Lung Cancer Diagnosis
In most patients the diagnosis was raised before clinical and radiological study when an abnormality is detected lung. Less often try to pinpoint the diagnosis in patients to that in a routine radiological have been revealed a suspect image or trying to locate the tumor with a histological study showing neoplastic cells. The objectives to be met for the diagnosis of lung cancer are:
- Clinical suspicion of symptoms (is nonspecific), especially in the population at risk than male smokers make up more than 45 years.
2. Location with chest X-ray and other tests.
3. Meet the histological type of tumor, which confirms the diagnosis.
4. To determine the staging of lung cancer. This together with the histological features of the tumor are the two key objectives of all diagnostic examinations.
5. Assess the general state of the patient.
6. Treatment decisions driving the above characteristics.
Plain chest radiograph
It is one of the first complementary test we perform. It must make a posteroanterior radiograph displaying the 70% of the lungs and side displaying the remaining 30%. The plain chest X-rays can be observed any abnormalities in almost 98% of patients with bronchogenic carcinoma and 85% are suggestive images to suspect the diagnosis of distal pulmonary abnormalities (atelectasis), the presence of lymphadenopathy (enlargement mediastinal) or chest intrusion detection, including the wall. Chest radiography detected 75% of lung cancers. The chest radiograph usually diagnosed in 5-15% of lung cancers in asymptomatic patients.
Small Cell Lung Cancer (SCLC)
This cancer is normally classified as limited or extended. Studies have shown that usually this type of lung cancer has already spread at the time it is detected (although such propagation can not be seen on X-rays or other imaging tests), so it is usually not the SCLC can be cured with surgery alone.
Limited stage: If you have limited stage SCLC, receive chemotherapy. The most commonly used treatment is a combination of two or more chemotherapy drugs. These would be combined with cisplatin or carboplatin, etoposide, usually administered for approximately six months. Studies are currently underway to determine whether the addition of topotecan or paclitaxel improve survival.
There have been many studies to determine whether radiation treatment to the chest (usually at the center, where the cancer spreads to lymph nodes) improved expectations compared to chemotherapy alone. These studies have shown that radiotherapy provides a small benefit. However, there will be more toxicity with radiation therapy with chemotherapy. They may experience more shortness of breath (dyspnea) due to damage to the lungs and difficulty swallowing (dysphagia) due to the esophagus is in the radiation field.
Thoracic radiation therapy is not performed in patients suffering from severe lung disease (and cancer) or some other serious medical problems. Sometimes, if the SCLC is highly localized, the cancer removed by surgery and then administered an adjuvant combination chemotherapy (polichemotherapy).
Lung Cancer Treatment
Treatment options for lung cancer are surgery, radiotherapy and chemotherapy, alone or in combination, depending on the stage of cancer.
After the diagnosis of lung cancer and rated their stadium, the oncology team should discuss treatment options with patients. It is important that the patient take the time to think about all possible options. When selecting a treatment plan, the most important factors to consider are the type of cancer (small cell or non-small cell) and stage it. For this reason, it is important to make all necessary diagnostic tests to determine the stage of cancer. Other factors to consider include the general health status, possible side effects of treatment, and the chances of curing disease, prolonging life or relieving symptoms.
When considering treatment options is often a good idea to get a second opinion. A second opinion can give the patient more information and help you feel more confident about the treatment plan you select.
Depending on the type and stage of lung cancer, surgery may be performed to remove the cancer in addition to some of the surrounding lung tissue.
* If you removed a lobe of the lung, the procedure is called a lobectomy.
* If the entire lung is removed, the surgery is called a pneumonectomy.
* Removal of part of a lobe is known as a segmentectomy or wedge resection.
Lung Cancer Prevention
- A) Primary prevention
The primary lung cancer prevention is to prevent it appears. Because snuff is the main risk factor and you can almost call causal factor, if people quit smoking, the incidence of lung cancer fall by more than 85%, almost to the figures of the early twentieth century (when people did not smoke). This requires the involvement of governments in promoting health. At present it is paradoxical and absurd to pass laws and anti-smoking programs in Spain, when the state receives huge amounts of money from taxes snuff. It is estimated that the Spanish state income taxes arising from snuff are double the health costs caused by diseases related to snuff. In this situation it is difficult (but not impossible) primary prevention or health promotion to prevent lung cancer.
- B) Secondary prevention
Early diagnosis of lung cancer is not established because it can not prevent death from lung cancer, not even the increased survival, as with other types of cancers even controversial: breast cancer, prostate cancer, cervical cancer uterine and colorectal cancers. The population at risk of developing lung cancer is well identified: the smokers. If we were to choose a diagnostic test to detect lung cancer early, to treat “on time”, this test would be simple to perform, cheap and accepted by the population, such as a chest radiograph, which has a low sensitivity in detecting early-stage lung tumors. Reliz a high-resolution chest CT or magnetic resonance imaging all smokers regularly exceed the country’s health spending more advanced. The timing of this alleged diagnostic technique would be at least twice a year, taking into account the speed of duplication of lung cancer.
Symptoms of Lung Cancer
Lung cancer is one of the most insidious and aggressive neoplasm of the entire field of oncology. The typical cases are described in the sixth decade of life and patients have symptoms for about 7 months ago. The symptoms of lung cancer is highly variable, depending on multiple factors:
- Tumor size.
2. Location of the tumor.
3. Time evolution.
4. Presence or absence of local infiltration.
5. Presence or absence of metastasis.
- A) Local symptoms of central tumor
Are due to bronchial obstruction and physiological impact on the lung.
Irritative cough *: The most common symptom and early and in 50% of cases the first symptom. It’s kind of irritating, because the foreign body acts as a tumor or ulceration of the mucosa. This symptom is often underestimated by the patient as to be at a high frequency in smokers, the cough is attributed to smoking, usually delaying consultation with the specialist. Sometimes the first warning sign is a change in the type of cough is why the individuals in the population at risk should see any change in his cough. The cough usually occurs in 70% of lung cancers.
Cause of lung cancer
The etiology of lung cancer is unknown but it is known that certain risk factors are closely related to lung cancer. These are exogenous factors such as snuff. Both population studies and animal experimental data do assume it is a disease of civilization and which is closely related to population density, urban development, the degree of industrialization and consumption of snuff.
The demonstration of a positive relationship between snuff and lung cancer is well established, to the point that almost considered more than one risk factor and a causative factor is indisputable data accumulated from:
- Frequency: 80-90% of lung cancers occur in smokers, but there is no evidence that is associated with a particular histological variety, but is more related to squamous cell carcinoma and small cell cancer. Statistically not associated with adenocarcinoma.
2. Number of cigarettes / day: Smokers have a risk of 10 to 20 times more likely to develop lung cancer (according to the number of cigarettes smoked per day) than nonsmokers. Ie there is a dose-response relationship.
3. Tendency to suck the smoke snuff: The deep breath especially if you smoke the last third of the cigarette burns on the lips, because that’s where they accumulate more toxic, more predisposed to cancer.
4. Duration and onset of smoking: The more years of life a person smokes and especially if it is at an early age, is more about cancer and cancer that the doses are cumulative. For example, the risk increases of 60-70 times in a man who smokes two packs a day for 20 years, compared to non-smoker.
5. Smoking cessation: Smoking cessation for 10 years reduces the risk level of controls (nonsmokers). In smokers there are structural and functional changes in the bronchial epithelium (disruption of cilia, mucosal hyperplasia with squamous metaplasia, etc) that take years to disappear once you have quit smoking, to more than 13 years.
Epidemiology of Lung Cancer
- Frequency: The lung cancer or lung cancer accounts for 97% of lung tumors. Of this 97%, 93% corresponds to the primary lung cancer and 4% form secondary tumors or metastatic. The 2% corresponds to bronchial adenoma and 1% are benign. Bronchogenic the term applies to the majority of lung cancers but it is wrong because it involves a bronchial origin for all of them, although adenocarcinomas, which are peripheral, are more frequently bronchiolar origin.
- Mortality: It is a highly lethal malignancy and most patients die within the first year after diagnosis. It is the most common cancer in men over 35 countries, mostly developed or industrialized countries, including Spain, being the leading cause of cancer death in both men and women. More people die of lung cancer than of colon, breast and prostate cancers combined. Representing 12.5% of all malignancies in Spain. In 2003, there will be about 171.900 new cases of lung cancer in the United States: 91.800 men and 80.100 women. About 157.200 people die of this disease: 88.400 men and 68.800 women.
- Increasing incidence: The number of cases has been increasing since the early century, doubling every 15 years. The incidence has increased about 20 times between 1940 and 1970. Earlier this century, it was considered that most lung tumors were metastatic and primary cancer that was rare.
- Prevention: Efforts started smoking since l970 have begun to result in a flattening of the incidence of death from lung cancer in white males, while among women the incidence is still increasing, because every day there are more women smokers