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The best way to treat lung cancer is to diagnose early and treat aggressively
From maintaining a strong immune system to seeking medical intervention when necessary, there are various ways to prevent and manage respiratory issues effectively
Lung cancer is the leading cause of cancer-related death in our country. Estimates indicate that lung cancer ranks as the third most common cause of cancer deaths among males in India. The main types of lung cancers are non-small cell lung cancer and small cell lung cancer. Dr. Naveen Sanchety, Director, Surgical Oncology, Sarvodaya Hospital, Faridabad shares all you need to know:
Non-small cell lung carcinoma (NSCLC)
Almost 80 to 85% of lung cancers are non-small cell lung cancers. The main types of NSCLC are adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and large cell neuroendocrine carcinoma.
Small cell lung cancer (SCLC)
Almost 10 to 15% of all lung cancers are small-cell lung cancers. These cancers tend to grow and spread faster. In most patients with SCLC, the cancer has already spread beyond the lungs at the time of diagnosis.
Treatment options
Lung cancer is diagnosed by taking a biopsy from the suspicious area of the lung, which can be done with both bronchoscopy and CT. Imaging tests like CT scans of the lung are done to know about the exact size, location, number, and position of the suspected lung lesion.
With the advancements of molecular testing or genomic testing of lung cancer, various genetic tests (KRAS, EGFR, ALK, RET, BRAF) are being done to know for specific genetic changes that could respond to specific targeted therapies.
For complete staging workup, we usually do whole-body Positron emission tomography (PET), an MRI scan for the brain, and a whole-body bone scan for skeleton lesions.
Treatment approaches for lung cancer are surgery, radiotherapy, and systemic therapy and these are the three modalities most commonly used to treat patients with non-small cell lung cancer.
Non-small cell lung cancer
Stage I and II: Surgery offers the best chance of cure in patients of lung cancer. The overall plan of treatment, determination of respectability, and preoperative assessment of cardiopulmonary reserve of the patient are done before taking a decision for surgery.
Multidisciplinary evaluation is recommended to determine the safest and most efficient approach and treatment of lung cancer patients.
The surgical procedures are segmentectomy, lobectomy, and pneumonectomy with or without mediastinal lymph node dissection.
The patients who are medically unfit or unwilling for surgery and should be offered stereotactic body radiation.
In stage III, the majority of the patients require concurrent chemoradiotherapy, which can be definitive or as a neoadjuvant, followed by surgery if feasible. Surgery in stage III is also associated with a potential greater risk of complications, particularly stump breakdown and broncopleural fistula.
For patients with advanced stage IV disease with extensive metastasis, systemic therapy is offered. Palliative radiation can be used for symptom relief for pain, bleeding, or obstruction.
The most commonly used chemotherapy drugs used in lung cancer (NSCLC) are cisplatin, etoposide, carboplatin, gemcitabine, and paclitaxel, alone or in combination.
Small cell lung cancer
Early stage I/IIA can be offered lobectomy with mediastinal lymph node dissection if they are medically fit and willing for surgery.
The majority of the patients otherwise would be offered stereotactic radiation and/or systemic chemotherapy.
Stage II B/III SCLC
Medically fit patients can be offered systemic chemotherapy with concurrent radiotherapy, whereas medically unfit patients can be offered systemic chemotherapy only.
Stage IV SCLC
The majority of the patients would require a combination of chemotherapy plus immunotherapy. The patient will also require radiation for brain metastasis and spinal cord compression.
Various new targeted immune checkpoint inhibitors like Durvalumab, Atezolizumab, and Ipillimumab.
Unfortunately, the majority of the patients who present in stage two or stage three will have a disease recurrence. More than 50% of these recurrences will have brain metastasis, which requires brain radiation.
Lung cancer is a heterogeneous disease, and the majority of the patients in our country are present in stage III/IV, and despite aggressive treatment, there is high mortality in these patients.
The best way to treat lung cancer is to diagnose early and treat aggressively. More than 85% of the patients with lung cancer have tobacco intake in one or other form. In western countries, the incidence of lung cancer is decreasing 2.5 to 3% every decade, whereas unfortunately in our country, as the incidents of smoking and tobacco intake are increasing, so is the incidence of lung cancer, and that too is diagnosed in the advanced stages.
