Lung Cancer

Lung Cancer

The incidence of lung cancer, which is one of the social health problems, is increasing day by day. Lung cancer, which is the first cause of cancer-related deaths, is seen in both women and men. The risk of lung cancer, which is mainly caused by smoking, increases with environmental and genetic factors. Early diagnosis is of great importance in lung cancer, which can progress silently. Treatment of the disease is planned according to the type and stage of the tumour and the patient. What is lung cancer? Lung cancer is defined as the uncontrolled proliferation of some cells in normal lung tissue and the formation of a mass in the lung. The mass, which first grows within the lung, can spread to surrounding tissues or other organs through circulation as the disease progresses. Lung cancer, which is the most common cancer in the world at all ages and the leading cause of cancer-related deaths, is seen in both sexes. 62.5% of deaths due to lung cancer occur under the age of 65. What are the types of lung cancer? Lung cancer is divided into two main groups: small cell (SCLC) and non-small cell (NSCLC). Squamous cell carcinoma, adenocarcinoma and large cell carcinoma are included in the non-small cell lung cancer group. The non-small cell group accounts for approximately 80 percent of lung cancer. In our country, the prevalence of NSCLC and SCLC is 85 percent and 15 percent, respectively, while adenocarcinomas account for 35-40 percent of all lung cancers. The prevalence rate in our country is 32.3 percent. Squamous cell carcinomas constitute 25-30 percent of lung carcinomas and are associated with smoking in 90 percent of cases. What are the stages of lung cancer? Determining the stage of lung cancer is important in determining the type of treatment and the severity of the disease. Whether the disease has spread to other organs, the patient's effort capacity and mobility in daily life also affect the success of treatment as well as staging. The International Lung Cancer Study Group (IASLC) TNM system is used for staging (T: primary tumor, N: regional lymph nodes, M: distant metastasis). In staging, it should be determined in every patient whether the tumor in the lungs has spread to other organs via the lymph nodes or systemic circulation. Staging is important in planning the treatment to be applied to the patient and determining the course of the disease. It is also necessary to group patients with the same disease, to determine the incidence of the disease and to determine the corresponding treatment methods. What are the causes of lung cancer? The causes of lung cancer can be listed as follows:

• Smoking (tobacco): Smoking is the most important proven risk factor for the development of lung cancer. Smoking causes 90 percent of lung cancers. Cigarette smoke contains more than 4,000 chemicals, more than 50 of which cause cancer. Smoking is the most important known cause of lung cancer. The reason why this disease is so common today is the development and expansion of the tobacco industry. It is estimated that 1.2 billion people worldwide smoke cigarettes and if the current trend continues, approximately 2 billion people will be smokers in 2030. Polyvinyl hydrocarbons, vinyl chloride, nickel, aldehydes, peroxides, nitrosamines and benzopyrene are some of the identified carcinogens found in cigarette smoke.
• Prevention of smoking in countries with a high socioeconomic level and a certain level of development leads to a gradual decrease in the incidence of lung cancer in these countries. However, unfortunately, the rate of smoking is very high in our country; according to 2016 data from the Turkish Statistical Institute, 26.5 percent of the population over the age of 15 in our country uses a tobacco product every day.
• Passive smoking: People who do not smoke but stay or work in a smoking environment are also at risk of lung cancer. Especially not smoking in closed environments is one of the practices that reduce this risk.
• Fibrous minerals (asbestos and erionite): Both occupational and living environment exposure to substances such as asbestos and erionite increases the risk of cancer. Workers in sectors such as mines, shipyards and insulation material production are exposed to asbestos. In addition, environmentally, the asbestos material in the material used for plastering the walls of houses, which is called 'white soil' in some rural areas of our country, and the asbestos-like erionite material found in the Cappadocia region can cause cancer by settling in the lungs and membranes through breathing over the years.
• Radon (radiation): Studies have shown that radon gas causes lung cancer. Radon, an odourless radioactive gas found naturally in the soil, can sometimes be found in domestic environments, especially in uranium mines.
• Familial predisposition: The risk of developing this disease is doubled in people with a family history of lung cancer. Although lung cancer is not normally a hereditary disease, the presence of lung cancer in relatives increases this risk for people. In particular, reasons such as smoking and showing similar behavioural personality traits increase this risk. For this reason, children and close relatives of people with lung cancer should avoid other risk factors (especially smoking) and should not neglect periodic check-ups according to their complaints and lifestyle.

How lung cancer is diagnosed? For the diagnosis of lung cancer, a physical examination is first performed by a physician specialised in chest diseases. Along with the examination, a chest X-ray is requested. If abnormal shadows are seen on the chest X-ray, different tests may be requested to confirm the diagnosis. These tests can be listed as follows:

• Computerised tomography: Computed tomography images obtained in appropriate patients can be used to better visualise the disease and how the mass should be reached.Sputum cytology Sputum cytology is a method of looking for cancer cells in sputum.
• Bronchoscopy: A bronchoscope, which is an optical device with a camera and light at the end, is inserted through the patient's mouth or nostrils to access the bronchi and thus visualise various parts of the lung and take samples at the same time. The procedure is usually performed under sedation. This painless procedure does not cause any progression or spread of the tumour. The diagnosis and type of cancer is determined by pathological examination of the sample taken during this procedure..
• Fine needle aspiration: It is the process of taking a sample from the tumour by entering the patient's chest wall with special needles under the guidance of imaging methods..
• Thoracentesis: In case of fluid accumulation in the membrane surrounding the lungs, a needle is inserted through the chest wall and a sample is taken and analysed.
• Thoracoscopy: It is the procedure of entering the chest cavity between the two ribs with a lighted tube and obtaining a sample. If thoracoscopy is performed under video guidance, it is called videothoracoscopy or VATS. During VATS, the lungs and their membranes as well as lymph nodes can be sampled.
• Thoracotomy: It is a surgical opening of the thorax to take a piece of the tumour to diagnose the cancer..

How lung cancer is treated? Prolonging the patient's survival time and trying to improve the quality of life constitute the basis of lung cancer treatment. For this purpose, chest diseases, thoracic surgery and medical oncology departments should apply personalised treatments with a multidisciplinary approach. The most important point in the treatment of lung cancer is that the patient can reach the right treatment method after diagnosis. The treatments to be applied in this disease are special chemotherapeutic agents, surgical treatments and immunotherapies. The patient and his/her family should be educated and informed about each treatment. In addition, psychological support, palliative care, nutrition education and support are other important components of the treatment. Follow-up is one of the most important aspects of lung cancer. With these follow-ups, recurrence or progression of the disease during the treatment process and especially after surgical intervention is determined. In this process, patients and their relatives should be included in the psychological support process and treatment flow. What are the risk factors of lung cancer? General risk factors for lung cancer are smoking, radiation exposure, environmental toxins (asbestos arsenic radon, etc.), pulmonary fibrosis or pulmonary sequelae, HIV, genetic factors and alcohol. Lung cancer is more common in whom? The survival rate of lung cancer patients diagnosed at an early stage is 70 per cent on average. This rate decreases in advanced cancer. Despite all treatment methods, 86 per cent of lung cancer patients die within five years following diagnosis. For this reason, it is very critical to diagnose lung cancer at an early stage. The incidence of new lung cancer cases is higher in current smokers than in never smokers or those who have quit smoking. It has been observed that the risk of lung cancer decreases by 50 per cent 10 years after quitting smoking. In terms of the prevalence of smoking, the male gender is still at the forefront in lung cancer incidence rates in our country. High risk groups for lung cancer are as follows:

• As announced by the Ministry of Health, 90 per cent of lung cancers in our country are caused by smoking. When an effective tobacco control is provided, approximately 110 thousand deaths related to tobacco use, including lung cancers, can be prevented every year.
-Although the male gender is predominant, the gender difference has been decreasing in recent years as a result of widespread smoking among women. Lung cancer has an annual incidence of 61.2 per 100,000 for both sexes in our country
• Having a family history of lung cancer increases the risk of lung cancer compared to other individuals in the community.
• A history of occupational or environmental chemical exposure and a family history of lung cancer doubles the risk in people with lung cancer. However, there is an 8-11 per cent increase in the risk of radon gas exposure due to environmental radiation and a 1.5-5.4-fold increase in the risk of asbestos exposure. Radon gas is the most important factor in lung cancer after smoking and is responsible for 3 to 15 per cent of lung cancer.
• Having a high-risk disease such as tuberculosis, pulmonary fibrosis or COPD increases the risk of lung cancer.

Is there a chance of surviving lung cancer? Since the most important of the identified risk factors is smoking and other tobacco products, the most important step is the fight against tobacco and tobacco products. Smoking cessation is very important in terms of response to treatment and quality of life. Early diagnosis is life-saving in lung cancer. Therefore, follow-up of people at risk with the most appropriate examination in terms of screening methods increases the chance of early diagnosis. Unfortunately, there is still no definite method for early diagnosis of lung cancer. Depending on the stage and prevalence of cancer after diagnosis, there is a chance of complete recovery from this disease. With the new treatment methods developed in recent years, life expectancy can be increased. How many years of smoking can cause lung cancer? The risk increases with the number of cigarettes smoked per day and the number of years of smoking. Approximately 1/7 of long-term smokers (average 30 years) develop lung cancer. However, within 10 years following smoking cessation, the risk of developing lung cancer decreases by 50 per cent compared to the normal population. Some people may be at risk of developing cancer regardless of the amount of cigarettes smoked and the duration and dose due to personal differences. What happens if one lung is removed? If one of the lungs is completely or partially removed, the remaining lung tissue takes over the functions and tasks of the removed tissue by growing and increasing its capacity. However, in some patients this may be limited enough to maintain the standard of living at a certain stage. Sometimes there is no functional loss in the patient and almost complete recovery is realised. However, the most important issue here is to adopt a lifestyle that will not affect the basic functions of the remaining lung tissue (such as not smoking). Does lung cancer go away on its own? Lung cancer is a condition in which the growth and division activity in normal tissue increases uncontrollably, i.e. gains autonomy. Therefore, treatment and lifestyle changes are required to control this event. After the proliferation in the tissue gains autonomy, in other words, after the cancerous process starts, the event is irreversible. The disease requires treatment and follow-up after diagnosis. What people with lung cancer should pay attention to? It is important to avoid smoking and other known risk factors, healthy and balanced nutrition, personalised sports and exercise programmes, regular medical check-ups, compliance with treatment plans, and psychosocial support for the healthy conduct of all processes after cancer diagnosis..