Lung Cancer

 

What is lung cancer?

Lung cancer is when the cells in your lung change and start to grow out of control. These cells increase to form a tumour. Cells from this tumour may spread to other parts of the body.

Around 2430 people are diagnosed with lung cancer each year in Ireland

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What are the lungs and what do they do?

The lungs are two organs found in your chest and form part of your respiratory system. This system is responsible for your breathing. Your right lung is slightly bigger than your left and has three areas called lobes. Your left lung has two lobes.

When you breathe in, air passes through your nose or mouth into your trachea (windpipe), which separates into two further tubes called bronchi. Each of these bronchi connects to a lung. The bronchi divide even further into much smaller tubes called bronchioles. Air passes through these bronchioles and into tiny air sacs called alveoli.

In the alveoli, oxygen is absorbed from inhaled air into your bloodstream and is sent around your body. The lungs are covered by a lining called the pleura, which has two layers. The pleural cavity also contains pleural fluid, which acts as a lubricant and allows the layers to slide effortlessly against each other during respiratory movements. The cavity between the two lungs is called the mediastinum. This cavity contains the heart, the oesophagus (food pipe), the trachea (windpipe), and large blood vessels. Oxygen is needed in every cell of your body for various activities. During these activities, the waste gas, carbon dioxide, is made. It passes back through the alveoli and leaves your body when you breathe out.

Symptoms of lung cancer


  • Difficulty breathing, or wheezing

  • A cough that doesn’t go away or a change in a long-term cough

  • Repeated chest infections that won’t go away, even after antibiotics

  • Feeling more tired than usual

  • A hoarse voice

  • Coughing up blood-stained phlegm

  • Pain in your chest, especially when you cough or breathe in

  • Loss of appetite/weight loss

  • Swelling around your face and neck

  • Difficulty swallowing.

All these symptoms can be caused by conditions other than cancer, but it’s important to go to the GP and get any unusual changes checked out.


Can I be screened for lung cancer?

Testing for lung cancer when you have no symptoms is called screening. Currently, there is no national screening programme for lung cancer in Ireland, if you notice any of the symptoms above or if you have any concerns we recommend that you speak with your GP.


Diagnosing lung cancer

Your family doctor (GP) will talk to you about your symptoms. Your GP may organise for you to have a chest X-ray, to check your lungs for any abnormal changes.

If your doctor thinks you need more tests, he or she will refer you a rapid access lung clinic.  These are consultant-led assessment and diagnostic services for patients with suspected lung disease.  There are eight rapid access clinics located around the country, your GP will send you to your nearest one. Tests you might have include:

 

Blood tests

Specialist technicians and doctors look at your sample under a microscope.  They can identify different types and count different types of blood cells.

 

Pulmonary function tests

These are breathing tests.  You blow into a mouthpiece to check how well your lungs work.

 

CT scan

This is a type of X-ray that can build up a detailed picture of the lung.

 

Bronchoscopy

This test uses a long tube with a camera at one end to view the tissues in your lung. A biopsy may be taken at the same time.

EBUS

A type of bronchoscopy which uses an ultrasound probe to look at the lungs and surrounding lymph nodes. Biopsy samples from the lung or lymph nodes can be taken by passing a needle through the tube. This is called a transbronchial needle aspiration (TBNA).

Lung biopsy

During a bronchoscopy, EBUS or CT scan, your doctor can take small amounts of tissue samples from your lung. These are called biopsies. Biopsies are sent to a laboratory and looked at under a microscope. These biopsies will be examined to see if there are any gene mutations or proteins on cancer that specific treatments can target.

Results of all these tests are usually available within a month. The clinic will contact you to come back to the clinic for your results.

 

What increases my risk of lung cancer?

 

Smoking

Smoking causes around 9 in every 10 lung cancers. The risk increases with the amount of time you have smoked, the number of cigarettes you have smoked and if you started young. Low-tar cigarettes do not reduce your risk. Those who smoke pipes and cigars have a lower risk of lung cancer than cigarette smokers, but they are at a much greater risk than non-smokers

Passive smoking: Inhaling other people’s cigarette smoke increases the risk of lung disease and cancer. But the risk is still much less than if you smoke yourself. 


Chemicals

Certain chemicals such as asbestos, uranium, metal dust and fumes, nickel, paints, diesel exhaust, nitrogen oxides. These risks are higher if you smoke as well.

Air pollution: Might be a cause in countries where it is particularly bad. 


Radon Gas

Radon is a radioactive gas found naturally in the soil. But if your home traps it inside, it can build up and cause harm. 

Family history: If you have a parent, brother or sister who has had cancer which started in their lung, your risk is doubled.

 

Treatment Options for Lung Cancer


Surgery

Surgery aims to remove the part of the lung containing cancer or even an entire lung. If the cancer is found in one lung only – or in one lung with only lymph nodes close to the tumour involved – it may be possible to remove all the tumour by surgery. You may also have surgery to stage your cancer or to help manage your symptoms.

Radiotherapy

Radiotherapy can be used on its own or with other therapies to treat non-small cell lung cancer. It can also be used to control symptoms such as breathlessness or pain. Advanced radiotherapy treatments might be given to treat non-small cell lung cancer instead of surgery.

Radiofrequency ablation (RFA) and microwave ablation (MWA)

These treatments use heat to treat very early-stage lung cancers for people who can’t have surgery or don’t want to have surgery. They may also be used to relieve breathlessness if the tumour is blocking an airway. 

Chemotherapy

Chemotherapy is using drugs to cure or control cancer. Many lung cancer patients receive a combination of two or three chemotherapy drugs. Chemotherapy can be given before or after radiotherapy or surgery. Sometimes chemotherapy is given together with radiotherapy to make the radiotherapy work better. This is called chemoradiation.

Chemotherapy can also be used to control symptoms.

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