This mass expands over time, causing:

  • Organic dysfunction: the tumor blocks the normal flow of air into the lungs
  • Metastases : the tumor spreads to other organs of the body

Cancer threatens the entire human body.

Lung cancer can develop in the cells that form:

  • The bronchi
  • The bronchial ones
  • The alveoli.

Tumor growth causes an increase in the number of cells in the affected region.

 

Types of lung cancers

More than 90% of primary tumors develop in the bronchi, one of the two main branches of the trachea .
This is known as bronchogenic carcinoma

Pulmonary carcinoma Lung
cancer includes malignant neoplasms that are formed in the epithelial tissues that make up:

  • The bronchi
  • Pulmonary tissue.

This type of cancer represents more than 95% of malignant lung tumors, the others are:

  • Lymphomas and connective tissue tumors (<0.5%)
  • Benign tumors (such as amartomas) and low grade malignancies (such as carcinoids) that are less than 5%.

Lung tumors are usually divided into 2 groups according to the type of therapy that can be done:

1) Non-small cell carcinoma

Non-small cell lung cancer can be treated with surgery in combination with radiation therapy and chemotherapy.

Squamous cell carcinoma
Squamous cell carcinoma is also called squamous cell carcinoma.
This type of cancer originates in the large caliber bronchi (high airways) and accounts for 40-50% of the cases.
Generally, it forms in the central part of the lung and can affect the bronchi causing:

  • Stenosis (shrinkage)
  • Atelectasis (partial collapse of the lung)
  • Necrosis (cell death) due to blockage of the blood circulation caused by the tumor mass
  • Pulmonary abscess in the area of ​​necrosis.

This type of cancer is the most common type in men and smokers.

Adenocarcinoma
is the second most frequent type of non-small cell lung cancer, accounting for 30-50% of cases.
Adenocarcinoma can lead to:

  • In the bronchi: bronchial adenocarcinoma
  • In the alveoli: bronchiole-alveolar carcinoma. The least aggressive adenocarcinoma subtype is bronchiole-alveolar carcinoma.
    This type of cancer affects the small air sacs of the lungs.

It occurs in people who do not smoke, especially in women.

It forms more externally compared to squamous cell carcinoma.

Even small in size, it can cause:

On the radiography, you can see:

  • An opacity (white color), as in the case of pneumonia
  • A solid nodule
  • Scattered nodules.

Large Cell Carcinoma Large cell
lung cancer is less frequent and is seen in only 10% of patients affected by non-small cell lung cancer.

It is the most aggressive form of non-small cell carcinoma.
Large cell carcinoma causes the formation of brain metastases in 50% of cases.

 

 

2) Small cell lung carcinoma

Small cell lung carcinoma is less frequent compared to the other.
It is the most aggressive form of lung cancer.
It can be treated only with the help of radiotherapy and chemotherapy.
The staging of cancer of small cells is different from the standard.

 

Causes of lung cancer

There are very important risk factors.

The exogenous or external risk factors include:

  • Cigarette smoke : represents the main risk factor. In 90% of cases of lung cancer in men and 70% in women it is related to smoking.
    The risk is related to the number of cigarettes smoked, the number of years of smoking and the age of onset.
    The risk of cancer decreases by 50% after one year of smoking, however, it can not return like nonsmokers.
  • Passive smoking : it accounts for 20% of lung cancer among those who never smoked, so it has important relevance
  • The hormone replacement therapy (postmenopausal) is an important risk factor
  • Occupational exposure : asbestos increases the incidence of lung cancer by 5% and mortality by 7%.

Endogenous or internal risk factors

  • Pulmonary fibrosis (especially in females)
  • COPD (70-80% of lung cancer cases are preceded by this disease),
  • Pulmonary infections and their scarring results

Lung cancer in nonsmokers has these characteristics:

  • Affects younger individuals
  • It is more common in women
  • In most cases it is an adenocarcinoma
  • It has a better prognosis (especially the operated ones).

 

First symptoms of lung cancer

There is usually no early symptom. When the disease reaches an advanced stage, the symptoms manifest themselves.
For this reason it is difficult to diagnose lung cancer earlier.

The symptoms that may indicate lung cancer are :

Early Symptoms of Lung Cancer
In the first phase, the symptoms are especially felt if the tumor is in the inner part of the lung.
One of the first symptoms is the cough with blood that occurs along with chest pain . Coughing can become chronic.

  • Dry and persistent cough that worsens over time, a patient suffering fromchronic bronchitis should go to the doctor if the cough becomes more frequent or change the type of secretion. Even a tumor on the outside of the lung can cause cough if it causes an ulcer in the mucosa.
  • Cough with phlegm and blood , called hemoptysis, can be caused by: formation of new blood vessels in the tumor, ulcer in the mucosa, death of the cancerous tissue or traumas by cough;
  • Pain in the chest  if the mass presses against the pleura and the ribs (especially in the case of peripheral tumors). You may also feel the feeling of heaviness in your chest, as if there is a stone on top.
    Moderate pain in the sternum can become severe and may radiate to the shoulders, neck, and spine.
    It often worsens with coughing.
  • Pain in the shoulder , in the arm , that can reach the hand . Pancoast syndrome is caused by tumors that affect the pulmonary apex, especially the right. These tumors can affect the first and second ribs, brachial plexus nerves, subclavian arteries and veins. Normally, the patient arrives at the clinic supporting the diseased arm with the healthy one.
  • Shortness of breath  can be caused by: obstruction of the trachea or bronchi, a large mass in the lung that occupies a lot of space, pleural effusion,inflammation of the lymph nodes , embolism formed by tumor cells that blocks the blood vessels.
    You may experience difficulty breathing, especially when lying down.
  • Breathing with wheezing or stridor caused by the passage of air into an obstructed area in the trachea or bronchus;
  • Fever because an infection can develop in the part of the lung where the air does not arrive.
  • Pneumonia and persistent bronchitis ;

 

Symptoms of tumor in the intermediate-advanced stage

The tumor spread to the organs of the rib cage.

 

Complications caused by the spread of cancer in the chest

Claude-Bernard-Horner’s syndrome : if the tumor is at the apex of the lung and reaches the star-like ganglion or cervicothoracic ganglion (nerve nucleus of the sympathetic chain), it can cause:

  • Enophthalmia or enophthalmus (abnormal retraction of the eye relative to the orbit)
  • Miosis (reduction of pupil diameter)
  • Sweating on the face only on one side
  • Ptosis of the eyelid (lowering of the upper eyelid).

Rarely, these phenomena are all together.

Upper vena cava compression syndrome : Compression may be due to:

  • A tumor in the right upper lobe
  • A mediastinal lymph node (near the bronchi) affected by the tumor
  • The formation of a thrombus secondary to venous congestion.

In 40% of cases, the culprit is a small cell carcinoma.
The symptoms of vena cava compression are:

  • Swelling of the face, eyelids, and neck
  • Headache (from cerebral venous hypertension)
  • Dizziness
  • Somnolence
  • Visual field reduction
  • Cough
  • Dysphagia (dysfunction of the digestive system)
  • Dysphonia (voice disorders)
  • Cyanosis.

It is a problem that needs to be urgently addressed with the use of internal prostheses that allow blood to circulate within the vessel

Recurrent laryngeal nerve palsy : occurs in the case of left upper lobe cancer or masses in lymph nodes below the aortic arch that compress or irritate the nerve.
The consequences are:

  • Difficulty speaking because of vocal cord paralysis (dysphonia / stridor)
  • Swallowing problems (dysphagia) because this nerve innervates the intrinsic muscles of the larynx and the upper part of the esophagus.

Paralysis / Irritation of the phrenic nerve: a central or mediastinal cancer can compress the phrenic nerve causing:

  • Hiccup (due to nerve irritation)
  • Shoulder and neck pain
  • Dyspnoea (if phrenic nerve palsy causes reduction of diaphragm movement on one side).

Cardiac problems : If the tumor or metastases presses the heart, it can cause arrhythmia , accumulation of fluid in the pericardium (cardiac membrane) and enlargement of the heart until  heart failure .
Metastases in the heart and pericardium occur in 15% of cases.

The penetration of the esophagus is usually caused by:

  • Tumors of the main bronchus or left inferior lobe
  • Mediastinal lymph nodes.

The consequence is dysphagia (difficulty swallowing) before solid foods, then also liquids.

Penetration into the trachea or bronchus – is a rare occurrence, but may result in a bronchial-esophageal fistula (anomalous communication channel). The consequence is the slipping of food ingested in the lungs. Here it may cause aspiration pneumonia .

 

 

Final Symptoms of Cancer – Terminal Stage

  • Abnormalities in the fingers or nails, such as excessive growth of tissue at the tips of the fingers (digital attachment);
  • Paleness or bluish coloring of the skin;
  • Swelling or pain in the joints ;
  • Bone pain  caused by metastases (30-40% of cases).
  • Neurological disorders: descent of the eyelids, restriction of the pupil.

 

Diagnosis of lung cancer

The doctor checks the medical history and performs a physical examination in which he controls the lungs and lymph nodes laterally cervical (on the side of the neck) and over the clavicle. These are swollen only in the advanced stage in 20% of cases.

Instrumental Exams
The main exam to diagnose lung cancer is chest radiography ,

Radiography may show the presence of:

  • An opacity in the lungs
  • Atelectasis (pulmonary collapse)
  • Pleural effusion, you see a large white spot and eventually the deviation of the bronchi.

 

Laboratory Tests

  • Bloodtests
  • Search for tumor markers: they do not allow to make the diagnosis even if they are present or increase in certain types of cancer. They are useful in monitoring the disease. The most important tumor markers are CEA (carcinoembryonic antigen), more specific for adenocarcinoma, NSE (neurospecific enolase) and chromogranin for small cell lung carcinoma and neuroendocrine tumors and CYFRA 21 (a cytokeratin) for squamous cell carcinoma .
  • Cytological (cellular) and histological (tissue) analyzes of sputum (secretions): 3 samples collected on 3 different days are required. It may give a false negative result in case of peripheral tumor (on the outside). Very useful for squamous cell carcinoma that causes a greater degree of desquamation.

 

Biopsy
A biopsy is the examination of a sample of tumor tissue.
With the biopsy the pathologist examines a tissue sample to determine the type of tumor and the severity of the disease.

A biopsy may be performed during other invasive tests, such as:

  • Video-bronchoscopy or fibro-bronchoscopy  performed with the introduction of a bronchoscope (a tube with a camera) that travels through the airways to the bronchi. During this examination the doctor collects tissue samples that should be analyzed.
  • Computed tomography-guided transthoracic thick needle biopsy : local anesthesia is required for this examination. The doctor, guided by a CT scan, inserts a needle into the lung and collects a sample.
  • Thoracentesis : is the collection of pleural fluid through the thorax. In the case of pleural effusion, cytological analysis of the withdrawn fluid may show the presence of cancer cells. This means that the tumor is in the advanced stage because if the pleura is reached it is inoperable. Especially adenocarcinoma causes the presence of tumor cells in the pleural effusion. In any case, in more than half of the cases, it may not be useful for the diagnosis.
  • Thoracoscopic surgical biopsy : This test is performed under general anesthesia . The surgeon makes three small incisions and, in one, inserts the thoracoscope, a fiber optic probe that allows to study the lungs and the pleural cavity. During this examination, the surgeon collects the tissue for analysis. This procedure is more invasive and you need hospitalization.

 

Instrumental exams of images

The patient may also undergo other tests to assess the extent of the tumor:

 

Staging of lung cancer

Lung cancer staging is an important field of study because it helps doctors determine how much the cancer has grown.
Depending on the maturity and severity, the doctor establishes:

  • The prognosis of cancer
  • The treatment.

 

Staging of Small Cell Lung Cancer
Tumor staging in the small cell lung is divided into two stages:

  1. Limited disease (DL): the tumor is located only in the lung, only in the hemithorax (one side of the thorax) of the primary tumor, in the mediastinum and in the supraclavicular lymph nodes.
  2. Extensive disease (ED): the tumor developed distant metastases.

 

Non-small cell carcinoma staging Staging of non-small cell
lung cancer is the standard

Stage I
The tumor is in the initial phase:

  • Less than 3 cm in diameter
  • It is not yet widespread.

Therefore, it can easily be removed with surgery.

Stage II
At this stage the cancer is slowly spreading to neighboring parts.

This stage is divided into:
Stage 2A:

  • The tumor measures between 3 and 4 cm
  • The adjacent lymph nodes are involved.

Stage 2B:

  • The tumor measures between 4 and 7 cm
  • The adjacent lymph nodes are involved
  • The tumor may also have spread to:
    • diaphragm ;
    • Lung wall;
    • Thoracic wall;
    • External wall of the heart (pericardium).

Survival rate of lung tumors in stages 1-2
Survival at 5 years is 65-80%.

Stage III
At this stage, the cancer develops further and may spread to the blood vessels between the lungs and the heart. It is a highly dangerous and irreversible stage.

 

Stage 3 is divided into two subtypes.

In the first stage called 3A, cancer is limited in one part of the body.

  • It has a dimension between 3 and 7 cm in diameter
  • The adjacent lymph nodes and thoracic lymph nodes are involved
  • It spread to the chest wall, the diaphragm, and the pericardium.

In the second phase called 3B, cancer:

  • It spreads aggressively: it also attacks the heart , the trachea, the esophagus
  • The lymph nodes of the entire thorax are involved.

Therapy for stage III lung cancer

For most patients, stage 3B cancer is difficult to remove surgically and treatment is limited to radiation therapy  and chemotherapy.

Lung Cancer Survival Rate Stage 3
The lung cancer survival rate in the third stage varies according to the patient’s treatment and health status.
However, the average survival ranges from 7 to 17%.

Only 5-10% of lung cancer patients in Stage 3B survive for up to 5 years.
Patients undergoing chemotherapy have a higher chance of survival if they maintain a healthy lifestyle.
The prognosis of lung cancer is best for people who do chemotherapy because the survival rate in 5 years is 15-20%.
These statistics are not significant because they do not consider:

  • To genetics
  • The lifestyle of the patients.

The prognosis for lung cancer is usually lousy because of the lifestyle of most patients after diagnosis.

 

Lung cancer in the fourth stage

It represents the worst stage because it has no cure.
The cancer has spread to other parts of the body and the only solution is the limitation:

  • Of damage
  • Of the symptoms.

The final stage of stage 4 lung cancer is an irreversible disease in which cancer cells have spread to other healthy body organs (distant metastases).

 

Symptoms of stage 4 lung cancer
The symptoms of stage 4 lung cancer depend on the location of the primary tumor and metastases.
Staging is based on the spread of the tumor in the organs of the body.

After having performed all the diagnostic tests, the doctor establishes the treatment and prognosis of lung cancer in the fourth stage.

In the final stage, the cancer has spread from the chest to other organs of the body ( lung metastases ).

Symptomatic treatment from the time of diagnosis is essential to treat cancer.

Treatment for stage IV lung cancer
Chemotherapy or radiation therapy is given to kill cancer cells and slow down development.
It is not possible to perform the surgical removal of the diseased part in the fourth stage because it is not effective.

How much do you live? Prognosis and life expectancy for a person with lung cancer

The survival rate depends on the person’s physical condition and the treatment he is doing.
In most cases, the third stage of lung cancer leads to  stage 4 that is deadly.

You should consider several factors for prognosis and life expectancy.
It is important to know:

  • The age
  • The gender (male or female)
  • Individual health status
  • The extent of the tumor
  • The patient’s response to administered therapy, etc.

These factors play an important role in the prognosis of the last stage.

The tumors with the best prognosis, therefore with greater survival , are those found in patients:

  • Asymptomatic
  • With symptoms only related to primitive cancer.

Patients with systemic symptoms have a worse prognosis , such as:

  • Loss of appetite (anorexia, 35%)
  • Weight loss (40-50%)
  • Astenia (30%)
  • Symptoms related to metastasis.

Usually, patients without objective or laboratory abnormalities are less likely to have metastases :

  • In the brain
  • In the bones
  • Abs

The survival rate in the fourth stage is very low.
Only 5-10% of people affected by lung cancer survive for up to 5 years.
In non-small cell cancer only 10-15% of people live up to 5 years.
Compared to other types of cancer, the prognosis of stage 4 lung carcinoma is worse.

Late diagnosis is one of the main factors that determines the low survival rate in people affected by lung cancer.

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