Lung cancer (part 2)

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Lung cancer treatment or therapy depends on the stage of cancer and varies from person to person. Sometimes doctors perform combined therapies for curing cancer. The theray may have two purposes:

  • Curative: These are for the purpose of cure and treatment of lung cancer.
  • Palliative: if the cancer become malignant as in stage 4, treatment may not possible. However, there palliative therapies or drugs reduces the symptoms such as pain and suffering of the patient.

Lung cancer treatment strategies

1. Surgery

In the initial stages of cancer, the tumor is removed surgically. For instance in stage I and in non- small cells lung cancer NSCLC. Surgery remove about 10-35% of the tumors. However, this does not guarantee the complete cure from cancer. Sometimes the tumor may reappear and may already spread to the other parts of body. On the other hand, in 35-40% cases, the patient’s life expectancy increases up to five years.

There are few limitations of this treatment method.

  • This is possible for localized tumors.
  • Also, for the tumors of initial stage cancer otherwise it may spread to other parts of body
  • Patients who already have some diseases may not get this treatment. These cases may be diabetics and cardiac issues.

Depending on the size and location of tumor, surgeon opens the chest wall and performs surgery. Different parts are removed for the purpose of complete removal of tumor and treatment of lung cancer. This involves:

  • Wedge resection of lungs : removal of one lobe of lungs
  • Lobectomy: removal of whole one lobe
  • Pneumonectomy: removal of entire lung
  • Lymhadenectomy: lymph node regions of lungs are removed

2. Radiation therapy

Radiation can be applied both for small cell lung cancer SCLC and non-small cell lung cancer NSCLC. This therapy involves use of high energy X-rays or other radiations to kill the cancerous cells. Radiations therapy has both curative and adjuvant role in which radiations are used along with other medicines for treatment of lung cancer.

The radiations may be applied externally or internally. In first case, machines deliver high energy radiations at site of tumor. While in case of internal pathway, a radioactive substance sealed in a container is placed in body of patient at site of tumor.  This is termed as Brachytherpay in which the health cares place a small palette of radioactive substance in body with the help of bronchoscope.

Radiation therapy replaces the surgical removal of tumor. Especially, when the tumor has already spread to other parts of body. Radiations shrink the tumor and limit its growth. In 10-15% cases, this prevents spreading of cancer for long time.

Gamma knife is an external form of radiations therapy. This involves beams of radiations from different directions but focus on the single tumor. However, this is more applicable for brain tumor. To perform the external radiation therapy, stimulation process is necessary. The healthcare provides use CT scans and MRI to identify the precise location of tumor called as treatment field or port. This may take 30 minutes to two hours. And the exposure time for radiations may vary from few hours to five days a week.

Radiation therapy has some limitation or side effects as well. It may cause fatigue, weakness, reduce the number of white blood cells which weakens the immune system. Moreover, there is decrease in number of platelets, which results in difficult blood clotting in case of injury.

3. Chemotherapy

This refers to application of chemotherapeutic drugs to stop the growth and spreading of cancerous cells. This is applicable for treatment of both NSCLC and SCLC types of lung cancer. This is more suitable along with other therapeutic methods. A class of chemotherapeutics, platinum- based drugs are most effective ones for treatment of lung cancer.

This therapy can increase the survival rate up to five folds and also reduce the symptoms such as pain and sufferings. The medicines or chemotherapeutic drugs may be given as pills, as intravenous infusions or both. The series of treatment is termed as cycles.

This strategy may harm the normal cells of body along with the target cancerous cells. Other side effects are reduction in blood cells number, fatigue, mouth sores, weight and hair loss etc. The side effects may persist even after the completion of therapy.

4. Targeted drug therapy

This involves the administration of drugs that target those cell which have some genetic mutation or alteration. These are:

ECFR- targeted therapy

This therapy includes the drugs that target cancerous cells and cause less damage to normal body cells. These include erlotinibe, afatinibe and gifatinibe (Iressa). These drugs target a protein; epridemal groth factors receptors (EGFR) which promotes growth of cancerous cell because of a mutation in its gene. Most common mutation is EFGR T790M and targeted drug therapy target the protein product of this mutated gene.

Other targeted therapies include tyrosine kinase inhibitor drugs. For instance, alectinibe, brigatinib and critinib etc.  These target the ALK gene mutation. Another gen linked to lung cancer is ROS1 gene, (BRAF gene). Its protein product promotes cancerous cells. So drugs target this abnormal protein.

5. Antiangiogenic drugs

These drugs block the oxygen supply to cancerous cells by inhibiting the development of new blood vessel. When there is inadequate supply of oxygen and blood, these cancerous cells eventually die. One of the drugs is bevacizumab (Avastin). The doctors apply this via intravenous rout. Another example is ramucirumab (Cyramza) drug for SCLC.

There are some possible side effects as well. This is not suitable for that patient who coughs blood and those already receiving anticoagulanet medications. This is because this drug may cause excessive bleeding.

These are the treatment options which healthcare usually provides to patients. However, this is an area of extensive research to devise the best possible treatment method for all type of cancers.

Prognosis of lung cancer

Prognosis refers to survival and life expectancy of the patient after the cancer diagnosis. Unfortunate, the lung cancer is more fatal compared to others. Also, the overall rate of survival is low as well. This is because the cancer spreads to respiratory track and other vital body parts. On average, there is life expectancy of 5-10 years after diagnosis. The symptoms, spreading of cancer, treatment therapy and the lifestyle of the patient all contribute to determine the life expectancy. For instance, a successful radiation therapy may increase the survival chances up to 75% in some cases. The adjuvant therapy usually provides better results and life expectancy.