Lung Cancer

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Lung cancer develops when healthy cells start mutating to form tumourous masses, just like in other types of cancers. Lung cancer is a deadly disease, ranked in the top ten cancers in the UAE. Smoking is the number one cause as well as a risk factor responsible for causing lung cancer, irrespective of the type of cancer. Most lung cancers are formed in the air passages, in the same pathways that tobacco smoke traces when inhaled. 

Lung Cancer in the UAE

In 2017, lung cancer was the third topmost cause of death in the UAE. What’s concerning is that, almost 80% of the cases are diagnosed in the later stages, such as stage 4 lung cancer, when treatment options are limited and the recovery rate is very low. In addition to that 90% of stage 4 lung cancer cases are already spread to other parts of the body such as bones, making the treatment a lot more complex. Lung cancer is not only deadly, it is one of the most common cancers in the UAE, the sixth most common to be precise. It accounts for more than 4% of total cancer cases in the country and almost 9% of the total mortality due to cancers. 

Types of Lung Cancer 

There can be two main types of lung cancers – non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancers can further be divided into several types. Apart from that, depending on how far cancer has spread, there can be different types of lung cancer. Given below is a detailed description of all types of lung cancers:

  • Non-Small Cell Lung Cancer: Also known as NSCLC is the malignant type. That is pretty much the biggest difference between the two major types of cancers. Non-small cell lung cancer may shed cancer cells that can travel to other parts of the body like lymph nodes which are responsible to fight infections in the body. Following are different types of non-small cell lung cancer. 
    • Adenocarcinoma: This is the most common type of lung cancer with almost 40% of the total lung cancer cases. It begins on the outermost layer of the lungs where mucus is formed – the epithelial cells. 
    • Squamous Cell Carcinoma: This type of non-small cell lung cancer starts in the squamous cell of the lungs which form the innermost layer of the organ. Almost 30% of lung cancer cases are squamous cell lung cancer. 
    • Large Cell Carcinoma: The only differentiating thing about large cell carcinoma is that the cells look larger than the other two kinds of non-small cell lung cancer. 
  • Small Cell Lung Cancer: This type of lung cancer starts in the hormone-producing cells of the lungs – the nerve cell. Upon growing, these cancerous cells form a tumour mass in the lungs. Just like non-small cell lung cancers, this type of cancer also sheds cells that can travel to other parts of the body like lymph nodes. 
  • Spreading Lung Cancer: As the name suggests, this situation occurs when lung cancer spreads to other body parts like the bones. 

Lung Cancer Risk Factors 

  • Smoking: This is the biggest risk factor of not only lung cancer but also several other respiratory diseases. Smoking tobacco is laden with heightened risk factors for cancer. Combine it with one or more other risk factors and you will have a very high chance of getting lung cancer. Smokers, especially chain smokers, are at a very high risk of getting lung cancer. Any form of smoking is its cigar, pipes or cigarettes. Almost 90% of lung cancer patients are smokers in the UAE. 
  • Second-Hand Smoke: Even people who do not smoke themselves directly may be exposed to the same level of risk of getting lung cancer as smokers themselves. Second-hand smoke or passive smoke is another one of the big risk factors for lung cancer. If you are constantly in the company of a smoker inhaling the smoke, your chances of getting lung cancer are very high. 
  • Radon Exposure: An odourless gas, radon exposure may increase your risk of getting cancer yourself. It can be found in several indoor offices as well as homes. Lung cancer is not the only one on the list of probably diseases radon exposure can cause. You may be exposed to several other types of cancers. 
  • Asbestos Exposure: Asbestos alone may not be as harmful as it is when combined with activities like smoking tobacco. Asbestos is tiny little fibres with a hair-like appearance. Asbestos can be found in several types of rocks which are often used to design fireproof insulation in buildings. Workplaces that involves mining, automotive workshops, shipbuilding, asbestos mining, and insulation industry are at the highest risk of being in contact with asbestos. Protective breathing equipment is prescribed to ensure that the employees do not inhale this harmful substance. Being exposed to asbestos increases the risk of getting non-small cell lung cancer. 
  • Dietary Supplements: Beta carotene supplements can increase the risk for lung cancer when taken by people who smoke. Many studies were conducted to establish the fact that vitamin supplements can decrease the risk of getting lung cancer. However, the results have almost been in a negative direction. As of now, any beta carotene supplements combined with smoking can cause horrible  
  • Arsenic Consumption: People from geographical locations where the volume of arsenic is quite high in drinking water are at increased risk of getting lung cancer. People from Southeast Asia and South America are at higher risk of consuming arsenic through water and hence getting lung cancer. Arsenic can come from other sources as well. Regardless of the source, arsenic consumption significantly increases the risk of developing lung cancer. 
  • Radiation Therapy: Localised radiation therapy to the chest can lead to cancerous growth in the lungs later on. An example can be radiation therapy taken for breast cancer residual treatment after mastectomy. This applies to radiation therapies received to treat diseases other than cancer as well. However, this only applies to mastectomy and not lumpectomy. Women who have had radiation therapy after a lumpectomy do not have an increased risk of having lung cancer. 
  • Air Pollution: There is no respiratory disease that does not get inflamed by air pollution. And same goes for lung cancer as well. Most of us are regularly exposed to at least some level of air pollution no matter where we live. Combining exposure to air pollution with smoking results in very high risks of developing lung cancer even faster. 
  • Family History: If someone in your family has had lung cancer, you are all the more exposed to the risk of getting it yourself. This applies even when you have never smoked in your entire life or are very cautious about being exposed to other harmful elements and gases. However, the exact level of effect that family history has on lung cancer risk is quite uncertain. If the relatives were diagnosed with lung cancer at a younger age, the risk is all that much higher. 

Symptoms of Lung Cancer 

  • A persistent cough that either keeps getting worse or just does not go away
  • Blood coming up when coughing or rust coloured phlegm 
  • Persistent chest pain which gets worse when breathing coughing laughing or anything of the same league
  • Hoarseness in the voice
  • Sudden loss of appetite or unexpected and unexplained weight loss
  • Shortness in breath 
  • Fatigue 
  • Infections like pneumonia start to get persistent or worse over time

Lung cancer that spreads to other parts of the body also begins to present new symptoms. Given below are some of the new symptoms one may experience when lung cancer starts to spread to other body parts like bones:

  • Bone pain 
  • Worse fatigue and breathing problems
  • Headaches and seizures
  • Speech impediments 
  • Low blood sodium levels or high calcium levels

Lung Cancer Screening 

There are a few ways to identify lung cancer. From biopsy to several kinds of imaging tests, lung cancer can be identified using one or a few different types of lung cancer screening methods. Given below is a description of the same:

  • Biopsy: One of the most assured lung cancer screening methods to identify lung and other kinds of cancers, a biopsy is done by removing some of the cancerous cells from the affected area. The pathologists remove a sample of the cancer cell and take it for examination. A needle is used to remove the sample from the lungs. If the first sample taken is not enough to get conclusive results, further samples may be required to run more tests. Both small cell and non-small cell lung cancers can be identified via biopsy. 
  • Imaging Tests: Both non-small cell lung cancer and small cell lung cancer require several imaging tests in combination with chest x-rays and other tests for proper treatment and lung cancer screening procedures. CT Scans, Positron emission tomography scans or PET scans, Magnetic Resonance Imaging scans (MRI), and Bone Scans are the imaging tests doctors may prescribe for proper identification of the cancer growth and the effects of the treatment. A bone scan is used to see if cancer has spread to the bones after the lungs. Radiated tracers are used to trace the cancer growth in the bones.
  • Bronchoscopy: In this lung cancer screening method, a thin tube with a camera is passed down by a pulmonologist into the main windpipe via the nose or the mouth. The pipe along with some tools is sent to the lungs to check the environment down there and collect some samples. Fluids from inside the lungs or tissues are collected for examination. Lymph nodes can also be examined using bronchoscopy and ultrasound. 
  • Thoracentesis: This lung cancer screening method involves the passing of a needle into the chest cavity from outside. Fluid can get collected between the lungs in the chest cavity. This fluid is collected by the needle that is passed through the chest cavity and the sample is examined by a pathologist for cancer. 
  • Thoracoscopy: Small incisions are made in the chest cavity in this lung cancer screening method. The surgeons use some tools and a camera into the chest cavity via incisions. General anaesthesia is required for this procedure since incisions are to be made in the chest cavity. Samples are collected by the surgeons and then examined for cancerous growth. This procedure is also often referred to as video-assisted thorascopic surgery or VATS. 
  • Mediastinoscopy: The same incision process is repeated in mediastinoscopy lung cancer screening as well. Incisions are made at the bottom of the breastbone. The samples taken in this diagnosis process takes the sample of lymph nodes from the centre of the chest cavity. Yet again, anaesthesia is required. 
  • Thoracotomy: This lung cancer screening method includes examining the lung directly and taking a tissue. A thoracotomy is the most direct process of diagnosing lung cancer. It is rarely used and only when highly necessary. This procedure is also often used to remove the tumour itself. 
  • Biomarker Testing: This particular lung cancer screening method is used to identify the genes, protein and other elements that are unique to a patient’s tumour. This test is used to determine the kind of medicine to be used in targeted therapy. 

Lung Cancer Treatment 

  • Surgery: Surgeries are one of the most common lung cancer treatment plans for cancers, no matter what kind. The same goes for lung cancers as well. However, the surgeries may differ as per the type of cancer the doctors are dealing with. Surgeries are used to treat non-small cell lung cancers predominantly. Small cell lung cancer is not generally treated with surgeries unless it is at the earliest possible stage. Lobectomy is the most preferred surgery for non-small cell lung cancer. There are a total of 5 lobes in total in our lungs. Lobectomy removes the complete lobe at once. If lobectomy is not possible, wedge dissection is used to make an incision and remove the tumour and some healthy cells around it. Segmentectomy is another surgical option when lobectomy is not possible. Segmentectomy removes a part of the lung where the tumour is located. The final surgical option for lung cancer is pneumonectomy. It removes the entire lung instead of a lobe or apart. 
  • Radiation Therapy: Radiation therapy is another common lung cancer treatment course for many types of cancers. Radiation therapy is also often used in combination with other lung cancer treatment options like surgery. In radiation therapy, high-intensity x-ray beams are used to destroy the cancer cells in the lungs. The most common type of radiation therapy is external-beam therapy. A beam of radiation is passed through the cancer cell from outside to destroy them. However, radiation therapy is only used for small-sized cancers since healthy cells also get damaged when destroying the cancerous ones.
  • Chemotherapy: Amid medication-based lung cancer treatments, chemotherapy is one of the most preferred ones. Few anti-cancer drugs can be prescribed in combination or alone in cycles depending on the situation and requirements. Just like radiation therapy, chemotherapy also damages the healthy cells of the body. Etoposide, Docetaxel, Vinorelbine, Carboplatin and Cisplatin are a few examples of the anti-cancer drugs used in chemotherapy.
  • Immunotherapy: Cancer cells, just like healthy cells, use checkpoint proteins as signals to stop the immune system from destroying them. Immunotherapy aims to destroy these checkpoints and make the immune system aware of the existence of cancerous cells. Immunotherapy drugs target immune system pathways like CTLA-4 or PD-1 which are responsible for cancer cell growth. Drugs like Atezolizumab, Nivolumab, Durvalumab and Pembrolizumab are often used for immunotherapy. 
  • Targeted Therapy: Certain genes, cells and proteins are targeted in targeted therapy sessions. Some tests are conducted to ensure the best possible kind of targetted therapy for the patient’s specific condition. Abnormal levels of proteins can be often found in most lung cancer cells. The type of protein found in the cancer cells can be a great help in matching the patients with the ideal lung cancer treatment they need. The inhibitors used in target therapy can differ as per the type of gene mutation that has caused the cancerous growth. 

Lung Cancer Preventions 

There are no sure shot ways to prevent lung cancer completely, whether it is small cell cancer or non-small cell cancer. Several experts are still going on with this research of finding concrete methods to prevent lung cancer. However, there are still a few things you can do to prevent lung cancer to some extent at the least. Given below is a list of the same:

  • Steer clear of tobacco. Whether it is chewing tobacco or cigarettes. Tobacco doesn’t only cause lung cancer but may also cause mouth cancer. 
  • Wear proper preventive gear when you are working in places that are exposed to elements like arsenic. 
  • While supplements like vitamins can help prevent the risk of lung cancer, make sure you are not mixing smoking and supplements since that can have an opposite effect. 
  • If you have a family history of lung cancer, be careful about habits like smoking and preventive screenings.
  • Make sure that you get checked at the very first sight of any related symptom or discomfort. 
  • Preventive screening for lung cancer can help identify the disease even before the onset of primary symptoms. 
  • If possible, track the air quality in your area or the area that you are planning to visit and get a fair idea of the air pollution you are going to face. If possible, avoid going out on days with especially bad air quality.  

Health Insurance for Lung Cancer 

Lung cancer is not covered by generic health insurance plans. However, you can get a critical illness plan to cover the lung cancer treatment costs of the disease. Critical illness health insurance plans offer you a lump sum compensation amount as the benefit of the plan. The compensation amount can be used to cover the lung cancer treatment cost of cancer or for any other use that you feel like. Critical illness plans generally offer a handsome enough compensation to cover surgery costs as well as hospitalization and pre and post-hospitalization costs as well. If you have been pre-exposed to lung cancer before buying the critical illness plan, you may have to get it covered as a pre-existing illness. Since all health insurance plans are mandated to cover all pre-existing health insurance conditions, lung cancer will also be covered. A waiting period of 6 months to 2 years will apply. 

In a Nutshell 

Lung cancer, as established, is one of the leading causes of death in the UAE. Since prevention of lung cancer is not as strong as other types of cancers, the only thing one can do is steer clear of all the primary risk factors like tobacco smoking and air pollution while having a good backup plan in the hindsight. Make sure you are prepared with a good health insurance plan and lead a healthy lifestyle to avoid it altogether.

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