We’re in the business of blogging about respiratory health, and perhaps the most widely known deadly disease to affect our airways is lung cancer.
Cambridge Mask reached out to a Macmillan Cancer nurse for more details on the disease, the treatments available, and how to keep oneself or family members whole during a lung cancer diagnosis.
According to the World Health Association, lung cancer accounts for 1.69 million deaths globally each year (2018) and is the leading cause of cancer deaths.
Smoking and tobacco use is responsible for the death of approximately 7 million people every year globally, the highest majority from direct tobacco use and more than 890,000 deaths from exposure to second-hand smoke. Globally cigarette smoking is by itself responsible for over 80 percent of all lung cancer cases. However, with pollution levels on the rise, many non-smokers are contracting the disease due to poor quality air environments.
What is lung cancer?
Lung cancer is when abnormal cells divide in an uncontrolled way to form a tumor in the lung. The main symptoms are coughing, breathlessness, and weight loss. Examination makes a diagnosis possible. First, a spirometer measures how much air is breathed in and out.
Doctors may then order blood tests, chest x-rays, and a CT scan which creates detailed images of the body. PET – CT scans are also an option which can show active cancer cells. Bronchoscopies and biopsies are used to examine the lungs and take a sample of cells for microscopic examination. Small surgical procedures may even be used to take samples from the lungs by the use of needle biopsy and thoracoscopy with a tube and surgical camera.
Is there more than one kind of lung cancer?
Treatment depends on the type of cancer and the current state of general health. With information, support and good nutrition the whole person can be helped to deal with the situation rather than just treating a disease in the body.
There are different types of lung cancer, and they are divided into two main groups, small cell lung cancer, (SCLC) and non-small cell lung cancer, (NSCLC).
Smoking usually causes small cell lung cancers. These spread quite early on. This form of cancer is very rarely found in non-smokers.
Non-small cell lung cancer makes up 87 percent of diagnosis in the United Kingdom and globally.
These are further divided into three common types, adenocarcinoma, squamous cell cancer, and large cell carcinoma:
- Adenocarcinoma, this is the most common type and begins in the mucous making cells in the lining of the airways.
- Squamous cell, this type develops in the flat cells covering the surface of the airways and tends to grow near the centre of the lung. Smoking or poor quality air usually cause it.
- Large cell carcinoma, these appear large and round under the microscope.
Treatments are dependent on the type, and stage of the lung cancer diagnosed and current general health. Generally, these would be, chemotherapy, radiotherapy, surgery, as the more common approaches.
Research has enabled further treatments of laser therapy, microwave ablation, chemoradiotherapy, radiofrequency ablation, diathermy, and photodynamic therapy. Treatments are generally discussed as a multidisciplinary approach with doctors and other health professionals. The final decision rests with the patient following professional medical recommendations.
What are the main treatments for lung cancer?
- Chemotherapy is the use of anticancer drugs, ( cytotoxic) drugs to destroy cancer cells. Generally, it is given by an infusion into the bloodstream. Sometimes my mouth as a medicine or pill. It works by stopping cancer cells from reproducing and can also affect healthy cells causing some side effects of sickness, fatigue or infection. The healthy cells usually recover, but the cancer cells eventually die. Close monitoring of the procedure takes place in a day unit or hospital.
- Radiotherapy uses high energy x-rays to destroy cancer cells. It can also be used to relieve symptoms when a cure is no longer possible. Radiotherapy is given in a hospital specialised radiotherapy department and is closely monitored. Side effects may include, nausea, flu-like symptoms, fatigue, hair loss, changes in blood, skin reactions and problems with eating and drinking. Most side effects last for about 10 to 15 days after treatment finishes.
- Surgery involves removing all or part of the cancer with an operation and is generally all that may be required and sometimes follow up radiotherapy is advised depending on the cancer.
How to manage the symptoms and keep a sense of yourself in a lung cancer diagnosis.
Whatever type or stage of lung cancer a person is diagnosed with, the most significant part of the diagnosis alongside treatment is learning to live with the disease. In the first instance, an individual approach is always going to be the most effective. Everyone responds in their own way and is dependent on what stage the cancer is at and the treatment available. Culture and ethnicity, religious beliefs and experience can all impact on affecting daily life with lung cancer diagnosis.
Talking through a range of emotions and sharing thoughts and feelings may help some people in dealing with a lung cancer diagnosis. There is no right way to feel, and some close family members may also feel similar emotions. Health care professionals can help with this. There may be local support groups in the area and some hospitals have cancer advice centres which are invaluable.
In the UK there are more than 900 independent cancer support groups and organisations. Macmillan Cancer supports these in the UK and provides specialist cancer nurses.
There are also online resources and support groups as well as phone support from many of these organisations. Having information to help to deal with the situation can help enormously with making decisions about care and treatment, and practical advice regarding money matters and benefits can stop issues building up. Worry about work and child care is much lessened once information and help are underway. Keeping a sense of yourself is a positive step in managing the situation.
The BIG C Cancer Support and Information is one such resource in the UK and specific to the city of Norwich in Norfolk. It is maintained by charitable donations and offers counselling, complementary therapies, relaxation, look good and feel better makeup and headwear sessions, nutrition workshops, carers club. It also provides a library, internet, and WI-Fi facilities and is fully accessible for everyone including an interpreter service. This is such a valuable resource for people to help with looking at how to deal with cancer issues and raise self-esteem.
Resting and taking care of the symptoms of fatigue are essential, with a balance of doing some low energy gentle physical exercise for well being if this is tolerated. Relaxation exercises can be beneficial too.
Eating and diet can be made more difficult if there are problems with swallowing and blisters in the mouth. A dietician can help advise on the best ways to eat small soft high protein foods, frequently and high-calorie specialists drinks. Liquidising soft fruits into milkshakes and vegetables into a soup can help.
Depending on the treatment there may be a need to have intravenous nutrition and feeding tubes. Nausea is sometimes managed by eating cold foods which are low in fat and less odorous. Mouthwashes which are mild can help with the blistering and general daily mouth care.
Medical approaches to the physical symptoms of lung cancer may include dealing with persistent breathlessness. Drugs and breathing exercises can help along with a surgical stent to relieve pressure. If the breathlessness is caused by a build-up of fluid in the layers protecting the lungs, this can be drained off with a needle and attached to a tube into a drainage bag.
Pain can be managed with medications such as opioids, nonsteroidal anti-inflammatories, corticosteroids, and antidepressants. Nerve blocks can sometimes alleviate nerve pain, and radiotherapy can also be used to reduce the pressure of the cancer in another area.
Living with lung cancer is complex. Making the most of information and support to help deal with daily living can impact on treatment and help the whole person and not just be treated as a disease in isolation.