HYDERABAD: Lung cancer is a formidable global health concern, surpassing all other forms of cancer in terms of lives claimed. It accounts for a staggering 11.6% of all new cancer cases worldwide and is responsible for 18.4% of cancer-related deaths. In India, it ranks fourth among all cancers, with a concerning second place among males and sixth among females. As November is Lung Cancer Awareness Month, let’s delve deeper into the insights provided by experts.
Dr Yugandhar Sarma, Senior Consultant and HOD of the Department of Radiation Oncology at Renova Soumya Cancer Centre, notes, “Every 1 in 100 persons faces the risk of developing lung cancer in their lifetime. Unfortunately, approximately 40% of these patients seek medical help very late, often when their cancer is in an advanced stage.”
The primary culprit for lung cancer is smoking tobacco, with the risk increasing in proportion to the number of pack years smoked. Shockingly, non-smokers are also at risk due to exposure to secondhand smoke, responsible for 85-90% of lung cancer cases. While lung cancer screening isn’t recommended for everyone, it’s a vital tool for high-risk current or former smokers who’ve consumed more than a pack daily for over 30 years. Other risk factors include family history, aging, previous lung disease, exposure to air particulates like asbestos and arsenic, and occupational lung diseases.
Most cases are diagnosed at advanced stages, with 80-90% presenting in stages III and IV. The significant reason for late diagnosis is the lack of awareness and delay in diagnosis in many patients. Common symptoms include a persistent cough, breathlessness, chest pain, unexplained weight loss, repeated respiratory infections, body pain, and blood in sputum. The disease can spread to distant organs, leading to various complications.
Early diagnosis is pivotal, and sometimes lung cancer does not cause any symptoms and is incidentally discovered during evaluations for other conditions. Biopsies and chest and abdomen CT scans are primary diagnostic steps. It is also imperative to note that the same symptoms can be caused by other conditions, so they may not necessarily indicate cancer.
In the early stages, surgery provides the best chance of a cure, with lobectomy and pneumonectomy considered. Post-surgery chemotherapy is typically administered in stages II and beyond. For medically inoperable patients, stereotactic radiotherapy is an option, while stage III patients often receive combined modality treatment with radiation and chemotherapy. Unfortunately, even after curative surgery, 30-55% of patients experience disease recurrence.
The landscape of stage IV lung cancer management has evolved significantly in recent years. New drugs have improved the outlook for stage IV non-small cell lung cancer, with average survivals approaching two years. Patients with specific mutations, especially women and non-smokers, are now offered tyrosine kinase inhibitors in place of chemotherapy. These oral medications provide a more effective and less taxing alternative, enhancing patients’ quality of life. However, it’s important to note that stage 4 lung cancer remains incurable.
As patients live longer, they may face new challenges like brain metastases. Dr Deepak Kopakka, Consultant Medical Oncologist at CARE Hospitals, emphasises, “The main message for society must be to avoid smoking and promote healthy living. Those experiencing persistent cough, unexplained breathlessness, blood in the sputum, or non-improving pneumonia should get themselves evaluated to rule out lung cancer.”
Barriers to early presentation for lung cancer include lack of awareness about the symptoms and their misinterpretation, poor follow-up with doctors, and lack of access to healthcare services. Thus, creating cancer awareness, arranging mass screening camps, preventing risk factors, adopting healthy habits, and improving access to healthcare services would result in impressive control and cure of cancer.