About Lung Cancer

The lungs carry the oxygen necessary for the vital functions of all organisms to the body. Lung cancer occurs when cells in the lungs take on cancerous characteristics (uncontrolled and limitless multiplication and growth). Lung cancer is top of the ranks both in terms of frequency and cancer-related deaths. However, very few people understand the significance of this, or realize the risks they face.  Early diagnosis, and a concomitant increase in survival rates, has been greatly facilitated by new methods of treatment. For these reasons, it is important to know and look out for the early warning signs that should lead you to seek advice from your doctor.

Are you at risk?

Lung cancer risk factors:

Smoking: responsible for 90% of lung cancer cases.  

Passive smoking: Other people’s smoke can cause lung cancer, and your second hand smoke can give your loved ones the disease. 65% of lung cancer cases in women are caused by passive smoking.   

Air pollution: can be a cause of lung cancer.

A family history of lung cancer: indicates increased risk.

Other diseases: People with chronic bronchitis or a previous history of tuberculosis and certain lung diseases are at higher risk.  

Are people with family members who have lung cancer at higher risk?   

Yes. People with family members who have contracted lung cancer at an early age (before reaching 50) are at twice the risk. This risk increases with smoking and the number of cigarettes the person smokes.    

Can smoking one or two cigarettes a day lead to cancer?  

 The risk increases in line with the age at which a person starts smoking, how long they have smoked, and the number of cigarettes they smoke.  Don’t ever say “I’m just a social smoker.” A person who smokes one cigarette a day is medically defined as a cigarette addict and is exposed to all the harmful effects of smoking. In addition, people who smoke ‘light’ cigarettes, pipes, cigars and water pipes are exposing themselves to higher risk. 

Are there screening tests for early diagnosis?   

Up until now there has not been any proven screening method that extends people’s life spans. It is important to know the signs, and if you notice any of these signs to consult a doctor. Most cases of lung cancer show no indications at an early stage, therefore the most crucial thing is to avoid risk factors.  

What are the indications?

The nature and timing of lung cancer symptoms varies from person to person, and according to the location in which it first emerges. If the disease begins deeper in the lungs rather than in the main airways, symptoms may not be evident until it reaches an advanced stage. 

The most frequently occurring indications to look out for are:

Persistent coughing, or coughing that varies in type and frequency over time

Bloody sputum 

Shortness of breath 

Hoarseness 

Wheezing  

Difficulty in swallowing

Weight loss, loss of appetite or fatigue 

Unexplained fever  

Recurring bronchitis and lung infections  

Chest, shoulder, arm or back pain  

Swelling in the face and neck regions 

How many types of lung cancer are there?  

There are many types of lung cancer, but the disease may be categorized into 2 main groups in terms of its behavior, and approaches to treatment.

Small cell lung cancer 

Non- small cell lung cancer 

How is the disease diagnosed?

People displaying indications of lung cancer or those who are suspected of having the disease as a result of regular X-ray examination should seek immediate consultation from the hospital’s chest diseases department. In cases where there is evidence of tissue mass (tumor), an initial CT scan is performed. The detailed imaging obtained during the scan serves to determine the best treatment method.

 A pinhead-sized biopsy sample is taken from the patient either by tomography guided methods, or by means of a bronchoscopy, in which a flexible tube with a light and a camera at its tip is extended into the lung. 

A definitive diagnosis of cancer is obtained after examination of the biopsy sample in the pathology clinic. In some cases, where a definitive diagnosis cannot be achieved by means of a small biopsy sample, a limited diagnostic surgical intervention may be necessary. The choice of method is determined in line with the principle of exposing the patient to the minimum difficulty and risk, but in any case a definitive diagnosis is achieved within a short period of time.

Does the biopsy procedure have a negative impact on the progress of the disease?

A definitive diagnosis can only be obtained after the biopsy sample has been subject to detailed examination in the pathology clinic. A reasonable suspicion of cancer can be established by looking at the imaging and films, but this is not sufficient for a definitive diagnosis and the initiation of treatment. Comments sometimes made about patients not recovering after their biopsy, or the procedure making the condition worse, are unfounded; such rumors only create unnecessary fear and concern, as well as delays to diagnosis that may limit or even destroy the chance of effective treatment. This reflects a general tendency to dwell on negative events rather than remembering positive and life-saving outcomes. Patients are less likely to benefit from treatment when their condition is only diagnosed at a later stage in the disease’s progress; for this reason, early diagnosis is of crucial importance. Most patients diagnosed early are successfully treated and maintain a high quality of life for a prolonged period of time. The biopsy procedure has no negative impact at all. It is only a diagnostic procedure.

What are the stages of the disease?     

The first thing that the specialist needs to establish following diagnosis is the extent to which the cancer has spread, or in other words the stage the disease has reached. This staging determination is necessary in order to decide on the correct method and order of treatment. There are 4 maim stages in lung cancer. Examinations such as abdominal or brain CT or MRI scans, bone screening (whole body bone scintigraphy) and PET scans are carried out to establish the stage of the cancer correctly. In order to be able to determine the stage the disease has reached, certain limited surgical interventions may be required. To determine whether the disease staging is operable, a procedure called a mediastinoscopy is carried out, in which a lighted tube is extended into the mediastinal cavity via a small incision in the neck; a further examination involving the taking of lymph node samples may be performed during this procedure.  If there is fluid accumulation between the pleura, thoracentesis (taking a sample of the fluid with a needle) may be required to establish whether the disease has spread to that region.          

How is lung cancer treated?  

The treatment of small cell lung cancer, and non- small cell cancer, differs. Treatment also differs according to the stage, and precise type, of the disease. According to these criteria, radiotherapy, chemotherapy, or a combination of both, may be applied in varying order, according to the patient’s condition and the characteristics of the disease. The objective of cancer treatment is to eliminate the disease, or if that is not feasible, to halt or limit its progress in order to extend survival periods and increase the patient’s quality of life. A multidisciplinary approach is crucially important in optimal lung cancer treatment.     

What does a ‘multidisciplinary approach’ mean? Why is it so important?  

Every lung cancer patient’s condition is different. Joint decisions of a number of specialists across departments and fields of specialization concerning various treatment methods, and whether to use one or more in combination, are required in order to reach the correct decision on how to treat each individual patient. This facilitates rapid implementation of the most appropriate and advanced treatments. In a multidisciplinary approach, the expert opinion of specialists from the fields of medical oncology, chest surgery, chest diseases, radiation oncology, pathology, radiology and nuclear medicine is sought. In addition, when required the patient may benefit from the expertise of dieticians, psychiatrists and pain relief specialists.

What is the role of surgery in treating lung cancer?

In the early stages of lung cancer, providing the patient does not have any other condition that prevents it, surgery is the most effective method of treatment. Popular myths about cancer being surgically untreatable or that the cancer must have spread if a biopsy has been taken can lead to patients being reluctant to accept surgical treatment at the time it is advised. In reality, lung cancer patients for whom surgery is recommended at a relatively early stage have the highest chance of their cancerous tissue being entirely removed, and thus the highest survival rate. However, 80% to 85% of adult lung cancer patients no longer have the chance of surgical treatment by the time they go to the doctor. Therefore, surgery is not recommended to every patient. If your doctor advises you that you need an operation, and that your general condition is able to withstand surgery, you should not miss this chance. Because it is unlikely you will be able to achieve the same likelihood of recovery with other methods of treatment.        

Does Yeditepe University Hospital perform a range of different surgical techniques?  

Yes, in appropriate cases Yeditepe University Hospital’s Department of Chest Disease Surgery carries out a procedure that differs from classic ‘thoracotomy’ operations. This involves a much smaller incision and a limited surgical intervention to avoid surgical damage to the muscles, and achieves far less loss of function. In addition, operations that are entirely camera-guided can be performed in early stage cancer cases without compromising the fundamental principles of cancer surgery.     

Can a decision not to operate ever be reversed?

A decision not to operate is a highly significant one in terms of a patient’s treatment planning and recovery chance. Such a serious decision should only be taken after painstakingly thorough and detailed investigation, using the most advanced technology. This is unavoidably related to the quality of the equipment and technology infrastructure at the institution where the examination and investigation is being conducted. Another critically important factor is the capacity of the medical specialists there to analyze the detailed data obtained as a result of the screening and examination processes in the most appropriate manner, for the benefit of the patient.       

There are also a not insubstantial number of cases in which, although initially diagnosed as inoperable, are resolved to be appropriate cases for surgery after examination of data from further detailed tests. In such cases we are able to give patients a higher chance of survival by combining surgery with other treatment methods.  

What happens before the decision to operate?  

Patients definitively diagnosed with operable lung cancer following the completion of detailed staging analysis need to be evaluated with respect to their suitability for surgery.

This evaluation takes under consideration various factors including the patient’s age, general condition, the existence of any associated conditions, and lung capacity. Advanced age is of itself no barrier to surgery; the important factor is the elevated possibility of heart, lung and brain dysfunction. All patients undergo lung and cardiac function tests. Only then is a patient declared fit for surgery.   

What is chemotherapy?

Chemotherapy is a method of treatment in which medications that either destroy or restrict the growth and multiplication of cancer cells are administered. Chemotherapy may be used in different sequences either in isolation, or in combination with surgery and / or radiotherapy according to the type and stage of the cancer.

In which kinds of lung cancer cases is chemotherapy administered?

Albeit in differing sequences, chemotherapy is given to more or less all lung cancer patients who are in otherwise good condition, depending on the stage of the disease. In operable cases, the visible cancerous tissue is removed.  

In these cases, chemotherapy aims to prevent the spread of the disease by eliminating cancer cells that might remain at a radiologic level. Chemotherapy is administered in inoperable cases in order to halt the disease’s advance, diminish the size of the tumor, reduce tumor related complaints, and to increase the length and quality of life. Contrary to common opinion, chemotherapy does not deteriorate, but improves, the quality of life in the long term. Its side effects are short term and reversible.         

Does it matter who administers chemotherapy, and where?

The wide array of chemotherapy medications is such that they need to be administered by a specialist medical oncologist who knows the medication’s particular characteristics, methods of use and side effects, and can thus administer the treatment correctly and effectively at the right dosage while protecting the patient against side effects. The most important aspect of chemotherapy treatment is close post-treatment monitoring and early intervention against side effects. It is therefore important to be treated at a center where you can reach your doctor 24 hours a day.    

Are there other treatment methods that improve the quality of life?  

Certain surgical and endoscopic procedures, radiotherapy, and pain relief methods are available to treat the disease at different stages, designed to reduce complaints and improve the quality of life. Pleurodesis is a procedure carried out to evacuate fluid that collects between the lungs and the rib cage and can cause shortness of breath. Various surgical treatments and stent applications serve to keep the airways free of tumor-related blockages while laser treatment can be used to reduce the size of tumors within the airways. Radiotherapy shrinks tumors that are causing respiratory difficulties, while effective pain management and relief also contribute to improving the quality of life. Once again, the most appropriate method and its correct timing need to be determined within the principles of a multidisciplinary approach involving joint decisions taken by specialists in the fields of chest diseases, chest surgery, radiation oncology, medical oncology and pain relief.

Do other tumors apart from lung cancer ever appear within the thorax?

In rare cases, cancers in the lymph nodes around the pleura and originating in other structures can appear within the thorax. These tumors are treated with surgery, radiotherapy and chemotherapy, either in isolation or combination. These cases are treated at Yeditepe University Hospital through the collaborative efforts of the Departments of Chest Surgery, Chest Diseases and Medical Oncology.

How is lung cancer treated at Yeditepe University Hospital?   

YEDİTEPE UNIVERSITY HOSPITAL is equipped with the most advanced technology and diagnostic capacity for the diagnosis and treatment of patients suspected of having lung cancer. All advanced diagnostic tests are completed within a few days of the patient’s admission.  Definitively diagnosed lung cancer cases in which the biopsy has undergone pathologic examination (within one or two days) are referred to the LUNG CANCER COUNCIL for discussion and determination of the most appropriate method of treatment. This Council consists of specialists in medical oncology, chest surgery, chest diseases, pathology, radiology and nuclear medicine. Our hospital’s own PET/CT equipment provides patients with a significant advantage in terms of disease staging. 

Before reaching a final decision, every patient undergoes detailed evaluation to assess their suitability for treatment, lung capacity, cardiac function and any issues with other systems. Only then is a decision meticulously reached on the most appropriate method of treatment. Doctors are available to patients 365 days a year, 24 hours a day, in the event that any problems arise. As doctors working at the Lung Cancer Diagnosis and Treatment Center, our aim is to offer all our patients diagnosis and treatment with the minimum of discomfort, within the shortest possible time, in the best possible manner, thus facilitating the longest possible lifespan at the highest possible quality of life.    

REMEMBER!

100% of smoking-related deaths are preventable. All you have to do is not to start smoking, or give up immediately.

If you are having difficulty giving up smoking, seek medical assistance. Consult our Giving Up Smoking Clinic.

Early diagnosis saves lives. Learn the signs and risks of lung cancer. Go straight to your doctor if you or a loved one displays any of these symptoms.

Insist on a center that works with a multidisciplinary approach. Because the best outcomes come from a cooperative team of professionals working in harmony and unison.  

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