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Lung Cancer: Causes, treatment & prevention

Lung cancer results from abnormal growth of cells in the lining of the lungs, leading to the growth of a malignant tumour.

There are two different types of lung cancer – small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) – which differ in terms of how they grow and spread to other parts of the body and how they’re treated.

 

Causes:

The development of lung cancer is strongly associated with cigarette smoking – approximately 90% of lung cancers are attributable to tobacco use. Pipe and cigar smoking can also cause lung cancer, but the risk is not as high as with cigarette smoking. Tobacco smoke contains more than 4,000 chemical compounds, many of which are cancer-causing (carcinogens).

Passive smoking, i.e. the inhalation of tobacco smoke by non-smokers who live or work with smokers, is also an established risk factor for the development of lung cancer.

Although the majority of lung cancers are linked to tobacco smoking, not all smokers go on to develop lung cancer suggesting that genetic susceptibility (i.e. family history) may play a role in the development of lung cancer.

Other causes of lung cancer include air pollution (from vehicles, industry, and power generation) and inhalation of asbestos fibres (usually in the workplace).

Signs, symptoms, and diagnosis :

Symptoms of lung cancer are varied and warning signs are not always obvious. Up to 25% of people who get lung cancer display no symptoms. In people who do display symptoms, they include the following:

  • Persistent cough and hoarseness
  • Shortness of breath, wheezing, and chest pain
  • Blood-streaked sputum
  • Chest pain
  • Frequent episodes of bronchitis or pneumonia
  • Weight loss, weakness, and fatigue.

A wide range of diagnostic tests and procedures are used to diagnose lung cancer, including taking a patient history, physical examination, blood tests, chest x-rays, computerized tomography (CT) and positron emission tomography (PET) scans, bone scans, bronchoscopy, cytological studies of sputum, bronchial washings, and fine needle biopsy. Many of these procedures are also used to determine the stage of the cancer.

Staging of lung cancer:

The stage of a lung cancer refers to the extent to which the cancer has spread to other parts of the body. Staging helps to determine how the cancer should be treated. Lung cancer can spread to any organ in the body but the liver, brain, and bones are the most common sites. The two types of lung cancer are staged differently. A simplified overview of staging is as follows:

NSCLC
Stage I: cancer that is confined to the lung
Stage II: cancer that is confined to the chest
Stage III: cancer that is confined to the chest but with larger and more aggressive tumours than at stage II
Stage VI: cancer that has spread to other parts of the body.

SCLC
Limited-stage: cancer confined to the area of the chest
Extensive-stage: cancer that has spread to other parts of the body.

Treatment :

Treatment for cancer involves a combination of surgery to remove cancer cells, and chemotherapy and radiation therapy to kill cancer cells. Lung cancer is incurable unless complete surgical removal of the tumour cells can be achieved.

Surgery is the most effective treatment for lung cancer but only about 20% of lung cancers are suitable for surgery i.e. Stage I and II NSCLC and cancer that has not spread beyond the lung.

Radiation therapy may be used for both NSCLC and SCLC and is a good option for people are not suitable for surgery or who refuse surgery.

Chemotherapy is used for both NSCLC and SCLC. Chemotherapy drugs may be given alone or in combination with surgery or radiation therapy. Chemotherapy is the treatment of first choice for SCLC since it has usually spread extensively in the body by the time it has been diagnosed.

Also used in the treatment of lung cancer are targeted therapies. These are drugs (gefitinib and erlotinib) or antibodies (cetuximab, bevacizumab) that block the growth and spread of cancer by interfering with specific molecules involved in tumour growth and progression. They are used in some patients with NSCLC that does not respond to standard chemotherapy.

Prevention :

The most effective measure that can be taken to prevent the development of lung cancer is to stop smoking. Reducing exposure to passive smoking is also an effective method of prevention.

Adenocarcinoma: Treatments & therapy options

Adenocarcinoma

Adenocarcinoma is a type of cancer that forms in mucus-secreting glands throughout the body. It can occur in many different places in the body, and is most prevalent in the following cancer types:

  • Lung cancer: Non-small cell lung cancer accounts for 80 percent of lung cancers, and adenocarcinoma is the most common type.
  • Prostate cancer: Cancer that forms in the prostate gland is typically an adenocarcinoma, which makes up 99 percent of all prostate cancers.
  • Pancreatic cancer: Exocrine pancreatic cancer tumors are called adenocarcinomas. They form in the pancreas ducts.
  • Esophageal cancer: Cancer that forms in the glandular cells of the esophagus is known as adenocarcinoma. This is the most common type of esophageal cancer.
  • Colorectal cancer: Cancer that develops in the intestinal gland cells that line the inside of the colon and/or rectum is an adenocarcinoma. It makes up 95 percent of colon and rectal cancers.

Adenocarcinoma can also develop elsewhere in the body.

Diagnosing adenocarcinoma

Diagnostic tests vary according to where the cancer is located. When diagnosing adenocarcinoma, the following tests may be performed:

  • Biopsy: The removal of a sample of abnormal tissue in the body. Once the tissue is removed, a pathologist can examine it under a microscope to determine whether cancer is present. If cancer is present, a biopsy can determine whether the cancer originated at the biopsied site or in another part of the body.
  • Computerized tomography (CT) scan: An X-ray procedure that uses a computer to take detailed, three-dimensional pictures of abnormal tissue in the body. CT scans are also performed during treatment to check the effectiveness of current treatment.
  • Magnetic resonance imaging (MRI): Uses radiofrequency waves to create detailed cross-sectional images of different parts of the body.

Adenocarcinoma treatment & therapy options

Treatment for adenocarcinoma varies depending on where it grows in the body, but may include:

  • Surgery: Adenocarcinoma is often treated with surgical removal of cancerous glandular tissue, as well as some surrounding tissue. Minimally invasive surgical treatment methods can help to reduce healing time and minimize the risk of infection after surgery.
  • Radiation therapy: This adenocarcinoma treatment option is typically used in combination with surgery and/or chemotherapy. Advanced radiation therapies make use of image guidance before and during treatment to target adenocarcinoma tumors, while sparing healthy tissues and surrounding organs.
  • Chemotherapy: Chemotherapy treats adenocarcinoma with drugs that destroy cancer cells, either throughout the whole body, or in a specific area. In some cases, chemotherapy may be used in combination with other forms of adenocarcinoma treatment, such as radiation therapy or surgery.

Cirrhosis of the Liver: Diagnosis, treatments and prevention

The liver weighs about 3 pounds and is the largest solid organ in the body. It performs many important functions, such as:

Manufacturing blood proteins that aid in clotting, oxygen transport, and immune system function,
Storing excess nutrients and returning some of the nutrients to the bloodstream,
Manufacturing bile, a substance needed to help digest food,
Helping the body store sugar (glucose) in the form of glycogen,
Ridding the body of harmful substances in the bloodstream, including drugs and alcohol,
Breaking down saturated fat and producing cholesterol.
Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually, preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

According to the National Institutes of Health, cirrhosis is the 12th leading cause of death by disease.

What Causes Cirrhosis of the Liver?

Hepatitis C, fatty liver, and alcohol abuse are the most common causes of cirrhosis of the liver in the U.S., but anything that damages the liver can cause cirrhosis, including:

Fatty liver associated with obesity and diabetes
Chronic viral infections of the liver (hepatitis types B, C, and D; Hepatitis D is extremely rare)
Blockage of the bile duct, which carries bile formed in the liver to the intestines, where it helps in the digestion of fats; in babies, this can be caused by biliary atresia in which bile ducts are absent or damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked, or scarred, due to another liver disease called primary biliary cirrhosis.
Repeated bouts of heart failure with fluid backing up into the liver Certain inherited diseases such as:

Cystic fibrosis, Glycogen storage diseases, in which the body is unable to process glycogen, a form of sugar that is converted to glucose and serves as a source of energy for the body. Alpha 1 antitrypsin deficiency, an absence of a specific enzyme in the liver. Diseases caused by abnormal liver function, such as hemochromatosis, a condition in which excessive iron is absorbed and deposited into the liver and other organs, and Wilson’s disease, caused by the abnormal storage of copper in the liver. Although less likely, other causes of cirrhosis include reactions to prescription drugs, prolonged exposure to environmental toxins, or parasitic infections.

Do People Who Drink A Lot of Alcohol Always Get Cirrhosis of the Liver?

Most people who drink large amounts of alcohol harm their livers in some way, but not all of these people get cirrhosis of the liver. Women who are heavy drinkers are at higher risk than men. People who have hepatitis B or hepatitis C are more likely to suffer liver damage from alcohol.

What Are the Symptoms of Cirrhosis of the Liver?
The symptoms of cirrhosis of the liver vary with the stage of the illness. In the beginning stages, there may not be any symptoms. As the disease worsens, symptoms may include:

1.Loss of appetite
2.Lack of energy (fatigue), which may be debilitating
3.Weight loss or sudden weight gain
4. Bruises
5. Yellowing of skin or the whites of eyes (jaundice)
6. Itchy skin
7. Fluid retention (edema) and swelling in the ankles, legs, and abdomen (often an early sign)
8. A brownish or orange tint to the urine
9. Light colored stools
10.Confusion, disorientation, personality changes
11. Blood in the stool
12. Fever

How Is Cirrhosis of the Liver Diagnosed?
Cirrhosis of the liver is diagnosed through several methods:

Physical exam. During a physical exam, your doctor can observe changes in how your liver feels or how large it is (a cirrhotic liver is bumpy and irregular instead of smooth).
Blood tests. If your doctor suspects cirrhosis, you will be given blood tests to find out if liver disease is present.
Other tests. In some cases, other tests that take pictures of the liver are performed, such as a computerized tomography (CT scan), ultrasound, or another specialized procedure called a radioisotope liver/spleen scan.
Biopsy. Your doctor may decide to confirm the diagnosis by taking a sample of tissue (biopsy) from the liver.
Surgery. In some cases, cirrhosis is diagnosed during surgery when the doctor is able to see the entire liver. The liver also can be inspected through a laparoscope, a viewing device that is inserted through a tiny incision in the abdomen.

What Complications Are Caused by Cirrhosis of the Liver?

Complications associated with cirrhosis of the liver include:

Variceal bleeding. Variceal bleeding is caused by portal hypertension, which is an increase in the pressure within the portal vein (the large vessel that carries blood from the digestive organs to the liver). This increase in pressure is caused by a blockage of blood flow through the liver as a result of cirrhosis. Increased pressure in the portal vein causes other veins in the body to enlarge (varices), such as those in the esophagus and stomach, to bypass the blockage. These varices become fragile and can bleed easily, causing severe hemorrhaging and fluid in the abdomen.
Confused thinking and other mental changes (hepatic encephalopathy). Hepatic encephalopathy most often occurs when cirrhosis has been present for a long time. Toxins produced in our intestines are normally detoxified by the liver, but once cirrhosis occurs, the liver cannot detoxify as well. Toxins get into the bloodstream and can cause confusion, changes in behavior, and even coma.

Other serious complications of cirrhosis of the liver include:

1. Kidney failure
2. Reduced oxygen in the blood
3. Diabetes
4. Changes in blood counts
5. Increased risk of infections
6. Excessive bleeding and bruising
7. Breast enlargement in men
8. Premature menopause
9. Loss of muscle mass
Most of these complications can initially be treated with medicines or dietary changes. Once treatment for these complications becomes ineffective, a liver transplant is considered. Almost all of the complications can be cured by liver transplantation; however, in many circumstances, careful management can reduce the harmful effects of cirrhosis and delay or even prevent the need for a liver transplant.

What Is the Treatment for Cirrhosis of the Liver?
Although there is no cure for cirrhosis of the liver, there are treatments available that can stop or delay its progress, minimize the damage to liver cells, and reduce complications.

The treatment used depends on the cause of cirrhosis of the liver.

For cirrhosis caused by alcohol abuse, the person must stop drinking alcohol to halt the progression of cirrhosis.
If a person has hepatitis, the doctor may prescribe steroids or antiviral drugs to reduce liver cell injury.
For people with cirrhosis caused by autoimmune diseases, Wilson’s disease, or hemochromatosis, the treatment varies. Medications may be given to control the symptoms of cirrhosis. Edema (fluid retention) and ascites (fluid in the abdomen) are treated, in part, by reducing salt in the diet. Drugs called diuretics are used to remove excess fluid and to prevent edema from recurring. Diet and drug therapies can help improve the altered mental function that cirrhosis can cause. Laxatives such as lactulose may be given to help absorb toxins and speed their removal from the intestines.

Liver transplantation may be needed for some people with severe cirrhosis.

How Can I Prevent Cirrhosis of the Liver?

There are several ways to reduce your risk of developing cirrhosis of the liver:

Don’t abuse alcohol. If you do drink alcohol, limit how much you drink and how often. Remember, it’s not only the heavy drinker who gets cirrhosis. If you drink more than 2 drinks a day, you are increasing your risk. A drink is a 5-oz glass of wine, a 12-oz can of beer, or a 1 1/2-oz portion of hard liquor.
Avoid high-risk sexual behavior such as unprotected sexual contact with multiple partners.
Be careful around synthetic chemicals, such as cleaning products and pesticides. If you come into contact with chemicals often, wear protective clothing and a facemask.
Get vaccinated against hepatitis B.
Eat a well-balanced, low-fat diet high in fruits and vegetables and take vitamins.
Maintain a healthy weight, because excess body fat can cause fatty liver, which may lead to liver disease.

Details of Lumpectomy procedure for breast cancer

Lumpectomy is a surgical procedure that involves removing a suspected malignant (cancerous) tumor, or lump, and a small portion of the surrounding tissue from a woman’s breast. This tissue is then tested to determine if it contains cancerous cells. A number of lymph nodes may also be removed to test them for cancerous cells (sentinel lymph node biopsy or axillary dissection). If cancerous cells are discovered in the tissue sample or nodes, additional surgery or treatment may be necessary. Women who undergo a lumpectomy normally receive radiation therapy (RT) for about six weeks following the procedure to kill any cancer cells that may have been missed with the removal of the tumor. Lumpectomy is also referred to as partial mastectomy, wedge resection, breast conserving therapy, wide excision biopsy, tylectomy, segmental excision, and quadrantectomy.

A few decades ago, the standard surgical procedure to treat breast cancer was radical mastectomy, which involves the complete removal of the breast, muscles from the chest wall and all the lymph nodes in the armpit. Lumpectomy replaced radical mastectomy as the preferred surgical treatment because lumpectomy is designed to leave the natural appearance and cosmetic quality of the breast mostly intact while removing the malignancy. In addition, studies have shown that lumpectomy with radiation treatment is as effective as mastectomy in treating breast cancer.

The size and location of the lump determine how much of the breast is removed during a lumpectomy. A quadrantectomy, for example, involves removing a quarter of the breast. Before surgery, a woman should discuss with her doctor how much of the breast will be involved so that she can know what to expect.

The size of the cancer in relation to the size of the breast is the main factor that a woman’s doctor considers to determine if a lumpectomy is an appropriate treatment. Additionally, some of the features of the cancer (if it is confined to one area of the breast and does not involve the skin or chest wall) help the doctor determine if lumpectomy is appropriate. Most women who are diagnosed with breast cancer, especially those who are diagnosed early, are considered good candidates for lumpectomy. However, under some circumstances, lumpectomy is not a recommended surgery for some women. These factors include the following:

  • Multiple cancers in separate locations of the same breast: This means that the potentially malignant tissue cannot all be removed from a single location, meaning that the breast may become drastically disfigured as a result of lumpectomy.
  • Prior lumpectomy with radiation: Women who have had a lumpectomy with radiation therapy to remove cancer cannot have more radiation; therefore, they usually need a mastectomy if they experience cancer again in the same breast.
  • Extensive cancer: Since a lumpectomy removes a specific area with malignancy, this surgery option would be inappropriate if the cancer has spread to other locations.
  • Problematic tumors: A tumor that is rapidly growing or has attached itself to a nearby structure, such as the chest wall or skin, may require surgery that is more extensive to remove the tumor.
  • Pregnancy: Radiation therapy, which usually follows the lumpectomy, can damage the woman’s fetus.
  • Large tumors: Lumpectomy to remove a tumor that is larger than 5cm in diameter may drastically disfigure the breast. However, in some cases, the size of the tumor may be able to be reduced with chemotherapy, or endocrine therapy, to a size that is more manageable with lumpectomy. Small breasts, especially those that contain large lumps, may also be drastically disfigured after lumpectomy.
  • Preexisting conditions that make radiation treatment more risky than usual: Radiation treatment may scar or damage connective tissue in women with collagen vascular diseases, such as scleroderma or lupus erythematosus.
  • Prior radiation to the chest area, for instance, to treat Hodgkin’s disease.

Some women may prefer the idea of a mastectomy to lumpectomy in order to feel more confident that they will not develop breast cancer again. Other women may not feel comfortable with radiation therapy or be able to commit to a series of radiation treatments, which may involve an unacceptable time commitment or extensive travel. In most situations, though, women can safely choose between lumpectomy and mastectomy.