About Lung Cancer
Each year, lung cancer causes more deaths than any other cancer in Australia. It is the result of uncontrolled growth and multiplication of cells due to changes in their genetic material that, over time, form a malignant tumour in the tissue of the lungs.
A tumour that begins in the lung is known as primary lung cancer. Tumours in the lung may also be due to cancer that has spread from other areas of the body such as the bowel, breast, or prostate. These lung cancers are known as secondary or metastases. Treatment is guided by the site of the primary tumour, even if the cancer is now in other areas such as the lung.
Lung cancer types
There are two types of lung cancer, each depending on which cells are affected.
Small cell carcinoma
Small cell carcinoma is believed to arise from cells within the lining of the lung’s airways (bronchi). This type of lung cancer is rarer. Initially it does not show symptoms, but spreads early and quickly via the bloodstream to other organs within the body.
While both types of lung cancer are strongly linked with a history of smoking, small cell carcinoma almost always occurs in heavy smokers.
Non-small cell carcinoma
This more commonly diagnosed type of lung cancer accounts for the majority of lung cancers both worldwide and in Australia. Historically it wasdivided into sub-types depending on the type of cells which became malignant. These sub-types included:
- Adenocarcinoma – Begin in the peripheral lung tissue
- Squamous cell carcinoma – Usually develops in the lining of the lung’s larger airways
- Large cell carcinoma – Can appear in any other part of the lung
More recently there is an understanding that cancers express different characteristics, which influence appropriate treatment options.
What Causes Lung Cancer?
The most major cause of lung cancer is smoking. Tobacco smoke contains many toxic substances that damage the lung’s lining and airways. Multiple comprehensive studies of lung cancer have unequivocally found that smoking is its major cause.
Lung cancer can also occur in non-smokers, however the risk is most extreme if you are, or have ever been, a smoker. The amount of cigarettes you have smoked in your lifetime increases your lung cancer risk.
Other causes of lung cancer include:
- Second-hand smoke inhalation
- Exposure to occupational substances such as chromium, nickel, radon, and coal products
- Exposure to other forms of smoke, including smog, wood smoke, exhaust fumes, tar, or paint fumes,
- Exposure to asbestos
- Family history of lung cancer
- History of lung diseases or inflammation
A very small percentage of lung cancer diagnoses occur in patients who have never smoked and are rarely exposed to other potential causes. The reason for this is currently unclear.
Lung Cancer Symptoms
Lung cancer can be difficult to diagnose in its early stages, because there are usually no significant symptoms until it has progressed. Many people with lung cancer eventually develop several of the following symptoms:
- Shortness of breath and/or wheezing
- Chest or shoulder pain
- A cough that does not go away
- Spitting up blood or bloody phlegm
- Hoarseness and/or difficulty swallowing
- Recurring lung infections
- Fatigue and unexplained weight loss
These symptoms can be caused by a number of other medical conditions, so it is important to discuss them with a doctor.
How Is Lung Cancer Diagnosed?
If lung cancer is suspected, your doctor will order a number of tests to try and diagnose the type and stage (how advanced the cancer is)
These tests may include:
X-rays create pictures of the inside of the body. Cancers as small as one centimetre can be seen using this method.
These scans involve specialised imaging that can reveal smaller lesions that don’t show up on an X-ray.
A small amount of radioactive material is injected, and in conjunction with a low doe CT scan, a scanner uses signals from this material to identify areas that where tumour may be present.
If you are coughing up phlegm, your doctor may obtain a sample of this and send it to a laboratory to check for cancerous cells.
A biopsy is crucial to confirm the diagnosis and assess the characteristics of the tumour to allow appropriate management. It is usually obtained in one of two ways:
This procedure involves inserting a thin, flexible instrument called a bronchoscope through the mouth into the lungs to examine the airways. A small tissue sample is then taken from the lungs or airways and sent to a laboratory to check for abnormal cells. An ultrasound probe can be used to identify sites to biopsy.
Fine needle aspiration
Areas of concern on the edge of the lung may be biopsied using a thin needle that is inserted through the chest wall under anaesthetic.
Rarely surgery may be required if the area of concern cannot be biopsied by less invasive methods.
Lung Cancer Stages
Staging is a system used to describe where the lung cancer is located, how advanced it is, and whether it is affecting other parts of the body. As a general rule, lung cancer falls into the following stages:
Stages I & II – early lung cancer
Stage III – locally advanced lung cancer (lymph nodes within or close to the lung are involved)
Stage IV – advanced lung cancer (spread to other parts of the body)
Lung Cancer Treatment
The type of lung cancer treatment you receive depends on multiple factors. Your oncologist will discuss with you to allow you to make an informed decision, taking into account:
- Whether the cancer is small cell or non-small cell carcinoma
- The location of the cancer within the lung
- Specific characteristics identified from the biopsy specimen
- How advanced the cancer is
- Your overall general health
Depending on the above, treatment may include one, or a mixture of, the following treatments:
Lung cancer surgery
Surgery aims to remove tumours via three main methods – removing an entire lobe (a lobectomy), removing part of a lobe (a wedge resection), or removing one lung entirely (a pneumonectomy).
Used either alone or in combination with surgery or chemotherapy, radiotherapy uses X-ray radiation to target and kill cancer cells.
This common form of cancer therapy uses certain anti-cancer drugs to destroy cancer cells. It can be used either following surgery, concurrently with radiotherapy or as a stand-alone treatment.
Specific drugs are used to stimulate the body’s immune system, to combat some forms of non-small cell lung cancer.
This form of treatment involves using medicines that target specific mutations in cancer cells. It is generally used for advanced non-small cell carcinoma.
Clinical trials may also be an option to consider. Trials are designed to answer specific questions and so an individual trial will not be right for every patient. It is important that standard treatment (treatment we know works) is used to its maximum potential prior to trial treatment because a trial treatment may not be effective.
Trials are being run locally in both Small and Non-Small cell lung cancer. Your oncologist will discuss these with you if they may be suitable.
Lung Cancer Prognosis
Lung cancer is a complicated disease. It is not possible to predict the exact outcome of the disease for each individual. Instead, your oncologist can give you an idea of the general outlook for people with the type and stage of cancer that you have.
As with all cancers, the prognosis is generally better the sooner the cancer is found and treated. Australian lung cancer statistics indicate that the five year survival rate for lung cancer is 17%
Lung Cancer Treatment at Hunter Valley Oncology
At Hunter Valley Oncology, we understand that cancer diagnosis and treatment can be a frightening time. It is our aim to give you the guidance and care you require at every stage of your cancer journey.
When you have been referred to us by your GP to our Maitland or Newcastle cancer clinics, we will help you make sense of the information you’re receiving. We are here to answer your questions, give you a solid understanding of what your diagnosis means, and explain your treatment options.
Consultations begin with a review of your medical history. It is a good idea to bring a list of your current medications with you. Your family’s history of cancer will also be reviewed, as well as your current level of fitness and general health.
Sometimes, more information will be needed before a full discussion of your treatment options can occur. If this is the case, our caring oncologist will advise making a second appointment for more thorough investigation into your unique situation, prognosis and suggested treatment route.
Once a plan has been agreed upon, arrangements will be made for treatment to commence. You will be able to choose a treatment centre that is most convenient for you. Dr Paterson treats patients at Newcastle Private Hospital and Lake Macquarie Private Hospital in the Newcastle and Hunter region.