By Tedler D. Depaynos, MD
The lungs are described as spongy organs found in the chest. They are responsible in delivering oxygen to the bloodstream.
Lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs. They divide rapidly and form tumors. As the tumors become larger and numerous, they undermine the lung’s ability to provide the bloodstream with oxygen.
From a recent literature, lung cancer comes in four stages. In stage one, the cancer is located only in the lungs and has not spread to any lymph nodes. In stage 2, the cancer is in the lungs and nearby lymph nodes. In stage 3, the cancer is in the lungs and in the lymph nodes in the middle of the chest. In stage 4, the cancer is found in both lungs and has spread to the areas around the lungs or to other parts of the body such as the liver and other organs or has already metastasized. Most of the time it is diagnosed when it is already in the late stage and the result is a very high mortality rate.
Like most cancers, no one is exactly sure what causes lung cancer but several studies show that smoking is the main culprit. The greater the quantity and duration of smoking a person had done, the greater is his risk of developing lung cancer.
Smoking is the consumption of tobacco by burning it in the mouth. In the Ilocos provinces, where you could see some elderly ladies burning it in reverse where the lighted end is inside the mouth, the effect is the same. In both cases, the tobacco smoke is inhaled into the lungs.
Primary smokers are those that burn tobacco. The secondary smokers or sometimes called passive smokers are those that are exposed to tobacco smoke because of their closeness to primary smokers or are in enclosed spaces where the smoke is confined. They also inhale the smoke. Many of the passive smokers with lung problems who seek consultations are the wives of the primary smokers who smoke inside their bed room. Tertiary smokers are those who happen to be exposed to tobacco smelling environment like walls, curtains and clothes. This is a new finding and research is now being done on those individuals constantly exposed to these environments like cleaners, janitors, waiters, etc.
Heavy smokers are those that consume at least 40 sticks per day and moderate smokers are those that consume at least 20 sticks per day. Many of those “addicted” to smoking we are familiar with smoke even 3-4 packs per day making their mouth look like a chimney. Some do not agree that “addicts” cannot stop smoking. A cardiologist stopped smoking suddenly when a lady patient he was examining unexpectedly had severe bouts of coughing after she inhaled the Marlboro smell accompanying his wide smile. Stopping it is just with severe determination.
Smoke could cause irritation in the bronchial tree leading to various ailments like chronic cough, allergic or asthmatic attacks and even difficulty of breathing. It causes of course repulsive mouth aroma and stains previously presentable dental assets with chronic use. The most dreadful however are the chemicals that it contains that could cause lung Ca.
Incidence of lung Ca to the primary smokers especially those with genetic history may reach up to 100%. With passive smokers, the incidence is increased to 17 – 20%. The incidence quoted did not mention the presence or absence of filters in the cigarettes consumed.
Other environmental hazards like hydrocarbons coming from vehicular exhausts may also contribute to lung cancer appearance so that those exposed daily to the vehicular exhausts like the traffic enforcers who take a break and relax by inhaling their cigarettes are doubling their incidence.
Asbestos may also cause the disease but studies reveal that the disease may appear 20 years after chronic exposure. It means that the individual will manifest the Ca when already retired. The findings made officials in a local city hall replace the ceiling with asbestos components of their offices placed earlier. Likewise, the previous water supplier of Metro Manila made sure that their pipes are no longer with asbestos.
In almost all of the lung cancer patients we encountered in the hospital, however, the common denominator is still smoking. The exceptions are rare. I could recall a late non-smoking lawyer friend who went into hands-on farming claiming to be breathing fresh air constantly wondering with wet eyes how he ever got his lung tumor.
There are many types of lung Ca but they are classified in general into two – small cell lung Ca (SCLCA) and non-small cell lung Ca (NSCLC). The former has a very rapid growth and metastasize early. Sometimes the metastasis is diagnosed first before the primary lesion. The later may have a delayed growth and could be treated completely when diagnosed at Stage I or II. In both instances, however, their early manifestations are non-specific and when confirmed that they are due to lung Ca, in almost all instances, they are already at the late stages. Hence early diagnosis is always attempted by practicing MDs.
A history of heavy smoking with genetic tendencies always make MDs suspicious and entertain the possibility of lung Ca when these patients seek consultations due to chronic respiratory problems like coughing, difficulty of breathing and even chest heaviness. After an extensive family history interview, a routine work-up like chest x-rays or chest UTZ are requested. Many expert radiologists nowadays could tell whether a lung tumor is a primary one or a metastatic one.
Any suspicious lesions are biopsied. Many of our young pulmonologists are very familiar in doing these procedures. If the lesion is centrally located a bronchoscopy with biopsy is done and if it is at the lung periphery, a UTZ or CT Scan guided needle biopsy is recommended. An intrathoracic video assisted biopsy may also be done and if not feasible, an open thoracostomy maybe the alternative procedure.
Chemotheraphy and even radiotheraphy maybe prescribed to late stage patients in the hope to palliate and make them comfortable. Extending their life span however with these prescriptions may be futile. Hence, avoidance of the possible causes is a must.**