A delayed diagnosis in regards to any cancer can ultimately lead to complications and a higher staging, making this mistake incredibly detrimental, regardless of the specific disease. Some cancers, however, are more life-threatening than others, and among the more deadly is lung cancer.
If a diagnosis of lung cancer is missed, the efficacy of treatments diminishes greatly the longer they are delayed. As lung cancer is responsible for 25 percent of all cancer-related deaths, it is even more critical that proper screening, diagnosis, and treatment are performed and administered with care.
The Function of The Lungs
On its journey from the atmosphere into the lungs, air travels down the trachea, and reaches a section of the windpipe that splits into two main bronchi, known as the carina.
One section of the bronchi leads to the left lung, and the other to the right lung.
From there, like branches on a tree, the pipe-like bronchi split again into smaller bronchi and then even smaller bronchioles. This ever-decreasing pipework eventually terminates in the alveoli, which are little air sac endings. It is here, gas exchange occurs.
In order for the oxygen to enter the bloodstream, this exchange must take place. CO2 is carried to the lungs from cells through the bloodstream and released upon exhalation.
The whole system is powered by the diaphragm. Much like bellows, the diaphragm, the intercostal muscles (between the ribs), the muscles of the abdomen, and sometimes even muscles in the neck, all work together to expand and contract.
What Causes Cancer of the Lungs?
Smoking is responsible for the majority of lung cancers. Whether the result of smoking, directly, or as the result of secondhand smoke.
Smoking causes cancer by first damaging the cells of the lungs. Cigarette smoke is full of substances called carcinogens. When carcinogens hit the cells, they are damaged or injured almost immediately.
Initially, the body is able to repair the damage done to cells by cigarette smoke, but over time and with repeated exposure, they begin to mutate. As a result, cancer may eventually develop.
While smoking is the major culprit, lung cancer does occur in people who have never smoked or had any prolonged exposure to someone who has. It is in these cases that there is sometimes no real known cause for the cancer.
Types of Lung Cancer
There are two primary types of lung cancer that occur in the human body, Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
Non-small Cell Lung Cancer (NSCLC)
Non-small cell lung cancer is the most common type of lung cancer, responsible for roughly 85 percent of all people diagnosed with lung cancer each year, according to the American Cancer Society (ACS).
NSCLC, like most cancers, can be broken out into stages. The stages of cancer refer to the location and scale of the disease and provide a way for physicians to determine a course of action in care.
There is a TNM system used to determine which stage the lung cancer has reached. TNM stands for Tumor, lymph Nodes, and Metastasis.
A physician will conduct tests to determine which stage the cancer is at by evaluating:
- Tumor location
- Tumor size
- Involvement of lymph nodes
- Extent of metastasis, or spreading
Small Cell Lung Cancer (SCLC)
Small Cell Lung Cancer is a less common form of lung cancer as it only occurs in 10 to 15 percent of people. SCLC is more aggressive than NSCLC, spreading incredibly rapidly.
For SCLC there are two different ways of evaluating the stage. One is the frequently used TNM staging, also used in diagnosing NSCLC.
The more common staging system for SCLC, involves classifying the cancer in just one of two ways:
- Limited: the cancer is solely on one side of the chest and in a limited, defined area.
- Extensive: the cancer has spread from one lung to the other, to lymph nodes on the other side of the chest, or to other parts of the body.
Regardless of type or stage of the lung cancer, early detection is the best way to improve a prognosis, especially as treatments advance.
What are the Symptoms of Lung Cancer?
In the earliest stages of lung cancer, there are often no signs or symptoms of the disease, but symptoms can become increasingly severe as the disease progresses.
Signs and symptoms of lung cancer may include a new cough that persists over time, coughing up blood, shortness of breath, chest pain, weight loss, hoarseness, bone pain, and headaches.
What are Available Treatment Options?
Depending on its type and stage, lung cancer may be treated with surgery, chemotherapy, medications, or radiation therapy. There are also localized treatments such as laser therapy, or a combination of treatments may be used. This is called combination treatment or multimodality treatment.
A number of factors are used to determine the best course of treatment for each individual patient, including type of lung cancer and stage. Oftentimes, multiple or a combination of treatments will be used.
Surgery is typically part of the treatment plan for early stage lung cancers. The type of surgery depends on many factors, including the location and size of the tumor, the extent to which the cancer has spread, and the overall health of the patient.
Many surgeries are done with an incision in the side of the chest, known as a thoracotomy.
Types of surgery include:
- Segmental or wedge resection: removal of only a small part of the lung.
- Lobectomy: removal of an entire lobe of the lung.
- Pneumonectomy: removal of an entire lung.
- Sleeve resection: removal of a piece of bronchus, after which the lung is reattached to the remaining part of the bronchus.
There are two types of radiation therapy that are commonly used to treat lung cancer.
Internal Radiation therapy (internal beam therapy): is the use of high-energy radiation placed inside of the body to kill cancer cells and to shrink tumors. Radiation may also be used in combination with chemotherapy.
External radiation (external beam therapy): A treatment that precisely sends high levels of radiation directly to the cancer cells.
Surgery and radiation are beneficial when targeting one focused area of the body, chemotherapy however, goes throughout the body to search specifically for tumor cells. In most cases, chemotherapy is administered through an IV.
Because cancer is caused by abnormal growth in cells, chemotherapy is able to interfere with the cancer cell’s ability to both grow and reproduce.
In some non-small cell lung cancers, targeted drug therapy has been found to be useful. It works in a similar way as chemotherapy in that it goes through the body searching for cancer cells and works by keeping them from growing. It does this by prohibiting new blood vessels from forming around the tumor and nourishing it.
This process is called angiogenesis.
Some targeted drugs, called angiogenesis inhibitors, block this new blood vessel growth.
Two examples of which are:
- Bevacizumab (Avastin): used to treat advanced NSCLC. This treatment is a monoclonal antibody (a lab-made version of a specific immune system protein) that targets vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form.
This drug is often used with traditional chemotherapy, initially. If the cancer responds to the Bevacizumab, the chemotherapy may be stopped and the drug is given by itself until the cancer starts growing again.
- Ramucirumab (Cyramza): can also be used to treat advanced NSCLC. This drug is a monoclonal antibody that targets a VEGF receptor (protein). It helps stop the formation of new blood vessels.
This drug is often combined with chemotherapy, typically after another treatment stops working.
Immunotherapy is a new cancer treatment approach that uses drugs, vaccines, and other therapies to activate the immune system’s natural defenses so it can fight cancer.
One type of immunotherapy drug, called “anti-PD-1” has been shown to cause significant tumor regression in a quarter of patients who receive it, after a round of chemotherapy.
Three immunotherapy drugs—pembrolizumab, atezolizumab, and nivolumab—have been approved to treat certain non-small cell lung cancers.
Survival Rates for NSCLC and SCLC
Lung cancer is very dangerous and in the past, survival outcomes have not been very encouraging. Over the years though, research continues to evolve and the rates of surviving lung cancer are improving. People, in particular, who are diagnosed with early stage lung cancer are surviving at the highest growing rate.
The indicated survival rate is a statistic based on groups of people with the same stage of cancer. Each person’s experience may be different.
What is a 5-year Survival Rate?
The survival rate most often given for lung cancer is measured within the 5-year period after a patient has been diagnosed with or started treatment for lung cancer; this is called a five-year survival rate.
When a patient is diagnosed with lung cancer, there are many factors considered when determining the 5-year survival rate including type and stage of disease, treatment plan, and the overall health of the patient.
Non-Small Cell Lung Cancer (NSCLC) Survival Rates
The five-year survival rate for NSCLC varies according to the stage and extent of the disease.
The American Cancer Society ACS estimates 5-year survival rates based on NSCLC cancer stage:
The survival rates are based on staging using the following metrics:
- Localized: 63 percent survival rate: Cancer is limited to the place where it started, with no sign that it has spread.
- Regional: 35 percent survival rate: Cancer has spread to nearby lymph nodes, tissues, or organs.
- Distant: 7 percent survival rate: Cancer has spread to distant parts of the body.
- Unknown: There is not enough information to figure out the stage.
- All stages combined: 25 percent survival rate.
Small Cell Lung Cancer (SCLC) Survival Rates
Five-year survival rates for people with SCLC are challenging to qualify, as it is not often caught at an early stage. The overall survival rate for those who have SCLC is just 6.5 percent.
Delaying a Diagnosis
The delayed diagnosis of any cancer can be devastating, but in the case of lung cancer, it is often deadly. As the lungs are the center of the respiratory system, any damage can have a huge impact on a patient’s health, long-term.
A physician treating a patient who may have lung cancer must take great care to administer all of the appropriate testing and follow the established standard of care when treating that patient. Failure to do so may result in medical malpractice.
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