Mr. Patel*, 68, complained of constant cough and mild breathlessness. He was being treated for a smoker’s cough with bronchodilators and had been advised to quit smoking. But the cough persisted even after four weeks of treatment. He had no appetite, was fatigued and had lost about two kg in two weeks. He also complained of a mild headache. He had been on hypertension medication for 10 years.
A clinical examination, blood investigations and a contrast-enhanced CT scan of his chest was done for suspected chest infection. His scans showed a small peripheral nodule from which a biopsy was ordered. Mr. Patel had stage IV oligometastatic lung cancer.
Lung cancer is hard to treat. According to the World Health Organisation statistics, lung cancer accounted for 18.2 per cent of cancer mortalities in 2010. Survival rates are poor partly because it goes undetected till it is in an advanced state.
As the lung does not contain nerve endings, the occurrence of a tumor does not cause direct pain. This is experienced when the tumor reaches the pleura or the tissues surrounding the lungs, or when it presses on nerve structures in proximity. The tumor can also compress or invade other organs and cause other symptoms.
A clinical examination followed by a chest x-ray or a CT scan are the first steps in diagnosis. This is then confirmed by a biopsy. A PET-CT is the best to pick up distant metastases in lung cancer as it can detect tumors as small as 3-4 mm in any part of the body except the brain.
There are two main types of lung cancers classified according to the size and appearance of malignant cells, namely, non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC).
Traditional treatment options are surgery, chemotherapy and radiation therapy. New developments in imaging and radiation techniques have helped treatment of lung cancers. One such innovation is the Radiosurgery-CyberKnife technique. Little known in India, it is an advanced method of robotic radiosurgery for lung tumors, whether primary and early stage, recurrent, or secondary, central or peripheral. The technology delivers high doses of radiation with great accuracy with minimal radiation exposure and side effects as compared to traditional radiotherapy procedures.
Because of their anatomical location, lung tumors “move a lot” with respiration. The new technique’s image guidance capability, coupled with software that predicts the tumour’s location according to the respiratory cycle, allows for a correction of the radiation beam during the sessions, unlike other image-guided conventional radiation techniques.
Compared to invasive surgical methods, the healing process involves fewer complications. The system’s advanced technology enables treatment to be tailored for the needs of the individual.
Early detection is the best defence against cancer. According to the National Cancer Registry Project, India, more than 60 per cent of patients are diagnosed late due to poor awareness of symptoms.
Symptoms
Chronic cough, abnormal shortness of breath, repeated lung infections, coughing up blood, change in voice, persistent thoracic pain and permanent swelling of neck and face.
Lung cancer can also manifest through general symptoms such as fatigue, weight loss, prolonged fever, headache, nervous disorders, progressive swelling of fingers.
Causes
Chronic exposure to tobacco smoke, including passive smoking. Other risk factors include occupational hazards, exposure to contaminated drinking water, breathing polluted air and a family history of the disease.
