Cancers

What is Lung Cancer?

Akciğer Kanseri Nedir?

In order for people to continue his vital activities, they must breathe in oxygen and breathe out carbon dioxide through their respiratory system. Oxygen, which is needed and essential for life, is taken into the body thanks to the function of the cells in the lung, while carbon dioxide, which can be characterized as waste, is transmitted to the external environment. The lungs, which occupy a large region in the chest cavity, have a spongy structure and also resemble a cone. In its internal structure, there are bronchi, that is, air tubes, air sacs called alveoli, lymph fluid and blood vessels. Cancers are generally named according to the tissue in which they first occur.

The phenomenon of uncontrolled division of tissues and cells in the lungs is called lung cancer. These cells, also called tumor cells, multiply rapidly and form a massive structure after a while. With the progression of cancer, cells that multiply uncontrollably spread to the surrounding tissues. With the entry of cancer cells into the circulatory system, it can spread to distant organs.

The spread of cells to other places is called metastasis, and in such a case, the disease is more difficult to treat. According to the data of the World Health Organization, lung cancer was the most common type of cancer globally until recently, but even though it is replaced by breast cancer, it still occupies the first place in cancer-related deaths of both men and women. Smoking is among the main causes of this type of cancer. The incidence in non-smokers is minimal compared to smokers. Other factors that cause lung cancer include air pollution, chemicals such as asbestos, and genetic predisposition. The incidence of cancer increases with age, and the most common age is between 50-70 years.

What are the Symptoms of Lung Cancer?

Lung cancer, which is the type of cancer that causes the most death globally, progresses insidiously without showing many symptoms in most cases. For this reason, recognizing the symptoms at an early stage is an important factor for the treatment of the disease. Particularly, people who are middle-aged or older who smoke regularly have health screenings, which has an important place in this diagnosis. Diagnosis of lung cancer at an early stage greatly increases the chance of treatment.

Lung cancer symptoms vary widely. Early-stage symptoms include cough, sputum, high fever, weakness, unexplained weight loss, finger deformities, difficulty in swallowing, and dizziness.

The symptoms listed above vary from case to case. There may also be differences depending on where the cancer is located and the size of the mass. In some cases, it may take a long time for the symptoms of cancer to appear. For this reason, individuals in the risk group should perform regular health screenings. In general, the symptoms of lung cancer are listed below.

1. Persistent cough with a bad course

2. Cough-induced back pain

3. Change in sputum color

4. Bloody sputum

5. Wheezing when breathing

6. Hoarseness of the voice

7. Difficulty in breathing

8. A feeling of being stuck in the throat

9. Difficulty in swallowing

10. Having pneumonia and bronchitis frequently

11. Swelling in the neck and face region

12. Swelling of the tips of the fingers and toes (clubbing)

13. Pain in the bones

14. Anemia

15. Eyelid drooping

16. Pupil shrinkage

17. Headache

18. Loss of appetite

19. Weight loss

20. Weakness

21. Fatigue

What are the Causes of Lung Cancer?

When functional cells in the respiratory tract encounter cancer-causing factors, some mutations may occur in the bronchial cells of the lung. As a result of these exposures, cancerous changes occur. If the immune system is active enough, these cells can be eliminated and repaired. If there is a deficiency in the immune system in the organism, the cells whose structure is deteriorated are affected by the factors that cause cancer and begin to multiply uncontrollably and cancer masses occur. Apart from that, it gains the feature of metastasis with some changes and can spread to different organs of the body, including the surrounding tissues.

With the increase in the number of cells, tumor formation is observed in the lung and this is usually in the form of solid nodules. This tumor, that is, the mass, first grows in the lung and then can spread to other organs such as the brain, bones and liver.

What is a Solid Nodule?

It is a lesion located in the lung, surrounded by lung tissue, generally smaller than 3 centimeters in diameter, with clear borders and a round structure called nodule. There are factors that determine whether this nodule is benign or malignant. These are size, edge structure, presence of calcification, growth feature and density feature. Nodules that are observed to grow rapidly in tomographic evaluation pose a risk. The fact that the wall of the evaluated nodule is not regular also increases the risk of cancer considerably. Compared to this, the presence of calcification in the nodule increases the probability of being benign. The aforementioned solid nodules, that is, those that do not contain liquid, are considered to be at a very high risk in terms of causing cancer.

Close monitoring of solitary nodules is important. Computed tomography should be taken at certain periods, and in suspicious cases, the nodules should be removed by surgery. Radiosurgery may be a good option for patients who have a high probability of cancer but cannot undergo surgery due to their age or comorbidity. 

The Role of Smoking in Lung Cancer

The first thing that comes to mind when talking about cancer and especially lung cancer, smoking has a very old and interesting history. Like cancer, we know that although its history is not based on Egyptian mummies, it spread to our world in the 1400s, when Europeans discovered the Americas.

The natives of the Americas produced tobacco for medicinal and religious purposes. Although Rodrigo Jerez, who was the first to be caught smoking tobacco in Europe, smoked from his mouth, was interpreted as being possessed by the devil and was sentenced to prison; In the 16th century, the habit of smoking tobacco spread all over Europe. A century later, commercial tobacco cultivation would begin in America.

The first research on the tobacco-cancer relationship was published in 1761 by the English physician John Hill. The first statistical relationship between smoking and cancer came from Germany during the Nazi era. Although smoking bans gradually increased in that period, it became increasingly common during the 1st and 2nd World Wars, with the use and supply of cigarettes by the soldiers on the fronts. By the end of the war, 60-80% of the world’s adult population was smoking.

Tobacco was originally smoked with sticks or pipes, after the method of wrapping tobacco leaves or thin paper, modern cigarettes emerged.

According to the Tobacco Atlas, prepared with the contributions of the World Health Organization, the American Cancer Society and the World Lung Foundation, 83,100 people die from tobacco-related causes in Turkey every year, while 252 thousand children and 14.5 million adults use tobacco products. Lung cancer is the most common cancer amoung men in Turkey and its incidence in women is now in the 5th rank.

The name nicotine derives from Jean Nicot, who popularized smoking tobacco in France. The most familiar ingredient in cigarettes is nicotine, but nicotine only creates the addictive function of this beast. The cancer-causing part of the issue stems from the conversion of natural substances in the burning tobacco plant into combustion products such as nitrosamines and benzopyrene.

What is more dangerous than this transformation is; the transformation of today’s people into a community that believes that life will continue without changing their deadly habits and vital handicaps. Let’s quit smoking and hug life first. Otherwise, life will never be embraced first…

How is Lung Cancer Diagnosed?

After the factors determined in the patient’s history, the findings are brought together with the examination. These findings are supported by laboratory tests. Imaging of the tumor is important in the diagnosis of lung cancer. For this, some imaging technologies are used. The imaging systems used in the diagnosis of lung cancer are as follows.

  1. X-ray of Lung
  2. Lung tomography
  3. Brain MRI
  4. PET-CT
  5. Bronchoscopy
  6. Biopsy procedures
  7. Mediastinoscopy
  8. Thoracoscopy

For the definitive diagnosis of lung cancer, a biopsy is taken from the mass and pathological examination is performed. This examination is necessary to determine the distinctive features of cancerous cells. According to the results, the most appropriate treatment plan is selected for the patient.

What Are the Types of Lung Cancer?

We divide lung cancer into two main groups, small cell and non-small cell. While small cell lung cancer constitutes 10-15% of all cases, it is a type of cancer that tends to progress more rapidly and metastatically.

Non-small cell lung cancer also has subtypes. The most common of these are adenocarcinoma and squamous cell cancers.

How is Lung Cancer Treated?

After the necessary examinations are completed and the diagnosis is made, the cell structure of the tumor and whether it metastasizes are discussed. Correct treatment with early diagnosis prolongs life expectancy. During the treatment of the disease, radiotherapy and chemotherapy can be given depending on the condition of the tumor. These methods can sometimes be used in combination and sometimes separately.

If the diagnosis is made in the first two stages, the success rate in the treatment of lung cancer is higher. Cancer cells in the tissue are surgically removed. According to the doctor’s decision, a preventive treatment plan is made. If the disease is in the last two stages, methods such as targeted therapies, chemotherapy, radiotherapy and immunotherapy can be applied. These treatments are determined by the doctor according to the stage of the disease.

Radiotherapy

Radiotherapy is one of the main treatment options in lung cancer. Radiotherapy is one of the main treatment options in lung cancer. Radiosurgery instead of surgery at early stage tumors and simultaneous radiotherapy and surgery in more advanced stages are the main treatment methods in the treatment of lung cancer.

Radiosurgery is a form of treatment that is gradually replacing surgery. In the first years, radiosurgery, which was given to patients who were elder, had additional diseases or could not undergo surgery because it was located around critical organs, started to be given to more and more patients in parallel with technological developments and increasing developments in tumor biology. Since the immune system is not suppressed, it is a preferred treatment method for surgical operations that are postponed during the pandemic or increase the risk. In radiosurgery, hundreds of small beams of light are directed to the diseased tissue, creating an effect similar to surgery, but it is not a penetrating procedure. It can be tolerated very easily by the patient.

In a lung cancer that is encountered at a more advanced stage, we use radiotherapy, which is given simultaneously with chemotherapy, which we call fractionated, that is, divided into sessions. Intensity modulated radiotherapy (IMRT), arc treatments have been providing treatments that target the diseased tissue and protect the surrounding normal tissue in the best possible way in recent years.

Until the last few years, when a tumor spread to several foci other than its original location, it was referred to palliative chemotherapy on the grounds that there was no chance of cure. However, with the concept of oligometastatic disease, which has become more and more embedded in our language and daily practice in recent years, we are giving radiotherapy to more and more patients and giving more diseases a chance to cure.

In radiotherapy of organs in the chest or abdomen, such as the lungs, the patient has to hold his breath at certain intervals. While this allows us to better focus on the tumor, it also reduces the margins of safety we give to avoid missing the displaced tumor during breathing. Therefore, while the accuracy of our work increases, the damage we can do to normal tissue becomes minimal.

What is Oligometastatic Disease?

Although there are many concepts of oligometastaic disease, the Consensus of the European Union of Oncology is our main reference source. According to this Consensus, we call the disease with metastases not exceeding 5, in 3 organs or less, and oligometastatic disease. The importance of defining the oligometastatic disease is that local treatments such as radiotherapy or surgery can be given to each metastasis of these patients and the patient can be cured. The superiority of radiotherapy (especially radiosurgery) over surgery in oligometastatic disease can be summarized as not requiring hospitalization since it is not a penetrating procedure, not impairing the general condition of the patient, and not suppressing the immune system. In addition, most of the immunotherapies given today are developed against PDL-1 receptors, and radiotherapy increases the effectiveness of immunotherapy by increasing the amount of PDL-1 in tumors. For this reason, our advice to our patients who receive immunotherapy is to get the opinion of a Radiation Oncologist.

Radiotherapy should be given in good hands, with good devices and with a good team. Even a bad surgery can be compensated, but it should be remembered that a bad course of radiotherapy cannot be reversed and the given radiation cannot be recovered.

Note: For more detailed information on this subject, you can review our article titled Radiotherapy Treatment in Lung Cancer.

Chemotherapy

This treatment method involves the destruction of cancer cells with drugs. In general, the number of chemotherapies that consists of one or more drugs is called a cure. The cycles are repeated approximately every 21-28 days. In lung cancer, this treatment is given intravenously as a liquid or as an oral pill. In the treatment, which is determined according to the patient’s condition, the blood count is checked before the cure. The treatment planning of chemotherapy is determined according to the characteristics of the tumor in the pathology report of the patient. In this treatment, in which the general condition of the patient plays an important role, chemotherapy may not be given to patients with poor general condition, since they may not be able to remove the side effects.

Genetic tests

With the increase in technological opportunities, many genetic changes belonging to cancer cells are detected and as a result, many new drugs are introduced to the market. With genetic tests, healthy cells can be protected and targeted cancer treatment can be planned. Accordingly, the characteristics of the person and the tumor are determined and appropriate smart drugs and/or immunotherapies are determined.

Immunotherapy

Immunotherapy contributes to the recognition and destruction of cancerous cells by activating our immune system. Compared to chemotherapy, it is preferred because it has fewer side effects and gives positive responses in treatments with the developments in recent years. For patients with lung cancer, they are approaches that prevent the immune system suppression of the tumor by helping the cancerous cells that develop in the body to be recognized as foreign by our own immune system cells (lymphocytes). Again, it can be given in a personalized way after some analyzes made to the person.

It has been proven that the importance of intestinal flora in patients receiving immunotherapy, high-dose vitamin C, hyperthermia and radiotherapy increase the efficacy of treatment. While receiving treatment, you should definitely consult your doctor about the additional treatments that can be done to increase the effectiveness or you can get support from us in our clinic.

Lung Cancer Death Rate

The chance of treatment is determined by factors such as the course of the disease, cell type, stage, size of the tumor and the rate of spread of the disease. The most important thing in treatment is early diagnosis. While a lung cancer detected without spreading to lymph nodes or distant organs in the chest cavity can be easily treated with radiosurgery or surgery, a lung cancer that has spread needs systemic treatments and the treatment process becomes more complicated. However, targeted drugs and immunotherapy developed in recent years have revolutionized the treatment of lung cancer and offer a cure even for patients in the metastatic period. While approaching the metastatic patient as a patient who will die a few years ago and who has no chance of treatment, long-term survival can be achieved in patients who are treated with genetic tests.

The important thing is not to fall into despair when we are diagnosed with lung cancer and to know that “cancer does not equal death”. We should not forget that there is no disease without hope of recovery, and we should try to guide our treatment by staying in the light of science.

Another recommendation to our patients diagnosed with cancer is to continue their treatment with treatments proven by scientific medicine. It is not the right approach to rely on only herbal treatments. It is your most natural right to ask for additional treatments that will increase the effectiveness of the applied radiotherapy or chemotherapy, or to try to determine the appropriate diet, but to seek help only from these treatments is an approach that does not suit 21st Century Science and Technology and it also may cause an irreversible harm to your patients.

The information contained in this content is for awareness purposes only. You can consult the expert team of our clinic with your questions and concerns. You can reach us through the contact page.

Mesothelioma

Mesothelioma is a type of cancer that we see in the pleura surrounding the lung, the pericardium surrounding the heart and the peritoneum surrounding the abdominal organs. The incidence in our country is above the world average. The most important reason for this type, which we are very familiar with as a society, is asbest, which we know as white soil, and it often affects the lungs.

            Tuzköy, Karain and Sarıhidir villages in the Cappadocia region; Due to the white soil used in the construction of the houses, especially the floors in the region, it caused Mesothelioma to a remarkable extent, and the region was known as Cancer Villages for a while…

            Although the treatment consists of chemotherapy followed by surgery, only a minority of patients are suitable for surgery. Technically, it is not easy to interfere with the entire membrane structure without damaging the organ inside, and surgery cannot be applied to patients most of the time due to other accompanying diseases and general conditions. Until today, radiotherapy was used to eliminate the microscopic disease after surgery or to relieve the complaints of patients who could not be operated, but the new technology has given us the chance to use radiotherapy in the first-line treatment of mesothelioma, especially lung mesothelioma.

            It is now possible to irradiate lung mesothelioma cancer, which is a utopia for us, due to its proximity to many organs such as the lung, heart, liver, spinal cord and esophagus, and the large and irregular shape of the irradiated region. In a published study, we have shown that we can safely apply radiotherapy with minimal damage to neighboring organs with helical tomotherapy and linac-based arc treatments. In this study, two different targeted radiotherapy techniques for lung mesothelioma were compared; Arc and helical treatment techniques. As the machine moved around the patient, small beams of varying intensity were directed at the tumor to the patient. We performed our study on computed tomography images of 7 patients, and with both techniques, we were able to keep normal organ doses below the specified tolerance limits. While a more homogeneous dose distribution was achieved with helical tomotherapy, Ark treatment provided comfort for both the patient and the treatment team with a much shorter treatment time.

            In another study published in 2009, we showed the importance of Positron Emission Tomography (PET) in the treatment of Mesothelioma patients and reported that we could apply more sensitive treatments with PET, which has become more common in our lives with the developing technology and we can view the tumor better. With this study we conducted ten years later, we have shown that radiotherapy can open a new window in the treatment of Mesothelioma, where treatment options are limited. A larger clinical trial needs to be the next step in our experience with a limited number of patients.

            Reading Recommendation: For more detailed information about Lung Cancer Arc Radio Therapies, you can review our article titled Dosimetric Comparison of Lung-Sparing Radiation Therapy between Volumetric Arc Therapy and Helical Tomotherapy for Unresectable Malignant Pleural Mesothelioma

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