What is it and how frequent is it?
Lung cancer is a very serious disease that affects an organ that is vital to our body.
Epidemiology
Overall, it represents 11% of all cancers diagnosed.
In our country alone, there are about 33,000 deaths from lung / bronchial and tracheal cancer per year, of which about 25,000 cases involve males.
Risk factors
Cigarette smoke
The main culprit is smoking, guilty of 85-90% of all new cases of lung cancer observed in Western countries.
The risk increases with the quantity of cigarettes smoked and with the duration of the smoking habit.
- The relative risk of smokers compared to non-smokers increased approximately 14-fold and further increased up to 20-fold in heavy smokers (over 20 cigarettes per day).
- Stopping cigarette smoking produces a large reduction in risk.
The "smoking habit is constantly increasing among women, while since the end of the 80s there has been a slow regression in the number of male smokers. Currently about 1/3 of men smoke while among women the number of smokers is around 20%, a much higher percentage than in past decades.
This data is in clear relation to the continuous increase of the cases of lung cancer registered in the female sex. At the base of this increase there could also be a greater predisposition of the female organism to the carcinogenic effect of cigarette smoke.
The reduction in the number of male smokers in the last twenty years has instead been accompanied by a clear reversal of the trend, with a decrease in the number of men affected by lung cancer.
Epidemiological studies have also shown a higher incidence of lung cancer among disadvantaged social groups. The low socio-economic condition is in fact correlated with a greater exposure to tobacco smoke and, to a lesser extent, to environmental pollutants and infectious agents (eg tuberculosis).
However, the main culprit remains smoking, as a result of which about 1/3 of smokers die. Of these, just over half died of lung cancer. The relative risk is strictly correlated to the number of cigarettes smoked, the duration in years of the smoking habit, the tar content of the cigarettes smoked and the presence or absence of the filter.
- For a smoker, the chances of getting lung cancer are 14 times higher than for a non-smoker. For heavy smokers (> 20 cigarettes / day) this probability rises up to 20 times higher. The risk is therefore dose dependent (it "only" increases three times if you smoke 5 cigarettes a day)
- The earlier you start smoking, the greater the risk of developing lung cancer and other respiratory diseases. On the contrary, the sooner you quit, the lower these chances will be.
- Respiratory function improves rather quickly after quitting smoking. The acquired cardiovascular risk vanishes in about a couple of years from the cessation.
However, in former smokers the increased risk of developing lung cancer is eliminated only after 10-15 years of quitting smoking (cumulative risk). Only after this period of time are the chances of getting sick identical to those of a person who does not. has ever smoked Despite having such long reduction times, the oncological risk begins to diminish, albeit slightly, immediately after cessation. - For former smokers, the risk of lung cancer is on average 11.2 times higher than for non-smokers.
SOME DATA
The number of deaths due to lung cancer has risen from "1% of deaths at the beginning of the last century, to the current 10%. Similarly, the relative frequency compared to other cancers, has increased from 3-5% before the World War II to the current 11%. It is estimated that currently, in the course of life:
- 1 in 9 men and 1 in 37 women may develop lung cancer;
- one out of every 10 men and one out of 47 women would run the risk of dying from lung cancer
- Lung cancer is the leading cause of cancer death in males (27% of total deaths) and the third leading cause in women, after breast and colorectal cancer (11% of total deaths).
SURVIVAL
The survival of lung cancer patients has increased over the past 20 years, but to a negligible extent.
- The percentage of 5-year survivors among lung cancer patients moderately increased between the early 1990s and the end of the first decade of 2000, rising from 10 to 14% in males and from 12 to 18% in females.
Although the therapeutic techniques have undergone notable improvements in the majority of cases the disease is still diagnosed in an advanced stage, leaving little chance for the patient.
NOTE: Although the incidence of lung cancer in men decreases, the total number of cases increases due to the aging of the population, the increase in the number of women smokers and the improvement in patient survival.
Symptoms
For further information: Lung cancer symptoms
Lung cancer is a subtle disease that in many cases does not show signs of itself until it reaches an advanced stage. In the presence of these symptoms, fortunately not always indicative of a lung tumor, do not hesitate to contact your doctor for tests, even very simple ones such as a chest X-ray:
- chronic cough that becomes particularly insistent or changes its characteristics (intensity, duration and consistency of the sputum)
- breathing difficulties (dyspnea) even for not particularly intense efforts (walking briskly, climbing stairs)
- chest pain
- traces of blood in the sputum (haemophtoe)
- passing a large amount of blood from the mouth (hemoptysis)
However, these symptoms vary in relation to the type and location of lung cancer development. In 6% of cases the carcinoma is completely asymptomatic. Other times these symptoms are associated with: fever, asthenia (weakness), weight loss, shoulder or upper limb pain, slow-resolving pneumonia or recurrent pneumonia, dysphonia and dysphagia (painful swallowing).
Risk factors
- Tobacco smoke
- Passive smoking (not only in the home but also in the workplace and in public environments)
- Genetic factors and family heredity (not quantifiable): an "increased incidence in family members of lung cancer patients with specific genetic abnormalities was observed
- Occupational factors
- Environmental pollution
- Age (50-60 years in the highest risk group)
- Bronchopulmonary disorders such as COPD, TB outcomes, silicosis, sarcoidosis, idiopathic pulmonary fibrosis, scleroderma, bronchiectasis, anthracosis
The role of ENVIRONMENTAL POLLUTION in tumor development is negligible after all. It is estimated that the impact of environmental factors on the onset of lung cancer is only around 1-1.5% of all cases.
In Lombardy, for example, more men living outside the large urban centers and more women living inside are ill with lung cancer.
Environmental pollution, on the other hand, can cause other respiratory diseases such as asthma and chronic bronchitis.
More attention should instead be paid to "professional exposure:
- the incidence of lung cancer increases by 8 times in workers in close contact with tar, pitch, soot, raw paraffins, lubricating oils
- In smokers exposed to asbestos, the incidence of lung cancer is 80-90 times higher than that of non-smokers not exposed
- Particularly at risk are workers who work closely with radioactive materials
- Other dangerous chemical agents are arsenic, chromium, nickel, cadmium, silica, radon and fossil fuels.
In many cases, smoking tends to increase the carcinogenic potential of these elements, proving once again the number one enemy of our lungs. The sharp decrease in lung cancer cases in young males confirms the importance of smoking prevention campaigns in our country.
Diet and lung cancer
A diet rich in fruit and vegetables provides the body with all the vitamins, fibers and minerals it needs.
According to an authoritative study, smokers tend to consume lower amounts of vitamin C than non-smokers. To aggravate the situation is also added the reduction in vitamin C levels caused by smoking regardless of the quantities consumed with the diet.
To prevent lung cancer it is therefore very important to take the right doses of vitamin C (at least 60 mg / day, although to fully appreciate its antioxidant effects, much higher doses are recommended, in the order of 200 mg / day).
Other natural antioxidants necessary to counteract the free radicals produced by tobacco smoke are: vitamins A, C, E, selenium, carotenoids, lycopene, coenzyme Q-10 and lipoic acid. All these substances are naturally contained in most of the foods of plant origin (fruit and vegetables). Unfortunately, the administration of these substances in high doses through specific supplements has not shown appreciable benefits in reducing the incidence of lung cancer in smokers; indeed, in some cases (see the case of vitamin A), always among smokers, it seems even increase the risk.
It is also important for a smoker not to abuse polyunsaturated fatty acid supplements, which tend to produce free radicals and aggravate the negative effects of smoking. However, it must be considered that most of these harmful effects are neutralized by the presence of tocopherol, a vitamin naturally contained in vegetable oils and added to many polyunsaturated fatty acid supplements. In addition to these potentially harmful effects, there are other particularly beneficial effects as they are useful in preventing cardiovascular diseases.
Prevention and diagnosis
The only effective primary prevention action to reduce the incidence of lung cancer is the abolition of tobacco smoke.
Given that people over the age of 55 who quit smoking have a persistent increased risk of lung cancer, it is very important to implement the right secondary prevention rules.
In fact, prevention and early diagnosis can make a difference by enabling timely treatment of lung cancer.
Perfect recovery from lung cancer is all the more likely the earlier the anticancer therapy can be implemented
X-ray and CT scan
As far as screening or early diagnosis of lung cancer is concerned, the most useful examination is an x-ray, which must in any case be completed with a CT scan. X-ray may not be able to identify small nodules or located in areas of the lung that are difficult to explore. The CT scan can also show small pulmonary nodules (greater than 5-6 mm) reaching where traditional radiography cannot.
A development of this diagnostic technique has allowed the development of the spiral or helical CT scan that allows the rapid acquisition of rather clear images and not very sensitive to cardiac and respiratory movements. It also does not require contrast injection into a vein and exposes the patient to a low dose of radiation.
Particularly useful in the diagnosis of lung cancer is the comparison with any radiograms previously carried out.
Bronchoscopy
Bronchoscopy allows you to directly view the state of health of the bronchi thanks to the help of optical fibers. In the event of alterations such as to suggest the presence of a lung tumor during the examination, a small sample of tissue can be taken on the which to perform the histological examination.
To these diagnostic investigations is often added the "sputum test" in which the presence of any tumor markers is sought.
Other instrumental tests
OTHER EXAMINATIONS useful for the diagnosis of lung cancer are: positron emission tomography (PET), transthoracic fine needle biopsy, mediastinoscopy, magnetic resonance.
Several studies are currently underway also in our country to establish the effective preventive efficacy of screening programs which, albeit with some mole, have already proved particularly useful in reducing the incidence of other cancers such as breast cancer or breast cancer. neck of the uterus.
The major obstacles to the implementation of such a large-scale program derive from the aggressiveness of lung cancer and the very large costs that should be incurred to examine the one and a half million Italians at risk.
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