Lung Cancer

Diagnosing lung cancer early is important but it is not necessarily easy. The early beginnings of the disease may not have clearly recognizable symptoms. If you have early lung cancer symptoms, they may include:

• A cough that does not go away and gets worse over time
• Constant chest pain, often made worse by deep breathing, coughing or laughing
• Coughing up blood or rust-coloured spit
• Shortness of breath, wheezing

Other symptoms that may occur, depending on whether the disease spreads, include:

• Arm or shoulder pain, tingling in arms, hands or feet
• Pain in other parts of body – hips, back
• Hoarseness
• Repeated episodes of pneumonia or bronchitis or an infection that will not go away
• Swelling of the neck or face
• Loss of appetite and/or unexplained weight loss
• Feeling weak or very tired all the time
• Irritability and/or mood swings
• Clubbing of fingers

Should cancer spread to other parts of the body, it may cause other symptoms:

• Bone pain
• Arm or leg weakness or numbness
• Headache dizziness or seizure; difficulty remembering
• Jaundice (yellow colouring) of skin or eyes
• Swollen lymph nodes in the neck and shoulder

Experiencing these symptoms does not always mean that you have lung cancer. Other health problems can cause the same symptoms. It is important that you discuss any symptoms you have with your doctor as they may signal other health concerns.

For more information, call us at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.

Screening is test used to detect lung cancer before any symptoms appear. Screening with low-dose CT scans can reduce deaths in those at high risk. The test is not recommended for everyone and it has some risks as well as benefits. You are considered high risk with the following criteria:

• 55-80 year of age
• Have a 30 pack-year history of smoking (1 pack a day for 30 years,2 packs a day for 1 years, etc)
• Are a current smoker or have quit in the last 15 years?

A ‘positive’ result from the screening does not mean that you have lung cancer. However, the result means something is abnormal and there could be another condition that needs attention. You will likely need additional procedures to find out what out exactly what is abnormal.
Talk with your doctor about screening if you are in the high risk category.

For more information, call us at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.

If there is a suspicion of lung cancer, the doctor will order tests to look for cancerous cells or to rule out other conditions. There are many tests and exams that are used to diagnose lung cancer. Your doctor may use some of them. Not all are necessary or appropriate for every person.

Your medical history: your doctor may ask questions about any medical problems you have experienced, about smoking, about where you live and work, family history of cancer, and symptoms you have noticed.

• Physical examination
• Chest X-ray
• Sputum analysis (cytology): the phlegm you cough up is analyzed for cancerous cells
• Further Testing

If these tests indicate an abnormal area, further testing may be done with the following procedures:

• Bronchoscopy: a thin, flexible tube (bronchoscope) with a tiny light and camera is inserted through your mouth or nose and into your lungs while you are sedated; this helps to find tumors and can break a piece of tumor off for examination under a microscope
• 
  Needle biopsy (fine needle aspiration): a thin needle is inserted into your chest after you receive a local anesthetic for pain; the needle collects a small piece of the tumor for examination under a microscope
• 
  Thoracentesis: fluid from around the lungs is drawn out with a needle and looked at under the microscope
• 
  Endobronchial ultrasound (EBUS): this is a procedure in which the bronchoscope with an ultrasound is inserted into the airways and images are then sent to a monitor. Biopsies can be taken if lesions are identified.
• 
  Mediastinoscopy or thoracoscopy: this test helps to identify if there is spread of the tumor cells to the lymph nodes. It is done after you are given a general anesthetic. The doctor makes a small cut at the base of your neck and inserts a thin tube. The tube collects fluid samples and small pieces of tissue from the lymph nodes near your throat and lungs behind your breastbone. These samples are tested for cancerous cells.
• 
  Thoracotomy: for this procedure you will need a general anesthetic. The surgeon opens your chest and takes samples of lung tissue and lymph nodes. Usually this procedure would be done if previous testing had not confirmed a diagnosis.
• 
  CT scan: This scan takes detailed x-rays that are blended together in a computer. You lie on a table and stay very still while the scans are being done. Before the first scan you receive an injection of dye to help the CT scan take a better picture. The scan is painless, but you may find lying still is uncomfortable.

What Does Staging of Lung Cancer Mean?

Part of the diagnosis process is to determine the stage or extent of your cancer. This is important because it helps you and your doctor decide about the most appropriate treatment approach for you.

There are a number of tests that are completed to determine how large the tumor is, and whether the lung cancer has spread to the lymph nodes or other parts of your body. These imaging tests include CT scan, MRI (magnetic resonance imaging), positron emission tomography (PET) and bone scans. They provide a more detailed picture of the tumor and whether there is abnormal fluid buildup or swollen lymph nodes. The tests are usually painless and do not require an anesthetic.

However, not every test is appropriate for every person. It is important to talk about the plans for these procedures with your doctor.

Based on all the test results, the doctor will identify the stage of the lung cancer. Staging is a way to classify the cancer by how far and to which parts of the body it has spread. Staging helps the doctor and you plan the best treatment for you. The stages of lung cancer are as follows:

• Stage I: Cancer is limited to the lung and has not spread to the lymph nodes. The tumor is generally smaller than 2 inches (5 centimetres) across.
• Stage II: The tumor is larger than 2 inches or it may be a smaller tumor that involves nearby structures such as the chest wall the diaphragm or the lining around the lungs (pleura). Cancer may also have spread to the nearby lymph nodes.
• Stage III: The tumor has grown very large and invaded other organs near the lungs. Or a smaller tumor is accompanied by cancer cells in lymph nodes farther way from the lungs.
• Stage IV: Cancer has spread beyond the affected lung to the other lung or to distant areas of the body.

What is Tumor Testing?

Tumor testing is a promising new field in the diagnosis and treatment of lung cancer. It is referred to as molecular, biomarker or genomic testing and is a procedure to look for changes (mutations) in the tumor DNA. A piece of the lung cancer tissue is taken during a biopsy procedure and it is sent to a special laboratory that can identify the genomic profile of the tumor. Based on the result, a specific treatment may be available to target the specific mutation that exists in the tumor cells.

For more information, call us at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.

The kind of treatment you are offered for your lung cancer depends on a number of factors. These factors include the type of lung cancer you have, where it is located, how far it has spread to other parts of your body, and your overall general health. Often, individuals who have been diagnosed with lung cancer received more than one type of treatment.

The goals of cancer treatment may be different for different individuals. Those who have a chance for cure will be offered curative treatments. The goal of these treatments is to cure the cancer or to make it disappear. If the cancer cannot be cured, then treatments are given to help the individual feel more comfortable and manage the symptoms. These are called palliative treatments and the goal is to try to improve the person’s symptoms.

Cancer treatments are classified as being either local or systemic:

• Local treatments are directed at one part of the body such as the lungs. A local treatment is given when the cancer is limited to a specific area. Radiation and surgery are both local treatments.
• Systemic treatments can affect your whole body and are given when cancer is found in several parts of the body or to reduce the chance of cancer coming back. Chemotherapy is treatment with drugs and is a systemic treatment. Targeted therapy is another form of systemic treatment.

Clinical trials are research studies of experimental lung cancer treatments. Treatments need to be studied in a systematic way to determine their effectiveness and how they ought to be used in the future. You may be offered an opportunity to participate in a clinical trial as part of your treatment plan. This decision is one to talk carefully about with your doctor.

Individuals with lung cancer may have symptoms of the cancer as well as the side effects of treatment. They may be offered a referral to a supportive care or palliative care specialty team to help with managing these symptoms and side effects. This specialty compliments the other treatments that patients are receiving and can improve mood and quality of life. It can also help patients to complete their other treatments because their side effects are managed well.

Targeted Therapy

A new and promising approach for the treatment of lung cancer is the field of targeted therapies. When tissue is tested to identify the mutations or changes in the DNA and levels of specific proteins, doctors may be able to tell exactly what causes an individual’s tumor to grow. In this case, patients may be able to take a specific treatment that can directly ‘target’ mutations in the lung cancer cells. The treatments often have fewer side effects because they focus on the tumor cells and do not affect the normal, healthy cells. This treatment slows the tumor growth and keeps it controlled or shrinks the tumor.

For individuals with non-small cell lung cancer, targeted therapy approaches are based on genomic test results that identify specific mutations and proteins that are contributing to the cancer cells’ growth. Once a patient’s tissue is tested, and there is a full picture or genomic profile of your unique tumor, there may be a specific drug therapy that can be taken to slow or stop the lung cancer cell growth. The therapy may be FDA approved or be available through clinical trial. The best time to talk with your physician about completing a comprehensive tumor testing is before a biopsy.

RISKS AND COMPLICATIONS WITH LUNG CANCER AND ITS TREATMENT

SURGERY

This treatment option depends on the size and location of the tumor. During an operation all or part of the tumor as well as a portion of healthy tissue is removed. Surgery is done under a general anesthetic and you will require a stay in hospital for a few days following the surgery.

Surgery is most commonly used for non-small cell cancer or for small cell lung cancer if it is found at an early stage. There are a number of types of surgery that can be done (e.g., wedge resection, segmental resection, lobectomy, segmentectomy, pneumonectomy) depending on the nature of your tumor. Sometimes lymph nodes in the chest will be removed as well. There are some surgical risks including bleeding and infection.

It will take some time to recover after the surgery. Side effects can include pain or discomfort and the collection of air or fluid in the chest. You can also expect there will be some shortness of breath right after the surgery. These side effects are temporary and can be managed. You will likely need to perform coughing and breathing exercises several times a day.

RADIATION THERAPY

Radiation therapy may be given before surgery to shrink tumors (induction or neoadjuvant therapy) or after surgery to help destroy cancer cells that may remain in the body (adjuvant therapy).

This treatment makes use of both external and internal radiation treatment approaches. The therapy consists of high energy beams from sources such are x-rays and protons to kill cancer cells. It can be used after surgery to kill any remaining cells or can be used for lung cancers that cannot be removed by surgery. For individuals with advanced cancer, radiation therapy can be sued to relieve pain and other symptoms.

External beam radiation treatment uses a large machine to direct an external beam of radiation directly at the tumor. As a patient, you lie on a table without moving. Treatment times are short and there is no pain in receiving the treatment. Internal beam radiation or brachytherapy is provided by placing the radioactive material (i.e., seeds, needles, or catheters) directly into or near the tumor.

The radiation damages the cells in its path – normal as well as tumor cells – and the side effects are a result of the normal cells being damaged. The specific side effects result based on the part of the body being radiated. Fatigue and shortness of breath are the most common ones lung cancer patients experience.

Treatments are given at a cancer centre that has the radiation equipment. They are provided on a daily basis (for the duration of the treatment course). Most patients live at home during the treatment and travel to the clinic each day. Those who live too far away from the cancer centre for daily commuting may have to seek accommodation near the cancer centre for the duration of their treatment regime.

For people with lung cancers that are very small, one option may be stereotactic body radiotherapy. This form of radiation aims many beams of radiation from different angles at the lung cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments. In certain cases, it may be used in place of surgery for small tumors.

CHEMOTHERAPY

Chemotherapy may be given before surgery to shrink tumors (induction or neoadjuvant therapy) or after surgery to help destroy cancer cells that may remain in the body (adjuvant therapy).

This treatment may be given as an injection or an oral therapy, depending on the actual drug that is required. The chemotherapy drugs interfere with the ability of the cancer cells to grow and spread, but they damage the healthy cells as well. The healthy cells recover over time, but patients experience a range of side effects. You may experience side effects such as nausea, vomiting, loss of appetite, fatigue, lung problems, hair loss, and increased risk of infection.

Chemotherapy by injection is usually given at the cancer centre. There are a variety of protocols for various drugs and patients go to the cancer centre at various time intervals depending on the drug they are receiving.

More recently, there has been an increase in the number of drugs that can be given orally. This means individuals are able to take the medication on their own at home. This saves on the time and energy for patients to visit the cancer centre but means the individual may be required to monitor and manage his or her own symptoms. It is important to talk with the health care team about when you should call the cancer centre if you are experiencing changes in your side effects.

Managing Side Effects of Lung Cancer Treatment

Cancer treatments have side effects such as fatigue, loss of hair or nausea. However, treatments affect each person somewhat differently. It is hard to predict exactly what your experience with side effects will be. The important thing to remember is that side effects can be managed effectively. Talk with your health care team about what you are experiencing and seek their advice about managing the side effects. Below are tips for managing a few of the most common ones individuals experience. Some you can manage yourself while others will need the assistance of the health care team members.

Shortness of Breath

Shortness of breath is a common symptom of lung cancer. Having difficulty breathing can be a lonely, frightening and overwhelming experience, but it can be managed. As there are different reasons why you may be short of breath, it is important to discuss this symptom with your health-care team. They may need to investigate it further and determine what is causing it.

In the meantime, here are some general strategies that may be helpful to you:

• Move slowly and pace activities/plan ahead (try not to overexert yourself)
• Allow time to rest before and after activities
• Learn and practice breathing exercises such as pursed lip breathing
• Learn and practice relaxation techniques such as visualization, self-hypnosis and slow, deep breathing
• Be aware of your breathing patterns; notice when you become short of breath and do not hold your breath when you are engaged in activity
• Tell family and friends what they can do to help you (e.g. turning on a fan, staying with you, coaching you to breathe slowly, etc.) including issues of potential treatments such as thoracentesis or inhalers.
• Check out if there are local rehabilitation programs or Chronic Lung Programs that could help with breathing retraining
• Coughing up blood
• Lung cancer can cause bleeding in the airway and cause you to cough up blood (called hemoptysis). Sometimes bleeding can become severe. Treatments are available to control bleeding. Contact your health care team about this issue and what ought to be done.

Pain

Everyone who has cancer pain will feel it differently. Only you know how much pain you are feeling and how it affects you. Getting relief from pain is important because it can interfere with getting a good sleep, eating well, enjoying your time with family and friends, and doing your work or hobbies.

You do not have to accept pain as a normal part of living with cancer. Tell your health care team about what you are feeling.

Pain will feel different when it comes from different parts of your body.

Bone pain can be felt as a deep throbbing pain that can be sharp at times. It may get worse as you move around.
Neuropathic pain is from damage to your nerves. This pain can be burning, shooting or feel l like ‘pins and needles’. It can hurt when things touch your skin (i.e., clothing, water, wind)
Visceral pain is from the organs inside your body. It can be dull, deep or squeezing pain. Sometimes it is hard to tell where it is coming from.
If you are taking medication regularly for pain, you may experience breakthrough pain between doses. It can happen suddenly.
Discuss your pain experience with your doctor and the health care team. There are different medications for different types of pain. Sometimes it takes some adjusting to find the right dose and time to take your medications. Your doctor may prescribe more than one type of pain medication. It is important to work together to find the right plan for your situation.

Fluid In Chest (Pleural Effusion)
Lung cancer can cause fluid to accumulate in the space that surrounds the affected lung in the chest cavity (pleural space). This accumulation of fluid can result in shortness of breath and pain. Treatment are available to drain this fluid from your chest and reduce the risk that the pleural effusion will occur again. Contact your health care team about this issue.

Fatique
Fatigue is one of the most common side effects of cancer treatment. The fatigue with cancer treatment is different than usual fatigue. The difference, for cancer patients, is that this constant exhaustion is not relieved by rest.

Not all patients experience fatigue, but many notice their fatigue becomes worse over the course of their treatment. Sometimes it can feel particularly severe immediately following the end of treatment. Energy levels then tend to improve over the course of several months.

Experiencing fatigue may mean that you will have low energy for many of your usual activities including housework, social engagements, working, leisure or sports activities, or sexual relations. For a time, you may have to make choices about what you do each day. You may need to pick what is most important to you and do not try to do everything.

You may find the following strategies helpful in managing your fatigue:

• Save your energy/balance your daily activities
• Pace yourself/spread your activities out over the day
• Eat well/a balanced diet
• Distract yourself (for example, music, reading, movie, talk with others)
• Relax/practice stress management
• Get a good night’s sleep (talk with your physician if symptoms are preventing you from sleeping)
• Get help for some of the routine things that you do
• Exercise (according to what you are able to do)
• Do not be afraid to ask for help
• Cancer that spreads to other parts of the body (metastasis)
• Lung cancer can spread (metastasizes) to other parts of the body. Common sites of metastases are the brain and the bones. When cancer starts to grow in other parts of the body, there can be symptoms that develop; pain, nausea, headaches and other signs that an organ is affected. Once lung cancer has spread to other organs, it is generally not curable. However, treatments are available to decrease signs and symptoms and to help you live longer. Referral to a palliative care program will be helpful in managing the symptoms and supporting you and your family.

Prevention

There are a number of recommendations that have been made about preventing lung cancer. These recommendations include the following:

• Do not smoke. If you have never smoked, do not start. Talk to other family members about the dangers of smoking so that understand the risks. Discuss the issues with your children early so that they can manage the peer pressure in not smoking.
• Stop smoking. If you smoke, stop. It is never too late. Quitting reduces the risk of lung disease even if you have smoked for years. There are many resources to assist individuals with smoking cessation.
• Avoid secondhand smoke. Encourage those around you who smoke to stop smoking. If there is a smoker, encourage that individual to smoke outdoors (not in the house, workplace). Avoid areas where people are smoking. Seek smoke-free options.
• Test your house for radon. Have the levels of radon in your home checked, especially if you live in an area where radon is known to be a problem. High radon levels can be remedied.
• Avoid carcinogens at work. Take precautions to protect yourself at work from exposure to toxic chemicals. Follow your employer’s precautions. For example, if you are given a face mask, wear it. And remember, your risk increases if you are exposed to toxic chemicals at work and you also smoke.
• Eat a diet with plenty of fruit and vegetables. Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Avoid taking large doses of vitamins in pill form as they may be harmful.
• Exercise most days of the week. Try to exercise most days of the week. If you do not currently exercise, start out slowly.

For more information, call us at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.

For more information, contact our Lung Health Line at 1-888-344-LUNG (5864) or email us at info@lunghealth.ca