Is Lung Cancer Common?

Lung cancer is the most frequent cancer in men worldwide. In women, however, it is the second most frequent cancer after breast cancer. Statistics show a constant increase in incidence over the last twenty years, but in recent years this increase has affected women more than men. There is no doubt that smoking, which is on the rise in the female population, is responsible for this increase. The role of smoking in the occurrence of lung cancer has been known for many years, as has the impact of air pollution in Western industrialized cities. It is more difficult to scientifically demonstrate the cause-and-effect relationship between passive smoking and the appearance of a carcinoma, due to the discontinuity of exposure.

Symptoms of Lung Cancer

In the early stages, lung cancer can be totally asymptomatic, and there are cases that are diagnosed during examinations performed for other reasons. There are certain symptoms that, if present, should be discussed with your general practitioner: hoarseness, persistent cough, shortness of breath, chest pain, weight loss and appetite loss, persistent fatigue, presence of blood in sputum. Lung cancer can spread to other organs (metastasis) and thus cause disorders related to these sites of the disease, including jaundice, bone pain, headaches, and dizziness.

Early Diagnosis of Lung Cancer: Who Should Be Examined and When?

Lung cancer owes its high mortality rate to the fact that, asymptomatic in its early stages, it is generally discovered too late. Smokers over 40, i.e., those most at risk of developing the disease, are recommended to undergo semi-annual or annual CT scans. This test, even when repeated, presents no health risk and allows carcinomas to be identified while they are still operable and curable. Often, today, the patients who have the best chance of recovery are those who identify the carcinoma incidentally after a chest scan.

Diagnosis of Lung Cancer

The diagnosis of lung cancer usually begins with a first visit to the general practitioner, then continues with a consultation with a specialist pulmonologist, oncologist, or radiologist.

In order to establish a diagnosis and understand the stage of the disease, several tests can be used. Besides the CT scan, bronchoscopy, biopsy associated with a histological examination, chest X-ray, PET scan, pulmonary scintigraphy, and MRI.

What Treatments Are Considered for Lung Cancer?

Surgery in the Treatment of Lung Cancer

Surgery, in the absence of metastases or excessive surgical risk for the patient, is always the treatment of choice. Chemotherapy, radiotherapy, biological therapy, and targeted therapy may be used before surgery to reduce the tumor mass and make the carcinoma operable, or afterward as adjuvant therapy to prevent the risk of recurrence. In recent years, oncologists have made great efforts to increase the number of operable patients. Preoperative or neoadjuvant therapy is now a reliable reality. Before starting treatment, however, it is important that the patient be evaluated by a multidisciplinary team composed of oncologists, pulmonologists, radiation oncologists, surgeons, anesthesiologists, and intensive care specialists to identify the most appropriate treatment.

Radiotherapy and Lung Cancer

Radiotherapy involves using high-energy radiation to destroy cancer cells. Modern equipment allows the rays to be directed in an extremely specific and precise manner, sparing surrounding structures as much as possible. Radiotherapy can be used in combination (before or after surgery, as explained above) or after chemotherapy. It is also used in the brain to reduce the risk of possible metastases (prophylactic brain radiotherapy) or to treat these metastases. Radiotherapy is also used for palliative purposes (in the case of advanced disease).

In cases where the tumor has already reached distant organs such as bones, liver, etc., chemotherapy is performed as an exclusive treatment with the aim of slowing the progression of the disease and improving quality of life.

In recent years, the importance of histological definition in the choice of chemotherapy to be used has emerged.

In What Cases Is Immunotherapy Used?

Immunotherapy is the new frontier in the treatment of inoperable lung cancer. In some clinical trials currently in the final phase, it is also used as neoadjuvant or adjuvant treatment, before or after surgery. The use of molecularly targeted drugs is part of the concept of precision medicine, i.e., treating a patient not only according to their characteristics and those of their disease, but also by targeting specific targets present on tumor cells. In recent years, immunotherapy has proven effective in the second-line treatment of non-small cell tumors, after chemotherapy failure and, more recently, as a first-line option, alone or in combination with other drugs. More recently, it has been used for small cell tumors, for which promising results are yet to be observed.

What is the Postoperative Follow-up for Lung Cancer?

Once the surgery is complete, the last suture has been removed, and the patient's condition has been noted, it can be said that the surgeon's work is done. At this point, the clinician, whether oncologist, pulmonologist, or radiation therapist, takes over and follows the patient over the years. In fact, it is essential to never let your guard down after lung cancer surgery.