Lung Cancer: Smoking Is The First Risk Factor

Lung cancer is often called “big killers.” Unfortunately, it is the leading cause of cancer death worldwide. In 2021 41,000 new cases were recorded, of which 27,700 were in men. Lung cancer mainly affects men, ranking second in incidence after prostate cancer, but it is also growing among women, in third place after breast and colorectal cancer.

“The main risk factor is cigarette smoking. The other causes of lung cancer are represented by radon, a radioactive gas present in the subsoil, and by chemical or professional pollutants, such as asbestos. As for radon, it is an odorless, colorless, and tasteless gas that can penetrate homes starting from the foundations of buildings. There are tools to measure its concentration in the air, and fortunately, to disperse it. You need to ventilate the rooms regularly”.

Lung Cancer And Genetic Causes

“Lung cancer mainly affects patients between the ages of 60 and 75, and statistical data indicate that quitting smoking at age 40 brings the risk of developing lung cancer almost equal to that of someone who has never smoked cigarettes. Retiring at age 50, on the other hand, carries a three times higher risk than a non-smoker. From the reading of these data, it emerges that the prolonged exposure of our respiratory epithelial cells to cigarette smoke has a significant incidence in cancer development. 

As we have said, the first risk factor for lung cancer is cigarette smoking: out of about 100 operated patients, about 90 are or have been heavy smokers. However, there is a range of patients who develop lung cancer without ever having smoked. We do not yet have actual evidence of a genetic cause. Still, studies are underway on a group of patients who develop this tumor at a young age, between 30 and 45 years, who have never smoked and sometimes with other cases of the same tumor in the family and for which a correlation between the development of cancer and a genetic mutation is suspected”.

Lung Cancer Symptoms And Stages Of Diagnosis

“The symptoms with which lung cancer usually occurs can be represented by worsening cough and refractory therapy, chest pain, the presence of blood in the sputum, and shortness of breath. In this symptomatology, the treating physician may deem it appropriate to initiate a course of diagnostic tests. The first examination prescribed is the chest x-ray, followed by the chest CT scan with and without contrast medium, which highlights the presence of tumors or pleural effusions. 

The exams that are subsequently performed are the CT scan of the brain and abdomen with contrast media to exclude the existence of any metastases and the total body PET, which also studies the skeletal system and lymph node stations. Suppose the disease is localized in the central parts of the lung, therefore near the bronchi. In that case, a bronchoscopy will also be requested for diagnostic purposes, while for peripheral tumors, a CT-guided needle biopsy will be performed. 

A method that is performed using the optical fiber bronchoscope combined with an ultrasound probe and which allows us to achieve the biopsy of the lymph node stations. All these tests allow the specialist to type the tumor and, therefore, evaluate the most appropriate therapeutic approach”, explains the specialist. 

Is Early Diagnosis Possible?

“Lung cancer is considered a ‘big killer’ precisely because the disease is already locally advanced or metastatic by the time it comes to diagnosis. In fact, out of 100 diagnosed with lung cancer, about 70 are not operable. Many of these patients undergo chemotherapy, radiotherapy, and immunotherapy reduction treatments, which can also be treated surgically. 

The other patients, in whom the disease has already spread to other organs, will instead follow medical therapies to make the disease as chronic as possible. To date, several studies provide screening programs aimed at smokers or former smokers to anticipate the diagnosis and capture the tumor when it is still tiny through a CT scan of the chest without a contrast medium that is performed every 12 months. 

Lung Tumors: Benign And Malignant

“There are benign lung tumors: amarchondromas and carcinoids. The amartocondromi present themselves as enough round lesions, with well-defined margins and with calcifications inside them. They derive from connective tissue and rare tumors that can be kept under control by avoiding surgical excision unless they are in particular positions or are rapidly growing. However, the carcinoid tumors are divided into typical and atypical and are considered of uncertain behavior of tumors for which they are always treated surgically, “.

“Malignant tumors are divided into two large groups: small cell lung tumors, or macrocytosis, and non-small cell lung tumors. The former is very aggressive, and usually, when they occur, they are already in a metastatic phase, attack the brain, and spread to the adrenal glands, bones, and liver. They usually occur in patients who are heavy smokers and are treated with chemotherapy and radiotherapy medical therapies. Non-small cell tumors, on the other hand, are divided into adenocarcinomas (about 80%), squamous or squamous cell carcinomas (15%), and large cell lung cancer (5%).

These are tumors that, in the initial stages, are immediately taken to surgery. At the same time, if the diagnosis is made when the disease is already in a locally advanced stage, it is advisable to subject the patient to systemic cytoreductive treatment before surgery.  New therapies based on antiangiogenic drugs are also available, which destroy a tumor characterized by a specific genetic mutation. These biological drugs bind to the gene receptor on the tumor cell membrane, preventing the cell from being given the signal to replicate. 

It is an important discovery, also because they are drugs with minimal side effects and well tolerated by patients: an aspect that affects the quality of life, especially when the therapy has to be done for several years. Another possibility of treatment is represented by immunotherapy, which stimulates the immune system to recognize cancer cells and destroy them “, . 

How Is The Surgical Treatment Carried Out?

“Our lungs have three lobes on the right and two on the left. The lobectomy is the gold standard when you think of surgery for lung cancer and consists in removing the lobe in which it is established by removing the tumor and lymph nodes also tributaries pour present in other stations, to evaluate the possible spread of the disease that may have gone unnoticed in instrumental examinations. Then there is the pneumonectomy, which removes the entire lung, and then advanced thoracic surgery, which may also include vascular resections.

Thoracic surgery has seen continuous evolution. Today a type of minimally invasive surgery is used more and more, which can be thoracoscopic or robotic. In first, the cable is accessed through minor accesses by inserting a camera and the tools that allow the surgeon to perform the surgery while using the robot the surgeon operates sitting at the console by moving the robotic arms inside the thoracic cavity. Patients undergoing this type of surgery are selected and usually present with early-stage cancers. It is a surgery that allows a shorter and less painful postoperative course, following which the patient can quickly return to his usual activities”.


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