HEALTH TALK: Lung cancer

O.K., so not all of us did Biology in school, but for sure most of you know that you have a pairs of lungs in your chest which allows you to breathe in oxygen for your body’s needs, and to expel carbon dioxide and others. Cancer is abnormal excessive growth of cells, which may sometimes spread to other parts and may eventually cause death.

In the U.S., and in Dominica lung cancer is among the leading cancer killers in both men and women. The rate of cases appears to be dropping among both white and black men, while it continues to rise among both white and black women.

There are two major types of lung cancer: non-small cell, and small cell; the former variety being much more common and the one that spreads (metastasizes) to different parts of the body more slowly, such as to the liver, brain, adrenal glands and bone. Squamons cell carcinoma, adenocarcinoma and large cell carcinoma are three types of non- small cell lung cancer. Small lung cancers are also called oat cell cancers. 20% of lung cancers are of this type. Strange names, huh!

WHAT CAUSES CANCER?

Anyone over five years old ought to know that cigarette smoking is the number one cause.  Lung cancer is probably the most tragic cancer because in most cases, it might have been prevented; 87% of lung cancer cases are caused by smoking. Believe it or not, cigarette smoke contains more than 4,000 different chemicals, many of which are cancer-causing. Pipe or cigar smoking also increases one’s risk.

The more time and quantity you smoke, the greater your risk for lung cancer. But take note, if you stop smoking, the risk of lung cancer decreases every year, as normal cells replace abnormal  ones. After ten years, your risk drops to one third or one-half the risk of those who continue to smoke.

Many of the chemicals in tobacco smoke also affect the non- smokers inhaling the smoke, making “secondhand smoking” an important cause of lung cancer. Thousands of lung cancer deaths and many heart disease deaths occur to innocent non- smokers. Doesn’t sound fair, does it?

Radon is thought to be the second leading cause of lung cancer in the U.S. This is a colorless, odourless gas which is released from construction materials. It is not an important cause in Dominica, if at all it is.

Asbestos is a by now well-known cause of mesothelioma of the lung’s lining. Other causes are uranium, arsenic, and some petroleum products.

Of course, any of these substances put you at risk for lung cancer, but more than one for any given person will increase the risk. So if you smoke and inhale asbestos, and work at a gas station, we won’t need to do an autopsy to know what killed you.

Bear in mind that lung cancer takes many years to develop. But changes in the lung can begin almost as soon as a person is exposed to cancer-causing agents. With continued exposure, one is on one’s way to this horrible menace.

Some of us, I mean you, smoke pipes and cigars. Smoke from these is less irritating than cigarette smoke, so you may inhale less. So cigarette smoking is a bit more hazardous, BUT you’re not in the clear.  A little plus for Dominica’s history, but bad for the famous gentleman. Sir Winston Churchill’s favourite cigar was manufactured in our factory right here in Roseau!

HOW IS LUNG CANCER DETECTED?

Early on, lung cancer usually does not cause symptoms. When they do occur, the cancer is often advanced. Symptoms may include hoarseness, hemoptysis (coughing up blood), weight loss and loss of appetite, shortness of breath, fever of unknown origin, wheezing (such as asthmatics get), repeated bouts of bronchitis or pneumonia, and chest pain.

Because these symptoms or signs also occur in many other lung problems, a person having any of these systems should see the doctor for him to determine the real cause. You will be asked many questions about your medical history, including some about your exposure to hazardous substances. You will also  be examined, of course. If you have a cough producing sputum (mucus), it may be examined at the lab for cancer cells. It is almost certain that you will be asked to do a Chest X-Ray or even a CT scan. Abnormal spots in the lungs may be located this way.

Now, just as when something is wrong with your stomach or intestines, the doctor inserts a tube to see what’s happening and to take specimens, so it is that when something is going on in your lungs, a doctor may insert a tube down there for the same reasons. It is always important that if there is a tumor or cancer, a sample, or biopsy be taken to determine its type and hence the best treatment option to follow.

There is also a form of CT scan a number of doctors are using in smokers to spot small cancers, which are more likely than large ones to be cured. This is called a helical low-dose CT scan, and is very sensitive, detecting cancers when they are quite small. Unfortunately, this is not available to us in Dominica, although I stand corrected.

If you are diagnosed with cancer, further testing is done to determine if, or where, in the body the cancer has spread to. These other tests will include, again, a CT scan, a bone scan, or Magnetic Resonance Imaging (MRI).

HOW DO WE TREAT LUNG CANCER?

Treatment decided upon will be based on factors such as the type of lung cancer, the size, location, and extent of the tumor (whether or not it has spread), and one’s general health.

Options include:

1)    Surgery:
This may cure lung cancer. It is used in limited stages of the  disease. The type of surgery depends on where in the lung the  tumor is located. Some cancers cannot be removed because of  their size and location.

2)    Radiation Therapy:
This is a form of high- energy X-Ray that kills cancer cells. It is used:

a)    In combination with chemotherapy and sometimes with surgery.

b)    To offer relief from pain or blockage of the airways.

3)    Chemotherapy:
As most of you know, this is the use of drugs that are effective against cancer cells. These may be injected intravenously or be taken by month.

Chemotherapy can be used

a)    In conjunction with surgery

b)    In more advanced stages of the disease to relieve symptoms.

c)    In all stages of small cell cancer

Just before I go into a word about prevention, maybe a few additional statistics and tidbits may be of interest. Studies have shown that men who smoke more than one pack per day are at  greater than 20 times more at risk of developing lung cancer than are non- smokers, greater than 20 times! Let’s just say greater than 2,000%, because that’s what it is. The risk is greater in those who inhale, (and who doesn’t?), take more puffs per cigarette, relight half-smoked cigarettes and start smoking at an early age.

It seems that lung cancer was once a man’s disease but at the onset, recall that I mentioned it is one of the leading causes of cancer deaths in BOTH sexes. I just think this is a real tragedy, that women are dying in greater numbers because of something completely PREVENTABLE.

HOW CAN LUNG CANCER BE PREVENTED?

If you are a smoker, STOP SMOKING. There are books, videos, groups and even drugs (of course, I’m a doctor) that can help you quit for good.

If you are a non- smoker, avoid second hand smoke and know your rights in terms of places where smoking is banned, and kindly ask persons not to smoke, or alert the relevant authorities.

If you are exposed to known cancer-causing agents, such as asbestos, remove yourself. Ask your employer or union about protection from occupational hazards.
But most of all, DON’T SMOKE!

See you next week.