Lung cancer is a malignant, reproductive potential (maling) disease originating from the lung tissue, which initially appears mostly as a nodule or tumoral mass. Lung cancer is examined under two main headings as non-small cell (NSCLC) and small cell lung cancer (SCLC).
These two subtypes of cancer are diagnosed by following the same principles and using similar methods. However, the treatment of both types includes important differences. Non-small cell lung cancer also has subtypes such as adenocarcinoma, squamous cell carcinoma and large cell carcinoma.
Lung cancer is one of the most common types of cancer that patients are most worried about. The most important cause of lung cancer is smoking. According to scientific studies, it is seen that the incidence of lung cancer and the loss of life due to this disease decrease in men whose smoking starts to decrease, and the opposite situation occurs in women where smoking increases.
It can progress without any symptoms.
Lung cancer is most often manifested by persistent cough, lung infection, shortness of breath, hoarseness, chest pain, or blood in sputum. In addition, some people may experience symptoms such as fever, loss of appetite, involuntary weight loss and fatigue.
Lung cancer can sometimes progress without any complaints or symptoms in the patient. The diagnosis of lung cancer can be made with the radiological examinations taken when the patients consult a doctor for lung cancer or other diseases or reasons without any complaints of the lung itself.
Correct diagnosis is important for the treatment method.
Lung cancer can be successfully treated thanks to current medical advances and the patient’s life comfort is increased. In order to determine the treatment methods applied to the patient, the type and stage of lung cancer should be determined correctly.
A detailed medical history of the patient who applied to the doctor with the symptoms of lung cancer is taken, concomitant diseases and drugs used are recorded, and after the physical examination, lung imaging is performed mostly by radiological methods. The most commonly used methods are chest X-ray or thorax computed tomography (CT) examinations.
The mass or masses detected by computerized tomography (CT) are evaluated by the radiology and oncology team in terms of the possibility of lung cancer and lung metastasis of a tumor originating from other organs, and the definitive diagnosis is made by biopsy for a patient without a known cancer diagnosis. The main principle in biopsy is to select the method that will allow the patient to complete the process with the least risk, by taking enough tissue for molecular tests to help diagnose and guide treatment.
Determining if there is brain metastasis
PET/CT examination is mostly recommended for the patient in order to make a complete clinical staging simultaneously. Some types of lung cancer are more likely to metastasize to the brain. For this reason, brain magnetic resonance (MR) examination is performed even if the patient does not have any neurological complaints (such as headache, double vision, imbalance, nausea, vomiting, seizures).
At the end of all these procedures, appropriate treatment methods are determined for the patient who has a definite pathology and has been fully clinically staged with appropriate radiological methods. In some clinical situations, the physician and the patient decide together that more than one treatment modality may be appropriate for the patient, and which of these will be most appropriate for the patient.
The type of treatment is determined according to the type of lung cancer.
Surgical: Surgery is a very important treatment modality in the early stages of non-small cell lung cancer (NSCLC). There is also a small group of advanced non-small cell lung cancer patients who are considered to be fully recovered with surgery. At this point, it is important to discuss the patients in the multidisciplinary tumor council and to make a common treatment plan with other branches (such as medical oncology, thoracic surgery, neurosurgery, general surgery, radiation oncology, pathology, nuclear medicine).
Chemotherapy: Chemotherapy applied in the early stages of lung cancer reduces the risk of recurrence of the disease and the risk of death due to lung cancer. Postoperative chemotherapy is administered to patients with operated, early stage non-small cell lung cancer who have a high risk of recurrence. It is administered to patients with locally advanced non-small cell lung cancer before or after surgery. In addition, the vast majority of patients with advanced non-small cell lung cancer receive chemotherapy treatments.
Smart therapy (targeted therapy): There are many different sub-biological groups of non-small cell lung cancer. Some types of lung cancer occur as a result of a genetic change that develops in the tumor directly causing and advancing the disease. In order to determine this, a biopsy from the patient’s tumor (or sometimes a liquid biopsy from the blood) must be subjected to various, advanced molecular analyzes. Today, a series of additional molecular tests are required from tumor tissues of all non-small cell lung cancer patients in terms of smart therapy suitability. Patients whose molecular test results are suitable for smart treatments mostly use smart pill treatments.
Immunotherapy: Under normal conditions, our immune cells have the potential to recognize and destroy cancer cells in the body. However, cancer cells also develop the ability to evade immune cells. Modernly used immunotherapies (immune checkpoint inhibitors) enable our immune cells to better recognize and destroy cancer cells. Lung cancer is one of the cancer types for which immunotherapies are most effective. According to the stage of the disease, its biological characteristics, and previous treatments, very successful results are obtained from different immunotherapy treatments at various stages of lung cancer.
Radiotherapy: Depending on the stage of NSCLC, classical radiotherapy or stereotactic (targeted) radiotherapy can be applied to the metastasis sites for patients with metastases in the pre- or postoperative period.
The stage of admission is very decisive in the treatment of small cell lung cancer. If the application stage is “limited”, chemotherapy treatment combined with radiotherapy, followed by protective brain irradiation constitute the main framework of the treatment. In advanced small cell lung cancer, the main treatment is the combination of chemotherapy and immunotherapy. In patients with good response, chemotherapy is discontinued at a certain number of cycles and single immunotherapy is continued.
In case of medical necessity, radiotherapy is applied to the metastasis areas. Immunotherapy or other classical chemotherapy agents can be used after chemotherapy failure in patients with advanced small cell lung cancer who have not received immunotherapy for some reason at admission. All patients with advanced lung cancer are at risk for pain due to bone metastases, fractures and abnormal calcium elevations. Bone metastases at risk of fracture may require radiotherapy or orthopedic surgery. Again, in order to reduce these complications, drug treatments that can be described as bone strengthening can be recommended.