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November brings about a number of lung related awareness campaigns, you may have seen our recent blog post regarding COPD . The whole month however is dedicated to raising awareness of lung cancer in particular and Dr Arad Hussain, MSc Respiratory Medicine student has shared some facts about this disease, looking at the types of lung cancer we see and what the diagnosis of them can mean.

What are the lungs and why are they important?

Our lungs are made up of hundreds and thousands of small branches which eventually end in a small sac called the alveoli. The lungs themselves need a large amount of blood flowing around them to help us get oxygen into the cells of the body, and remove carbon dioxide from the blood. Any disruption of the lung tissue can have a massive impact on our ability to breathe, get energy and remove toxins. One such disruption is cancer, a process where abnormal cells of the body grow out of control and can grow into nearby healthy tissues. When cancer starts in the lungs, it is called lung cancer. Due to the anatomy of the lungs, cancerous cells can spread to the lymph nodes or other organs of the body, including the brain.

Large population studies clearly show smoking as the most common cause of lung cancer, but people who have never smoked or are former smokers can also develop the disease. Additionally, the risk of developing the cancer also depends on factors such as age, genetics, and exposure to risk factors (including ionising radiation, workplace exposures, and air pollution).

Why is lung cancer important?

Lung cancer is one of the most common and serious types of cancer. It is the most commonly occurring cancer in men and the third most commonly occurring cancer in women. In UK around 48,500 new lung cancer cases are diagnosed every year, and accounts for around 21% of all cancer related deaths or 35,000 people in the UK annually (1).

Clearly, lung cancer is an important and pervasive disease that poses a significant public health problem. However, it was not the case around 200 years ago, it was an extremely rare disease. Although the first description of lung cancer was recorded in 1761, it wasn’t until the 20th-century that the different types and stages of lung cancer were identified (2). There are two main types of lung cancer: small cell lung cancer and non-small cell lung cancer (including quamous cell carcinoma, large cell carcinoma, and adenocarcinoma) (3).

How can we spot it?

Early detection of lung cancer makes it more treatable, so encouraging people to recognise symptoms is important – the problem however is that lung cancer may not produce noticeable symptoms in the early stages, and people can present with different symptoms. This is because some people present with the symptoms of the lungs, while others may present with symptoms of other part of the body (metastasized).

People who develop any of the following symptoms should see a doctor for immediate assessment and find out the cause:

  • A new cough that getting worse or doesn’t go away.
  • Chest pain.
  • Shortness of breath.
  • Wheezing.
  • A raspy or hoarse voice
  • Coughing up blood.
  • Feeling very tired all the time.
  • Weight loss with no known cause.
  • Bone pain
  • Worsening headaches

What’s the outcome?

The key to surviving lung cancer is to catch it in the early stages. The cure rate of small early-stage cancer is as high as 80% to 90%, but the cure rate drops dramatically as the cancer becomes more advanced and spreads to other parts of the body. Therefore, as soon as the doctor suspects lung cancer, tests such as sputum cytology, chest x-ray, and spiral CT-scan scan is usually done to reach a diagnosis. When a diagnosis has been made, further tests are done to find out how far it has spread through the lungs, lymph nodes, and the rest of the body. This process is called staging. The type and stage of lung cancer helps the doctors to develop a treatment plan.

Conclusion

With the advancements in medical science several effective treatment methods has been established, depending on the type and stage of lung cancer. Around 80% to 85% of the diagnosed lung cancer are non-small cell lung cancer, and it is usually treated with surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these treatments. For example, no metastatic stage I/II non-small cell lung cancer is usually treated with surgery and excision of the tumour. However, at a higher stage chemotherapy and radiation therapy are also used in combination with surgery. Small cell lung cancer accounts for around 10% to 15% of all lung cancers and it is nearly always disseminated at presentation. Consequently, radiation therapy and chemotherapy are the mode of treatment for small cell lung cancer.

Even with the advancements in diagnostic tools and treatment methods, lung cancer still presents a public health challenge for all countries around the world. With the increase in the number of cases of lung cancer people are more aware and the lung cancer communities are also growing. Now there are lots of active support groups for the patients and their families, so that no one has to face lung cancer diagnosis alone.

Has this blog interested you in the world of respiratory medicine? All of our undergraduate programmes at Chester Medical School include the lungs and lung pathology in our core modules throughout the programme.

Register now for the University of Chester Virtual Undergraduate Open Day on Saturday 4th December 2021 to join live subject talks with our academic staff

For those looking to study it in more depth,  MSc Respiratory Medicine at Chester Medical School is an academic programme designed to develop and further your understanding and knowledge of respiratory medicine focusing on up-to-date research and developments in the diagnosis and treatment of respiratory diseases.

References

1.          Lung cancer statistics | Cancer Research UK [Internet]. [cited 2021 Nov 7]. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/s...

2.          Spiro SC, Silvestri GA. One Hundred Years of Lung Cancer. https://doi.org/101164/rccm200504-531OE [Internet]. 2012 Dec 20 [cited 2021 Nov 7];172(5):523–9. Available from: www.atsjournals.org

3.          Lung Cancer—Patient Version - National Cancer Institute [Internet]. [cited 2021 Nov 7]. Available from: https://www.cancer.gov/types/lung

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