MEDICAL BLOGS:LUNG CANCER (Part -1)

There are three types of lung cancer described and it is important to know which type one is suffering from, as the treatment is tailored accordingly:

1.    Non small cell lung cancer ( NSCLC)

·      85% of cases fall under this category

·      There are three sub types namely squamous cell, adenocarcinoma and large cell carcinoma.

2.    Small cell lung cancer  

·      10-15% of cases fall under this category.

·      Also known as Oat cell carcinoma. It is known to spread faster than other lung cancers.

3.    Carcinoid lung cancer

·      5% of cases fall under this category

·      Also called Neuroendocrine tumors. Grow slowly and spread is rare.

Non Small Cell Lung Cancer ( NSCLC)

Adenocarcinoma:

·      40% of NSCLC are adenocarcinomas.

·      Common in current or former smokers.

·      Also most common type of lung cancer seen in non-smokers.

·      It is more common in women than in men.

·      More likely to occur in younger people than other types of lung cancer.

·      Adenocarcinoma is usually found in outer parts of the lung.

·      It tends to grow slower than other types of lung cancer and is more likely to be found before it has spread.

            Squamous cell (epidermoid) carcinoma:

·      25% to 30% of all lung cancers are squamous cell carcinomas.

·      These cancers start in early versions of squamous cells, which are flat cells that line the inside of the airways in the lungs.

·      They are often linked to a history of smoking and tend to be found in the central part of the lungs, near a main airway (bronchus).

            Large cell (undifferentiated) carcinoma:

·      10% to 15% of lung cancers.

·      It can appear in any part of the lung.

·      It tends to grow and spread quickly, which can make it harder to treat.

Other subtypes: A few other rare sub types of NSCLC exist, such as adenosquamous carcinoma and sarcomatoid carcinoma, but are much less common.

American Cancer Society’s guidelines for lung cancer screening

·      Screening is meant to find cancer in people who do not have symptoms of the disease.

·      Patients should be asked about their smoking history

·      Patients who meet all of the under mentioned criteria may be considered as candidates for lung cancer screening:

*55 to 74 years old 

*In fairly good health.

*Have at least a 30 pack-year smoking history. A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.

*Are either still smoking or have quit smoking within the last 15 years. 

*If you fit all of the criteria listed above for lung cancer screening, you and your doctor should talk about screening, including possible benefits and harms, as well as the limitations of screening.

·      Like with any type of screening, not everyone who gets screened will benefit.

·      Screening with low dose CT, will not find all lung cancers, and not all of the cancers that are found will be found early.

·      One might need more CT scans, or even invasive tests such as a lung biopsy, in which a piece of lung tissue is removed with a needle or during surgery. These tests have risks of their own.

·      Those who have metal implants / pace makers are not screened as it interferes with the CT images.

SIGNS & SYMPTOMS OF NSCLC 

Most lung cancers do not cause any symptoms until they have spread. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed early.
Yellowing of the skin and eyes (jaundice), from cancer spread to the liver

The most common symptoms of lung cancer are:

·      Persistent cough

·      Coughing up blood or rust-colored sputum

·      Chest pain that is often worse with deep breathing, coughing, or laughing

·      Hoarseness

·      Weight loss and loss of appetite

·      Shortness of breath

·      Feeling tired or weak

·      Infections such as bronchitis and pneumonia that don’t go away or keep coming back

·      New onset of wheezing

·      When lung cancer spreads to distant organs, it may cause:

·      Bone pain (like pain in the back or hips)

·      Nervous system changes (such as headache, weakness or numbness of an arm or leg, dizziness, balance problems, or seizures), from cancer spread to the brain or spinal cord

·      Lumps near the surface of the body, due to cancer spreading to the skin or to lymph nodes, such as those in the neck or above the collarbone 

·      Most of these symptoms can be caused by something other than lung cancer.

Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

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Dr. Ganjoo 

Head-Yoddhas Medical Expert Panel

MEDICAL BLOGS:TREATMENT OF NON SMALL CELL LUNG CANCER (Part 4)

1) SURGERY 

If your doctor thinks the lung cancer can be treated with surgery, pulmonary function tests will be done beforehand to see if you would still have enough healthy lung tissue left after surgery.

·      Other tests will check the function of your heart and other organs to be sure you’re healthy enough for surgery.

·      SURGERY to remove the cancer (often along with other treatments) may be AN OPTION ONLY FOR EARLY STAGE LUNG CANCER ( NSCLC)

·      If surgery can be done, it provides the best chance to cure NSCLC.

·      Lung cancer surgery is a complex operation that can have serious consequences, so it should be done by a Thoracic surgeon or Onco-surgeon, who has a lot of experience operating on lung cancers.

·      The cancer has already spread to the lymph nodes between the lungs. This is often done just before surgery with mediastinoscopy.

Types of lung surgery

Different operations can be used to treat (and possibly cure) NSCLC:
If one can imagine a large airway with a tumour, as similar to the sleeve of a shirt with a stain a couple of inches above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and then sewing the cuff back onto the shortened sleeve. 
   *With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.
Increasingly, doctors now treat early-stage lung cancers in the outer parts of the lung with a procedure called video-assisted thoracic surgery (VATS), which requires smaller incisions than a thoracotomy.
Radiation therapy uses high-energy rays (such as x-rays) or particles to kill cancer cells.
There are 2 main types of radiation therapy:
    *Brachytherapy (internal radiation therapy)
External beam radiation therapy (EBRT) focuses radiation from outside the body on the cancer. This is the type of radiation therapy most often used to treat NSCLC or its spread to other organs.
In people with NSCLC, brachytherapy is sometimes used to shrink tumors in the airway to relieve symptoms.
Before surgery to shrink tumour size.
Concurrent therapy along with radiation for cancer that cannot be removed by surgery. As main therapy for advanced stages of cancer.
*Carboplatin
*Paclitaxel (Taxol)
*Albumin-bound paclitaxel (nab-paclitaxel, Abraxane)
*Docetaxel (Taxotere)
*Gemcitabine (Gemzar)
*Vinorelbine (Navelbine)
*Irinotecan (Camptosar)
*Etoposide (VP-16)
*Vinblastine
*Pemetrexed (Alimta)
Targeted drugs work differently from standard chemotherapy. At this time, they are most often used for advanced lung cancers, either along with chemo or by themselves. Drugs that target tumor blood vessel growth (angiogenesis) For tumors to grow, they need to form new blood vessels to keep them nourished. This process is called angiogenesis. Some targeted drugs, called angiogenesis inhibitors, block this new blood vessel growth:
This drug is often used with chemo for a time. 
Then if the cancer responds, the chemo may be stopped and the bevacizumab given by itself until the cancer starts growing again.
Ramucirumab (Cyramza) can also be used to treat advanced NSCLC. VEGF has to bind to cell proteins called receptors to act. This drug is a monoclonal antibody that targets a VEGF receptor. This helps stop the formation of new blood vessels. This drug is most often given after another treatment stops working. It is often combined with chemo.
Drugs that target cells with EGFR changes
Epidermal growth factor receptor (EGFR) is a protein on the surface of cells.
Erlotinib (Tarceva) 
Afatinib (Gilotrif)
Gefitinib (Iressa) 
These drugs can be used alone (without chemo) as the first treatment for advanced NSCLCs that have certain mutations in the EGFR gene.
EGFR inhibitors used for squamous cell NSCLC
Necitumumab (Portrazza) is a monoclonal antibody (a man-made version of an immune system protein) that targets EGFR. It can be used along with chemotherapy as the first treatment in people with advanced squamous cell NSCLC. This drug is given as an infusion into a vein (IV).
About 5% of NSCLCs have a rearrangement in a gene called ALK.
Ceritinib (Zykadia)
Alectinib (Alecensa)
These drugs can often shrink tumors in people whose lung cancers have the ALK gene change.

·      Pneumonectomy: This surgery removes an entire lung. This might be needed if the tumor is close to the center of the chest.

·      Lobectomy: The lungs are made up of 5 lobes (3 on the right and 2 on the left). In this surgery, the entire lobe containing the tumor(s) is removed. This is often the preferred type of operation for NSCLC if it can be done.

·      Segmentectomy or wedge resection: In these surgeries, only part of a lobe is removed. This approach might be used, for example, if a person doesn’t have enough lung function to withstand removing the whole lobe. 

·      Sleeve resection: This operation may be used to treat some cancers in large airways in the lungs. 

 *A surgeon may be able to do this operation instead of a pneumonectomy to preserve more lung function.

These operations require general anesthesia (where you are in a deep sleep) and are usually done through a surgical incision between the ribs in the side of the chest (called a thoracotomy).

The type of operation your doctor recommends depends on the size and location of the tumor and on how well your lungs are functioning.

Doctors often prefer to do a more extensive operation (for example, a lobectomy instead of a segmentectomy) if a person’s lungs are healthy enough, as it may provide a better chance to cure the cancer.

When you wake up from surgery, you will have a tube (or tubes) coming out of your chest and attached to a special canister to allow excess fluid and air to drain out. The tube(s) will be removed once the fluid drainage and air leak subside. Generally, you will need to spend 5 to 7 days in the hospital after the surgery.

Video-assisted thoracic surgery (VATS)

·      During this operation, a thin, rigid tube with a tiny video camera on the end is placed through a small cut in the side of the chest to help the surgeon see inside the chest on a TV monitor.

·      One or two other small cuts are created in the skin, and long instruments are passed through these cuts to do the same operation that would be done using an open approach (thoracotomy).

·      One of the incisions is enlarged if a lobectomy or pneumonectomy is done to allow the specimen to be removed.

·      Because only small incisions are needed, there is usually less pain after the surgery and a shorter hospital stay – typically 4 to 5 days.

·      Most experts recommend that only early-stage tumors near the outside of the lung be treated this way.

·      The cure rate after this surgery seems to be the same as with surgery done with a larger incision.

·      But it’s important that the surgeon doing this procedure is experienced, because it requires a great deal of technical

RECOVERY AFTER LUNG SURGERY

Surgery for lung cancer is a major operation. Recovering from lung cancer surgery typically takes weeks to months.

·      If the surgery is done through a thoracotomy (a long incision in the chest), activity might be limited for at least a month or two.

·      People who have VATS instead of thoracotomy tend to have less pain after surgery and to recover more quickly.

·      If the lungs are in good condition (other than the presence of the cancer) usually return to normal activities occurs after some time if a lobe or even an entire lung has been removed.

·      If one also has another lung disease such as emphysema or chronic bronchitis (which are common among long-time smokers), you might become short of breath with certain levels of activity after surgery.

2) RADIO FREQUENCY ABLATION (RFA) for NSCLC

This treatment might be an option for some people some small lung tumors that are near the outer edge of the lungs, especially if they can’t tolerate surgery.

·      RFA uses high-energy radio waves to heat the tumor. A thin, needle-like probe is put through the skin and moved in until the tip is in the tumor. Placement of the probe is guided by CT scans. Once the tip is in place, an electric current is passed through the probe, which heats the tumor and destroys the cancer cells.

·      RFA is usually done as an outpatient procedure, using local anesthesia (numbing medicine) where the probe is inserted. You may be given medicine to help you relax as well.

Radiation Therapy

·      *As main treatment approach along with chemotherapy if Surgery not possible (due to location or size of tumour or patient not fit)

·      After surgery ( alone or with chemo) to kill any remaining cancer cells

·      Before surgery ( along with chemo) to shrink tumour size.

·      To treat a single area of cancer spread, such as a tumour in the brain or an adrenal gland.

·      To relieve (palliate) symptoms of advanced NSCLC such as pain, bleeding, trouble swallowing, cough, or problems caused by spread to other organs such as the brain.

Types of radiation therapy

    *External beam radiation therapy

External beam radiation therapy

Brachytherapy (internal radiation therapy)

CHEMOTHERAPY for NSCLC:

Adjuvant chemotherapy After surgery ( sometimes along with radiation) to kill any cancer cells left behind. 

Drugs used to treat NSCLC

The chemo drugs most often used for NSCLC include:

*Cisplatin

·      Most often, treatment for NSCLC uses a combination of 2 chemo drugs.

·      Studies have shown that adding a third chemo drug doesn’t add much benefit and is likely to cause more side effects.

·      Single-drug chemo is sometimes used for people who might not tolerate combination chemotherapy well, such as those in poor overall health or who are elderly.

·      If a combination is used, it often includes cisplatin or carboplatin plus one other drug.

·      Sometimes gemcitabine with vinorelbine or paclitaxel, may be used.

·      For people with advanced lung cancers who meet certain criteria, targeted therapy a drug such as bevacizumab (Avastin), ramucirumab (Cyramza), or necitumumab (Portrazza) may be added to treatment as well.

·      Doctors give chemo in cycles, with a period of treatment (usually 1 to 3 days) followed by a rest period to allow the body time to recover.

·      Some chemo drugs, though, are given every day.

·      Chemo cycles generally last about 3 to 4 weeks.

·      For advanced cancers, the initial chemo combination is often given for 4 to 6 cycles.

·      If the initial chemo treatment for advanced lung cancer is no longer working, the doctor may recommend second-line treatment with a single chemo drug such as docetaxel or pemetrexed, or with a targeted therapy or immunotherapy drug.

Targeted therapy drugs for NSCLC:

Bevacizumab (Avastin) is used to treat advanced NSCLC. It is a monoclonal antibody (a man-made version of a specific immune system protein) that targets vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form.

It normally helps the cells grow and divide.

Drugs called EGFR inhibitors can block the signal from EGFR that tells the cells to grow. Some of these drugs can be used to treat NSCLC.

EGFR inhibitors used in NSCLC with EGFR gene mutations

These are more common in women and people who haven’t smoked.

Erlotinib can also be used for advanced NSCLC without these mutations if chemo isn’t working. All of these medicines are taken as pills.

EGFR inhibitors that also target cells with the T790M mutation

Drugs that target cells with ALK gene changes

This change is most often seen in non-smokers (or light smokers) who have the adenocarcinoma subtype of NSCLC.

Crizotinib (Xalkori) 

Although they can help after chemo has stopped working, they are often used instead of chemo in people whose cancers have the ALKgene rearrangement.

Thanks for reading and please keep visiting our blog to discover and appreciate more Yoddhas. 
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Author- 

   

Dr. Ganjoo 

Head-Yoddhas Medical Expert Panel

Beware of breathing! All you need to know about Lung Cancer.

What is that something that you do every second of your life? 

Breathe!   
Without this action it is impossible to survive. 

This breathing action is done with the help of the lungs and it is the most active organ of the human body. It is very essential to maintain its health at all times. Knowing what you inhale in your everyday lifestyle is important. An unhealthy lung leads to many infections and also Cancer. Lung infections are curable but not Cancer. It is always better to prevent than to cure any disease.

Lung Cancer is the abnormal growth of cells in one or both of the lungs. These cells or tumors reduce the lung’s ability to provide bloodstream with oxygen.

A total number of 1,370,000 people have died of lung cancer which is more than the number of deaths caused by any other type of cancer. 

 

Some important facts:

• Lung Cancer is the most common diagnosed cancer around the globe.  
•  Most people die of Lung Cancer compared to other type of Cancer such has breast,colon and prostate Cancer. 
• Smoking is responsible for 90% of all cases of Lung cancer. 
•  More than half of the Lung Cancer patients pass away within a year of diagnosis. 
• Passive smoking increases the chances of Lung Cancer for about 20-30%

What are the causes and symptoms of Lung Cancer?

 

Causes:

• Smoking causes Cancer, smoking kills.
•  Exposure to tobacco smoke or passive smoking increases the chance of lung cancer.
•  Air pollution also causes Lung cancer. Air containing carcinogens and exposure to this increases the risk. 
• Smoke coming out of burning coal contains carcinogens is a significant risk of developing Lung Cancer. 
• Low intake of foods rich in beta-carotene.

Symptoms: 

• Loss in appetite and reduction in body weight. 
• Cough that does not quit. 
• Feeling weak or tiredness. 
• Chest pain which gets intense when coughing, laughing or heavy breathing. 
• Abnormal changes in loudness of the voice. 
• Shortness of breath.
• Coughing Blood.

Treatment for Lung Cancer:

 

 The treatment for this Cancer depends upon the type of lung cancer that the person is diagnosed with. The tumor is located and the stage of the cancer is identified. General health of the patient is also taken in consideration.

Surgery, radiation and chemotherapy are common treatments used for lung cancer. These treatments are used alone or together.  

Home remedies: 

The patient experiences shortness of breath. To cope up with this there are few tips:

• Choose an activity such has music or meditation or any other activity that help you to relax. Fear makes it only harder to breathe. 

    

• Use your energy effectively. Save your energy for important tasks. Remove the non-essential tasks from your day.

      

• When you are in shortage of breath focus your mind on breathing.

                    

 Some other useful tips:

• Do not dehydrate your body. Take small sips of water frequently in a day. 
• Dry ginger or ginger-tea to reduce nausea. 
• Brush your teeth after you vomit which help to avoid tooth decay. 
• To have a good sleep avoid caffeine.

Tips for treating Constipation:

• Drink enough fluids to keep you hydrated. 
• Avoid alcohol containing drinks. 
• Increase your physical activity by exercise as advised by the doctor.

Thanks for reading and please keep visiting our blog to discover and appreciate more Yoddhas. 
Feel free to contact the Yoddhas team at team@yoddhas.com 

Lastly,

Praise the Yoddhas; Support the Yoddhas ; Love the Yoddhas!

Cheers!

Author- Akshith Vijaykumar