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Lung Cancer Introduction

Lung cancer kills around 14,000 Americans each year and accounts for approximately 20% of all cancer deaths.  Diagnosing any cancer as early as possible is essential for a good prognosis and to maximize the chances of making a full recovery.

Cancer is caused by the uncontrolled growth of cells in the human body, and depending upon where it originates in the body determines the initial classification. In the instance of lung cancer, the uncontrolled growth which creates a tumor begins in the lungs.  Unfortunately, cancer can spread and this is known as “metastasis” and it is also important to determine whether this has occurred as quickly as possible during the initial diagnosis.  This is because the treatment regime a patient undergoes will be partially determined by whether the cancer has spread to other areas of the body or not.

The most common symptoms of lung cancer are shortness of breath, persistent coughing or coughing up blood and weight loss.

The principal types of lung cancer are small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), and it is important again because it will help determine the treatment therapies which are appropriate for the patient in question.   NSCLC may be treated by surgical removal of the affected tissue, while SCLC is frequently better treated with chemotherapy and radiation treatment.

Smoking is frequently linked to the underlying cause of cancer, but in fact it is the frequent and prolonged exposure to tobacco smoke which is the key.  Passive smoking is also a serious factor in whether a person will be susceptible to developing lung cancer, but aside from tobacco smoke there are numerous other factors at work too.  Exposure to asbestos, genetic predisposition and air pollution all can play a part along with other factors which are not yet fully understood.

Lung cancer may be diagnosed as a consequence of a routine chest X-ray though there are much more sophisticated and accurate tools available for positive diagnosis.  A Computed Tomography or CT scan, is similar to an X-ray however, it also provides much greater detail and precision as to the extent of the tumor and the position within the lungs and body.  A biopsy is usually required to be taken in order to positively identify the cells as cancerous, and this is frequently carried out using a bronchoscopy or needle-biopsy which uses the CT Scan results to guide the surgeon.  In some instances, an operation is required to remove part of the affected lung tissue for testing in the lab to ascertain the condition.

After positive diagnosis of the condition, the next stage in the process is to stage the disease.  There are four stages running from Stage I (the best) to Stage IV (the worst) which ascertains the degree to which the cancer has spread – obviously, a very localized and smaller growth is much easier to treat than a cancer which has grown large and has spread to other parts of the body.  This is why it is important to identify the condition at the very earliest stage possible in order to effectively treat the disease effectively and survival rates are dramatically higher for Stage I sufferers than for Stage IV.

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Understanding Staging Lung Cancer

Staging is the process by which once lung cancer is confirmed, the degree to which the cancer has established itself and how it presents in a patient is categorized.  This is essential if an appropriate and effective treatment regime is to be recommended and implemented in a lung cancer patient.
Staging is frequently referred to as “TNM” by oncologists (cancer specialists).

TNM refers to the three main factors used in staging:

•    Primary Tumor (T) – whether there is a tumor or tumors which can be established;
•    Lymph Nodes (N) – whether the cancer has occurred in the lymph nodes; and
•    Metastasis (M) – whether the cancer has spread to or from other parts of the body.

Each of these factors is further assessed to provide more detailed clarification.  For instance, where a tumor cannot be located but it is confirmed by the presence of cancer cells, the assessment will be TX.
A detailed explanation follows:

Primary Tumor (T)
TX – no tumor is located but is confirmed by presence of cancer cells
T0 – no evidence of a primary tumor

T1 – primary tumor of less than 3cm and not in the main bronchus
T2 – primary tumor which is any of the following:

•    Larger than 3cm
•    Is present in the main bronchus or other important parts of the lung

T3 – primary tumor of any size invading surrounding tissue or chest wall
T4 – as T3 but affecting the heart, trachea, great blood vessels – more serious than a T3 tumor
Regional Lymph Nodes (N)

Lymph nodes are small, bean shaped objects which are reservoirs of immune cells and materials vital to protect the body.  Regional lymph nodes refers to those lymph nodes in the surrounding vicinity of the lungs.
NX – no assessment

N0 – no regional lymph node metastasis (i.e. the lung cancer has not spread to the lymph nodes)

N1, N2 and N3 – metastasis has occurred to increasing severity

Distant Metastasis (M)

Metastasis refers to the spreading of the cancer to or from other parts of the body.  This is important because primary cancer (i.e. cancer which has originated at that location in the lung) is susceptible to treatment by surgery whereas metastasized lung cancer usually is not).

MX – no assessment of distant metastasis
M0 – no distant metastasis has occurred

M1 – distant metastasis has occurred and includes separate tumor(s) in other parts of the lung or body
Allocation of a Stage

After assessment of the tumor, lymph nodes and metastases, a stage is allocated which depends on the findings of how many tumors, where they are located and how they have spread?

The stages are allocated as follows:

Occult carcinoma – TX, NO, MO – cancer is present because of the presence of cancer cells but it cannot be located or assessed.  This is not allocated a distinct stage but is classed as an “unknown” or medical wildcard.

Stage 0 – any Tumor, N0 and M0
Stage IA – T1, N0, M0
Stage IB – T2, N0, M0
Stage IIA – T1, N1, M0
Stage IIB – T2, N1, M0 or T3, N0, M0
Stage IIIA – T1-T2, N2, M0 or T3, N1-N2, M0
Stage IIIB – Any T, N3, M0 or T4, any N, M0
Stage IV – Any T, Any N, M1

This is obviously a complicated exercise which may require repeated visits to the hospital and your doctor, but it is vital to effective treatment that this staging process is properly conducted.  How well staging is conducted has a direct bearing on survival rates of patients with lung cancer.

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Explaining Medical Terminology Associated with Lung Cancer Treatment

Medical terminology is baffling for any layman and when we are confronted with a condition as serious as lung cancer, it helps to relieve some of the stress if you understand some of the terminology.  Your doctor will help you with understanding what is happening and the treatment regime which is available, but you can also do much to help yourself by learning more about the condition and its cure.

Diagnostic Tools and Techniques

Lung cancer is usually discovered because of a routine chest x-ray or because symptoms occur which send them to the doctor, such as persistent coughing or coughing up blood.  These are not conclusive indicators of lung cancer but prompt further investigation.

Lung cancer can be diagnosed using a combination of the following:

CT Scan – this is a tool using x-rays which provides a detailed picture of the lungs and any abnormality.  The CT stands for Computed Tomography.

PET Scan – PET stands for Positive Emission Tomography and is a non-invasive procedure which highlights the tumor by using an injection of mildly radioactive glucose solution – cancer tumors use a lot of energy and the raw material is glucose sugar – if you have a cancer tumor, it will show up because the radioactive sugars will concentrate around it.

Bronchoscopy – is the insertion of a tube which has a camera and swab or biopsy-taking scalpel on the end of it.  A biopsy is simply a small tissue sample which is taken from the affected area of the lung and sent to the lab for testing for cancer cells.  A bronchoscopy can be mildly discomforting as the tube is inserted through the nose or mouth to reach the major airways so a swab or biopsy can be taken.

Needle Biopsy – the doctor will use the results of a CT Scan to guide a needle into the affected area of the lung so a tissue sample can be taken for testing.

Surgical Biopsy – if the abnormality is in a difficult to access part of the lung or is too small for a needle to accurately find it, then a small incision is made through which the surgeon is able to remove part of the lung containing the affected tissue.  The tissue is then tested for cancer cells in the pathology lab.

Staging or TNM

Staging – the process by which a cancer is categorized based on a number of factors; the result is used to determine an effective and appropriate treatment regime.

TNM – staging is frequently referred to as “TNM” which stands for the three main factors – the presence of a Tumor, the cancer being present in the Lymph Nodes, and the spreading of the cancer to or from other parts of the body, referred to as Metastasizing.

Primary Cancer – this refers to a cancer which has originated at that spot and has not occurred because it has spread from another part of the body.  Surgery is frequently used to treat early forms of primary lung cancer backed by chemotherapy or radiation treatment.
Metastasized Cancer – this refers to a cancer tumor which has originated elsewhere in the body and has spread to the lungs.  It is not usually treated by surgery unless the cancer is non-aggressive and not too large.

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