Lung Cancer Diagnosis and Treatment

Medically Reviewed by Dr. K on 5 April 2021

How Is Lung Cancer Diagnosed?

Lung cancer will become a suspected diagnosis if your doctor picks up on the following signs during your physical examination:

  • The presence of swollen lymph nodes above your collarbone
  • An abdominal mass
  • Difficulty breathing, shallow breaths
  • Added sounds in your lungs
  • Dullness when your chest is tapped
  • Unequal pupil dilation and constriction
  • Droopy eyelids
  • Arm weakness in one arm
  • Enlarged veins in your neck, chest or arms
  • Abnormal swelling in your face

Unusually elevated blood levels of some hormones or substances, such as calcium, are produced by certain lung cancers. If your calcium levels are higher than average and there is no other reason, your doctor may suspect lung cancer.

Lung cancer may spread from the lungs to other areas of the body, including distant bones, the liver, adrenal glands, and the brain. It can be found in a distant location, but if there is proof that it originated there, it is often referred to as lung cancer.

Lung cancer is normally apparent on an X-ray once it begins to cause symptoms. A chest X-ray taken for another purpose may sometimes reveal lung cancer that has not yet begun to trigger symptoms. For a more comprehensive review, your doctor may recommend a CT scan of your chest.

A lung biopsy is commonly used to confirm a diagnosis of lung cancer. The doctor inserts a tiny, lighted tube into your nose or mouth and through the airways to the tumour, where they collect a small amount of tissue. A bronchoscopy is a diagnostic name for this procedure. This is beneficial for cancers that are found in the centre of the lung.

Your doctor will use other tests to assess the extent of cancer and how much it has progressed if the biopsy reveals lung cancer. A procedure called a mediastinoscopy may be used to check for cancer cells in nearby lymph nodes, whereas imaging procedures including CT scans, PET scans, bone scans, and either an MRI or a CT scan of the brain can diagnose cancer elsewhere in the body.

If the fluid is found within the tissue layers surrounding the chest wall and lungs, a thoracentesis (liquid removal using a needle) may help diagnose cancer and improve breathing symptoms. If the fluid does not test positive for cancer cells (which happens around 60% of the time), the doctor can conduct a procedure called video-assisted thoracoscopic surgery (or VATS) to check the lining of the lung for tumours and take a biopsy.

Annual chest X-rays for lung cancer screening are not recommended because spit, mucus, and chest X-rays have not proven to be particularly effective at finding small tumours.

Low-dose helical CT screening could, however, be provided to people at elevated risk of lung cancer. Smokers and ex-smokers aged 50 to 80 who have smoked for 20 pack-years or more who have either continued to smoke or stopped during the last 15 years are included. A pack-year is calculated by multiplying the number of cigarette packs smoking every day by the number of years an individual has smoked. If you haven’t smoked in over 15 years, the screening might not be essential.

What Are the Treatments for Lung Cancer?

Surgery for lung cancer

The type of lung cancer, the degree to which it has advanced, and your general health, especially the function of your lungs, both affect the decision to undertake surgery. Many patients with lung cancer, especially smokers, have additional lung or heart conditions that make surgery difficult. Cancer that has spread to lymph nodes between the lungs was once thought to be inoperable, but through combining treatment and chemotherapy, recovery rates have increased.

Non-small-cell lung cancer is typically treated by surgery. The tumour, as well as the underlying lung tissue and lymph nodes, are removed by a surgeon. In certain cases, the whole lung must be removed. You’ll have to remain in the hospital for a few days after surgery.

Radiation for lung cancer

To destroy any lingering cancer cells, radiation therapy might be needed, but it is normally postponed for at least a month until the surgical wound recovers. Radiation therapy, typically in conjunction with chemotherapy, is used to combat non-small-cell lung tumours that cannot be treated surgically.

Chemotherapy and combination therapy for lung cancer

Small-cell lung cancer is usually managed by combination chemotherapy, which requires the use of more than one medication, as well as radiation treatment, owing to its tendency for spreading widely. Surgery is used on rare occasions, but only because the disease is considered to be in its early stages. This is unusual.

Chemotherapy or radiation treatment was commonly used to treat cancers that have metastasized or spread to various areas of the body. Given the difficulty in curing metastatic lung cancer, the key aims of therapy are to offer relief and extend life. Tumours may be shrunk with new medications and may assist with discomfort and other effects.

Patients with advanced lung cancer can also undergo palliative care (care aimed at alleviating discomfort and other symptoms) in addition to cancer treatment. When chemotherapy is administered at the same period, this has been found to not only offer comfort but also to improve the outcome.

Chemotherapy can also help reduce lung cancer recurrence in patients that are also in the early stages of the disease, according to new research.

Other lung cancer treatments

Researchers are still searching for innovative and enhanced approaches to treat lung cancer, alleviate symptoms, and enhance quality of life. New chemotherapy combinations, new types of radiation, and the usage of medications that make cancer cells more resilient to radiation are also being researched at the moment.

Early lung tumours of individuals that cannot be managed surgically have been treated with stereotactic radiosurgery and radiofrequency ablation. This method of treatment will also be used to manage recurrent localised tumours.

Afatinib (Gilotrif), dacomitinib (Vizimpro), erlotinib (Tarceva), necitumumab (Portrazza), and osimertinib (Tagrisso), as well as bevacizumab (Avastin) and ramucirumab (Cyramza), which target the tumour blood supply, have shown significant activity in helping to regulate advanced lung cancer. Gefitinib (Iressa), a targeted treatment for tumours with unique EGFR mutations, has been licenced to treat metastatic NSCLC.

Immunotherapy medications such as atezolizumab (Tecentriq), durvalumab (Imfinzi), nivolumab (Opdivo), and pembrolizumab (Keytruda) block a protein that prevents the body from fighting cancer. Every 2-3 weeks, these medications are administered through IV infusion.

Alectinib (Alecensa), brigatinib (Alunbrig), certinib (Zykadia), crizotinib (Xalkori), and lorlatinib (Lorbrena) have been discovered to target a specific molecule, an ALK gene rearrangement, which is present in certain lung cancers. Dabrafenib (Tafinlar) and trametinib (Mekinist) are drugs that attack specific proteins in tumours with BRAF gene mutations.

Entrectinib (Rozlytrek) and larotrectinib (Vitrakvi) are drugs that target a tumour-specific gene named neurotrophic tyrosine kinase (NTRK).

Patients are also routinely tested to see if these medications are successful against a particular form of lung cancer.

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