Lung Cancer Treatment | Mouth Cancer Treatment | Mouth Cancer Treatment
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Lung Cancer is a major global health problem. Approximately 500 000 new cases of lung cancer are diagnosed annually. In the UK, lung cancer accounts for 20% of all malignancies, with 36,000 new cases presenting each year. Lung cancer is the most common cancer amongst males in the UK. The incidence of lung cancer is now falling, probably as a reflection of changing smoking habits within the population. The fall in lung cancer incidence however is principally amongst men, and there appears to be an increase in the incidence of lung cancer in women. This is predominantly due to a rise in the diagnosis of adenocarcinoma, a type of lung cancer less related to smoking. Recent statistics have shown for the first time slightly more deaths from lung cancer amongst women in the UK in 1999 than from breast cancer, traditionally the biggest cancer killer of women. This trend reflects the improved treatment of breast cancer. Mortality from breast cancer has fallen rapidly in recent years, unlike lung cancer, where there has been little change in the mortality figures. Mesothelioma is a rare malignancy of serosal surfaces, commonly affecting the pleura and linked to previous asbestos exposure. There is a long latency between asbestos exposure and the development of the disease of approximately 20 years. The frequency of this type of lung cancer is rising in the UK and Europe, and is predicted to peak in 2020, and then decrease due to controls now in place regarding asbestos use. Types of Lung Cancer There are two main types of lung cancer, small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Approximately 75-80% of presenting cases are non-small cell lung cancer and 20-25% small cell lung cancer. Small Cell Lung Cancer Mesothelioma This type of lung cancer can be divided into three main histological types: epithelial, sarcomatous and mixed. The epithelial type is the most common, probably occurring in about two-thirds of cases, and the sarcomatous type is less common but associated with a more aggressive pattern of disease. Causes of Lung Cancer It has long been established that the major risk factor in lung cancer development is smoking. Although the risk of having lung cancer is greater increasing numbers of cigarettes smoked, the duration of smoking is a stronger risk factor than daily intake. Smoking cessation is associated with a steady risk reduction so that in those who have smoked for up to 20 years, the risk of developing lung cancer becomes similar to a lifelong non-smoker 10 years after stopping smoking. Ninety percent of patients who develop lung cancer are, or have been smokers. Other carcinogens may predispose to lung cancer risk, such as asbestos, radiation, and also arsenic, mustard and radon gas, chromium, and nickel. Exposure to asbestos, particularly crocidolite, (blue asbestos) is linked with the development of mesothelioma. Some lung cancers are not related to smoking, such as adenocarcinoma and its subgroup alveolar cell carcinoma. Although there are strong environmental factors leading to lung cancer development, individuals differ in their sensitivities, and there is increasing evidence that genetic factors may play a role in lung cancer development. Common Symptoms of Lung Cancer Some patients with lung cancer present without symptoms when a chest X-ray is performed for other reasons (e.g. pre-operatively or for a medical) but the majority of lung cancer patients are symptomatic at presentation. Common presenting features of lung cancer are recurrent infections in a smoker, exacerbation of a cough or increasing shortness of breath. Fatigue or weight loss can often be present. Haemoptysis (coughing up blood) is common. Mesotheliomas tend to present more insidiously, with non-specific symptoms of slowly progressive disease. The commonest symptoms of this type of lung cancer are breathlessness, often due to a pleural effusion (fluid surrounding the lung) and chest pain due to the presence of the cancer on the pleural surface or invading the chest wall. Diagnosis of Lung Cancer Initial treatment of patients with suspected lung cancer is via the GP surgery. A GP may request a chest X-ray and blood tests. If a cough is productive, microscopic examination of the sputum may reveal cancer cells. Further treatment is usually hospital based, often after referral to a Chest Physician. A diagnosis of lung cancer requires a tumour sample that can be examined microscopically. This is often obtained at bronchoscopy where a flexible telescope is passed into the lung. Depending on the position of the tumour, a computed tomography (CT) guided lung biopsy may be performed. Alternatively, cancer cells are sometimes obtained from a lymph node or from pleural fluid. In addition to a chest X-ray, patients also require a CT scan of the chest and abdomen in order to determine the extent of the tumour. Other scans, such as a brain scan or a bone scan, may be performed as a part of the lung cancer treatment if symptoms indicate possible malignant involvement. Staging and Prognosis The extent of lung cancer is described as its stage, and this is important in deciding on the appropriate cancer treatment and the likely prognosis of the disease. In the case of non small cell lung cancer, early stage disease (stage I and II) can often be treated surgically, whereas more advanced disease is treated more commonly with chemotherapy and/or radiotherapy. Five year survival rates show a range from 60% for Stage I, to only 1% for Stage IV disease. Small cell lung cancer treatment is typically with chemotherapy and radiotherapy, with little role for surgery. However long-term survival rates remain poor with only 15-20% of patients with limited disease surviving 5 years or more and only 5% of those with extensive disease at presentation are alive at 5 years. Very few patients with mesothelioma are considered for surgery and treatment is palliative with the aim of symptom control. Survival from the time of diagnosis is approximately 7-12 months, with fewer than 5% of patients living beyond 5 years. Non Small Cell Lung Cancer Treatment The standard treatment for stages I and II disease is surgical resection.However, this type of lung cancer treatment requires removal of an entire lung, which can compromise breathing. For patients whose lung function is already compromised, for instance by asthma or chronic bronchitis, lung surgery may not be possible. In these circumstances radiotherapy is an alternative treatment that can be effective in eradicating the disease in some cases. Radiotherapy is usually given as a daily treatment over about a six-week period (excluding weekends). Chemotherapy treatment is often recommended for more advanced lung cancer, and is sometimes followed by either radiotherapy or surgery. A number of chemotherapy drugs have activity against lung cancer, and these may be combined in a ‘chemotherapy cocktail’ containing two or three different drugs. Most of these drugs are given by injection into a vein at intervals of between one and three weeks. The current standard treatment used at the Royal Marsden Hospital is a combination of three drugs: Mitomycin C, Vinblastine and Cisplatin. Treatment is given once every three weeks for a total of three cycles. It can be administered as a day case procedure, but many patients prefer to be admitted to hospital for one night. Another chemotherapy drug treatment frequently used at the Royal Marsden for non small cell lung cancer is Vinorelbine (also known as Navelbine), which is given as an injection weekly for two weeks followed by a week’s rest (one cycle) for a total of up to six cycles. Small Cell Lung Cancer Treatment Chemotherapy treatment is usually recommended for this disease. The standard treatment at the Royal Marsden Hospital is with a regimen of two chemotherapy drugs, Carboplatin and Etoposide given as an intravenous injection every three weeks for a total of between four and six cycles. Etoposide tablets are also taken on days 2 and 3 of each cycle for Small Cell Lung Cancer treatment. For patients with limited stage disease, radiotherapy is also recommended following chemotherapy. This is given to the initial sites of disease in the chest. In addition, radiotherapy to the brain is recommended to prevent disease relapse at this site, which is relatively immune to the effects of chemotherapy. This is because of the ‘blood-brain barrier’, a protective filter system that prevents toxins in our blood stream from poisoning the brain in usual circumstances. Mesothelioma Treatment Surgical resection of mesothelioma is contemplated if the disease is confined to a limited area of the pleura. However, in the majority of cases surgery is not possible and treatment is therefore directed at control of tumour growth and alleviation of the symptoms of lung cancer. As with the other types of lung cancer a multidisciplinary approach is central to the treatment of individual patients. A common feature of this disease is the accumulation of fluid in the chest surrounding the lung, known as a pleural effusion. This may result in difficulty with breathing, which can be alleviated by drainage of the fluid. To prevent recurrence of this problem, the lining of the lung may be sealed in a treatment called pleurodesis, which is usually performed by our cardiothoracic surgical colleagues. Following this kind of procedure, radiotherapy is recommended to the chest wall to prevent tumour from developing at the site of the surgical scar. Chemotherapy also has a role in controlling the symptoms of mesothelioma. Mitomycin C, Vinblastine and Cisplatin are the drugs most commonly used (see section on Small Cell Lung Cancer treatment). |
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