Lung Cancer FAQs
Question. One of my relatives is suffering from lung cancer, I want to know about lung cancer in brief.
Answer. Lung cancer is mainly of two types: non small cell and small cell. The most important cause of lung cancer is smoking, however with increasing pollutants in our environment lung cancer incidence is on the rise among non smokers too. The treatment of lung cancer depends on the stage. For stage 1, 2 and 3 we can expect a cure with adequate treatment with surgery, radiation and chemotherapy. For stage 4 cancer we treat with the intention of control of disease. With today's modern treatment many a times we are able to achieve good disease control for a few months to an year. Treatment options include chemotherapy, immunotherapy and targeted therapy. sometimes these can be offered in combination. kindly read following questions for further details
Question. I am a non-smoker, how did I develop lung cancer?
Answer. Though smoking is strongly associated with lung cancer, lung cancer can develop in the absence of history of smoking too. There are few genetic conditions also which run in family and can increase risk of a patient developing lung cancer in future. Tobacco in other forms can also increase lung cancer risk . There are few environmental toxins which also increase cancer risk such as Coal Tar, crystalline silica, ethylene oxide, formaldehyde, radon gas, soot, second hand tobacco smoke, wood dust, Thorium and Vinyl chloride. Many of these organic compounds are produced on burning plastic material and industrial exhaust.
Question. What could I have done to detect this lung cancer in early stage?
Answer. I believe what you mean is screening of lung cancer. Screening is done before the person develops any of the symptoms of the disease. Screening has helped in multiple diseases for early detection and better management. At present three screening tests are available for lung cancer, the most useful of them is low dose spiral CT. This has shown to decrease the risk of death from lung cancer in high-risk individuals like heavy smokers. Previous concept of chest X rays and sputum cytology have not been proven to reduce death risk from lung cancer.
Question. I have been suspected of lung cancer by my physician, what is my next course of action?
answer. Treatment and management of any type of cancer includes two major steps which are Staging and tissue diagnosis. Staging of lung cancer is done by fdg Pet CT or CT scan of whole body with optional MRI brain. Based on this we come to know about the stage of the cancer. After this we usually choose a site from which we can do a biopsy. Biopsy is a small procedure in which a tissue is removed with the help of a biopsy needle. In majority of cases biopsy is done without any complications. This tissue will be sent for multiple test but firstly histopathologic examination.
Question. My biopsy report came positive for lung cancer of type non small cell, what does it mean?
Answer. Biopsy report alone cannot guide the treatment. We need to have Staging information too. In simple words stage 1, 2 and 3 are localised diseases restricted to the lung. For these stages we offer surgery, radiation and chemotherapy in different combinations.
If a stage 4 is found in in Staging scan then usually we do not offer surgery or radiation.
Question. My Staging pet CT suggest that I have a stage 4 non-small cell lung cancer, what are my next management steps.
Answer. With biopsy report positive for or non small cell type of lung cancer and Staging pet-ct suggestive of of stage 4, the next type of action includes doing a molecular testing of the tissue. The benefit of doing molecular testing is that in today's world we can offer oral tablets alone or in combination of chemotherapy for controlling cancer growth if the molecular test comes positive. If the tests come negative then chemotherapy in combination with immunotherapy can be offered. If there are Logistic issues for immunotherapy then chemotherapy alone can be offered at this point of time
Question. My biopsy suggests small cell lung cancer type, what should I do next?
Answer. Small cell lung cancer is usually detected when it has already spread extensively. For patients who are detected in stage where it is localised we can offer combination of radiation or surgery depending on multiple factors. As I mentioned in majority of cases it is already in late stage, a treatment with chemotherapy is usually offered to begin with. However, with a small cell lung cancer it is always wise to do MRI brain in the beginning because it is has high chances of spreading to the brain.
Question. I have been treated with chemotherapy for my lung cancer in recent past, now I again developed cough which confirmed to be relapse of my disease. does this mean its end of life for me?
Answer. With adequate treatment we can increase the duration for which we can keep the disease under control. I believe in the context of this question it's a stage 4 cancer which has been treated previously and in which molecular analysis is negative. In this situation we can offer different type of chemotherapy depending on tolerance to the previous chemotherapy and the duration for which the previous chemotherapy kept the disease under control. if the patient achieved short duration of control with platin based chemotherapy we can add certain oral drugs to increase the effectiveness of further chemotherapy. If significant time has passed after the last treatment, we sometimes offer repeat biopsy to confirm the diagnosis and repeat the molecular testing
Question. I have heard a lot about immunotherapy in Cancer, can you briefly throw some light on it?
Answer. Yes, immunotherapy is ever expanding in the field of lung cancer. Immunotherapy agent druvalumab is now recommended to be offered in stage 3 lung cancer. This is usually offered to the patients after chemotherapy and radiation.
In stage 4 lung cancer the immunotherapy is more useful if a particular test known as pdl-1 is high in the biopsy. However even in PDL-1 low patients immunotherapy can be offered if he/she has received chemotherapy in the past and is unfit for chemotherapy again. Immunotherapy drugs available in India at present are atezolizumab pembrolizumab and nivolumab.
Question. What is the main difference between immunotherapy and chemotherapy and how is it given?
Answer. The main difference between immunotherapy and chemotherapy is that immunotherapy does not kill cancer cells directly but stimulate our own immunity to kill cancer cells. for this reason immunotherapy does not have the usual side effects of chemotherapy like hair loss.
Immunotherapy is also given in the form of intravenous injections either once in two weeks or once in 3 weeks. There are multiple centers which offer undocumented treatment options in the name of immunotherapy. It is my sincere request not to confuse immunotherapy for cancer treatment with other nutritional treatments which might have some effect on immunity.