The Disease: Lung Cancer

Lung Cancer begins when cells in your body start to mutate or change. There are many factors that can cause these mutations to happen. Most often, this change in the cells happen when people are exposed too and or breathe in dangerous and toxic substances. Even if you were exposed to these substances many years ago, you are still at risk (NCBI, 2011). There are many treatment options and support offered to those who are diagnosed.

Etiology of Lung Cancer

Smoking is the number one cause of lung cancer. Tobacco smoke contains many chemicals that are known to cause lung cancer. Radon exposure is the second-leading cause of lung cancer. Radon is a colorless, odorless radioactive gas that exists naturally in soil. It comes up through the soil and enters buildings through small gaps and cracks. One out of every 15 homes in the U.S. is subject to radon exposure. Exposure to radon combined with cigarette smoking seriously increases your lung cancer risk. Exposure to certain hazardous chemicals poses a lung cancer risk. Working with materials such as asbestos, uranium, arsenic, cadmium, chromium, nickel and some petroleum products is especially dangerous. Particle Pollution refers to a mix of very tiny solid and liquid particles that are in the air we breathe. Evidence shows that particle pollution”like that coming from that exhaust smoke”increases the risk of lung cancer. Finally, the last cause of lung cancer is through genes. Genetic factors also may play a role in one's chances of developing lung cancer. A family history of lung cancer may mean you are at a higher risk of getting the disease. (American Lung Association, 2018)

Clinical features of Lung Cancer

The Signs and symptoms of lung cancer can take years to develop and they may not appear until the disease is advanced. Symptoms of lung cancer that are in the chest include; coughing, especially if it persists or becomes intense; Pain in the chest, shoulder, or back; A change in color or volume of sputum; Shortness in breath, Changes in the voice or being hoarse, Harsh sound with each breath (stridor), Recurrent lung problems, such as bronchitis or pneumonia, Coughing up phlegm or mucus, especially if it is tinged with blood and or coughing up blood. If the original lung cancer has spread, a person may feel symptoms in other places in the body. Common places for lung cancer to spread include other parts of the lungs, lymph nodes, bones, brain, liver, and adrenal glands. Symptoms of Lung cancer that many occur elsewhere in the body include; Loss of appetite or unexplained weight loss, muscle wasting (also known as cachexia), fatigue, headaches and or bone and joint pain, Bone fractures, neurological symptoms, such as unsteady gait and or memory loss. Other symptoms include neck or facial swelling, general weakness, bleeding and or blood clots. (CDC, 2018)

Lab Data

There are several laboratory tests that may be done during the diagnosis and staging of lung cancer. These tests are any procedure that evaluates a sample of blood, urine, other bodily fluid, and or tissue. While there is not a single test that can determine if a person has lung cancer, it can provide additional information that helps doctors determine the best treatment for the patient. A complete blood count is a test that measures all different components in the blood. Blood is made up of many different cells: red and white blood cells, and platelets. Abnormal findings from a CBC include; low levels of red blood cells that can indicate anemia, low levels of blood platelets can point to a tendency to bleed and difficulty forming clots. Also, low levels of white blood cells can place a person at higher risk for infections. Blood Chemistry is another test that detects levels of substance in the body can identify abnormalities in some of the organs. (Lung Cancer, Laboratory Tests, 2017)

Red cell distribution width (RDW), one of many routinely examined parameters, shows the heterogeneity in erythrocyte size. We investigated the association of RDW levels with clinical parameters and prognosis of lung cancer patients. Clinical and laboratory data from 332 patients with lung cancer in a single institution were retrospectively studied by univariate analysis. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival. THE RDW LEVELS WERE DIVIDED INTO TWO GROUPS: high RDW (>=15%), n=73 vs. low RDW, n=259 (<15%). Univariate analysis showed that there were significant associations of high RDW values with cancer stage, performance status, presence of other disease, white blood cell count, hemoglobin, mean corpuscular volume, platelet count, albumin level, C-reactive protein level, and cytokeratin 19 fragment level. Kruskal-Wallis tests revealed an association of RDW values with cancer stage in patients irrespective of comorbidity (patient with/without comorbidity: p<0.0001, patient without comorbidity: p<0.0001). Stages I-IV lung cancer patients with higher RDW values had poorer prognoses than those with lower RDW values (Wilcoxon test: p=0.002). In particular, the survival rates of stage I and II patients (n=141) were lower in the high RDW group (n=19) than in the low RDW group (n=122) (Wilcoxon test: p<0.001). Moreover, multivariate analysis showed higher RDW is a significant prognostic factor (p=0.040). RDW is associated with several factors that reflect inflammation and malnutrition in lung cancer patients. Moreover, high levels of RDW are associated with poor survival. RDW might be used as a new and convenient marker to determine a patient's general condition and to predict the mortality risk of lung cancer patients. (PLOS, Koma, Onishi, Matsuoka, Oda, Yokota, Matsumoto, Koyama, Okada, Nakashima, etc, 2013)

Diagnostic Evaluations

There are many procedures utilized to identify lung cancer. The first evaluation is an X-ray. A chest X-ray uses high-energy electromagnetic radiation to provide images of the lungs and surrounding tissues. This image-guided technology is an important procedure for cancer diagnosis, staging and treatment. Another type is a CT scan for lung cancer. Computed tomography (CT) scan is one of the most commonly used tools for screening, diagnosis and treatment of cancer. A CT scan reveals the anatomy of the lungs and surrounding tissues, which cancer doctors use to diagnose and monitor tumor growth.

Lab tests for lung cancer are compiled of three separate tests. First, we have Genomic tumor assessment, which examines a tumor on a genetic level to find the DNA alterations that are driving the growth of cancer. By identifying the mutations that occur in a cancer cell's genome, we can better understand what caused the tumor and tailor treatment based on these findings. Second, we have Tumor molecular profiling. If a patient has a solid tumor, doctors will try to get a sample of tissue during a biopsy or surgery. Then, they will test for the presence of a variety of enzymes, proteins and genes to identify which therapies may help. The final part of lab tests is Nutrition panel. With this test, doctors evaluate patients for deficiency of nutrients, such as vitamin D and iron. The test helps the doctors identify what nutrients patients need replaced or boosted. In order or all of these tests to be completed, a doctor will collect a blood sample, and then send it to a pathologist.

A CT angiogram is another form of an evaluation. A CT angiogram allows doctors to examine the pulmonary artery, which is the main artery that supplies blood to the lungs from the heart. In this test, a special iodine-based contrast material in injected into the body before a CT scan to illuminate the pulmonary artery and smaller blood vessels in the chest. A CT angiogram is done when a patient is experiencing shortness of breath. A PET/CT scan for lung cancer is another form of evaluation. A PET/CT scan is an advanced nuclear imaging technique combines positron emission tomography (PET) and computed tomography (CT) into one machine. The scan reveals information about both the structure and functions of cells and tissues in the body during a single imaging session. The scan creates a 3D picture of the lungs, but it may miss small tumors if part of the lung has collapsed, as it sometimes the case. A PET scan goes beyond anatomy to show what is happening at a cellular level in the tissues of the lung. Biopsy for lung cancer is another form of evaluation that doctors use. During a lung biopsy procedure, the doctor removes a small piece of tissue or fluid from the chest, so it can be examined under a microscope to check for cancer cells. If the cells are found to be cancerous, a biopsy may help determine whether the cancer began at the site of the biopsy or if it started somewhere else in the body and spread to the biopsy site.

Endobronchial ultrasound (EBUS) for lung cancer is a less invasive bronchoscopic procedure used to evaluate and sample cancerous cells in the chest. In most cases, EBUS is performed as an alternative to a mediastinoscopy, a surgical procedure used to collect samples in the chest while the patient is under general anesthesia. An EBUS uses ultrasound guidance to detect cancerous cells in the lungs and in the lymph nodes of the chest in real time.

Autofluorescence bronchoscopy for lung cancer allows physicians to identify cancerous cells in the bronchial tubes that may not be visible under white light examination. The doctor can then remove a small sample of abnormal tissue for further analysis. This method is used to find and diagnose tiny tumors. For the procedure, the doctor will insert a scope through your mouth or nose and into your lungs. Then, a video camera and two different light sources will give the doctor a view of the patient's airways. (Cancer Center, 2017)

Treatments for Lung Cancer

Although there is no cure for lung cancer, there are several treatment options for this disease. The most common treatments are radiation, surgery and chemotherapy. Other treatments include; Immunotherapy, Neurosurgery, targeted therapy, interventional pulmonology and metastatic lung cancer to the liver. For everyone these treatments, there is a community of people to help you along the way. CancerCare has partnered with LUNGevtiy to develop a cancer helpline. There is financial assistance for those who cannot afford treatments. Connect with others in free support groups, either online or face to face. Community resources are available for those who need it. (CancerCare, help by diagnosis, 2016)

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