Since advancement in diagnostic techniques, cancer detection is increased. Amongst all cancers, Lung cancer is the most common cancer affecting men and women in the United States of America. The numbers are almost similar in other countries also, like in India.
Initially, it was considered to be a cancer of old age (above 60 years) but nowadays, lung cancer is very common in the age group of 30-40 years. Earlier it was believed to be more common in males but now females are equally vulnerable to Lung cancer due to biomass exposure and the rising trend of smoking in females.
[Read – Lung Pain After You Stop Smoking]
It is mainly divided into two types
This is further divided into
Lung cancer starts with a change in the mucosal lining of the bronchus. This change is because of the constant exposure of the above-mentioned substances. Chronic exposure will ultimately lead to metaplasia followed by dysplasia followed by malignant nodule formation followed by malignant mass formation followed by metastases in lung, lymph nodes and other body parts like the liver, brain, bones etc.
So in initial stages (stage 1 and 2), lung cancer affects Lungs only. But in stage 3 and stage 4, it affects other organs and lymph nodes also. So symptoms also depend on the Stage of Lung cancer.
The most common symptom is a cough. In the initial stages, a cough is dry and not associated with chest pain. This is often neglected as smoker’s cough. So it is very difficult to find lung cancer patients in stage 1.
Gradually tumor grows and causes intrinsic as well as extrinsic compression. So symptoms will also be increased. In stage 2, the patient shows symptoms of more intense cough with expectoration, hemoptysis (blood in sputum), chest pain on coughing, wheezing, breathing difficulty, weight loss, weakness, anorexia, decreased appetite.
A tumor further increases in size and now is able to spread outside the lungs in stage 3 and 4. So symptoms are also more pronounced now. Majority of Lung cancer patients presented in stage 3 and stage 4 because patients are very much symptomatic and have to seek medical attention. In these stages, the patient has continuous coughing even at night with more hemoptysis and worsening chest pain. Along with chest pain, in terminal stages, lung cancer affects breathing a lot. Perhaps this is the symptom which brings the patient to the doctor.
Breathing difficulty is seen during sleep, resting, minimal exertion etc. Breathing is also associated with wheezing. If brain Mets are there then the patient will have a headache and vomiting. If Liver Mets are there then the patient will have dull right hypochondriac pain, jaundice etc. If Bone Mets are present then the patient will have a severe backache, bone pains, pathological fracture etc. The patient also develops severe anorexia, loss of appetite and hence severe weight loss and cachexia.
Chest X-ray is the primary investigation. It should be done as screening for lung cancers in all smokers above 40 years of age.
This will guide about the exact size of Tumor, local spread, metastatic Lymphadenopathy or distal Mets present or not.
All peripheral lesions should undergo CT guided biopsy to confirm lung cancer also to identify the type of lung cancer.
Bronchoscopy is indicated in Central lung cancers. BAL (bronchoalveolar lavage) and Bronchoscopic Lung Biopsy are needed for the diagnosis.
Lung cancer causes decline in lung functions and this can be calculated by doing PFT studies.
If enlarged cervical lymphnodes are palpable, FNAC is advised.
This is aspiration of pleural fluid. If lung cancer involves pleura, it will cause pleural effusion and in that case, thoracocentesis is needed.
Medically Reviewed By
Dr. Kaushal M Bhavsar pursued his MD in Pulmonology. He is an Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad
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