What Are the Symptoms of Lung Cancer?
Symptoms
Lung cancer in many cases remains asymptomatic in the early stages, in fact, sometimes the disease is diagnosed during tests carried out for other reasons. When present, the most common symptoms of lung cancer are a continuous cough that does not go away or even gets worse over time, hoarseness, blood in the phlegm, shortness of breath, chest pain that increases with a cough or deep breath, loss of weight and appetite, tiredness, respiratory infections (bronchitis or pneumonia) that are frequent or return after treatment.
Prevent
To prevent lung cancer the first and most important step is without a doubt to avoid smoking.
In the case of non-smokers, it is almost impossible to be able to completely escape secondhand smoke, but it is good practice to ask at every opportunity that the prohibitions imposed in public and workplaces are respected, especially in the presence of children.
As regards the risk factors related to the profession, it is important to always use all the protective measures in the workplace in order to minimize risks and work safely.
In everyday life, to prevent disease it is good to do regular physical exercise and introduce lots of fruit and vegetables into the diet, rich in vitamins and other elements that can help the lungs stay healthy.
Despite the numerous types of research in this sector, there is still no agreement among the experts on the advisability of subjecting apparently healthy people, without any symptoms or signs of disease, to " screening " (ie periodic examinations for the early diagnosis of the population). The reason is that simple diagnostic tests, such as chest X-rays or sputum cytology, do not always allow for the detection of any tumor, much less early.
Several studies of high-risk, heavy smokers with many years of smoking suggest that spiral computed tomography ( CT ) of the lungs could be useful in detecting small lung cancer in asymptomatic patients, saving years of life. However, these tests also have some risks: the lungs are very sensitive to radiation and frequent tests of this type could cause tissue damage. Furthermore, these tests can also detect lung alterations that appear to be but are not necessarily tumors: a result that requires a biopsy, or an invasive tissue sample, to be clarified which, in turn, carries, risks. Population-based lung screening can also lead to problems with overdiagnosis, i.e. detecting lung cancers that may never become life-threatening, but in such cases, patients would be receiving unnecessary lung.
Diagnosis
In the presence of suspicious symptoms, it is important to contact your general practitioner who, after a thorough examination in which he will evaluate all the signs and symptoms, will be able to prescribe further in-depth examinations such as a chest x-ray for example. Further investigations may include the use of CT and PET, but to arrive at a certain diagnosis it is necessary to carry out a biopsy - taking a fragment of tumor tissue - and the subsequent histological examination, ie the study of the fragment taken under a microscope. To get a more accurate picture of the situation, the doctor may prescribe bronchoscopy, with which it is possible to visualize the inside of the bronchi thanks to a thin tube inserted through the mouth, also useful for taking tissue samples surgery.
Evolution
Non-small cell lung cancers are classified into four stages of increasing severity, indicated by Roman numerals I through IV. For staging (the process that allows assigning a stage to the evolution of the disease) the so-called TNM system is used. The T parameter describes the size of the primary tumor (i.e. the one that manifested first if the disease has spread to other sites), the N parameter indicates the possible involvement of the lymph nodes and finally, the M parameter refers to the presence or absence of distant metastases.
How to cure
The therapeutic approach changes according to the patient's condition and stage, the molecular characteristics, and above all the histological type of the tumor.
Non-small cell cancer
In non-small cell cancer, surgery is the most common therapy of choice, unless distant metastases are already present. Since portions of the lung are removed with surgery, it is important to evaluate the patient's lung function before surgery, to be sure that there will be no breathing problems.
Radiotherapy is used alone or in combination with chemotherapy in cases where it is not possible to proceed with surgery, due to the characteristics of the tumor or the patient's state of health.
Pharmacological therapies are used in already operated patients at high risk of recurrence and with advanced-stage disease or who have developed metastases. Standard chemotherapy is cisplatin or carboplatin in combination with gemcitabine, etoposide, pemetrexed, docetaxel, paclitaxel, or vinorelbine. Radiation therapy and chemotherapy can be used before surgery (neoadjuvant therapy) to reduce the size of the tumor or after surgery (adjuvant therapy) to kill any remaining cancer cells.
Whenever possible, targeted therapies are used. Patients with mutations in the gene encoding EGFR, a growth factor receptor involved in cell proliferation, respond to tyrosine kinase inhibitors such as gefitinib, erlotinib, afatinib, and osimertinib. These mutations have been found in about 10-15 percent of patients diagnosed in Italy. A minority of patients (3-7 percent) who have an alteration in the gene encoding ALK, a protein that produces a growth stimulus for cells, respond to treatment with ALK inhibitors (crizotinib, alectinib, ceritinib, brigatinib, and lorlatinib). In non-squamous tumors, bevacizumab and nintedanib can also be used in combination with chemotherapy, drugs that block angiogenesis, i.e. the formation of new blood vessels.
The treatment of lung cancer has been partly revolutionized by immunotherapy. Immune checkpoint inhibitors interfere with a mechanism used by the tumor to stop immune cells from activating and stimulate the anti-tumor response. Monoclonal antibodies recognizing PD-1 (nivolumab, pembrolizumab) or PD-L1 (atezolizumab, durvalumab) proteins, alone or associated with chemotherapy, have become key drugs in the therapy of non-small cell cancer.
Finally, in specific cases, it is possible to resort to local treatments such as stereotactic radiotherapy, radiofrequency ablation (to destroy the tumor with heat), photodynamic therapy (a drug is injected which is then activated thanks to the light of a bronchoscope and destroys cancer cells) and laser therapy.
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