How is Lung Cancer Diagnosed ? Symptoms, Types, Treatment Options and Stages.

Lung cancer is the leading cause of cancer-related death in around the Globe, The Source of These Facts is from www.lung.org

• Lung cancer is the leading cancer killer in both men and women in the U.S. In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women.¹
• An estimated 154,050 Americans are expected to die from lung cancer in 2018, accounting for approximately 25 percent of all cancer deaths.²
• The number of deaths caused by lung cancer peaked at 159,292 in 2005 and has since decreased by 6.5 percent to 148,945 in 2016.¹
• Approximately 541,000 Americans living today have been diagnosed  with lung cancer at some point in their lives.
• During 2018, an estimated 234,030 new cases of lung cancer were expected to be diagnosed, representing about 13 percent of all cancer diagnoses.²
• The majority of living lung cancer patients have been diagnosed within the last five years. Lung cancer is mostly a disease of the elderly. In 2015, 86 percent of those living with lung cancer were 60 years of age or older.
• More men are diagnosed with lung cancer each year, but more women live with the disease. The rate of new cases in 2015 showed that men develop lung cancer more often than women (57.8 and 45.9 per 100,000, respectively).
• Black men and women are more likely to develop and die from lung cancer The lung cancer five-year survival rate (18.6 percent) is lower than many other leading cancer sites, such as colorectal (64.5 percent), breast (89.6 percent) and prostate (98.2 percent)
• About 8 million Americans qualify as high risk for lung cancer and are recommended to receive annual screening with low-dose CT scans.
• Smoking, a main cause of small cell and non-small cell lung cancer, contributes to 80 percent and 90 percent of lung cancer deaths in women and men, respectively.

Lets Dive in !

How is Lung Cancer Diagnosed ?

 

Every person and every case of lung cancer is different, and so the course to diagnosis is often individual as well. You may know this from personal experience, and I certainly do, because my Fathers  course to diagnosis was very atypical. But to at least start a discussion about diagnosis you might stick to a fairly standard course.

Since it’s estimated that about 90 percent of all lung cancers arise from smoking, let’s give our patient, we’ll name her Maria, Let’s say that over the years she developed a smoker’s cough, but decided to see a doctor one day when she was feeling like the cough was increasing, and at times she was coughing up bloody mucus and she’s consistently running a fever.

Her physician would probably immediately order a chest x-ray to get a picture of what’s going on inside of her lungs. Here’s my drawing of what a chest x-ray film might look like. Let’s say here in the lung is a round, suspicious-looking, dense mass. It would almost look like she breathed in a coin. Now a coin appearance on a chest x-ray can actually be a type of pneumonia, so pneumonia.

The radiologist might wonder if that’s exactly what’s going on with Maria, considering smokers are prone to lung infections, right? But pneumonia will clear or at least it will begin to clear in a few weeks with rest and antibiotics. Here are Maria antibiotics, and she takes them, and in a few weeks comes back for another x-ray and the radiologist finds that the coin mass is maybe a little bit bigger, maybe about the same size, but either way it hasn’t gotten smaller so  Maria Probably  doesn’t have pneumonia.

But be careful, because this doesn’t automatically mean that Maria has cancer, and a few other tests need to be done to rule out that. this just might be an outgrowth of normal, healthy cells. One of these tests is a computed tomography scan, or a CT.

Let’s say Maria goes and gets one to get higher resolution x-ray images to compile into a 3D image, making it easier to determine the size of the mass in her lungs. She might also go for a PET scan. PET scan stands for positron emission tomography scan, and it’s used to determine if the cells are using a large amount of glucose.

Since we know that cancer cells divide rapidly, they have a high demand for energy, and that means that they’re going to use a lot of glucose and will appear very bright in scans compared to background tissue in normal cells. And if the mass is a larger size or growing in size when compared to additional future CT scans, and if it appears bright in a PET scan, it’s worth taking the next step, which is more invasive but it’s the only way to definitively diagnose cancer, by getting a sample of cells from the mass.

Sometimes an invasive procedure can be avoided. For example, if cancer cells are found in the bloody mucus that Maria is coughing up. But this doesn’t frequently happen and so there are a few options for physically going in and removing the cells. Which option is used often is decided by the location of the cancer cells.

The Pleural space around the lungs that is filled with a protein-rich fluid that cradles the lungs, and sometimes cancer cells spread to this space. That’s called pleural effusion, and it causes this inflammation leading to an increase in the volume of the fluid. If this happens it will be visible on her  x-ray because where lung tissue used to be it’s now being covered by this fluid.

An oncologist may decide to pass a needle from the outside of the body into this space and take a sample of the fluid, including the cancer cells which will be floating around in it. But let’s say she doesn’t have pleural effusion. The medical imaging shows that the mass growing in her lung is closest to the outside of her body, like if they were here.

Well then the oncologist may decide that it makes sense to pass a needle from the outside of the body, through the pleural space and into the lung itself, where a biopsy of the tissue can be taken along with cells from the mass.

Let’s say that the mass is growing in one of Her major airways, It might be easiest then for the oncologist to insert a tube down the back of her throat in a procedure called a bronchoscopy. This allows for viewing of her lung internally, and an attachment on the tube can be used to take a biopsy of the lung tissue and the cells.

But any way that the cells are obtained, they’re going to be sent back to the lab and determined if they’re cancerous. This is done by looking at them and looking for hallmark signs of cancer, like specific mutations in their DNA.

Early discovery and diagnosis has a dramatic impact on lung cancer prognosis, and so the sooner the diagnosis is made, the better. to diagnose lung cancer you need a detailed medical history and a thorough medical exam if the patient is in the risk group you need more tests like :

CBC ,CMP,LFT  and bilirubin alkaline phosphatase and sputum cytology for cancer radiology contrast CT scan , chest abdomen pelvis and the lymph nodes these are involved in lung cancer .

Abdomen liver and adrenal could be the source of the cancer or it could be a secondary to lung cancer. Pelvis such as colon cancer because colon cancer can meta size to the lung if you suspect lung cancer please do more tests.

How about chest x-ray not for lung cancer  , you thought like you will start with x-ray then we will go to the CT scan then okay let’s say you  started with the x-ray and you saw something that you are not sure about what’s the next step CT scan then do the CT scan right away why waste your time and money? on two tests when you can just do one?

X-ray has a sensitivity of 74% this is dismal this is horrible. Sensitivity is low therefore the ability of chest x-ray to rule out the diagnosis is low . when we talk about lung cancer why do we use CT scan for screening because the sensitivity is 94%.

 

What are the Symptoms?(How Is Lung Cancer Diagnosed)

There are a number of symptoms of lung cancer but they can also all be caused by much less serious conditions these symptoms include having

• a cough that won’t go away
• or a change in a cough you have had for a long time.
• being short of breath
• coughing up pleghm with signs of blood in it chest
• shoulder pain when breathing or coughing
• loss of appetite
• unexplained tiredness
• weight loss

If you think you have any of these symptoms go and see your doctor if lung cancer is diagnosed at an early stage treatment is more likely to be successful.

Available Treatments ?(How Is Lung Cancer Diagnosed)

There are three main treatments for lung cancer

Surgery

Radiotherapy

Chemotherapy

The treatment you need depends on what type of lung cancer you have where the cancer is and your general health you may have an operation to remove the tumor and some surrounding tissue this may mean the surgeon removes a section of your lung a lobe or the whole lung it is suitable for some types of lung cancer that are at an early stage.

Radio therapy is the use of high-energy rays you may have it on its own or with another treatment such as chemotherapy or surgery. the amount of treatment you need depends on your cancer

Each treatment lasts for a few minutes chemotherapy is the use of anti-cancer drugs to destroy cancer cells you may be given chemotherapy alone or with other treatment you have most drugs by injection or through a drip into your bloodstream but some are tablets that you swallow most people have chemo as an outpatient but you may need a short stay in hospital you can find out more about these and other treatments for lung cancer Here.

 

Types of Lung Cancer ?How Is Lung Cancer Diagnosed

There are two groups in the Center and two groups in the periphery by Center and periphery i mean that this group is likely to arise in the Center of the lung or periphery of the lung starting with

• Squamous cell carcinoma which arises in the Center and is the most common cancer in smokers under the microscope they closely resemble skin cells with dismosomes and keratin perils these features are highly characteristic of squamous cell carcinoma they also secrete parathyroid hormone that is a little bit modified so they also cause hypercalcemia so in total we have only two conditions related to the lungs that cause
• Hypercalcemia squamous cell carcinoma and sarcoidosis in the center we also have small cell cancer and these are highly paraneoplastic secreting many hormones and they can cause cautioning syndrome syndrome .o
• These cancers are malignant and very common in the periphery we have adenocarcinoma which is the most common cancer in non-smokers in the lungs these cells produce a lot of mucus and they’re also malignant and the striking features is nail clogging although all lung conditions and cancers can cause clubbing clubbing by adenocarcinoma is much more prominent also in the periphery
• we have large cell cancer and these are notorious for producing estrogen and beta-hcg so they cause early puberty gynecomastia and galactoria.

Stages of Lung Cancer? How Is Lung Cancer Diagnosed

Lung cancer also is divided into various stages now when it comes to practical approach to this we would say a localised disease a regional disease and a you know advanced disease now an early cancer is a stage 1 and 2 cancer a regional cancer is a stage 3 cancer and advanced cancer is a stage for cancer now patients with stage 1 and 2 cancer do well stage 3 cancers are intermediate where the lymph nodes are involved and stage 4 cancers are advanced cancers and they don’t tend to do well

Like every cancer should be treated in a stepwise manner once you are diagnosed with a lung cancer the next important step is staging so why do we need staging staging helps doctors to communicate among themselves and it also helps to predict the prognosis of the patient and it also helps in deciding the treatment plan for the patient

So it’s a very important step lung cancers are mainly divided into small cell lung cancers and non-small cell lung cancers which comprise nearly 95 percent of the common lung cancers remaining five percent are very rare tumors

small cell lung cancers are mainly in the central part of the lung and these are aggressive tumors and they spread very fast so these are mainly staged into two that is limited stage small cell lung cancer and extensive small cell lung cancers apart from this small cell lung cancers comprise only 10 percent of all lung cancers apart from this 80 to 90 percent of the cancers are mainly non-small cell lung cancer.

non-small cell lung cancers are staged by TNM staging so once you are diagnosed with lung cancer based on the tumor size involvement of nodes and the spread of disease to elsewhere in the body you will be given a staging this non-small cell lung cancers are staged from stage one to stage 4

and these stages are again subdivided into stage  1a , 1b like that , why is this important so the lesser the number the early the stages so stage one is the early stage cancer and stage four is a metastatic cancer where it has spread to elsewhere in the body if you are belonging to stage one the survival is going to be very good and the response or the prognosis to the treatment is also going to be good for example s

tage one lung cancer has survival of we call something called as five-year survival rate for stage one lung cancers five-year survival rate is above 70 percent it’s again subdivided stage 1a lung cancers has survival rate up to 92 percent

also stage 2 lung cancers have survival rate up to from 50 to 70 percent stage 3 has 30 to 40 survival rate and

stage 4 has 5 year survival rate less than 10 percent here you can understand the importance of early detection so the earlier the stage ,the survival is going to be better.

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