Clearing The Air: Should You Be Concerned About Lung Cancer? (Part 2)

Do you fall into the at-risk group for lung cancer, or are you experiencing signs and symptoms of lung cancer? If so, early detection and treatment are critical. Read on to understand more about lung cancer symptoms and screening options.

Introduction
In Part 1, we explained the risk factors for lung cancer and how you can take preventive steps. If you suspect that you are at risk or are experiencing symptoms, read Part 2 of this article to find out more.

Types and Stages of Lung Cancer
Lung cancer has two main types: Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC). SCLC and NSCLC are staged differently but both generally have two main stages.

SCLC (Small Cell Lung Cancer) stages:

• Limited stage: Cancer cells are in only one lung or on only one side of the chest and can be encompassed and treated with surgery and/or radiation therapy.

• Extensive stage: Cancer cells have spread to the other lung or other side of the chest or other parts of the body and have to be treated with chemotherapy.

NSCLC (Non-Small Cell Lung Cancer) follows the TNM staging protocol:

• Early stage (stage 1–3): Cancer cells have grown in the lungs where they originated, and may have spread to nearby lymph nodes but not to the other lung or other parts of the body.

  • Stage 1: The cancer is small and has not spread to the lymph nodes. Stage 1A is when the cancer is 3cm or smaller. Stage 1B means the cancer is between 3 and 4cm.

  • Stage 2: This is sometimes called early-stage NSCLC. Stage 2A means the cancer is between 4 and 5cm but has not spread to the lymph nodes. Stage 2B means the cancer is up to 5cm and is also found in the nearby lymph nodes.

  • Stage 3: This stage is sometimes called locally advanced cancer. It is divided into 3A, 3B, and 3C. Each sub-stage can mean several different things, and more information can be found here.

• Metastatic stage (stage 4): This is also known as advanced lung cancer. Cancer cells have spread to other parts of the body away from the original lung tumour. Common sides of spread include the other lung, brain, liver, bone, and adrenal glands.

Symptoms of Lung Cancer
Symptoms of lung cancer are the same for smokers and non-smokers. According to the Mayo Clinic, you should see a doctor if you persistently experience these symptoms:

• A new cough that doesn’t go away

• Coughing up even a small amount of blood

• Shortness of breath

• Chest pain

• Hoarseness

• Losing weight without trying

• Bone pain

• Headache

Screening for Lung Cancer
Besides those exhibiting the above symptoms, screening is also recommended for those considered at risk of getting lung cancer.

If you are between 55 and 74 years old, have smoked 30 or more pack years (number of packs a day multiplied by years of smoking), and quit less than 15 years ago or are still smoking, consider screening via a low-dose CT scan.

In the US, over half of all lung cancers and two-thirds of SCLC have spread beyond the chest by the time of diagnosis. Only 16% of lung cancers are detected at an early stage. Increased screening for those with risk factors like a history of smoking could save lives. 

Tests to detect lung cancer include imaging tests like chest X-rays, MRI and CT scans, sputum cytology to look for lung cancer cells in the sputum under a microscope, and biopsies taken by removing tissue samples for testing.

Treatment for Lung Cancer
Treatment for lung cancer is tricky as most cancers are discovered late, since symptoms generally do not appear until the cancer has spread. Chemotherapy is typically the best treatment once the cancer has metastasized (spread). Unfortunately, some cancer cells are intrinsically resistant to chemotherapy while others can develop a resistance. 

Surgery is typically recommended for early-stage lung cancers. The goal is to completely remove the lung tumours and surrounding lymph nodes. Adjuvant or accompanying therapies include radiation therapy and chemotherapy.

Newer treatments like targeted therapy and immunotherapy are constantly improving and able to treat lung cancers that have metastasized or spread.

Survival Rates for Lung Cancer
Without treatment, the outlook for lung cancer is not ideal, with the average survival periods about 7 months for NSCLC and 2–4 months for SCLC.

From 2010 to 2016, the 5-year survival rate for NSCLC was 63% if localised, 35% if spread to nearby tissues, and 7% if spread further. For SCLC, the 5-year survival rate was 27% if localised, 16% if spread to nearby tissues, and 3% if spread further.

Conclusion
Survival rates for lung cancer, while still not very high, are improving significantly. The chances of survival also depend very much on the type and stage of cancer, and your general health and lifestyle.

As with most cancers, but particularly for lung cancer, early detection and treatment are important to increase the chances of survival. So if you suspect you have symptoms, or fall into the at-risk group, do consult a doctor as soon as you can.