Lung Cancer: The Status Quo in 2015

Fewer words in the English language invoke more anxiety and fear than the one that follows:  cancer. It can be argued that cancer strikes more fear in Americans than heart disease even though the latter illness kills more people each year than all forms of cancer combined (AHA 2015).  Perhaps this is because cancer seemingly kills more indiscriminately than other diseases, striking down countless individuals in the prime of their lives.  Or perhaps the great fear and anxiety rage because certain types of cancer can be linked to common human vices – things most of the population engage in regularly - such as smoking, drinking alcohol, and eating unhealthy foods. Frequently, society extends greater sympathy to cancer victims who were dealt an unlucky genetic hand compared to cancer victims whose unhealthy lifestyles contributed to or caused their illness.  Of all those afflicted with cancer, there can be little doubt that lung cancer sufferers are the most stigmatized group because of the irrevocable link between the disease and smoking.  This presentation will explore my interest in the social aspects and physiology of the disease while examining its causes, treatments, and other pertinent research.

Lung Cancer by the Numbers

The mere mention of lung cancer in 2015 causes many to conjure images of sickly, nicotine-addicted individuals who knowingly and willfully ignored countless health advisories in order to indulge their habit. The American Lung Association estimates that there will be 160,000 lung cancer-associated deaths in 2015, and the American Heart Association estimates 221,000 new cases of the disease.  These are serious numbers, especially considering that lung cancer will claim more lives than prostate, breast, and colorectal cancer combined in 2015.  Lung cancer is also the most common form of cancer worldwide, claiming 1.6 million lives in 2012 alone (ALA 2015).  In addition, it is crucial to point out that while 80-90% of lung cancer cases are attributable to smoking, 10 to 15% of the estimated death toll each year in the United States are caused by occupational hazards, unknown causes, and pollution – a statistical minority, but a somber reminder that approximately 20,000 to 25,000 human lives are claimed each year in this country from non-smoking induced lung cancer (ACA 2015).

Overview, Causes, and Symptoms

Lung cancer is often symptomless in its early stages and is caused by changes in lung tissue that have a cumulative and irreversible effect over time as inhaled carcinogens such as nicotine create abnormal cellular activity.  To clarify, cell growth and division in the lungs and bronchial tubes is disrupted eventually interfering with the body’s ability to take in oxygen and get rid of carbon dioxide – the two essential and inherent functions of the lungs.  While the body is able to repair the damage and mitigate the disruption initially, long-term exposure to the carcinogen has an overwhelming and catastrophic effect on the cells that line the lungs (Mayo, 2015).  It’s important to note that each case of lung cancer is unique and that the disease is essentially identified by the types of cells found within tumors and the patient’s unique genetic makeup of those cells (OSUCCC 2015).  Thus, each case requires specific analysis and treatment plans.

While the disease manifests itself in a myriad of combinations of cellular dysfunction, most diagnosed cases fall into two broad categories:  small lung cell cancer and non-small lung cell cancer.  It’s important here to note that many other cancers in the body can eventually find their way to the lungs via a process called metastasis, but are not classified as lung cancers (OSUCCC 2015).  Small lung cell cancer is almost exclusively the domain of chronic smokers, while non-small cell cancer is an overarching term that applies to several types of lung cancers that behave in similar ways (Mayo 1999).  Small lung cell cancer tends to form in the tissues of the lungs and spreads to other parts of the body.  It is an aggressive, fast-growing cancer that derives its name from how it appears under a microscope – minuscule and oval shaped (UMCC 2015).  Conversely, non-small cell lung cancer has a larger appearance and is much more commonly diagnosed, accounting for roughly 85 to 90% of all diagnosed lung cancers (ACS 2015).

Lung cancers are generally thought to begin as precancerous changes in the lungs.  As previously noted, these early changes or genetic mutations rarely produce any physical symptoms in the patient, and would likely only be identified as slightly abnormal if viewed under a microscope (ACS 2015).  As cancer develops, it becomes large enough to produce masses and tumors visible on imaging tests.  At this point, the disease typically becomes symptomatic in most people.  The classic symptoms include a cough that doesn’t subside, the appearance of blood in a cough, chest pain, wheezing, excessive or prolonged hoarseness, unexplained weight loss, bone pain, and headache.  Chronic smokers should pay particularly close attention to the onset of such symptoms (May 2015).  

Treatments

In general, there is a number of treatment options to consider depending on variables such as the progression or stage of the disease, a patient’s overall health, the type of cancer, and personal preference (Mayo 2015).  Common treatment options include targeted therapies, immunotherapies, surgery, and chemotherapy.  In brief, targeted therapies attempt to eradicate the unique features of a patient’s disease that may be driving the cancer.  Immunotherapies aspire to boost a patient’s immune system in a way to makes it easier to attack the cancer, and the goal of surgery – performed by thoracic specialists – is to remove cancerous tumors, accurately stage the cancer, and preserve healthy lung tissue. In many instances, therapies are used in combination (OSUCCC 2015).  In all cases, the treatment protocol considers the comfort of the patient with palliative care another option for patients who may be suffering from the symptoms of cancer and treatment.  Some studies have even suggested that patients with advanced non-small cell cancer who started palliative care soon after their diagnosis lived longer than those receiving standard care (Mayo 2015).

Since lung cancer is rarely diagnosed early, the survival rate of the disease is lower than in many other forms of cancer with a five-year rate of just 17.8%.  However, the rate jumps to 54% if the case is detected while the disease is still localized in the lungs.  Sadly, more than half of people diagnosed with lung cancer will die within a year even with smoking cessation (ALS 2015).  As with most forms of cancer, treatments are deemed effective if they prevent the cancer from spreading to other parts of the body or returning within five years.

A Ray of Hope:  Advancements and Optimism

Although a diagnosis of lung cancer remains bleak in 2015, leading medical professionals to continue to wage a valiant battle against the insidious disease with innovations such as the robotic-assisted surgeries taking place at James Hospital – a comprehensive cancer center at The Ohio State University.  With more surgeries of this variety performed at James than any other hospital in the United States, lung cancer surgery is becoming a less invasive procedure.  While curing lung cancer remains a distant goal, viable therapies for those suffering from the disease is becoming more attainable.

Final Thoughts

While most cases of lung cancer could be avoided with basic lifestyle changes such as smoking cessation, I believe the public unfairly condemns the victims of the disease.  After all, simple lifestyle changes could also prevent many cases of Type 2 Diabetes and heart disease.  Moreover, a little compassion goes a long way towards understanding, curing, and preventing terminal illnesses.  Many lung cancer patients picked up a cigarette or are currently experiencing the agonizingly painful death of decisions made in their youth.

References

1. American Heart Association. 2015. Heart Disease Statistics at a Glance [Internet] Available from https://www.goredforwomen.org/about-heart-disease/facts_about_heart_disease_in_women-sub-category/statistics-at-a-glance/.

2. American Lung Association. 2015. Lung Cancer Fact Sheet [Internet]. Available from http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html.

3. American Cancer Society. 2015. Cancer Facts & Figures 2015 [Internet].Available from http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf

4. Mayo Clinic Foundation for Medical Education and Research. 2015. Treatments and Drugs [Internet]. Available from http://www.mayoclinic.org/diseases-conditions/lung-cancer/basics/treatment/con-20025531.

5. University of Maryland Marlene and Stewart Cancer Center.  University of Maryland Greenebaum Cancer Center 2015[Internet] [cited 2015 April 2].  Available from http://www.umgcc.org/thoracic_program/258019general-information-about-lung-cancer.htm.

6. American Lung Association. 2015. Lung Cancer Fact Sheet [Internet]. Available from http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html.