Lung Cancer

What is Lung Cancer?

Cancer is a disease in which cells in the body grow out of control.
When cancer starts in the lungs, it is called lung cancer.

Lung cancer begins in the lungs and may spread to lymph nodes or
other organs in the body, such as the brain. Cancer from other
organs also may spread to the lungs. When cancer cells spread from
one organ to another, they are called metastases.

Although lung cancer is not a contagious disease it can still spread

from sexual contact, touching , sharing same meals , breathing same
air . I can transfer from organ transplant , pregnancy

Smoking tobacco, both cigarettes and beedis, is the principal risk

factor for causation of lung cancer in Indian men; however, among
Indian women, the association with smoking is not strong,
suggesting that there could be other risk factors besides smoking.
While the global trend of a rise in Lung Cancer appears to be
paralleled in India, we do not completely understand the alarming
rise in the incidence of lung cancer among the nonsmokers. Lung
Cancer is a major disease spread all over the world.
The National Cancer Registry Programme (NCRP) of the Indian
Council of Medical Research (ICMR) is implemented by the National
Centre for Disease Informatics and Research (NCDIR), Bengaluru.
The NCRP plays a vital role in cancer surveillance by collecting and
compiling data on cancer occurrence, patterns, outcome and
projections. An earlier report from the NCRP estimated a significant
increase in the age-adjusted incidence rate (AAR) of lung cancer in
both the genders since the early 1980.
 Index

S.no Contents Page numbers

1 What is lung 1-2
Cancer
2 Index 3
3 About the 4-7
disease
4 Case study 8-11
5 Summary 12
6 Photo gallery 13
6 Bibliography 14
What causes lung cancer?
Lung cancer is caused by cells that keep dividing even though they
shouldn’t. While cell division is a normal process, all cells have a
built-in off switch that keeps them from dividing into more cells
(senescence) or causes them to die off (apoptosis) when necessary.
The off switch is triggered when a cell has divided too many times or
has too many changes (mutations).

Symptoms of lung cancer

Most lung cancer symptoms look similar to other, less serious
illnesses. Many people don’t have symptoms until the disease is
advanced, but some people have symptoms in the early stages. For
those who do experience symptoms, it may only be one or a few of
these:

 A cough that doesn’t go away or gets worse over time.

 Trouble breathing or shortness of breath
 Chest pain or discomfort
 Wheezing
 Coughing up blood
 Hoarseness
 Loss of appetite
 Unexplained weight loss
 Unexplained fatigue (tiredness)
 Shoulder pain
 Swelling in the face, neck, arms or upper chest (superior vena
cava syndrome)
 Small pupil and drooping eyelid in one eye with little or no
sweating on that side of your face (Horner’s syndrome)
Diagnose lung cancer
Diagnosing lung cancer can be a multi-step process. First visit to a
healthcare provider will usually involve them listening to your
symptoms, asking you about your health history and performing a
physical exam (like listening to your heart and lungs). Since lung
cancer symptoms are similar to many other, more common
illnesses, we may start by getting blood tests and a chest X-ray.

Stages of lung cancer

Each stage has several combinations of size and spread that can fall
into that category. For instance, the primary tumor in a Stage III
cancer could be smaller than in a Stage II cancer, but other factors
put it at a more advanced stage. The general staging for lung cancer
is:

 Stage 0: Cancer is in the top lining of the lung or bronchus. It

hasn’t spread to other parts of the lung or outside of the lung.
 Stage I: Cancer hasn’t spread outside the lung.
 Stage II: Cancer is larger than Stage I. It has spread to lymph
nodes inside the lung, or there’s more than one tumor in the
same lobe of the lung.
 Stage III: Cancer is larger than Stage II. It has spread to nearby
lymph nodes or structures or there’s more than one tumor in a
different lobe of the same lung.
 Stage IV: Cancer has spread to the other lung, the fluid around
the lung, the fluid around the heart or distant organs.
Types of treatment of lung cancer
There are many ways how to treat lung cancer. It is based on the
stage of lung cancer and how much it has spread.
Cell lung cancer can be treated with surgery, chemotherapy,
radiation therapy, targeted therapy, or a combination of these
treatments. People with small cell lung cancer are usually treated
with radiation therapy and chemotherapy.

 Surgery. An operation where doctors cut out cancer tissue.

 Chemotherapy. Using special medicines to shrink or kill the
cancer. The drugs can be pills you take or medicines given in
your veins, or sometimes both.
 Radiation therapy. Using high-energy rays (similar to X-rays)
to kill the cancer.
 Targeted therapy. Using drugs to block the growth and
spread of cancer cells. The drugs can be pills you take or
medicines given in your veins. You will get tests to see if
targeted therapy is right for your cancer type before this
treatment is used.
Drugs approved for small cell lung cancer
Several cancer drugs approved by the Food and Drug Administration
(FDA) for lung cancer. The list includes generic and brand names. This
page also lists common drug combinations used in lung cancer. The
individual drugs in the combinations are FDA-approved. However, the
drug combinations themselves usually are not approved, although they
are widely used.

 Afinitor (Everolimus)
 Atezolizumab.
 Doxorubicin Hydrochloride.
 Durvalumab.
 Etopophos (Etoposide Phosphate)
 Etoposide.
 Etoposide Phosphate.
 Everolimus
 Case Study
A 71-year-old Japanese man experienced dry cough for 2 weeks and
visited the Department of Respiratory Medicine. Enhanced chest-
abdomen computed tomography revealed a tumor with a 3-cm
diameter in the left lower lobe and left pleural effusion (Fig. 1).
A 5-mm nodule, considered to be lung metastasis, was detected in
the left upper lobe. Cytological analysis of the left pleural effusion by
thoracic puncture led to the diagnosis of lung adenocarcinoma.
Gadolinium-enhanced brain magnetic resonance imaging and bone
scintigraphy did not reveal any other metastases.

Treatment to lung cancer

4 treatment policies may be the key to success:

 1. RC with CBDCA plus DTX;

 2. repeated re-challenge erlotinib administration;
 3. osimertinib administration after T790 M mutation in exon
20, which confers resistance to erlotinib; and
 4. use of both cytotoxic drugs and EGFR-TKIs.
Treatment begins
The response rate (RR) to RC of platinum doublets containing
pemetrexed (PEM) or taxanes is reportedly 27.5%, with a
progression-free survival (PFS) of 3.9 months and an OS of 8.7
months. This RR is high, but the PFS and OS are similar to those
seen with administration of a single-agent as second-line
treatment Advanced NSCLC patients for whom RC with 2-
drug combination therapy is performed have a longer median
survival than those administered only DTX as second-line treatment.
The current evidence that RC is superior to a single agent second-
line treatment is not sufficient, but if the side effects are acceptable,
RC may be a suitable option.
To safely perform RC using platinum-based 2-drug therapy, it may
be necessary to include a treatment holiday period for a certain
duration to facilitate physical fitness recovery. Time to progression
of >3 months after ending first-line chemotherapy is a predictor of
long-term survival (>2 years) in advanced NSCLC.
The treatment holiday after cytotoxic chemotherapy was
approximately 6 months. A prolonged treatment-free interval
appears to be important for restoring physical fitness; therefore,
the patient could tolerate the next treatment.
The next treatment
TAX 326 trial, CBDCA and DTX combination therapy helped
achieve an OS equivalent to that associated with CDDP and
Vinorelbine combination therapy; in addition, the CBDCA and
DTX combination was well tolerated and facilitated a high
quality of life

Here, disease control was possible by RC of platinum

doublets for approximately 6 cycles after the 6-month treatment
holiday. Therefore, we applied the RC strategy to EGFR-TKI
administration.
Toxicity and efficacy
were balanced by allowing an approximately 4–6-week treatment
holiday after the 4-week erlotinib administration.
Erlotinib was employed in
RC; this method was named repeated re-challenge administration
of erlotinib and was considered to alleviate suffering due to
toxicity. Although there is little evidence to determine whether
dose reduction, intermittent administration, or repeated rechallenge
administration is better, it is important to avoid
complete cessation of therapy
Result
RC of CBDCA plus DTX and
repeated re-challenge administration of erlotinib may be an
empirical option for long-term survival. Here the patient survived
more than 11 years only on the basis of drugs/medicine
.
Summary
Introduction

A 71-year-old man visited hospital because of dry cough.

Diagnosis:

Chest computed tomography revealed a tumor on the left indicating

lung adenocarcinoma.

Interventions:

Four cycles of chemotherapy reduced the size of the tumor;

however, it increased in size after 8 months, and re-challenge
chemotherapy (RC) with the same drugs was performed. Repeated
RC controlled disease activity for 6 years. After the patient failed to
respond to RC,

Erlotinib was administered for 3 years while repeating a treatment

holiday to reduce side effects. The disease progressed, and
epidermal growth factor receptor (EGFR) gene mutation analysis of
cells from the pleural effusion detected the T790 M mutation.
Therefore, osimertinib was administered, which has been effective
for >1 year.

Outcomes:

The patient has survived for >11 years since the diagnosis of lung
cancer.

Lessons: Long-term survival may be implemented by actively

repeating cytotoxic chemotherapy and EGFR-tyrosine kinase
inhibitor administration
 Photo gallery

Lung cancer slowly spreads amont the cells

It causes tumors which may be centimeters thick

One of its symptoms usually ignored by people is dry cough

Bibliography
 https://my.clevelandclinic.org/health/diseases/4375-lung-
cancer
 https://www.cancer.org/healthy/cancer-causes/general-
info/is-cancer-contagious.html#:~:text=Cancer%20is%20NOT
%20contagious,body%20of%20another%20healthy
%20person.
 https://www.cdc.gov/cancer/lung/basic_info/what-is-lung-
cancer.htm
 https://www.cdc.gov/cancer/lung/basic_info/
diagnosis_treatment.htm