carcinoma: Cancer that shows large and abnormal cells when viewed under the microscope.

Adenosquamous carcinoma: Cancer that starts from cells that appear flattened under the microscope and also shows glandular features.

Pleomorphic, sarcomatoid, or sarcomatous carcinoma: A group of cancers that present 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 Causes of Lung Cancer?

Although smoking is the biggest cause of lung cancer, lung cancer can also be seen in non-smokers. As a matter of fact, when we look at all lung cancer cases, 15 percent of them are people who have never smoked. Being in smoking environments increases the risk of developing lung cancer. It is possible to reduce the risk of lung cancer by 50 percent in 10 years by avoiding smoking. Products such as cigarettes, pipes, cigars and hookahs are among the most important risk factors proven to be a cause of cancer. Apart from smoking, genetic transmission, asbestos, radon gas and air pollution are also causes of lung cancer.

Some lung diseases such as tuberculosis and radiotherapy to the lungs may increase the risk. Another important reason is the high level of arsenic in drinking water. In recent years, an increase in lung cancer has been observed as a result of the increasing consumption of cigarettes by women.

What are the Lung Cancer Risk Factors?

Risk factors that increase lung cancer can be listed as follows:

• Air pollution
• Coal, carbon use
• Chronic lung diseases
• Tobacco and tobacco products
• Exposure to certain chemicals such as arsenic and radon gas by breathing
• Genetic causes

Imaging Methods in Lung Cancer

Chest X-ray: After the detailed history and physical examination of the patients, bilateral chest X-ray is the first step for diagnosis. In some cases, with this imaging technique, the damage seen in the lungs due to the tumor can be revealed with this film. Since chest radiography 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): It gives information about the size, shape and location of the tumor. It also shows the lymph nodes enlarged due to spread lung cancer, with the diagnosis of early-stage lung cancer, and the condition of other internal organs where lung cancer can spread.

Magnetic Resonance Imaging (MRI): Allows imaging of the lung by dividing the lung into sections with magnetic and radio waves, and there is no radiation hazard since x-rays are not used in MRI examination.

Positron Emission Tomography (PET): The procedure is applied to determine whether the tumor has spread in patients diagnosed with cancer by using a low-dose radioactive substance collected in cancerous tissues and to plan the treatment by staging lung cancer.

Bone Scintigraphy: Thanks to the radioactive substance given to the patient intravenously, it is determined whether the cancer cells have spread to the bones; It is a technique 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 (metastasize) to other parts of the body, including the lymph nodes, bone, and brain. Therefore, lung cancer and its type are determined by taking a tissue sample from the lung. The tissue sample taken by biopsy is examined under a microscope. Taking a biopsy of the lung tissue that is believed to be cancer does not cause the tumor to spread and the disease to worsen.

The methods used to retrieve this piece of tissue are:

• Bronchoscopy in Lung Cancer: The airways are examined through a thin lighted tube inserted orally into the bronchi and trachea, and small tissue samples are taken.
• Needle Aspiration Application in Lung Cancer: A sample is taken from the cancerous tissue by entering the needle through the chest wall for the mass in the lung. This sample is examined under a microscope.
• Thoracentesis Application in Lung Cancer: In order to detect cancer cells, a sample is taken from the fluid surrounding the lungs with a needle.
• Thoracotomy Application in Lung Cancer: This method, which is used for the diagnosis of lung cancer, is the opening of the chest cage with a surgical intervention. It is applied if all other methods are not suitable or if success cannot be achieved with all methods.
• Sputum Cytology Application in Lung Cancer: It is the method of examining the material coming out of the mucous membrane of the lungs with a deep cough under the microscope. The sputum sample taken from the patient is examined under a microscope to detect cancer cells.

Lung cancer treatment is personalized according to the results of the samples taken from the patient.

How Lung Cancer is Treated

Lung cancer treatment, as in other types of cancer, varies depending on many factors such as the general condition of the disease, its stage and the type of cancer. In many stages, different treatment combinations and personalized treatments are applied, so choosing a fully equipped hospital and specialist physician is of great importance in the treatment of lung cancer.

With adjuvant treatment after lung cancer surgery, a small number of cancer cells that are likely to be left behind are destroyed, even if they are not visible. This treatment method should be planned by considering the patient’s diagnosis report, age and general health status.

After lung cancer surgery, only chemotherapy or only radiotherapy or both chemotherapy and radiotherapy can be applied as adjuvant treatment, and in some cases, postoperative adjuvant treatment may not be required in early stage patients.

Lung Cancer Treatment Methods

Surgery in Lung Cancer

Lung cancer surgery is one of the lung cancer treatment methods. The type of surgical intervention depends on the location of the cancer in the lung, it is an operation to remove a small piece of the lung. If the entire lobe is surgically removed (lobectomy), it is defined as if one of the right or left lung is removed (pneumonectomy), some tumors cannot be operated due to their location, size and general health status of the patient.

Chemotherapy in Lung Cancer

Chemotherapy treatment is the destruction of cancer cells with drugs in lung cancer. Chemotherapy usually consists of 2 drugs and can be given by nurses who have received special training on this subject. The number of times that chemotherapy is given is “cure” and is usually repeated every 21-28 days. Chemotherapy in lung cancer is usually administered in the form of intravenous fluids or as oral pills in fully equipped outpatient treatment centres, sometimes chemotherapy is given as an inpatient depending on the unfavorable condition of the patient or the nature of the recommended drugs. After each chemotherapy course, patients are checked in the medical oncology outpatient clinic, during these controls the 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 damage 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 courses he will receive. The age and general condition of the patient play an important role in making these decisions. Giving chemotherapy to patients with poor general condition is not suitable because they cannot tolerate side effects. Patients who are scheduled to undergo chemotherapy should start chemotherapy preferably within 3 weeks after surgery, if they have had surgery. Patients who receive the first chemotherapy should have their blood and general condition checked in the medical oncology outpatient clinic about a week after the chemotherapy. In this control, the general conditions of the patients, the way they tolerate the treatment and their blood tests are examined, their complaints are listened to, and in the next cure applications, the blood controls and general conditions of each patient are examined before the treatment and the side effects of chemotherapy are evaluated, and if necessary, the dose of the drug is adjusted.

Smart Drugs and Smart Molecule Therapy

In recent years, it is the treatment of non-small cell lung cancers with drugs in the form of oral pills, after extensive pathological examination for non-squamous cell lung cancers. Further pathological examinations in patients are defined as the ‘EGFR’ mutation test and the ‘ALK’ fusion test. The rate of positive (positive) detection of these tests in non-smokers is higher, but even in smokers, the rate of positive for one of the two tests is around 20 percent. This means that one in five patients benefit from these treatments.

Radiotherapy in Lung Cancer

Radiotherapy, that is, beam treatments, is the use of high-energy rays to kill cancer cells, they are applied to a limited area and affect the cancer cells in this area. Radiotherapy can be applied before surgery to shrink a tumor or after an intervention to destroy the cancer cell. Physicians generally use radiotherapy as the first alternative in patients with locally advanced cancer that cannot be operated with chemotherapy, but not spread to a distant region (metastasis). In patients with advanced stages, radiotherapy can also be used to relieve symptoms such as shortness of breath or pain.

Vaccine Treatment in Lung Cancer

Significant advances have been made in the treatment of lung cancer, especially in recent years. Immunotherapy, also known as lung cancer vaccine, is one of the most important of these developments, which mostly concerns patients with stage 4 lung cancer. Immunotherapy means that the patient fights cancer cells by using his own immune system, so it has fewer side effects than other chemotherapy drugs. Nowadays, fourth stage lung cancer patients in America and Europe can be treated with this cancer vaccine from the very first moment.

In order to use the lung cancer vaccine, first of all, some tests are requested from the patient and it is determined whether he is a candidate for this vaccine according to the type of lung cancer. 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 has the ability to cause temporary inflammation in the intestines and thyroid gland.

Lung cancer vaccine is currently used only in the fourth stage patient groups and has a feature that affects life expectancy. All treatments in stage 4 are applied to prolong the life of the patient.

What are the Ways to Prevent Lung Cancer?

Lung cancer formation cannot be attributed to a single cause, researches have found many causes of lung cancer. Various factors may play a role in the development of lung cancer, most of which are related to tobacco use. Lung cancer is not contagious and some people may have a higher risk of developing lung cancer than others.

Smoking and lung cancer: Smoking causes lung cancer. Tobacco contains substances that damage the cells in the lung (carcinogens).

Over time, these can lead to cancer in the cells. Whether a smoker has lung cancer is closely related to the age at which he started smoking, how long he has been smoking, the number of cigarettes smoked per day, and how deeply he inhales the cigarette. Quitting smoking greatly reduces the risk of developing lung cancer.

Cigar, pipe and lung cancer: Cigar and pipe users have a higher risk of developing lung cancer than non-smokers. Cigar and pipe smokers are also at risk for other types of lung and mouth cancer.

Asbestos and lung cancer: It is a mineral group that is used in some industries and is naturally found in fiber form. asbestos fibers tend to break up into particles and circulate through the air and adhere to clothing. These particles settle in the lungs when inhaled. It increases the risk of developing cancer by damaging the lung cells there. Studies have shown that workers exposed to asbestos are 3-4 times more likely to develop lung cancer than those not exposed. This increase is higher for those working in industries such as shipbuilding, asbestos mines, insulation work, and brake repair. If asbestos workers smoke, they have a greater risk of developing Lung cancer. Asbestos workers should use protective materials provided by their employers and strictly follow recommended work and safety warnings.

Air pollution and lung cancer: An association between lung cancer and exposure to air pollution has been found, but this association has not been clearly described and further research is needed.

Lung diseases: Certain lung diseases, such as tuberculosis, increase a person’s risk of developing cancer. Lung cancer tends to develop more in areas affected by tuberculosis.

Patient’s history: A person who has had lung cancer once has a higher risk of developing lung cancer again than a person who has never had cancer. Quitting smoking after a diagnosis of lung cancer can prevent the development of a second lung cancer.