Lung Cancer: Diagnosis and Treatment

What is Lung Cancer?

Lung cancer is a disease that compromises lung function by causing the uncontrolled growth of malignant cells. These cells form a mass that can obstruct airflow or cause bleeding. The main types of lung cancer are:

• Non-small cell tumors (adenocarcinoma and squamous cell carcinoma);
• Small cell tumors (less frequent and typical in heavy smokers);

Causes and Risk Factors of Lung Cancer

What are the main causes of lung cancer?

Smoking is the leading cause of lung cancer, both for active smokers (who account for 85% of patients) and for those exposed to passive smoking. The risk of developing the disease increases proportionally to the number of years of smoking and the number of cigarettes smoked. Quitting smoking, even after many years of habit, significantly reduces the risk.

Smoking damages the cells lining the pulmonary alveoli because it contains carcinogenic substances that immediately damage lung tissue. Although the body is initially able to repair the damage, over time, exposure to smoke irreversibly damages cells and can lead to the development of cancer. In the case of non-smokers or those with low smoke exposure, the causes of the disease are not fully understood, although alterations in genes involved in its development have been identified.

What are the risk factors for lung cancer?

The main risk factors for lung cancer are:

• Active smoking, the most important;
• Exposure to passive smoking;
• Exposure, often for occupational reasons, to substances such as radon, asbestos, arsenic, nickel, tar, and chromium;

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Lung Cancer Diagnosis

Radiological Examinations

Radiological examinations play a crucial role in diagnosing lung cancer. A chest X-ray is often the first examination prescribed to detect abnormalities in the lungs. If a suspicious lesion is detected, other examinations such as chest computed tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI) may be necessary to confirm the diagnosis and determine the stage of the disease. These examinations help doctors assess the size, location, and extent of the tumor, as well as the presence of metastases in other organs. The choice of radiological examination depends on the type of lung cancer, the patient's situation, and the preference of the treating physician.

Biopsy

For definitive diagnosis of lung cancer, biopsy (tissue) and cytology samples are taken using various examinations and procedures, including:

• Bronchoscopy;
• Transesophageal and transbronchial ultrasound;
• Needle aspiration and biopsy;
• Mediastinoscopy;
• Thoracentesis;
• Video-assisted thoracoscopic surgery (VATS);

Pulmonary Function Tests

Blood Tests

Lung Cancer Treatment

Surgery

Surgery for the treatment of lung cancer can be performed through different procedures:

• Wedge resection: removal of a small part of the lung, which can also be performed using a minimally invasive technique (thoracoscopy);
• Segmental resection or segmentectomy: removal of a segment (part of a lobe) of the lung;
• Lobectomy: removal of an entire lobe of the lung. The right lung has three lobes, while the left has two. Lobectomy combined with lymph node removal is the most common type of surgery for lung cancer;
• Resection with bronchial plastic surgery: is performed for endobronchial tumors or those that overlap two lung lobes. This is a technique that allows saving entire lung lobes while ensuring oncological radicality, resulting in great benefits for the patient;

Radiation Therapy

Radiation therapy for lung cancer is mainly performed by external beam irradiation. Radiation oncologists develop an individualized treatment plan for each patient based on the stage of the tumor and the patient's overall health. Treatments can be administered in conjunction with surgery (before or after) and at the same time or after chemotherapy.

Advances in radiological techniques, such as computed tomography and positron emission tomography, provide radiation oncologists with more precise ways to locate tumors. This allows for the delivery of a maximum dose of radiation aimed at the tumor from different angles, damaging surrounding tissues less.

Chemotherapy

The indication for chemotherapy is determined based on the stage of the tumor, i.e., based on the presence of distant organs or regional lymph nodes. This is referred to as "adjuvant" or precautionary treatment when chemotherapy is administered after radical surgery to reduce the risk of disease recurrence. However, if the tumor is initially inoperable due to the extent of the main lesion or involvement of lymph nodes, chemotherapy may be administered in the "neoadjuvant" phase, i.e., before surgery, to reduce the size of the tumor and allow a more conservative intervention.

In the case of locally advanced disease, chemotherapy may be administered simultaneously with radiation therapy, increasing its effectiveness. Finally, in cases where the tumor has already reached distant organs such as bones, liver, etc., chemotherapy is administered as the exclusive treatment to slow the progression of the disease and improve quality of life.

Other Types of Treatments for Lung Cancer

Biological Therapies

Biological therapies are forms of treatment used to neutralize the activity of altered proteins in tumor cells or in the microenvironment surrounding them. The most frequently used biological therapy in lung cancer targets the epidermal growth factor receptor and is administered orally.

Laser Therapy

Laser therapy is effective in treating lung cancer affecting the bronchi. In very early-stage tumors, this treatment can eliminate the tumor. In more advanced cases, laser therapy is used to reduce symptoms of bronchial obstruction.

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