How Does the Treatment for Lung Cancer Vary from Person to Person?

Dr. Rajeev VijayakumarConsultant - Medical Oncologist, Hemato-Oncologist & BMT PhysicianGleneagles Global HospitalsRajeev Vijayakumar is a Consultant - Medical Oncologist, Hemato-Oncologist & BMT Physician with 11 years of experience in this field. He has completed his MBBS from Kempegowda Institute of Medical Sciences (KIMS).

Lung cancer has been witnessed as one of the most common causes of death in India and across the world. Earlier it was believed that smoking was the key risk factor for lung cancer, but doctors and healthcare experts have tried to create awareness of the various other factors that can cause lung disease. Apart from smoking tobacco, both cigarettes and beedis, other causes such as passive smoking, pollution and hazardous work environment that allow exposure to items like asbestos, mica, coal and bauxite mining also affect the health of the lungs.

Lung cancer is a condition in which the cells in the lungs divide uncontrollably. As more cancer cells develop, there is a high risk in the growth of tumor in the body, reducing the person’s ability to breathe normally. Lung cancer like other cancers is treated depending on the stage of disease. Those who are diagnosed in the early stage are curable, but unfortunately it is not easy to detect. Most of the time people are diagnosed at a later stage when the disease has spread outside the chest. Lungs are considered to be very sensitive organs thatmay not be able to withstand intense cancer treatment. Patients are treated based on the stages of cancer, but it also varies from person to person and the condition of the disease. Some treatments are used to control the cancer and others are used to improve the quality of life.

Today, doctors typically diagnose for two types of lung cancer, small cell and non-small cell, depending on how they appear under a microscope. It is believed that 80– 85 percent of the cases are non-small cell lung cancer. NSCLC (Non-Small Cell Lung Cancer) has a slightly better prognosis than small cell cancer. SCLC (Small Cell Lung Cancer) is comparatively less common than NSCLC. It is considered more aggressive form of lung cancer and grows quickly to other parts of the body. Most of the time, this condition is detected at the later stage, causing difficult to recover.

An active lifestyle, quitting tobacco, avoiding passive smoking and regular exercise will keep cancer at bay and give us a long healthy life

However, if detected early, it can be treated effectively before the cancer gets into the advance stage. Identifying lung cancer in its early stage can be difficult, but if the doctor detects the exact stage and recognize the nature of the disease it can become less life-threatening. It is essential to recognize the symptoms and find the most effective and quickest treatment method; though this may vary from person to person. Some of the common symptoms are appetite loss, frequent chest infection, lingering cough, shortness of breath, unexplained headache, weight loss, wheezing, and many others. Some even experience severe chest pain, bone pain and coughing of blood.

The staging of lung cancer indicates on how far it has spread throughout the body. It can be extremely complex and extensive or mild, for instance, doctors typically stage non-small cell lung cancer using the tumor size and decide the treatment accordingly. In Stage 1 & Stage 2 of lung cancer, the tumor is likely to have developed in the lung and would be less than five centimeter and it may or may not have spread to other parts of the body. Doctors prescribe to undergo surgery, followed with chemotherapy, if needed. In Stage 3, the cancer spreads to the lymph nodes and reaches other parts of the lung for which doctor’s recommends treatment with combined chemotherapy and radiation therapy. For Stage 4 & Stage 5, the cancer spreads to other parts of the body for which doctors treat primarily with chemotherapy or targeted agents.

Today, five-year survival rate for lung cancer is 56 percent for cases detected when the disease is still localized (Stages 1, 2 & 3). However, only 16 percent of lung cancer cases are diagnosed at an early stage. If the tumors have spread to other organs, the five-year survival rate is only five percent. Around two decades ago, there was a simple classification of lung cancers and similar treatments were being offered to almost all patients. However, today doctors and healthcare experts found that not all patients respond equally or predictably. With this research question in mind, doctors embarked on the process of further identifying the genetic factors for the same. The EGFR mutation in lung cancer and the therapeutic benefit of a tablet Gefitinib was discovered in early 2000, which helped in treating certain subtype of cancers with oral tablets. Rapidly, over the next few years, other magic bullets for lung cancer were found, ALK Translocation (mutation), ROS1 mutation, MET, KRAS, along with other barrage of mutations were identified to treat patients.

Presently, in around 30 percent of nonsmokers suffering from a subtype called ‘adenocarcinoma lung,’ oral-targeted agents are used, and are doing away with chemotherapy. Some patients now continue to maintain their normal lifestyle and just pop in a pill daily. What was once considered a death knell for many patients has now been converted into a chronic disease like diabetes and hypertension. The pills one takes would act for a few months to years, followed by another pill and so on. Our patients now back to enjoying life like never before, know well that the cancer is just a part of their life and not the center of their life anymore. With the Advent of immunotherapies, the treatment landscape has further grown to offer a small but possible chance of cure even in Stage 4 lung cancers. Science is helping us conquer cancer and newer drugs are helping us to do so. An active lifestyle, quitting tobacco, avoiding passive smoking and regular exercise will keep cancer at bay and give us a long healthy life.