Lung Cancer Diagnosis: Where We Are Heading To - Term Paper Example

Lung cancer diagnosis where we are heading to? Introduction Lung cancer, like any other cancer is caused by the abnormal growth of cells in the tissue of the lungs. “There are over 1 million deaths world wide due to lung cancer, making it truly an epidemic” (Driscoll 3).Unlike other cells, the cancer cells do not die programmatic death and divide and grow exponentially. Instead of developing into healthy, normal lung tissue, the cells grow uncontrollably and form lumps called tumors. If a tumor remains in one place and show a limited growth, it is commonly considered to be benign. “Cancer that originates from lung cells is called a primary lung cancer. Primary lung cancer can start in the airways that branch off the trachea to supply the lungs (the bronchi) or in the small air sacs of the lung (the alveoli)” (Hong ,Tsao 2008).Instead if the cancer originated elsewhere and metastasized to the lungs, it is called “secondary”. These two types of cancer are taken as different forms of cancer from diagnostic and treatment perspectives Lung cancer is generally classified into two main types based on the outlook of cancer under a microscope: Non- small cell lung cancer and small cell lung cancer. Non – small cell lung cancer is the type found in majority of cases diagnosed, whereas the small cell lung cancer with lesser cases. “Since lung cancer tends to spread or metastasize very early after it forms, it is a very life-threatening cancer and one of the most difficult cancers to treat”(Stoppler). Cause and symptoms of lung cancer The main cause of lung cancer can be related to smoking and inhaling carcinogens in tobacco smoke. “Air pollution, particularly smoke from fossils, appears to increase the risk of lung cancer but its effect is small compared with that of cigarette smoking”(Williams 20). Several studies have shown that lifetime exposure to smoking can lead to the development of lung cancer. The reason for smoking being harmful is that, tobacco contains exorbitant amount of chemical agents, including carcinogens which cause cancer. The studies have also shown that radon is the primary cause of lung cancer among non – smokers .Overall it can be said that radon is the second leading cause of lung cancer. Radon is tasteless, odorless and invisible gas produced by the decay of naturally occurring uranium water and soil. “Although the progeny of radon are now a well- recognized cause of lung cancer, radon itself has again become a topic of controversy and public health concern because it has been found to be a ubiquitous indoor air pollutant to which all persons are exposed”(Health Effects 22) However, there is no evidence to support that children are at a higher risk of lung cancer than adults. In an attempt to lower the rate of lung cancer around the world, the World Health organization launched an International radon project to help countries increase the awareness level, collect data and enhance action to reduce radon – related risks. It is believed that the radon in the homes of people is the main source of exposure to ionizing radiation .Radon is found in the indoor and outdoor of buildings of all types. But people have the tendency to take this fact for granted and give least precaution against radon exposure. But the main culprit in the substantial increase in the disease over the last 50 years has been the increase in the number of people smoking cigarette. “Lung cancer may be causally related to cigarette smoking in 90% of cases in men and 79% of cases in women.”(Haustein, Groneberg 88).The risk of lung cancer of an ex smoker comes to the same level as a non smoker in about 15 years of quitting smoking. Another element which cause cancer is exposure to radiation in job areas or through repeated submission to chest x-rays. Even the inhaling of carcinogens like asbestos in the construction sites can lead to lung cancer. Some industrial substances like arsenic, coal products, and nickel chromate can also cause lung cancer. The fault in gene is also found to be a major cause of lung cancer. “While environmental factors -- especially smoking -- are the dominant triggers for lung cancer, researchers have uncovered strong evidence for a genetic predisposition to the disease”(Sharetto ). Symptoms of lung cancer can be different according to the location of the cancer, and the size of the tumor. Lung cancer symptoms may take years before surfacing and usually show around the advanced stage. The symptoms mostly affect the air passage and the chest. Some symptoms seen are: intense and continuous coughing, difficulty in breathing and swallowing , pain in the chest and shoulders, harsh voice and so on. Diagnosis of lung cancer “Lung cancer is often suspected after an abnormal spot is found on a chest x-ray done to evaluate a cough or chest pain”(Eldridge ) If the abnormality is found to be malignant, further studies are done related to it. Chest x- ray is usually the first test performed to evaluate the situation along with a detailed check on the history of physical condition of the person. During diagnosis of lung cancer, sometimes the x-ray shows a normal condition, and in this condition more advanced test are required to detect the cancerous spot. A CT scan is generally performed if an abnormal chest x-ray finding, or to evaluate unfavorable symptoms in people with normal chest x-ray .CT scan involves a three dimensional view of the lungs. Even if the CT scan result is abnormal, a test on the sample of tissue is required to detect lung cancer. Common imaging techniques are used mainly in diagnosing lung cancer in advancing stages. These are x- rays, bronchoscopy, MRI scans, and CT scan and PET scans. A physical examination, a chest examination, and an analysis of blood in sputum are also carried -out by the physician to detect the existence of the tumor. Even though the above diagnostic technique delivers important information, obtaining cancer cells and scrutinizing them under the microscope is the only absolute way to diagnose lung cancer. This process is called biopsy. “Various biopsy techniques have been developed to help in making a diagnosis of questionable lung infiltration or densities of carrying size”(Kim 74). Once the biopsy confirms lung cancer, the pathologist categorize whether it is non –small cell lung cancer or small cell lung cancer. The oncologist will determine the stage of the cancer after the diagnosing process. This stage helps in determining what kind of choices of treatment are available for treating the patient. The treatment for lung cancer depends on the type of cancer, the stage of cancer, health status, age etc. of the patient. Generally there is no single treatment for cancer; patients usually receive combination of therapies and treatments. The modern technique like PET (Positron emission tomography) scan is an important cancer imaging tool which is very beneficial in diagnosis and staging of lung cancer. “A PET scan uses radiation, or nuclear medicine imaging, to produce 3-dimensional, color images of the functional processes within the human body”(Kumar). PET scan has been proven to be very credible when compared to CT scan in diagnosing cancer at early stages. The main advantage of PET scan is that it allows the observation of cellular level metabolically changes in the tissue of an organ. As a result, this technique allows the detection of cancer at little earlier, unlike MRI scans and CT scans. This has helped enormously in detecting cancer at early stages, although people being undiagnosed are at high. It is found that 15% of people who was affected with lung cancer have never been smoker throughout their life. So there is no a specific reason for the cause of cancer, which leave little space to prevent this disease completely. There are some screening techniques for lung cancer like, microscopic analysis of sputum, bronchoscope, CT scans, and Molecular marker evaluation in sputum etc. “A number of studies have reported on the utility of CT and FDG-PET scanning in the assessment of patients with lung cancer”(Spiro). The techniques like CT scans can help detecting tumor at early stages of the disease although its contribution in saving life of the patient is highly controversial subject. Some experts claim that CT scan screening can lead to over diagnosis, or detection of cancers which are less harmful. Also the procedures, such as biopsies done with needle, that are required to investigate irregularities on the scan can have risk element involved, such as failure in the functioning of the lungs. False results can also common which create another hurdle in the early detection and screening process. Survival chances in Patients Early detection of lung cancer is very important for the survival of this disease because only 15% of lung cancer is shown when they are localized. As there are very less symptoms in the early stages of the disease, the majority of lung cancer is diagnosed in the advanced stages of the disease. This is cause of numerous death among the people affected with lung cancer. So for saving the lives of lung cancer patients , screening program should be encouraged among them .It helps in treating the cancer at an early stage when there are fewer symptoms present. Treatment at early stage of cancer helps in providing more treatment options to the patient and assure high survival rate. Even though early detection assists in saving lives of people, there is hardly any approved screening test for lung cancer that has proven to enhance survival rate, or detect localized disease. “Conversely, no professional society has yet recommended screening for lung cancer in any situation, for the simple reason that all clinical studies have uniformly failed to show a mortality benefit from screening”(Eckdart 5-6). Individuals after 60 yrs of age who smoke excessively are of greater risk of getting affected by lung cancer. A serious effort is undertaken to find effective ways to screen for lung cancer. People with smoking habits should take initiative to undergo screening program to detect cancer at early stages to avoid complication and threat to life. Gene mutation in cancer patients Recent studies have shown that non smokers affected by lung cancer have had mutation in their gene structure. A gene mutation occurs when there is a permanent change in the DNA make up of the gene. “Gene mutation vary from a small portion of the DNA molecule to a large part of chromosome”(Adnan). It can happen in two ways: they can be inherited from parent or acquired during an individual’s life time. Mutation that are passed from parent to child are termed as hereditary mutations or germ line mutations (because they are present in the egg and the sperm cells, which are also called germ cells). “Those who inherit the mutation from both parents are said to have an 80 per cent greater chance of developing lung cancer than those without it”(Derbyshire). People carrying genetic disorder previously linked to lung disease may have a 70 – 1000 % increased risk of getting affected by lung cancer. The disorder in which the deficiency of alpha- antitypic, is one of the common genetic condition affecting the individuals from European descent. Persons with two sets of the associated genetic mutation often develop cancer at an early stage. An individual with common gene mutation has double the chance of getting lung cancer .Generally in this condition the person lose the elasticity of the lung tissue. This disorder is mainly found in people suffering with chronic bronchitis or emphysema. “Because cancer is a clonal disease in which the phenotypic consequences of mutation are subject to Darwinian natural selection, accumulation of mutations conferring selective advantage on cancer sub clones will manifest as an excess of non-synonymous mutations”(Pleasance 184 - 190).The scientist estimates that the smokers with gene mutation are a thousand percent more likely to develop lung cancer. Researchers have discovered that it takes a series of genetic changes to create a lung cancer. Before turning to fully cancerous, cells can be precancerous, which means that they show some irregularities (mutations) but still continue functioning as lung cells. However the Precancerous changes may indicate progression towards cancer. It is observed that, once a cell has a genetic mutation, it may develop in a more complex nature. With each new mutation, the cells tend to become more irregular and may not be as efficient in carrying out the function in lung tissue. At advanced stage of the disease, it can be seen that some cells migrate from the main tumor and start developing in other parts of the body. These areas are called metastases. Death in lung cancer patients With all the treatments and therapies available, the death from lung cancer is not been able to be controlled. “Current developments in conventional radiological imaging are too early in the stage of development to predict their usefulness in staging of early brochial carcinoma”( Hirsch 174).This shows that the treatments for lung cancer has a long way to go. Lung cancer was thought to be an illness of the middle – aged or elderly, but physicians throughout the UK are observing increasing number of women in their 30s or early 40s dying from the disease. It is seen that the type of lung cancer killing these women are slightly different from that attacking the older people. Older men with lung cancer usually have a history of bronchitis and their cancer surface with a repeated chest infection. But the women who show up with cancer in 30s have a slight different symptom. It is seen that women with symptoms, who approach doctor are already in advanced stage. “Women are targeted in tobacco advertising, and teenage girls are often drawn to cigarette smoking under a variety of social pressures”(Patel 1763-1768).This is reason for the upsurge in lung cancer among women. The control of tumor growth in the patients is the safest way to avoid the spreading of the disease and save the life of the patients. “Patients with inoperable early stage lung cancer are generally offered conventional radiation treatment (most commonly given during 20-30 outpatient treatments) or observed without specific cancer therapy”(Jama). It is seen that however, the convention radiotherapy fails to control the primary lung tumor in major number of patients. More than half of patients ultimately become victims to death who have been under observation and patients with two year survival are less than 40 percent with either approach. “It is estimated that there are around 243,100 lung cancer death each year in the European Union” (Tobias and Hochhauser 213).However, it is very unfortunate to know that most lung cancer is diagnosed too late for curative treatment to be possible. In more than half of cases the cancer is detected when it has already spread throughout eh body leaving the person in fatal condition. Early diagnosis is difficult due to the reason that many of the usual symptoms of lung cancer are similar to those of smoker’s lung. Apart from this, most lung cancer patients will also have smoker’s lung as both conditions are usually caused by smoking. However, only small fraction of smoker’s lung cases will go on to develop as lung cancer. “Chest Xray is a primitive screening modality,usually detecting lung cancer, at a later incurable stages”( Yarbro 1387) .If a lung tumor is present; it should be at least a centimeter in diameter to be detectable by an ordinary x – ray. Unfortunately, when the tumor reaches this size the cell becomes cancerous and would have divided 36 times. “ One reason for the high death rate of lung cancer is that tumors are not usually detected until the disease is at a late stage, at which point the cancer is non-curable”(Mulshine 65-73). Development in lung cancer treatment “The main treatment option in lung cancer surgery, chemotherapy, and radiation therapy”(Muma 25)There is another radiation therapy called stereo tactic body radiation therapy (SBRT) wherein radiation beams are used to treat the target tumor. These treatments can reduce the intensity of the spreading of tumor and can increase the survival chances of the patient but hundred percent cure is not yet confirmed. Primary tumor control is an important requirement for curing the lung cancer. Stereo tactic body radiation therapy has provided double rate of primary tumor control than conventional radiation therapy. “The assessment of dose shaping in SBRT is important for the evaluation of the quality of the applied treatment”.(Kavanagh 58)This shows that modern science is improving in the treatment of lung cancer Recently have been big changes in the staging classification of lung cancer and improvement in stage identification using minimum invasive technology. There has been decline in the post surgical mortality rate since 1950s but 5 year curative rates have barely seen any improvement. The most important and cost efficient management for lung cancer is smoking cessation. A century ago lung cancer was a reportable condition and now it a reason for more deaths worldwide from cancer than any other malignant disease. Even the techniques like re-operative staging have become very refined along these years. In the coming years, a considerable effort will be taken to classify lung cancer, to discover gene involved in lung cancer pathogenesis, and to understand the biochemistry and the contribution of those genes in lung cancer. The major tools for tissue processing, array -production,are all in place for these efforts. There can be seen a combined effort from pathologists, clinical scientists, molecular biologist, statisticians and informatics specialists. Collaborative efforts also should be initiated by cancer research because these programs require sophisticated tools and specialized expertise. The principles of treating lung cancer have changed little over the last 50 years, and remain surgery, chemotherapy, or radiotherapy, or a combination of all these. In the beginning of 20th century there was no effective treatment for lung cancer. However, in the last 50 year’s surgery proved to be safer, and remain main modality to offer a chance for cure The administration of chemotherapy and radiotherapy has also become sophisticated and quality of treatment has improved to a certain degree. “One of the main factor limiting the ability of chemotherapy and/or radiation therapy to achieve cure is effective dosing”(Chu 5). Despite this the survival rate of the patients has hardly shown any difference since 30 years of time. Even though surgery is feasible the chances of operation was very dwindling among some patients as they were thought to be at high risk to attend the surgery. Nowadays histopathological sub-classification is performed on non-small cell lung to enhance the treatment facility. According to this procedure the lung cancer is sub –divided into four different subtypes namely, Small Cell Lung Cancer (SCLC),Squamous Cell Carcinoma(SCC),Large Cell Carcinoma(LCC) and Adenocarcinoma(ADC).The treatment of NSCLC is conducted with the help of histopathological features and staging. But it has been found that this method give little assistance in treating lung cancer. However, the recent studies show that gene profiling alone could help in predicting clinical outcome of patients with non- small lung cancer. The latest research carried out by ISTM has revealed that Selected Ion Flow Mass could help in screening of the lung cancer .In this method the breath of the patient is analyzed with a technique which uses Selected Ion Flow Tube Mass Spectrometry (SIFT- Ms).SIFT –MS is a form of chemical ionization. This technique might prove to be very useful in the coming times to be a non invasive way of screening lung cancer. There has also been a new development of vibrational spectroscopic technologies in the area of cancer treatment. “The Concept of applying vibrational spectroscopy to identify the primary tumor is that metastatic tumor cells contain molecular information of the primary tumor”(Salzer 56) Conclusion Lung cancer is undoubtedly a subject which requires a great deal of research work The promising areas in the field of research include the study of chemopreventive agents and targeted therapies, both of these depict a potential to cease the advancement of the development of cancerous cell. However, lung cancer is not getting the due attention which it owes, both in funding terms and in awareness among public comparing to other forms of cancer. There should be a very strong awareness among the masses and different organizations should work hard for the same. Information and services should be offered exclusively for patients and their families in order for a safe recovery from the disease. Lung cancer is definitely a significant medical and health problem, which need constant attention from all corners of the society. The best way to prevent lung cancer is to avoid smoking completely. Individuals should also be careful with the exposure to passive smoking. It is suggested that lung cancer is one of the most preventable type of cancer. People should also avoid circumstances which lead to radiation exposure and chemicals which lead to cancer development. National Cancer Institute has found that food containing more substance like flavenoids reduce the risk of cancer. So a cautious lifestyle along with a health eating habit can to an extent reduce the risk of developing lung cancer. Work Cited Adnan, Amna. "Types of Gene Mutations.Disease Caused By Gene Mutation". 08,August.2010 . Chu, Edward . Physicians Cancer Chemotherapy Drug Manual . 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