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Lung Cancer Awareness Month: Understanding The Formidable Lung Cancer

Lung cancer, a formidable adversary within the realm of oncology, has long been a source of concern and curiosity. Lung cancer kills more people than breast, colon, and prostate cancer combined, thus we at RRMCH bring to you this blog that aims to shed light on the intricacies of this disease, exploring its causes, risk factors, types, symptoms, and the crucial role of early detection and prevention strategies. 

Understanding Lung Cancer

Lung cancer occurs when abnormal cells within the lungs undergo uncontrolled growth, leading to the formation of tumours. Primarily categorised into two types—small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC)—this disease is notorious for its aggressive nature and potential to metastasize.

Risk Factors

Several factors contribute to the development of lung cancer, with tobacco smoke being the leading culprit. Individuals who smoke, or are exposed to secondhand smoke, face a significantly higher risk. Other risk factors include exposure to radon gas, asbestos, certain chemicals, a family history of lung cancer, and pre-existing lung diseases.

Types of Lung Cancer

These two main types, NSCLC and SCLC, have distinct characteristics, behaviours, and treatment approaches.

Non-Small Cell Lung Cancer (NSCLC)

  • Prevalence: NSCLC accounts for approximately 85% of all lung cancer cases, making it the most common type.
  • Subtypes: NSCLC is further categorised into three main subtypes based on the type of cells where cancer originates:
    • Adenocarcinoma: This subtype often begins in the cells that produce mucus in the bronchi and is more common in non-smokers and women.
    • Squamous Cell Carcinoma: Arising in the squamous cells lining the bronchial tubes, this subtype is often linked to smoking.
    • Large Cell Carcinoma: This is a less common subtype and tends to grow and spread quickly as it can spread in any part of the organ.

Small Cell Lung Cancer (SCLC)

  • Characteristics: Small-cell lung cancer is characterised by small, round cells that grow rapidly and have the potential to metastasize early in the disease.
  • Aggressiveness: SCLC is known for its aggressive nature, and it is often diagnosed at an advanced stage.
  • Association with Smoking: Almost all cases of SCLC are associated with a history of smoking, either current or past.
  • Treatment Approach: SCLC is typically treated with a combination of chemotherapy and radiation therapy. Surgical removal is less common due to the tendency of SCLC to spread quickly.

The choice of treatment depends on factors such as the type and stage of lung cancer, the patient’s overall health, and whether the cancer has spread to other parts of the body. It’s important to note that within NSCLC, the specific subtype (adenocarcinoma, squamous cell carcinoma, or large cell carcinoma) can influence treatment decisions. Additionally, advancements in molecular and genetic testing have led to the identification of specific mutations and biomarkers that can further guide targeted therapies for certain types of lung cancer, contributing to more personalised and effective treatment strategies.

Symptoms

Lung cancer symptoms can be subtle in the early stages, making it challenging to detect. However, as the disease progressed the symptoms became apparent and more commonly noticeable. Common signs include persistent cough, chest pain, shortness of breath, hoarseness, weight loss, and recurring respiratory infections. When the symptoms prompt and you recognize them more commonly seek medical attention as it might help with early diagnosis.

Diagnosis

To develop an effective treatment the doctor will require an accurate diagnosis. Diagnostic methods include imaging tests (X-rays, CT scans), biopsy, and bronchoscopy. Early detection significantly improves the chances of successful treatment and increases survival rates.

Treatment Options

The treatment of lung cancer is complex and varies based on several factors, including the type and stage of the cancer, the patient’s overall health, and individual preferences. Here, we’ll delve into the primary treatment modalities for lung cancer:

Surgery

During surgery, the tumour and surrounding tissue are removed. The kind and stage of the cancer determine how much surgery is required.

  • Applicability: Surgery is often most effective for early-stage lung cancer when the tumour is localised.
  • Types:
    • Lobectomy: Removal of the entire lobe of the lung.
    • Segmentectomy: Removal of the infected portion of the lung.
    • Wedge resection: Removal of a small section of the lung containing the tumour.
  • Considerations: Surgery may not be suitable for advanced stages or certain health conditions.

Chemotherapy

Chemotherapy involves the use of drugs to kill or slow the growth of cancer cells throughout the body.

  • Applicability: Used in various stages of lung cancer, often in combination with other treatments.
  • Administration: Chemotherapy can be given orally or through intravenous infusion.
  • Considerations: While effective, chemotherapy can have side effects, including nausea, fatigue, hair loss, and an increased susceptibility to infections.

Radiation Therapy

Radiation therapy as the name suggests uses high doses of electromagnetic waves to target and destroy developing cancer cells.

  • Applicability: Can be used as a standalone treatment or in conjunction with surgery or chemotherapy.
  • Types:
    • External Beam Radiation: Radiation is directed at the cancer from outside the body.
    • Internal Radiation (Brachytherapy): Radioactive material is placed directly into or near the tumour.
  • Considerations: Side effects may include fatigue, skin changes, and irritation of the oesophagus.

Immunotherapy:

Immunotherapy helps revamp the body’s immune system to protect, recognize and attack cancer cells.

  • Applicability: Particularly effective for certain types of non-small cell lung cancer (NSCLC) that express specific markers.
  • Types:
    • Checkpoint Inhibitors: Block proteins that prevent immune cells from attacking cancer cells.
    • CAR T-cell Therapy: Genetically modifies a patient’s T cells to target cancer cells.
  • Considerations: Immunotherapy can lead to long-lasting responses and has shown promising results.

Targeted Therapies:

Targeted therapies focus primarily on particular molecules involved in cancer growth.

  • Applicability: Primarily used for advanced-stage NSCLC with specific genetic mutations.
  • Types:
    • EGFR Inhibitors: Target mutations in the epidermal growth factor receptor.
    • ALK Inhibitors: Target mutations in the anaplastic lymphoma kinase gene.
  • Considerations: Targeted therapies often have fewer side effects compared to traditional chemotherapy.

Clinical Trials

Clinical trials involve testing new treatments or combinations of existing treatments to evaluate their effectiveness.

  • Applicability: Patients may consider clinical trials, especially if standard treatments are not yielding desired results.
  • Considerations: Participation in clinical trials can provide access to cutting-edge treatments, but potential risks and benefits should be carefully weighed.

Patients must work closely with their healthcare team to determine the most appropriate treatment plan based on their specific diagnosis and circumstances. Additionally, ongoing advancements in research and personalised medicine continue to shape the landscape of lung cancer treatment, offering new hope for improved outcomes.

Prevention and Early Detection

While certain risk factors, such as genetics, cannot be modified, adopting a proactive approach can significantly reduce the likelihood of developing lung cancer. Key prevention strategies include smoking cessation, minimising exposure to environmental carcinogens, and routine health check-ups.

Sum Up

Lung cancer remains a formidable health challenge, but advancements in research and medical technologies provide hope for improved outcomes. Increased awareness, early detection, and lifestyle modifications can collectively contribute to a reduction in the incidence and impact of this disease. By unravelling the mysteries surrounding lung cancer, we empower ourselves to confront it head-on, fostering a future where its shadows no longer loom so ominously. 

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Pregnancy-Associated Breast Cancer Diagnosis and Treatment

The second most typical malignancy that affects pregnancy is breast cancer. Breast cancer discovered during pregnancy or the first postpartum year is referred to as pregnancy-associated breast cancer (PABC). Your treatment options may be more difficult if you are diagnosed with breast cancer while expecting a child since you will want to seek the finest care possible for your illness while also safeguarding the unborn child. Your cancer care team and your obstetrician will have to meticulously prepare and coordinate the type and timing of therapy.

The goal of treating a pregnant woman with breast cancer is the same as treating a non-pregnant woman: to cure the cancer whenever possible, or, if that is not possible, to control it and prevent it from spreading. However, the added concern of safeguarding a developing foetus may make treatment more challenging.

Few studies address the optimal management and therapy options for PABC because it is a very uncommon event complicated by many characteristics. Together, let’s investigate the therapies.

Can A Woman Get Breast Cancer During Pregnancy?

Although it is uncommon because the breast cancer is unrelated to the pregnancy, it is possible to receive a breast cancer diagnosis while you are pregnant. Because they are worried about the well-being of their unborn child, women who receive a breast cancer diagnosis while pregnant are under a great deal of added stress. Despite the fact that the situation might be traumatising and incredibly challenging, there is still hope for both mother and child because of the many therapy choices available.

If you have been given a diagnosis of cancer and are pregnant, it never hurts to confirm that your oncology team and the members of your obstetric care team are in regular touch with one another. Your medical team will carefully develop a treatment plan to manage breast cancer while protecting your unborn child.

How Is It Diagnosed?

Visiting your doctor frequently is the finest thing you can do while pregnant. Prenatal (or “before birth”) checkups are what these appointments are known as, and they’re essential for maintaining the greatest possible health for both you and your unborn child. You might get breast exams to look for changes during some of these visits.

Although mammography is generally considered safe during pregnancy, because of the increased density of the breasts, it might not be as beneficial. A three-dimensional mammography may be preferable.

Your physician should do a biopsy if a suspicious lump is discovered. They will use a needle or a small cut to retrieve a small sample of the questionable tissue. To screen for any cancer cells, the sample tissue is examined under a microscope and using other techniques. Additionally, your doctor might do an ultrasound on you to determine the severity of any disease and to direct the biopsy.

Breast Cancer Treatment During Pregnancy?

Get professional advice and make sure you are aware of all your options if you are pregnant and have breast cancer because you may have to make difficult decisions. Although the timing and type of treatment may be impacted by pregnancy, pregnant women can safely receive treatment for breast cancer. Your recommended course of treatment if you have breast cancer and are pregnant depends on:

  • The tumour’s dimensions
  • The place where the tumour is
  • How far has the cancer spread
  • How far along in your pregnancy you are
  • Your general well-being
  • What you prefer

Surgery for breast cancer while you are pregnant is generally safe. If administered during the second or third trimester of pregnancy, chemotherapy appears to be safe for the unborn child, but not during the first. Other breast cancer therapies like radiation therapy, targeted therapy, and hormone therapy are less common during pregnancy because they pose a greater risk to the developing foetus.

The best-known course of treatment for the mother may conflict with the baby’s health, complicating treatment decisions. For instance, a woman might be counselled to consider terminating the pregnancy if she is diagnosed with breast cancer early in her pregnancy and requires immediate chemotherapy. Your healthcare team should also include a counsellor or psychologist to help provide you with any necessary emotional support.

As previously noted, the size, spot, and span of your pregnancy will all affect your treatment approach. Surgery is typically the initial step in treating early-stage breast cancer in women who are not pregnant. Your medical team will likely proceed with a lumpectomy or mastectomy and potentially some lymph nodes from beneath your arm because surgery can be safely done during pregnancy with little harm to your unborn child.

Depending on the type of cancer you have and the stage of your pregnancy, chemotherapy may be an option for treatment. Chemotherapy can be administered during certain windows of time during pregnancy without endangering the unborn child.

Radiation cannot harm an unborn kid, thus if it is advised, it is always administered after the baby is born.

It is unclear exactly how hormone therapy affects unborn children. Because of this, hormone therapy will probably only be given after the baby is born if it is prescribed.

Can A Mother Breastfeed During Breast Cancer?

No proof stopping your breast milk production would help your cancer. When you have this disease, it’s frequently good to breastfeed, but check with your doctor or a lactation consultant to determine what’s best for you and your baby. It is probably best to stop breastfeeding if you are receiving chemotherapy as numerous potent chemotherapy medications can reach the infant through your milk.

Survival Rates For Breast Cancer?

It may be more difficult to detect, identify, and treat breast cancer while pregnant. According to the majority of research, breast cancer patients who are pregnant or not and are diagnosed at the same stage often have similar outcomes.

For some women with advanced breast cancer, some doctors may advise terminating the pregnancy because they think it might delay the progression of the disease. Research in this field is challenging because there aren’t any high-quality, unbiased studies. Pregnancy termination simplifies therapy, but there is now no proof that it enhances a woman’s overall survival or cancer prognosis.

Studies have not demonstrated that treatment delays—which may be necessary during pregnancy—had an impact on the course of breast cancer. However, research on this subject as well has proven to be challenging. Furthermore, there is no evidence that breast cancer can harm an unborn child. If you are battling this malignancy visit us at RRMCH and get your treatment started.

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Weight Loss After 50 Years Of Age Reduces Breast Cancer Risk

Breast cancer is one of the most common cancers amongst women in India and worldwide. A recent study about women who lost weight at 50 and maintained a healthy weight thereon showed a decreased risk of breast cancer as compared to women with more weight. This study is therefore a way to help women work around prevention of cancer.

Breast Cancer Risk

The study is published in the Journal of the National Cancer Institute. In USA over two third of the adult women are overweight or obese. The study was carried out by the researchers at the American Cancer Society, Harvard T. H. Chan School of Public Health using the Pooling Project of Prospective Studies of Diet and Cancer (DCPP) in order to determine the connection between sustained loss of weight after menopause or later adulthood and the risk of breast cancer.

The study involved over 180,000 women over 50 years of age across 10 studies. The sample size is huge and this analysis is the first to assess the breast cancer risk impact over sustained weight loss. The study did examine weight three times across 10 years period viz. at the time of enrollment, post five years and again four years thereafter.

The results showed that women who were able to reduce more weight in later adulthood and sustained it were able to lower the risk of breast cancer. The women who were able to shed around 9 kg’s of weight and then game some of it but not all did show a significant reduction in breast cancer risk.

The lead author of the study Lauren Teras, PhD says ‘These findings may be a strong motivator for the two thirds of American women who are overweight to lose some of that weight. Even if you gain weight after age 50, it is not too late to lower your risk of breast cancer”.

*Sourced from Internet

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Hodgkin Lymphoma – A Sneak Peek

One of the common cancers across the world, Hodgkin Lymphoma affects the lymphatic system of the body. The cancer causes the cells in the lymphatic systems grow uncontrollably and spread across the body. There are mainly two types of lymphoma cancers, Hodgkin Lymphoma (HL) and the other Non-Hodgkin Lymphoma (NHL). The latter is much more common as compared to the first one. The treatment is different for both and hence it’s vital to know what kind of lymphoma you suffer from.

Hodgkin’s Lymphoma usually occurs around 20 to 40 years of age of after 55. The risk factors for this condition include a family history with the condition and a history of Epstein Barr infection. The condition is most common in between 15 and 30 year olds and particularly males.

The diagnosis requires a physical examination and blood tests, imaging tests or biopsy if lymph node as well as bone marrow if needed. The treatment is based on the diagnosis and the stage of cancer. The Hodgkin’s lymphoma has four stages of cancers.

Cancer Stages

Stage 1 – It’s the preliminary stage of cancer when it is limited to the single organ or lymph node only.

Stage 2 – If the cancer has spread through other lymph nodes and another nearby organ as well, it is stage 2.

Stage 3 – Stage 3 cancer is when the cancer spreads to lymph nodes both above and below the diaphragm.

Stage 4 – Known to be the most advanced stage of Hodgkin’s lymphoma, Stage IV is when the cancer is spread through lymph nodes as well as other parts of the body like lungs, bones and liver.

If diagnosed at an early stage the cancer can be cured to a great extent and even the life expectancy levels increase. Though, accurate diagnosis is the key and it requires an expert pathologist to do so because there have been a lot of cases of misdiagnosis based on biopsy tests due to lack of experience. So, a good idea is to take second opinion even if it is diagnosed.

Treatment

Based on the diagnosis, the treatment involves chemotherapy sessions that uses chemicals to treat the affected cells. Post the chemotherapy, radiation therapy is carried out. At times they are done in combination. While chemotherapy can be done using pill or even through veins, radiation therapy involves usage of high energy rays like protons and X-rays to kill the cancer causing cells. The therapy is spread over several weeks and is carried out daily for half an hour period. Another option that could work is bone marrow transplant but there is a possibility of underlying infection risk. Targeted therapy is another kind of treatment that focuses on targeting specific cells and immunotherapy works in activating your immune system to fight these cancer cells. If these treatment are of no use then genetic mutations is another way that involves using drugs that target specific mutations of the lymphoma cells. Targeted therapy is the latest in cancer treatment options and is under research.

*Sourced from the Internet

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Ductal Carcinoma in Situ (DCIS) & Mastectomy

In India Breast Cancer is the top occurring cancer amongst females with a mortality rate of 12.7 per 1,00,000. A non-invasive form of breast cancer, Ductal carcinoma in situ (DCIS) is a common form of cancer in India. Ductal means ducts as its starts in the milk ducts and carcinoma means cancer that starts in the skin or any other tissues covering the internal organs and in situ means in its original place. The reason this cancer is known as non- invasive cancer is that is has not spread beyond the milk duct to the neighboring tissues.

DCIS is a grade 0 cancer and is not a life threatening cancer but having it in first place does increase the risk of developing an invasive breast cancer later on compared to people who haven’t had it before. The possibility of recurrence is usually 5 or 10 years post the first appearance with a 30% likelihood.

Ductal carcinoma in situ (DCIS)

The possibility of recurrence in women undergoing the breast conserving surgery is around 25% to 30% . To lower the risk of recurrence by 15% you need to include radiation therapy in the treatment plan. Also, if DCIS comes back after treatment it could either be non-invasive or invasive too, chances are 50% for each.

Here’s a look through the symptoms, causes, diagnosis and treatment of the condition.

DICS – Symptoms
Generally there are no visible symptoms of DCIS. Only a few people might have a lump in the breast or some nipple discharge. Diagnosis is only possible for most of the cases through mammography.

DICS – Diagnosis
Breast Examination – A physical examination of breasts is carried out if a lump is present though such lump is rarely noticeable.

Mammography – A mammography can easily detect DCIS. Even when a physical examination fails, mammography can be used to detect DCIS.

Biopsy – Biopsy is only carried out when a mammogram does not give a clear result. There are two kinds of non-invasive biopsies which involve a bit of surgery.

  •  Core needle biopsy – A large needle is inserted for a big sample of tissue from the suspicious area.
  •  Fine needle biopsy – A sample of cells are obtained by inserting a small hollow needle in the breast and then examining it under the microscope.

Though more invasive biopsies are rarely need for DCIS, if the above are not able to give conclusive results then biopsies like incisional and excisional biopsy’s are to be done.

Treatment – Once the diagnosis confirms DCIS, surgery is done to remove the cancer as well as the border of the healthy tissues surrounding the cancer, known as the clear margins. This means doing the procedure of lumpectomy or sometimes mastectomy.

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Cancer to Curd – The Journey of Ramadevi Nimmanapalli

Ramadevi Nimmanapalli, a cancer researcher by profession had been in the US till 2015. She returned to India leaving behind this career in order to take up another challenging opportunity of setting up a faculty of Veterinary and Animal Sciences at the Benaras Hindu University in Varanasi. She herself had done her Science Graduation from Sri Venkateswara Veterinary University in Hyderabad after which she did her Masters in Sciences, topping the University. She further went to Oxford to pursue PhD there.

Cancer to Curd

Describing her experience in Oxford England as a rather challenging one even though she was a topper, she mentioned that the education system in India and England was different. Catching up was quite a task because Indian education courses do not offer in-depth study as compared to Oxford. So, she had to work really hard with her research in microbiology in bluetongue virus that affects deers and cattle as well. After completing her Phd. She shifted to USA where she researched in areas of human cancer and chemical pathways for drug Gleevac. Before returning to India she was teaching at the Philadelphia college of Osteopathic Medicine and MD Anderson Cancer centre, Tuskagee University.

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Though shifting to India was also not an easy decision for her as she was already married and living there with her husband, it’s when her husband supported the decision to take the decision to go to Indi without him joining her right away, after she moved here.

Now, in India, as the Dean at the Benaras University, she is all set to revive the faculty which already has a dairy farm on its main campus besides a research ready campus that is being setup in Mirzapur for MSc and Doctoral students, which is nearby. She is working hard to set up this new faculty and her straight forward attitude which she brought along as a learning from her USA lifestyle has been of a great aid. She has already published around 40 research papers but the one that stands out is about dealing and characterization of curd or dahi. Though the founding dean of the faculty has not had any admissions, later this year, the faculty is going to welcome its first batch of undergraduate students. The team is ready, the labs are set and the preparations are on to take the plunge. Though a lot of preparations are underway as well, as per the Dean, it’s a long way to go.

*source from the internet