Lung Cancer Awareness Month 2022: Possible treatments for non-small cell lung cancer patients

Lung Cancer Awareness Month 2022: Lung cancers are of two types—Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC). Upon detection, treatment is recommended based on the size or spread of cancer. Here's how stage I, II, III and IV non-small cell lung cancer can be treated

Lung cancers are of two types—Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC) where the former originates in the neuroendocrine cells, rapidly spreads to the body with patients presenting in late stages and causes less than 20% of lung cancer ailments largely due to tobacco consumption. In NSCLC, malignant cells start at the broncho-alveolar junction, meaning the meeting point of airway and the air-sac where the growth of the cancer cells within air passage causes a block and leads to difficulty in breathing.

In an interview with HT Lifestyle, Dr Tejinder Kataria, Chairperson of Radiation Oncology at Cancer Institute, Medanta in Gurugram, explained, “Non-Small Cell Lung Cancer is categorized into three variants by type of cells contained in the tumour—Adenocarcinoma (affects the outer portion of the lungs), Squamous cell carcinoma (grows in the central segments of the lungs), and Large cell carcinoma (develops indiscriminately in any part of the lungs). Over 80% of total lung cancers are NSCLC. Smoking accounts for most cases of this type of cancer. Its symptoms may include a wheezing-cough, persistent fever, non-resolving pneumonia, sudden weight loss of more than 10% in 6 months, coughing up blood, shortness of breath, fatigue, and chest pains.”

She revealed that a pulmonologist or chest physician investigates the symptoms by prescribing preliminary tests and upon detection, treatment is recommended based on the size or spread of cancer. According to her, Stage I and II can be treated using the following surgical options -

1. Lobectomy: Small-sized tumors are treated with a lobectomy. This involves the removal of the lobe of lung harbouring the cancer.

2. Wedge-resection: A wedge-resection eliminates the tumor along with some healthy tissue.

3. Segmentectomy: This procedure involves removal of anatomical segment of lung and removes more healthy tissue than a wedge resection but less than a lobectomy. Lymph node dissection is combined with either lobectomy, wedge resection or segmentectomy.

4. Pneumonectomy: Lung removal is considered if the tumor is centrally located, and partial surgery is not possible.

For patients who are stage 1-2 but cannot be operated due to high anesthesia risk, Dr Tejinder Kataria suggested they can be offered stereotactic body arc therapy (SABR)or stereotactic body radiotherapy (SBRT) which is a type of radiotherapy called Radio Surgery. She insisted that if cancer has spread, surgery isn’t advisable but stage III lung cancer is treated by the options below -

1. Radiofrequency ablation: This method uses image-guided heat waves to incinerate both benign and cancerous tumors, shrinking them in size.

2. Chemotherapy: Chemotherapy uses intravenous transmission of high-power anti-cancer drugs to eliminate cancer cells.

3. Radiotherapy: It uses a linear accelerator to ionize powerful X-rays to destroy cancer-causing cells.

4. Immunotherapy: It helps to increase immunity levels in the body, building the individual’s natural resistance to cancer injecting medication or biomaterials.

Dr Tejinder Kataria shared, “Stage IV NSCLC requires a customized treatment plan combining radiotherapy, immunotherapy and intravenous drug options with palliative care. The survival rate of early-stage cancer patients is greater if timely treatment is administered. Metastatic (rapidly growing) cancers are likely to spread to other parts of the body, making survival chances even slimmer. Most of lung cancers are directly or in-directly attributed to smoking/pollution. Prevention and early screening can assist in identifying early cancers and offering curative treatment. To mitigate high incidence of lung cancer, it is best to make responsible lifestyle changes.”

She advised, “Smokers are recommended to cut down and eventually stop smoking coupled with stress management. As stress is one of the prime triggers of smoking. A nutritious and balanced diet, complemented by exercise and rest helps immensely. The individuals with respiratory occupational hazards must wear protective gear to cut down on risk. Avoiding polluted areas and participating in community efforts to reduce pollution are one of the best preventative measures. “Prevention is better than cure” is a saying that stands true for healthcare and treatments for cancer. The value of low-dose CT scanning has been proven in smokers with more than 10 pack years of smoking as it can identify early-stage cancers.”