Lung Cancer

Lung cancer remains one of the most formidable health challenges globally, claiming more lives each year than any other type of cancer. In India, the issue is particularly severe, with nearly 100,000 new cases diagnosed annually. While smoking is a significant risk factor, it’s crucial to recognize that many individuals who have never smoked also develop lung cancer, highlighting the complexity of this disease.

What Is Lung Cancer?

Lung cancer occurs when cells in the lungs grow uncontrollably, forming tumors that can interfere with normal lung function. These cancerous cells can also spread to other parts of the body, a process known as metastasis. The people who smoke are at greater risk of developing cancer with ease. Although, the risk can minimize once a person reduces or quits smoking. Since cancer risk is directly proportional to the cigarette smoking duration or its count, the more is its duration or count the more are chances of developing cancer.

It can also occur in people who do not smoke or are exposed to passive smoking. However, the chances of developing among non-smokers or passive smokers are very minimal. The main lung cancer symptoms include coughing accompany with blood, wheezing, chest pain, and weight loss. But in most of the cases, these symptoms appear in advanced stages of cancer. Other symptoms might include hoarseness, extreme body fatigue, swollen lymph nodes, and weight loss, etc.

Lung cancer treatment options vary broadly depending upon the cancer stage and the health of an individual. The treatments might include radiation therapy, chemotherapy, immunotherapy, and even surgery in extreme cases.

Types of Lung Cancer

Lung cancer is broadly categorized into two main types:

1. Non-Small Cell Lung Cancer (NSCLC)

This is the most prevalent form of lung cancer, accounting for about 80–85% of all cases. NSCLC encompasses several subtypes:

• Adenocarcinoma: The most common subtype, especially among non-smokers and women. It typically develops in the outer regions of the lungs and originates from mucus-producing glandular cells.
• Squamous Cell Carcinoma: Often linked to smoking, this type arises in the flat cells lining the airways and usually forms in the central parts of the lungs, near the main airways (bronchi).
• Large Cell Carcinoma: A less common and more aggressive subtype that can appear in any part of the lung. It tends to grow and spread faster than the other NSCLC types.

NSCLC generally progresses more slowly than Small Cell Lung Cancer, and treatment options often include surgery, radiation therapy, chemotherapy, targeted therapies, or a combination of these, depending on the stage and specific characteristics of the tumor.

2. Small Cell Lung Cancer (SCLC)

Representing about 10–15% of lung cancer cases, SCLC is less common but notably more aggressive. It’s strongly associated with smoking and tends to grow rapidly, often spreading to other parts of the body before it’s detected.

SCLC is categorized into two subtypes:

• Small Cell Carcinoma (Oat Cell Cancer): The most prevalent form, characterized by small, round cells that multiply quickly.
• Combined Small Cell Carcinoma: A rarer form that includes both small cell and non-small cell components.

Due to its aggressive nature, SCLC is typically treated with chemotherapy and radiation therapy rather than surgery. Early detection is crucial, but unfortunately, SCLC is often diagnosed at an advanced stage, which can limit treatment effectiveness.

Complications of Lung Cancer

Lung cancer can lead to various complications, either from the disease itself or as a result of treatments. These complications can affect multiple systems in the body and may impact a patient’s quality of life.

1. Shortness of Breath (Dyspnea): Tumors may obstruct airways or cause fluid accumulation around the lungs, making breathing difficult. This can lead to persistent shortness of breath, especially during physical activity.
2. Coughing Up Blood (Hemoptysis): Bleeding within the airways can result in coughing up blood. While it may be minimal, significant bleeding requires immediate medical attention.
3. Chest Pain: Tumor growth can press against nerves or the chest wall, causing pain that may worsen with deep breathing, coughing, or laughing.
4. Pleural Effusion: Fluid buildup between the lungs and chest wall can compress the lungs, leading to breathing difficulties and increased risk of infections like pneumonia
5. Superior Vena Cava Syndrome: A tumor pressing on the superior vena cava—a major vein—can impede blood flow, leading to swelling in the face, neck, and upper chest, along with shortness of breath and dizziness.
6. Blood Clots: Lung cancer increases the risk of blood clots, which can lead to conditions like deep vein thrombosis or pulmonary embolism, posing serious health threats.
7. Infections: A weakened immune system, whether from the cancer or its treatments, makes patients more susceptible to infections, including pneumonia and bronchitis.
8. Hypercalcemia: Some lung cancers produce substances that elevate calcium levels in the blood, leading to symptoms like nausea, constipation, frequent urination, and confusion.
9. Spinal Cord Compression: Cancer spreading to the spine can compress the spinal cord, causing back pain, numbness, and even paralysis if not treated promptly.
10. Paraneoplastic Syndromes: These are rare disorders triggered by the immune response to cancer, leading to symptoms like muscle weakness, hormonal imbalances, and neurological issues.

Managing these complications involves a combination of treatments aimed at controlling cancer growth and alleviating symptoms. Regular monitoring and prompt medical attention are crucial to address these issues effectively.

Causes and Risk Factors

Smoking and Tobacco Use

Smoking and Lung Cancer: The Direct Link

Cigarette smoke contains over 7,000 chemicals, including at least 70 known carcinogens. These substances damage the cells lining the lungs, leading to mutations that can result in cancer. The risk of developing lung cancer increases with the number of cigarettes smoked per day and the number of years a person has smoked. Even low levels of smoking can significantly elevate the risk.

Secondhand Smoke: An Invisible Threat

Secondhand smoke, also known as passive or environmental tobacco smoke, is a mixture of the smoke exhaled by smokers and the smoke emitted from the burning end of cigarettes. Non-smokers exposed to secondhand smoke inhale many of the same toxic chemicals as smokers. This exposure increases their risk of developing lung cancer by 20–30%.

Environmental and Occupational Exposures

In India, air pollution is a growing concern. Exposure to pollutants like particulate matter (PM2.5 and PM10), industrial emissions, and vehicular exhaust can damage lung tissue over time. Indoor air pollution from burning solid fuels for cooking and heating, especially in rural areas, further exacerbates the risk.

Occupational exposure to carcinogens such as asbestos, arsenic, and certain chemicals can also increase the likelihood of developing lung cancer.

Genetics and Other Risk Factors for Lung Cancer

While smoking is the primary cause of lung cancer, several other factors—including genetics, exposure to radon gas, and previous radiation therapy—also play significant roles in increasing an individual’s risk.

Family History and Genetic Predisposition

Having a close family member, such as a parent, sibling, or child, diagnosed with lung cancer can elevate your own risk of developing the disease. Research indicates that individuals with a first-degree relative who had lung cancer have approximately a 50% higher risk compared to those without such a family history.

This increased risk may be due to shared genetic factors that predispose individuals to cancer. For instance, certain genetic mutations, like those in the EGFR gene, are more prevalent among families with a history of lung cancer and can influence cancer development.

It’s important to note that this elevated risk applies to both smokers and non-smokers, highlighting the role of inherited genetic factors independent of tobacco exposure.

Radon Gas Exposure

Radon is a naturally occurring radioactive gas that can accumulate in homes, particularly in areas with poor ventilation. It’s the second leading cause of lung cancer after smoking and the leading cause among non-smokers. The Environmental Protection Agency estimates that radon exposure is responsible for about 21,000 lung cancer deaths annually in the United States.

The risk from radon is significantly higher for smokers, but non-smokers are also at risk. The combination of smoking and radon exposure increases lung cancer risk more than either factor alone.

Testing homes for radon is crucial, especially in areas known to have high radon levels. Simple test kits are available, and if high levels are detected, mitigation systems can be installed to reduce radon concentrations indoors.

Doctors For Lung Cancer

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Dr. Vinod Raina

Medical Oncology, Hematology, Bone Marrow & Stem Cell Transplant

40+ years of experience

Chairperson, OncoSciences; Executive Director & Head, Medical Oncology & Hematology

Fortis Hospital Gurgaon - India

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Dr. Kapil Kumar

Surgical Oncologist

30+ years of experience

Director & HOD, Surgical Oncology

Fortis Hospital, Shalimar Bagh – Advanced Oncology Care - India

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Dr. Niranjan Naik

Surgical Oncologist

23+ years of experience

Director – Breast & GI Onco‑Surgery

Fortis Hospital Gurgaon - India

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Prof. Dr. Suresh H. Advani

Senior Medical Oncologist & Hematologist

50+ years of experience

Director of Medical Oncology

Jaslok Hospital - India

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 Dr. (Col) Ranga Rao Rangaraju

Medical Oncologist

40+ years of experience

Chairman, Medical Oncology

Paras Hospitals, Gurgaon - India

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Symptoms and Early Detection

Lung cancer often develops silently, with noticeable symptoms appearing only in advanced stages. However, being aware of potential warning signs can lead to earlier diagnosis and better treatment outcomes.

Common Symptoms Include:

• Persistent Cough: A cough that doesn’t go away or worsens over time.
• Coughing Up Blood: Even small amounts of blood in sputum can be a warning sign.
• Chest Pain: Discomfort that may worsen with deep breathing, coughing, or laughing.
• Shortness of Breath: Difficulty breathing or feeling winded during routine activities.
• Unexplained Weight Loss: Losing weight without changes in diet or exercise.
• Fatigue: Persistent tiredness or lack of energy.
• Recurring Respiratory Infections: Frequent bouts of bronchitis or pneumonia.

Early-Stage Lung Cancer Symptoms

In the initial phases, lung cancer might not cause noticeable symptoms. However, some individuals may experience:

• Persistent or worsening cough – A cough that doesn’t go away or changes in character.
• Shortness of breath – Difficulty breathing during routine activities.
• Chest pain – Discomfort or pain in the chest area, especially when breathing deeply or coughing.
• Hoarseness – Changes in voice quality.
• Unexplained weight loss – Losing weight without trying.
• Fatigue – Feeling unusually tired or weak.
• Recurrent respiratory infections – Frequent episodes of bronchitis or pneumonia

Advanced-Stage Lung Cancer Symptoms

As lung cancer progresses, symptoms may become more severe and widespread:

• Coughing up blood –  Presence of blood in sputum.
• Severe chest pain –  Intensified pain that may spread to the shoulder or back.
• Significant shortness of breath – Breathing difficulties even at rest.
• Bone pain – Discomfort in bones, indicating possible spread to skeletal structures.
• Neurological symptoms – Headaches, dizziness, or seizures if cancer has spread to the brain.
• Jaundice – Yellowing of the skin and eyes, suggesting liver involvement.
• Swelling in the face or neck –  Due to blocked blood vessels.
• Persistent fatigue and weight loss – Ongoing tiredness and continued weight reduction.

If you or someone you know is experiencing these symptoms, it’s essential to consult a healthcare professional promptly. Early detection and treatment can significantly improve outcomes in lung cancer cases.

Importance of Early Detection

Early detection significantly improves survival rates. Low-dose computed tomography (LDCT) scans are effective in identifying lung cancer at earlier, more treatable stages. However, awareness and access to screening remain limited in many regions.

Diagnosis and Staging

Diagnostic Procedures

If lung cancer is suspected, several tests may be conducted:

• Imaging Tests: Chest X-rays, CT scans, PET scans, and MRIs help visualize tumors and assess their spread.
• Sputum Cytology: Examining mucus from the lungs under a microscope can reveal cancer cells.
• Biopsies: Samples of lung tissue are taken using bronchoscopy, needle biopsy, or surgical methods to confirm the presence of cancer cells.

Staging

Determining the stage of lung cancer is crucial for treatment planning:

• Stage I: Cancer is confined to the lungs.
• Stage II: Cancer has spread to nearby lymph nodes.
• Stage III: Cancer has spread to lymph nodes in the middle of the chest.
• Stage IV: Cancer has spread to both lungs, fluid around the lungs, or other parts of the body.

Small cell lung cancer is often classified as either limited stage (confined to one lung) or extensive stage (spread beyond one lung).

Treatment Options

1. Surgery: Removing the Tumor

Surgical intervention is typically considered for early-stage non-small cell lung cancer (NSCLC) when the cancer is localized and hasn’t spread extensively. The primary surgical procedures include:

• Lobectomy: Removal of an entire lobe of the lung.
• Pneumonectomy: Removal of an entire lung.
• Segmentectomy or Wedge Resection: Removal of a small part of the lung.

Minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS), are increasingly used, leading to shorter recovery times and fewer complications.

2. Radiation Therapy: Targeting Cancer Cells

Radiation therapy employs high-energy rays to destroy cancer cells. It’s often used:

• When surgery isn’t an option due to the patient’s health or cancer’s location.
• To shrink tumors before surgery (neoadjuvant therapy).
• After surgery to eliminate remaining cancer cells (adjuvant therapy).
• For palliative care to relieve symptoms in advanced stages.

Advanced techniques like stereotactic body radiotherapy (SBRT) allow for precise targeting, minimizing damage to surrounding healthy tissue.

3. Chemotherapy: Systemic Cancer Control

Chemotherapy uses drugs to kill rapidly dividing cancer cells and is a cornerstone in treating both NSCLC and small cell lung cancer (SCLC). It’s utilized:

• Before surgery to shrink tumors.
• After surgery to eliminate residual cancer cells.
• In advanced stages to control cancer spread and alleviate symptoms.

Common chemotherapy regimens include combinations of platinum-based drugs like cisplatin or carboplatin with other agents.

4. Targeted Therapy: Precision Medicine

Targeted therapies focus on specific genetic mutations or abnormalities within cancer cells. These treatments are particularly effective for patients whose tumors have identifiable mutations, such as:

• EGFR Mutations: Treated with drugs like osimertinib (Tagrisso), which has been shown to double median disease-free survival time.
• ALK Rearrangements: Managed with medications like alectinib or crizotinib.

Genetic testing of tumor samples is essential to determine eligibility for targeted therapies.

5. Immunotherapy: Harnessing the Immune System

Immunotherapy empowers the body’s immune system to recognize and combat cancer cells. Checkpoint inhibitors, such as pembrolizumab (Keytruda) and nivolumab (Opdivo), have revolutionized lung cancer treatment by:

• Improving survival rates in advanced NSCLC.
• Offering treatment options for patients who cannot tolerate chemotherapy.

These therapies are often used alone or in combination with chemotherapy, depending on the cancer’s characteristics.

6. Emerging Therapies and Clinical Trials

Ongoing research continues to introduce innovative treatments, including:

• Bispecific Antibodies: Drugs like ivonescimab target multiple pathways simultaneously, showing promise in clinical trials.
• Laser Therapy: Utilizes focused light to remove or shrink tumors, often used in combination with other treatments.
• Clinical Trials: Provide access to cutting-edge therapies and are crucial for advancing lung cancer treatment.

Survival Rate of Lung Cancer in India

Lung cancer remains one of the most challenging cancers to treat, with survival rates heavily influenced by the stage at which the disease is diagnosed.

Overall 5-Year Survival Rate

In India, the overall 5-year survival rate for lung cancer patients is approximately 9.6%. This statistic underscores the aggressive nature of the disease and the importance of early detection.

Survival Rates by Stage

The likelihood of surviving lung cancer significantly depends on the stage at diagnosis:

• Stage I: When detected early and confined to the lungs, the 5-year survival rate can be as high as 92%.
• Stage II: If the cancer has spread to nearby lymph nodes, the survival rate decreases to around 60%.
• Stage III: With further spread within the chest, the survival rate ranges between 13% to 36%, depending on the extent.
• Stage IV: In cases where the cancer has metastasized to distant organs, the 5-year survival rate drops to approximately 5%.

Factors Influencing Survival

Several factors can impact survival rates:

• Early Detection: Patients diagnosed at an early stage have a significantly better prognosis.
• Type of Lung Cancer: Non-small cell lung cancer (NSCLC) generally has a better outcome compared to small cell lung cancer (SCLC).
• Advancements in Treatment: The introduction of targeted therapies and immunotherapies has improved outcomes for certain patient groups.
• Access to Healthcare: Timely access to quality healthcare services plays a crucial role in treatment success.

Improving awareness about lung cancer symptoms and promoting regular health check-ups, especially for high-risk individuals, can aid in early diagnosis and potentially improve survival rates.

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Living with Lung Cancer

A lung cancer diagnosis can be overwhelming. Support from healthcare providers, counselors, support groups, and loved ones is vital. Managing side effects, maintaining a healthy lifestyle, and addressing emotional well-being are integral parts of care.

Prevention and Awareness

Lifestyle Changes

• Quit Smoking: The most effective way to reduce lung cancer risk.
• Avoid Secondhand Smoke: Limit exposure to environments where smoking occurs.
• Reduce Exposure to Pollutants: Use clean cooking fuels, ensure proper ventilation, and advocate for cleaner air policies.

Regular Screenings

High-risk individuals, such as long-term smokers aged 50 and above, should consider annual LDCT scans for early detection.

Public Awareness

Dispelling myth that only smokers get lung cancer is crucial. Over half of lung cancer patients in India are non-smokers, emphasizing the need for broader awareness and early detection strategies.

Why Choose Cancer Rounds for Lung Cancer Care?

• Team of top lung cancer specialists
• Personalized treatment plans for every patient
• Access to advanced therapies and clinical trials
• Support at every step — from diagnosis to recovery
• Transparent communication and easy second opinions
• Seamless coordination with hospitals and labs
• Compassionate care focused on quality of life

FAQs About Lung Cancer

Q1. Can lung cancer be detected early?

Yes, early detection is possible, especially with regular screenings like low-dose CT scans for those at high risk. Early-stage lung cancer often has better treatment outcomes.

Q2. Is lung cancer treatable?

Absolutely. Treatment options include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. The choice depends on the cancer type and stage, but many patients respond well to these treatments.

Q3. Do non-smokers get lung cancer?

Yes, non-smokers can develop lung cancer. Factors like exposure to radon gas, air pollution, and genetic predispositions can contribute. In fact, a significant number of lung cancer cases occur in non-smokers.

Q4. What are the common symptoms of lung cancer?

Symptoms can include a persistent cough, shortness of breath, chest pain, and unexplained weight loss. However, some individuals may not experience noticeable symptoms in the early stages.

Q5. Can lifestyle changes help in lung cancer prevention?

Yes, avoiding tobacco, reducing exposure to environmental pollutants, and maintaining a healthy lifestyle can lower the risk of developing lung cancer.