Lung cancer

What is lung cancer?

Lung cancer is one of the most common forms of cancer in Ireland, accounting for about 20% of all deaths from cancer each year. It is the leading cause of cancer deaths in men and the second most common cause (after breast cancer) in women. The disease is uncommon before the age of 40.

What causes lung cancer?

Cigarette smoking is the main cause of lung cancer. The more cigarettes smoked per day and the lower the age at which smoking started, the greater the risk of lung cancer. This is one of the most preventable kinds of cancer. At least four out of five cases are associated with cigarette smoking.

Exposure to passive smoking has also been shown to increase the risk of developing lung cancer. Living in an environment with a high level of air pollution or working with substances such as asbestos may cause some cases of lung cancer.

Stopping smoking works. The risk of lung cancer for an ex-smoker fall to the same level as a non-smoker after 15 years.

What are the symptoms of lung cancer?

The first and most common symtom is a cough. This occurs in about 80% of people with lung cancer.

Other symptoms include:

  • Coughing up blood (haemoptysis).
  • Breathlessness and wheezing.
  • Fatigue.
  • Weight loss.
  • Chest pain.
  • Repeated attacks of pneumonia or asthma.
  • Hoarseness.
  • Pain in the shoulder, arm or hand.

How is lung cancer diagnosed?

Early diagnosis is difficult because many of the symptoms of lung cancer resemble those of chronic obstructive pulmonary disease (COPD). Indeed, most lung cancer patients will also have COPD because both conditions are mainly caused by smoking, although only 1%-2% of COPD patients will go on to develop lung cancer. However, the doctor will examine the individual and order one or more of the following tests:

  • Chest x-ray — this is the first step in the investigation.
  • CT (computed tomography) scans of the chest — this will provide further information on whether the tumour has spread.
  • Sputum analysis — sputum (coughed up from the respiratory tract) can be examined for cancer cells instead of a biopsy.
  • Biopsy — depending on the site of the cancer, a biopsy will be obtained either by a bronchoscopy or a needle biopsy. Needle biopsy is more useful for cancers located closer to the ribs than to the centre of the chest. Bronchoscopy is most useful for tumours in the main bronchi (air passages) in the centre of the chest.
  • A blood test may reveal certain substances, which are produced by a cancer tumour.
  • Lymph nodes can be tested for cancer cells.

How is lung cancer treated?

Treatment choices and long-term survival with lung cancer depend on the type of cancer, location, size, lymph node involvement and whether the cancer has spread to other parts of the body. It will vary depending on the type of cancer— small cell cancers respond best to chemotherapy whereas other types (often referred to collectively as non-small cell cancer) are better treated with surgery or radiotherapy.

Any treatment strategy will probably include surgery, radiation or chemotherapy, or a combination of these.

While surgery can cure lung cancer, only one in five patients are suitable for this treatment. The tumour must not have spread outside the chest and the patient must not have severe bronchitis, heart disease or other illnesses that will place too great a strain on the patient for him or her to be able to survive surgery.

What can I do?

  • If you smoke, stop and also stay away from other people's smoke.
  • Keep all your follow-up appointments with your doctor and contact him/her immediately should symptoms reappear.
  • Follow the exercise and diet plan recommended by your doctor.
  • Get plenty of rest.

What is the outlook?

The earlier lung cancer is treated, the more successful treatment is likely to be. However, survival rates for lung cancer after five years is poor. The majority of people with lung cancer will benefit from symptom control that improves their quality of life. Given the low success rate in curing cancer, prevention is the best hope of limiting the condition.

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