Lung Cancer: Care and Treatment

“Lung cancer

Types of Lung Cancer

Based on the appearance that cancer cells present to microscopic examination, two different types of lung cancer can be distinguished:

small cell lung cancer (microcytoma, oatmeal tumor) (18-20% of cases)
NON-small cell lung cancer (squamous or epidermoid carcinoma, adenocarcinoma and large cell carcinoma)

Specifically:

Squamous cell carcinoma: it is the most common type in men, it originates from the cells that line the respiratory tract; it represents about 30% of cases
Adenocarcinoma: develops from cells that secrete mucus; it is more common in women. In recent decades there has been a decrease in the number of cases of squamous cell carcinoma associated with a relative increase in adenocarcinomas, probably due to the increased incidence of lung cancer among women.
Large cell carcinoma: the name derives from the large rounded cells that show up on microscopic examination; it affects about 15% of patients

Another type of lung cancer is mesothelioma, a form that affects the pleura (a kind of double-layered sheet that lines the lungs and makes them adhere to the costal surface). The major risk factor for developing mesothelioma is exposure to asbestos.

Danger of various forms of cancer

Contrary to what one might think, the small cell form is significantly more dangerous than the large cell form. The microcytoma is in fact subject to rapid growth and is more likely to spread to other organs. Statistically, approximately 90% of patients with small cell tumors present with locally advanced or metastatic disease

Precisely because of this aggressiveness, in many cases it is completely useless to remove the portion containing the tumor mass (at the time of diagnosis the tumor cells are often disseminated in various organs); consequently chemotherapy - alone or in combination with radiotherapy - is the treatment of choice.

Small cell lung cancer responds very well to chemo and radiotherapy but despite this, the average survival is 14-18 months for the limited forms and 9-12 months for the extended forms.

The probability of surviving five years after diagnosis is low overall, in the order of 3-8% of cases.

Fortunately, this type of lung cancer is the less common of the two categories.

On the other hand, non-small cell lung cancers are more common (about 80% of cases) which are grouped into a single category due to their uniformity of characteristics and therapeutic needs.

Care and Treatment

For further information: Medicines for the treatment of Lung Cancer

Lung cancer therapy differs according to the characteristics of the cancer:

histological type (small cell or non-small cell)
presentation stage

In the case of small cell cancer, the standard approach involves subjecting the patient to cycles of chemo and radiotherapy. Surgery is rarely used.

Surgery, on the other hand, remains the most important weapon in the treatment of non-small cell lung cancer. Doctors classify these tumors on a scale consisting of 4 stages of increasing severity. Specific treatments are provided for each of these stages.

Stages I and II are candidates for radical surgery. Sometimes it is also necessary to perform chemotherapy before surgery (neoadjuvant chemotherapy) in order to reduce the size of the tumor.
Stage I A and I B survival at 5 aa. it is respectively 67% and 57% of cases.
Stage II A and II B survival at 5 aa. it is respectively 55% and 39% of cases.
This partial success of surgical therapy (risk of metastasis after some time after the operation) suggests the need to associate systemic (chemotherapy) and local (radiotherapy) "adjuvant" treatments to surgery.
Surgery is usually indicated for the treatment of stage III A lung tumors. Given the low probability of survival, the operation is often associated with or replaced by neoadjuvant (preoperative chemotherapy) and adjuvant (postoperative) therapy. The two therapeutic modalities (radiotherapy and chemotherapy) can be concomitant or performed in sequence. Survival at 5 yrs. it is 23% of cases.
The stages III B and IV (metastatic stages) are generally not operated and the treatment of choice is represented by the radiochemotherapy combination. Many clinical studies have shown that polychemotherapy (using multiple drugs) is better than single chemotherapy. Survival at 5 yrs. it is respectively 5% and 1% of cases.

NOTES: The chemotherapy treatment, when indicated, must be started as soon as possible, immediately after obtaining the histological diagnosis.

The pivotal drug for chemotherapy is platinum and its derivatives (cisplatin and carboplatin) generally combined with other antiblastic agents. Alongside cisplatin, the active drugs are mitomycin-C, vinca alkaloids, etoposide and ifosfamide.

Since the 1990s, new antiblastics have been introduced, namely: gemcitabine, vinorelbine, taxanes (paclitaxel and docetaxel) and topoisomerase inhibitors (irinotecan and topotecan).

Pharmacological research, fortunately, progresses year after year, discovering new drugs and increasing the patient's life expectancy. Newly developed medicines, such as monoclonal antibodies, aim to improve efficacy and decrease the side effects of therapy.

The type of surgery varies in relation to the size and location of the tumor.

Lobectomy (removal of a single lung lobe): performed in the case of a small tumor with peripheral localization
Pneumomectomy (removal of an entire lung): it is performed in larger or more central forms