The COVID19 treatment protocol in India has had the unintended consequence of detecting lung cancer in many people who were unaware of their condition, with the effect that treatment was started early, which improved odds of recovery. Doctors say that lung cancer generally ends up being detected at advanced stages in India. Around 75% of all detected cases are diagnosed in Stage 4, and the prognosis is generally not good.
Here’s a brief interaction with Dr T Sujit about the dreaded health condition:
Is lung cancer very common?
Dr T. Sujit: Yes, the incidence of lung cancer is definitely growing. It is among the top 3 cancers among males in India. Lung cancer was the most prevalent cancer in nine of the 28 Population-Based Cancer Registries (PBCRs) in India. In particular, the incidence of lung cancer among urban populations is growing. It is also distressing to notice that more females are diagnosed with lung cancer.
At what stage is lung cancer commonly diagnosed?
Dr T. Sujit: By the time patients take heed of their symptoms and approach a hospital, the disease would have grown and spread beyond the lungs. This is because lung cancer does not produce any symptoms when it is quite small ( except when it is blocking an air passage within the lung).
This cancer has plenty of space to grow unhindered within the lung without causing many symptoms. By the time it has grown to a size of 1.5 – 2.0 cms, it has the potential to spread to different parts of the body through the bloodstream. Generally, lung cancer is detected due to symptoms from metastasis in distant organs like liver, bone, brain or lymph nodes in the neck ie. Stage 4.
Are there any causative agents for lung cancer?
Dr T. Sujit: There are many risk factors for developing cancer. Tobacco is the most important and modifiable risk factors among these.
i. Tobacco – first-hand smoke, second-hand smoke and third-hand smoke.
a) First-hand smoke – smoking beedi, cigarette ( including light or low tar cigarette), cigar etc.
b) Second-hand smoke – breathing in the exhaled tobacco fumes from a person smoking nearby.
c) Third-hand smoke – coming into contact with tobacco smoke residue on objects like curtains, sofa,
towels, bedsheets etc.
ii. Exposure to Radon: Radon is a naturally occurring radioactive gas that results from the breakdown of uranium in soil and rocks. Naturally occurring radioactive elements in the stones and soil can emit small amounts of beta and gamma radiation. However, all these get diluted by good ventilation and spacing and is generally not a problem.
iii. Exposure to asbestos dust – Asbestos is used in many industries and also in homes as roofing. It can cause a type of lung cancer called Mesothelioma.
iv. Pollution from vehicles: Many international bodies like International Agency for Research on Cancer (IARC), Environmental Protection Agency (EPA), National Institute for Occupational Safety and Health (NIOSH) of the US have declared diesel exhaust to be either carcinogenic or potentially carcinogenic with implications for lung cancer.
What are the symptoms of lung cancer?
Dr T. Sujit: i. When it is quite small: usually no symptoms. When the tumour is present in an air passage, it may cause dry cough or wheeze not improving with medications. Sometimes, it may completely block a small air passage within the lung, causing the collapse of the lung compartments beyond the block, but still not causing significant symptoms. If the collapsed lung gets infected, pneumonia-like symptoms may be present.
ii. When it has grown and spread to lymph nodes within the chest: The primary tumour may cause obstructive symptoms of the air passages as described above. It may be accompanied by a vague, dull pain over the chest or back. Enlarged lymph nodes within the chest may compress on blood vessels or nerves or airways or the oesophagus (food pipe) within the chest. Symptoms include increasing facial puffiness, incessant cough, change in voice, food getting ‘stuck’ beyond the throat etc.
iii. When it has spread to other organs: Lung cancer commonly metastasises to bones, liver & brain. Metastasis to the bone may cause bone pain, weakening of the bone and fracture. Liver metastasis may cause liver swelling, loss of appetite and in late stages, liver failure. Metastasis to the brain may be life-threatening and usually presents with headache and vomiting along with other neurological symptoms like seizures ( fits ), paralysis of limbs, disturbance of vision etc.
How is lung cancer diagnosed? Can it be detected early?
The diagnosis of lung cancer involves two parts – (i) visualisation of the tumour and (ii) getting a small bit of tissue for pathological confirmation. The tumour can be visualised on CT or MRI scans. Depending on the location of the tumour, a biopsy can be done either by a scopy (bronchoscopy) or by a needle under CT scan guidance. A PET-CT scan may be required to find out the stage of the disease. Screening for early detection among high-risk individuals, particularly tobacco smokers, can be done by Low Dose CT scan.
What are the treatment options for lung cancer?
Dr T. Sujit: The treatment options for lung cancer may vary based on (i) variety of lung cancer (ii) stage of the disease and (iii) fitness of the patient.
Early-stage disease: The treatment is usually surgery. Based on the surgical pathology report, further chemotherapy and/or radiation therapy may be required. If surgery cannot be done due to some reason, definitive radiation therapy using Stereotactic Ablative Radiotherapy ( SABR ) or Stereotactic Body Radiation Therapy ( SBRT ) can be done with equivalent results.
Locally advanced disease: The choice of treatment is Radiation Therapy along with chemotherapy/targeted therapy
Metastatic disease: Palliative chemotherapy / targeted therapy is the mainstay of treatment. Radiation Therapy may be required for special situations like brain metastases, painful bone metastases, bleeding from tumour etc.
What is your advice for a healthy life?
Dr T. Sujit: Diet: Eat a wholesome, balanced diet with natural and local cereals, fruits and vegetables rather than exotic ones. Avoid machine manufactured foods. Do not overeat. Drink adequate quantity of warm water.
Exercise: Any form of appropriate regular physical activity is a must across all age groups – at least 20 minutes a day.
Know your body: If you think something is abnormal or find any new symptom, which is unusual for your body, get it evaluated without waiting too long. It may be nothing most of the times, but if it is something serious, it could be detected and treated early.
Give & Live: Give up bad habits and stress.
Don’t give in to anger and other negative emotions.
Give your time to life satisfying activities like spending time with family or doing social work.
Most importantly, learn to forgive