Lung cancer

Diagnosis of Lung Cancer

Diagnosis involves several steps in testing to confirm cancer and determine how far it has spread:

Taking a Medical History and Physical Exam

Imaging Studies

Conducting a Chest X-ray, CT scan, PET scan, or MRI for lung masses and assessing for metastasis.

Sputum Cytology

Sputum Cytology is an examination method in which mucus from saliva samples is carefully examined to detect cancerous cells.

Biopsy

• Bronchoscopy: A flexible tube is inserted into the lung to gather tissue samples which a pathologist examines.
• Needle biopsy: Using a tiny needle with CT or ultrasound guidance to aspirate tissue.
• Liquid biopsy: Acquiring tissues via blood samples.

Molecular and Genetic Tests

As part of targeted therapy, molecular genetic testing allows physicians to detect specific mutations (EGFR, ALK, or KRAS), enabling targeted drug treatments.

Workup for Staging

Vital for treatment plan selection, including imaging of the bone and brain for metastasis.

Lung Cancer Treatment

Treatment options vary based on health, genetics, type, and stage of disease. They are divided into:

A. Traditional Treatment Options (TTOs)

1. Surgical Procedures

• Lobectomy: Removal of one lung lobe in early-stage NSCLC.
• Pneumonectomy: Complete removal of a lung for large or centrally located tumors.
• Segmentectomy/Wedge Resection: For smaller tumors or patients with limited lung function.

2. Radiation Therapy

• External Beam Radiation Therapy (EBRT): Uses high-energy beams to target tumors externally.
• Stereotactic Body Radiotherapy (SBRT): Precision treatment for small tumors.

3. Chemotherapy

Systemic drugs administered via IV or orally to destroy cancer cells. Common medicines include cisplatin, carboplatin, paclitaxel, and docetaxel.

Targeted Therapies

• EGFR inhibitors: Erlotinib, Afatinib for patients with EGFR mutations.
• ALK inhibitors: Crizotinib, Alectinib for ALK-positive patients.
• ROS1 and BRAF targeted agents: For rare mutations.

Targeted Radiation Therapy

• Brachytherapy: Radioactive seeds near or within tumors for local treatment.
• Radioembolization: Used for lung tumor metastases to the liver.

Advanced Immunotherapy and Stem Cell Therapies

• Immunotherapy Drugs: Nivolumab, Pembrolizumab activate T-lymphocytes to attack tumors.
• CAR-T cell therapy: Clinical trials ongoing for lung and other solid tumors.

Prevention and Lifestyle Management

Strategies focus on controlling exposure to carcinogens:

• Complete smoking cessation
• No exposure to secondhand smoke
• Regular home radon testing
• Safe handling of asbestos and industrial toxins
• Antioxidant-rich diet
• Regular exercise and maintaining proper weight
• Screening with low-dose CT for high-risk individuals

Prognosis and Survival Statistics

Prognosis depends on general health and intervention methods. According to the American Cancer Society:

• About 65% five-year survival for localized stage
• 45% survival for regional spread
• 35% survival with nearby lymph node involvement
• 8% survival for distant metastases

Participation in screening programs significantly improves outcomes, especially for high-risk groups like smokers.

Conclusion

Lung cancer remains one of the deadliest cancers. Early detection, risk recognition, prevention, and targeted therapies can improve life expectancy. Education, screening, and innovative treatment approaches provide hope against this devastating disease.