The stigma of lung cancer: All you need to know

There is emerging role of Immunotherapy and Biologic therapy in lung which has increased the survival of this dreaded problem.

The stigma of lung cancer: All you need to know
Lenalidomide is an immunomodulatory prescription drug that is indicated for several hematological malignancies in adults. (File)

Dr. Niti Raizada

Lung cancer is a disease in which abnormal cells in the lungs proliferate uncontrollably, resulting in a tumor. The most common cancer in 2020 according to WHO was lung cancer which 2.21 million deaths after breast cancer which was reported at 2.26 million deaths.

The most common type of lung cancer is non-small-cell lung cancer (NSCLC). The other type of epithelial lung cancer is small cell lung cancer (SCLC). The most prevalent types of NSCLC include squamous cell carcinoma, large cell carcinoma, and adenocarcinoma. However, several more types are less common, and all varieties can occur in atypical histologic variants. Even though lung cancers are linked to cigarette smoke, adenocarcinomas can develop in people who have never smoked too. A slight increase of prevalence is noted recently in young women, and the cause of it remains an enigma.

The exact reason why lung cancer happens can be classically defined as ‘multifactorial’. This can be environmental factors and then some genetic factors as well. We as Oncologist, regularly deal with cancer of the lung, head, and neck and even gastric, bladder etc., primarily caused by excessive tobacco intake. In most cases, what begins as a fad turns into an obsession leading to a life-threatening disease before the victim realizes it. Smoking is the most critical risk factor for lung cancer development.

Some other factors that lead to lung cancer are:

  • Radon, a radioactive gas found naturally in soil and rocks
  • Mineral and metal dust (exposure in mines like asbestos etc. and so can be an occupational hazard in these situations)
  • Chronic obstructive pulmonary disease (COPD) 
  • Pulmonary fibrosis 
  • Air pollution 
  • Chest or breast radiation treatment 

The signs and symptoms aren’t recognizable at the early stages. One could also mistake them for something else, such as pneumonia, tuberculosis or a collapsed lung. Other symptoms could be:

  • Cough of long duration or getting worse 
  • Chest pain that aches worse when you cough, laugh or take deep breaths, just like other types of lung cancer
  • Hoarseness or changes in voice 
  • Wheezing 
  • Weight loss and lack of appetite 
  • Coughing up blood or mucus 
  • Shortness of breath 
  • Feeling weak or weary. 
  • Long-term lung problems, such as bronchitis or pneumonia

Screening is a method of detecting cancer when there are no symptoms in a high-risk case: Low-dose helical CT scanning is the only early detection screening technique proven to reduce mortality in people at high risk of lung cancer. High risk individuals who require lung CT screening are long term smokers. Lung cancer screening by chest radiography and sputum cytology has not been shown to reduce lung cancer mortality rates.

So how do we diagnose lung cancer? Patients with suspected lung cancer require confirmation of diagnosis by biopsy or cytology and later to determine the degree of the disease called as staging (which is done by CT scan/ MRI scan / PET-CT). Patients’ treatment options are governed by their histology, stage, general fitness and comorbidities.

A skilled lung cancer pathologist must analyze the pathologic material before a patient begins treatment for lung cancer. This is important because SCLC, which responds well to chemotherapy and is rarely treated surgically, whereas NSCLC may require multi-modality treatment. Immunohistochemistry and electron microscopy are helpful tools for diagnosis and subclassification of most lung cancers. Now a days we give special importance to molecular characteristics of lung cancer and so Next Generation Sequencing and other molecular diagnostic tools are always needed to guide treatment for better results in various molecular sub-types. There is emerging role of Immunotherapy and Biologic therapy in lung which has increased the survival of this dreaded problem.

Remember that Cancer is lifestyle disease. Cancer may be curable if diagnosed early enough. Even if it isn’t, the treatment should improve your quality of life and help you live longer. Also, we as oncologist want to convey to every individual to make their lifestyle choices wisely. Each person has a right to his/her life and health, and the decision about it solely lies with him/her. My only advice will be that if you ever plan on quitting tobacco, do it one shot. Decide a day and time for doing it, and make sure this was the last time you ever had it. Reducing tobacco intake gradually will rarely work in curbing risk factors of developing diseases like lung cancer.

(The author is Director, Medical Oncology & Hemato-Oncology, Fortis Group of Hospitals, Bangalore. Views expressed are personal and do not reflect the official position or policy of

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