Last Updated 12 Aug 2020

Lung Cancer in the UK

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Lung cancer is the third most common cancer in the UK, accounting for about one out of five malignancies in men and one out of nine in women. However worldwide Lung cancer is the most common cancer in men. There are many factors that can increase a person’s chance on getting lung cancer, including age, genetics and exposure to risk factors. In addition, Men between 60 and 65 and women about 70 are at greater risk of having lung cancer.

Those who smoke have a risk of developing lung cancer that is 10 to 17 times higher than that of non-smokers. Women who smoke have a risk that is 5 to 10 times higher than that of women who do not smoke. Manufacturing and atmospheric pollutants are responsible for a small percentage of lung cancer. For example, the risk of death from lung cancer is six to seven times greater for asbestos workers compared to the general population.

To put it simply, Lung cancer occurs when a cancerous (malignant) tumor grows inside the lungs, in structures such as the bronchi. Lung cancer can metastasize (spread) to other parts of the body, just like other cancers.

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Lung cancer develops overtime through multistep carcinogenesis, also known as oncogenesis, your tissue starts off as your normal epithelium, and oncogenesis then occurs which is the complex, multi-step process by which normal cells turn into cancerous cells, leading to cancer growth in the body. 1 the first step in carcinogenesis is initiation where damage to the genome is made. At this point, normal genes called proto-oncogenes can become "oncogenes" when mutated and code for proteins that drive the growth of cancer, and give cancer its immortality. Whereas a tumor suppressor is a gene that blocks cell cycle progression.

It is the key in controlling DNA repair. The formation of cancerous tumors is prevented by tumor suppressors. When a cell’s DNA is damaged a sensor protein activates the tumor suppressor to bring the cell cycle to a halt. (used from the book ) when a tumor suppressor gene does not work effectively due to a mutation (which could be down to genetics) , this will cause cells to grow out of control, which can lead to cancer.

The second stage is promotion, this is the point where cells divide and multiply rapidly, this is called hyperplasia. This is where the Warburg effect comes into play, cancerous cells need energy fast therefore they use anaerobic respiration so they can multiply quickly. During promotion they avoid Apoptosis - this is a process of automatic cell death that occurs in multicellular organisms. A protein is created by cancer cells that blocks apoptosis. If apoptosis does not take place, these damaged cells may survive and advance into cancerous cells. The cells in promotion become pre-neoplastic but our body has 70 percent progressive cells and 30 percent regressive cells, therefore meaning its reversible and go back to initiation.
Thirdly, propagation/progression takes place

The most common and acknowledged cause of lung cancer is smoking, specifically high levels of carcinogens, which is one of the constituents enclosed in cigarettes. Another cause of lung cancer is inhalation of radon gas, which is a gas generated when radioactive materials are broken down by radium. Asbestos is another major cause of cancer, it can be found in walls and building materials however asbestos is illegal in many countries now because of the strong link with cancer. Lung cancer can also be inherited from family members, this is known as genetic predisposition. There are two focal kinds of lung cancer: primary lung cancer and secondary lung cancer.

Primary lung cancer starts in the lungs while secondary lung cancer begins someplace else in the body and metastasizes, then reaches the lungs. Secondary lung cancer is not as common as primary lung cancer. 2 Furthermore, there is an uncommon type of lung cancer known as the pleural mesothelioma. It occurs when mesothelioma develops in the pleural. It is quite an aggressive form of cancer that commences in the tissue that lines the lungs, heart, stomach, and other organs, pleural mesothelioma is caused by persistent exposure to asbestos. Unfortunately pleural mesothelioma cannot be cured but can be prevented by decreasing the amount of exposure to asbestos.

There are several factors affecting the growth of lung cancer, such as, amount of exposure to carcinogens, how many progressive/ regressive cells there are and what type of cancer it is. Cancer is diagnosed in different stages to calculate the severity of the cancer.

Stage 0 cancer, also known as CIS, Carcinoma in situ consists of cells with the abnormal changes found in cancer cells, but this is not known as “cancer” because it has not spread to the outer tissues. 11 stage 1, this is when the cancerous cells have traveled into the tissue by breaking down the basement membrane, forming a lump in the tissue. Stage 2 and 3 mean the cancer has become aggressive, grew larger and grown into nearby tissues. Lastly, stage 5, also known as advanced or metastatic cancer, means the cancer has spread to other parts of your body.

The best way to treat cancer is from early detection. This is possible with an x-ray or sputum analysis and some doctors demand these tests, especially for people who smoke. However chest x-rays can sometimes miss cancer therefore they are usually followed up with a CT scan, this consists of a series of x-rays. Once detected the doctor will use a method called a biopsy which involves direct removal of tissues or cells from a patient and examining it to determine the extent of infection. In addition, Endoscopy is another method which is the procedure where a flexible plastic tube is inserted into the body cavities and organs so that the area of concern can be viewed appropriately.

The picture on the right, shows what these detection methods try and pick up, doctors will examine a person’s chest if they complain of symptoms of lung cancer or are between the ages of 55 and 80, Smoke or smoked for a total of 30 pack-years and/or continue to smoke or quit smoking in the past 15 years.

During the length of uncertainty as to whether or not you have lung cancer non-diagnostic tests are frequently performed such as pulmonary function tests (PFTs): These test lung ability and can conclude how much a tumor is interfering with breathing. Also blood tests can be used to figure out the person’s general health and to detect biochemical irregularities caused by lung cancers. Detection of lung cancer can have a big impact on being able to treat it and is vital to perform the correct and safest treatment regimen for you.

The treatment of lung cancer is based on the size and position of the tumor, whether the cancer has spread and the persons overall health. There are four ways to treat lung cancer: surgery, radiation therapy, chemotherapy and targeted therapy. Treatment options differ for each individual. Chemotherapy is the most commonly used treatment for cancer. Chemotherapy uses anti-cancer drugs, such as Platinol (cisplatin) and Paraplatin (carboplatin) to destroy cancer cells, these drugs work by stopping cancer cells dividing and growing.

Chemotherapy can cure, control and ease symptoms. Can be used with radiotherapy, given after surgery or it can be given before surgery to shrink the tumor. However there are several side effects with chemotherapy and patients will have full disclosure as to what could come. Your bone marrow and digestive system is more sensitive to chemotherapy drugs so healthy cells can be affected. Additionally, you are more prone to infections due to a weakened immune system, moreover, nausea and hair loss are also common side effects to chemo.

The drawbacks of the treatment include, the interference with other medication particularly causing problems for diabetic patients. Immunotherapy drugs, on the other hand, work by essentially assisting your immune system to help rid your body of cancer cells. Doctors may prescribe immunotherapy drugs if your tumor has certain proteins in it or other treatments haven’t worked. Side effects of immunotherapy for lung cancer consist of fatigue, nausea and fevers.

The more severe drawbacks of the treatment are the immunotherapy drugs may be more successful than the doctor was hoping for sending the patient’s immune system into overdrive causing more damage to their body, such as inflammation of the kidneys and pituitary gland. This makes it harder to conclude if cancer is treatable as treatments are not always successful and create other problems for the patient.12 Chemotherapy and immunotherapy can be combined, prolonging patient’s survival rates, which is shown in the study on the right.

Moreover, Surgery is another form of treatment, it takes time to plan a successful surgery and is usually a backup option if other treatments haven’t worked. One form of surgery is a lobectomy which is a procedure where one of the lobes of the lung is removed.

Secondly, Pneumonectomy is a surgical procedure to remove a lung. This is needed when the cancer is located near the center of the lung or if a smaller surgery was not able to remove all the cancer.

Lastly wedge resection is another form of surgery where a small piece of the lung is removed.

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