2022 Southern Medical Research Conference

Metastatic Cancer To The Lung

Cancer that starts elsewhere in your body can spread to your lungs. This isn't lung cancer, but it may cause lung symptoms. Treatment options depend on the original cancer site and may include surgery or chemotherapy.

When cancer develops, it typically forms in one area or organ of the body. This area is known as the primary site. Unlike other cells in the body, cancer cells can break away from the primary site and travel to other parts of the body.

Cancer cells can move in the body through the bloodstream or the lymph system. The lymph system is made up of vessels that carry fluids and support the immune system. When cancer cells travel to other organs in the body, it's called metastasis.

Cancer that metastasizes to the lungs from other areas is a life-threatening condition that develops when cancer in another area of the body spreads to the lung. Cancer that develops at any primary site can form metastatic tumors.

These tumors are capable of spreading to the lungs. Primary tumors that commonly spread to the lungs include:

If the primary site of your cancer is in the lungs, the cancer commonly spreads to the following areas:

the other lung

adrenal glands

lymph nodes

bones

brain

liver

Although less common, lung metastases can also spread to the stomach, intestines, pancreas, and kidneys.

Metastatic cancers take the name of the primary cancer instead of the name of the organ they've spread to. For instance, if you have lung cancer, but it has metastasized to the brain, it would still be called lung cancer.

Second primary cancer refers to a second type of cancer in a different primary site. A second primary cancer can occur at the same time or be identified later.

For cancer cells to metastasize, they must go through several changes. First, the cells have to break away from the primary site and find a way to enter the bloodstream or lymph system.

Once they're in the bloodstream or lymph system, the cancer cells can form a new tumor in another part of the body. In the case of lung metastases, the cancer cells travel to the lungs and form a new tumor.

When the cells arrive at the lung, they'll need to change again in order to grow in the new location. The cells must also be able to survive attacks from the immune system.

Lung metastases don't always cause symptoms. When symptoms do develop, they can be difficult to identify. This is because the symptoms may be similar to health conditions other than cancer.

The symptoms of lung metastases can include:

Your doctor will perform a physical exam and order various diagnostic tests if metastatic cancer is suspected.

Your doctor will confirm your diagnosis by using a diagnostic test, such as:

Chest X-ray. This test creates detailed images of the lung.

CT scan. This test produces clear, cross-sectional pictures of the lung.

Lung needle biopsy. Your doctor removes a small sample of lung tissue for analysis.

Bronchoscopy. Your doctor can directly visualize all the structures that make up your respiratory system, including the lungs, with a tiny camera and light.

The goal of treatment is to control the growth of the cancer or to relieve any symptoms. There are numerous different treatments available. Your specific treatment plan will depend on various factors, including:

your age

your overall health

your medical history

type of primary tumor

location of the tumor

size of the tumor

number of tumors

Chemotherapy is often used to treat lung metastases. This drug therapy helps destroy cancerous cells in the body. It's the preferred treatment option when the cancer is more advanced and has spread to other organs in the body.

In some cases, surgery may also be performed to remove the metastatic tumors in the lung. This is usually done if someone already had their primary tumor removed or if the cancer has only spread to limited areas of the lung.

Your doctor may also recommend:

Experimental treatments for metastatic cancer are also available. Heat probes can be used to destroy cancer cells in the lungs. Chemotherapy drugs may also be applied directly to the affected area of the lung containing the metastatic tumor.

You can also find clinical trials in your area at ClinicalTrials.Gov.

Your long-term outlook will depend on the size and location of your primary tumor. It'll also depend on how much the cancer has spread. Certain cancers that spread to the lungs can be very treatable with chemotherapy.

Primary tumors in the kidney, colon, or bladder that spread to the lungs may sometimes be completely removed with surgery.

In most cases, metastatic cancer can't be cured. However, treatments may help prolong your life and improve the quality of your life.

It's very difficult to prevent lung metastases. Researchers are working on preventive treatments, but nothing is common practice yet.

One step toward preventing metastatic cancer is prompt and successful treatment of your primary cancer.

It's important to have a strong support network that can help you deal with any stress and anxiety you may be feeling.

You may want to speak with a counselor or join a cancer support group where you can discuss your concerns with others who can relate to what you're going through. Ask your doctor about support groups in your area.

The National Cancer Institute and American Cancer Society websites also offer resources and information on support groups.

Interstitial Lung Disease: Causes, Symptoms, And Treatment

The term interstitial lung disease (ILD), also known as Diffuse Parenchymal Lung Disease (DPLD) comprises more than 200 separate disease entities  that cause progressive scarring of lung tissue. Scarring caused by interstitial lung disease eventually impairs one's capacity to breathe and absorb adequate oxygen into the bloodstream.. The crude annual incidence of ILDs in India is 10.1–20.2 per 100,000 population.

The pathogenetic sequence involves a series of inflammation and fibrosis that extends beyond disrupting the interstitial bed to changing the parenchyma (alveoli, alveolar ducts, and bronchioles).

Interstitial lung disease is much more likely to affect adults, although infants and children sometimes develop the disorder.

Some of the known cause of ILD include : 

Long-term exposure to occupational or environmental agents like mineral dust, organic dust, and toxic gases. Most common are silica, asbestos, coal mine dust. 

Allergic reaction to inhaled molds, fungi, bacteria and bits of bird feathers or droppings.

Auto immune diseases and connective tissue diseases like rheumatoid arthritis, lupus, systemic sclerosis.

Granulomatous diseases like sarcoidosis.

Drug induced ILDs.

Smoking. Some forms of interstitial lung disease are more common in smokers, and active smoking may aggravate the condition, especially if there is accompanying emphysema.

When the cause of ILD is unidentified, it is labelled as Idiopathic Iinterstitial Pneumonia of which, Idiopathic pulmonary fibrosis is the most common and with a bad prognosis.

In contrast to developed countries, sarcoidosis and Hypersensitivity pneumonitis are the ILDs with the highest burden in India.

The most frequently reported symptom is gradual onset of shortness of breath which is usually progressive, but sometimes it may simply be a persistent cough. Fatigue, chest discomfort, weight loss are other symptoms associated with ILDs. Some patients may be asymptomatic and are incidentally diagnosed on ct scan of the lungs.

ILDs are diagnosed based on history, clinical examination, relevant blood investigations that include auto immune workup, pulmonary function tests, HRCT chest and a lung biopsy as and when required.

Most of the ILDs cause irreversible lung damage and are progressive. Early diagnosis and treatment play a vital role in slowing down the progression of the disease and improving the quality of life.

Treatment for ILD usually focuses on treating underlying disease and improving symptoms.  General supportive measures include smoking cessation, pulmonary rehabilitation which can help improve functionality, and good pulmonary hygiene.

Gastroesophageal reflux disease (GERD) can make ILD worse, hence requires adequate treatment. The mainstay therapy for treatment of ILD is corticosteroids and immunosuppressive therapies to intercept the inflammatory process within the lungs.

Antifibrotic drugs have proven benefits in IPF and other progressive fibrotic ILDs not responding to corticosteroids and other immunosuppressive therapy.

Supplemental oxygen is necessary for those who demonstrate hypoxemia (sao2 less than 88). Pulmonary rehabilitation plays an important role in the management of ILDs.

Unfortunately, despite all the efforts most of the ILDs progress and significantly impair the quality of life.

Vaccination against common pulmonary pathogens is recommended for all patients with ILD irrespective of their age. This will help reducing infectious ecxacerbations and hospitalisations.

When left untreated, idiopathic pulmonary fibrosis (IPF), the prototype of fibrotic ILDs, has a prognosis of 3-5 years survival following diagnosis. Predicting prognosis for individual ILD patients is still difficult. Signs of pulmonary hypertension and right ventricular failure, as well as the presence of a pneumothorax, have been linked to poorer outcomes in ILD.

Lung transplant is the sole treatment modality that can reinstate physiological function in patients with ILD, who worsen despite maximum medical therapy.

No biomarker or clinical prediction algorithm has been identified as a reliable predictor of disease outcome or response to therapy in ILD at this time. As a result, early referral to a lung transplant programme is still suggested to minimise the possibility that a potentially eligible patient would miss out on a lung transplant.

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Views expressed above are the author's own.

END OF ARTICLE

Small Cell Vs. Non-small Cell Lung Cancer

Small cell and non-small cell are the two main types of lung cancer. There are several key differences, including the outlook for each.

In a person with small cell lung cancer, the cancerous cells appear small and round under a microscope. The cells of non-small cell lung cancer are larger.

Smoking is a major risk factor for both types. Of those who receive a diagnosis of small cell lung cancer, 95% have a history of smoking.

There are several subtypes of both small and non-small cell lung cancer. Non-small cell lung cancers include adenocarcinoma, squamous cell, and large cell carcinoma.

Small cell lung cancers vary depending on the expression of specific genes.

Some types are more aggressive than others, but generally, small cell lung cancer is more aggressive than non-small cell lung cancer.

Lung cancer — including both small and non-small cell types — is the third most common form of cancer among adults in the United States. Lung cancers account for 13% of new cancer diagnoses.

Small and non-small cell lung cancers cause similar symptoms. Sometimes, symptoms do not appear until the cancer reaches a later stage.

Symptoms include:

hoarse voice

persistent cough

fatigue

shortness of breath and wheezing

difficulty swallowing

loss of appetite

chest pain and discomfort

blood in the mucus brought up by coughing

swelling in the veins of the face and neck

The symptoms of small and non-small cell lung cancers are similar, but small cell lung cancer spreads more rapidly.

A person may be more likely to experience symptoms after lung cancer has reached a later stage.

Does lung cancer affect women differently? Learn more here.

Can shoulder pain be a sign of lung cancer? Find out more.

Causes and risk factors for small and non-small cell lung cancer tend to be similar.

Smoking is the main risk factor. Cigarette smoke and the chemicals it contains can damage the lungs. This can lead to cellular changes that may result in cancer.

Additional risk factors include:

exposure to secondhand smoke

living in an area with significant air pollution

older age

past exposure to radiation

exposure to arsenic and other chemicals

exposure to asbestos, nickel, chromium, soot, or tar

having a family history of lung cancer

having HIV

Smoking is a major risk factor for lung cancer. Find some ideas about how to quit here.

If a person sees a doctor about a persistent cough and other possible symptoms of lung cancer, the doctor will ask questions and take a medical history. They will also perform a physical examination.

If lung cancer may be present, the doctor will also request imaging scans, such as an X-ray or CT scan, and look for signs of a tumor, scarring, or a buildup of fluid.

They may also request samples of phlegm in order to perform a sputum test. This can help indicate whether cancer is present. The doctor will probably ask the person to provide a sample every morning for 3 days in a row.

Doctors may also perform a biopsy. This involves using a needle to take a sample of cells from the lungs for examination under a microscope. They may do this during surgery.

A biopsy can show:

whether cells are cancerous

what type of cancer is present, if any

Sometimes, the doctor requests a bronchoscopy. This procedure involves inserting a tool with a built-in camera through the mouth or nose and into the lungs. This helps them see the area and take tissue samples.

They may also carry out other tests to determine whether the cancer has spread beyond the lungs.

What does lung cancer look like? Find out here.

Staging

The stage of cancer describes how far it has spread within the body.

There are different ways to describe the stages. One simple way is:

In situ: This means abnormal cells have been detected but have not yet become cancerous or spread.

Localized: This means the cancer is only in one place.

Regional: The cancer has spread to nearby tissues or lymph nodes.

Distant: The cancer has spread to other parts of the body, such as the bones, brain, liver, or other lung.

Unknown: This means there is not enough information to determine the stage.

However, each type of lung cancer has its own specific method of staging.

Non-small cell lung cancer

For this type of cancer, doctors typically use a 5-stage system.

Stage 0: Similar to "in situ," this means that a doctor cannot detect cancerous cells from traditional imaging methods, but tests have revealed precancerous cells in the mucus or elsewhere in the body.

Stage 1: This signifies that the cancer is only in the lungs.

Stage 2: The cancer has reached nearby lymph nodes.

Stage 3: The cancer has spread to other lymph nodes in the chest, possibly to those in the middle or on the other side of the chest.

Stage 4: The cancer has spread to both lungs, other parts of the body, or both.

Stages of small cell lung cancer

Doctors generally categorize small cell lung cancer with one of two stages:

The limited stage: This means the cancer is on one side of the chest. It may be in one lung and, possibly, nearby lymph nodes.

The extensive stage: The cancer has spread to either the other lung or other organs outside of the original tumor.

Some doctors use further staging for small cell lung cancer.

Can a person have both types?

Around 5–28% of small cell lung cancer cases are "mixed." This means that the person has small and non-small cell lung cancers. Research suggests that it may be easier to treat mixed cancer than small cell lung cancer alone.

After making a diagnosis, a doctor will describe the treatment options and develop a treatment plan.

Factors that affect the plan will include:

the type of cancer

how far it has spread

the individual's age and overall health

the availability of therapies

personal preferences

As each person's situation is different, treatment will vary accordingly.

Non-small cell lung cancer

Treatment options for non-small cell lung cancer include:

Surgery: A surgeon will remove cancerous cells and any nearby lymph nodes that may be affected. However, if cancer affects a large portion of the lungs, surgery may not be possible.

Radiation therapy: A radiologist will direct a beam of radiation toward malignant cells to destroy them.

Chemotherapy: A doctor will administer powerful drugs that can kill cancer cells.

Endoscopic stents: If a tumor has blocked part of the airway, a surgeon may insert a stent.

Targeted treatments: These drugs target specific genes or other factors that enhance cancer's ability to grow. Blocking these factors can help stop or delay the growth of some types of cancer.

Immunotherapy: This treatment aims to boost the immune system's ability to defend the body against cancer. It is an emerging treatment.

Small cell lung cancer

For small cell lung cancer, treatment mainly aims to manage the disease.

Options include:

chemotherapy, which is the main treatment

radiation therapy, which may help boost the effectiveness of chemotherapy or help prevent the cancer from spreading to the brain

surgery with chemotherapy, when the cancer has not yet reached the lymph nodes, which is rare

Doctors may use a combination of treatments for lung cancer, depending upon an individual's needs, the stage of the cancer, and the location of the tumor.

Experts use past statistics to estimate the percentage of people who are likely to live for 5 or more years after a diagnosis of cancer. These estimations are called survival rates.

They represent averages and do not take into account factors such as a person's age or overall health.

Non-small cell lung cancer

For non-small cell lung cancer, the American Cancer Society (ACS) reports the following relative 5-year survival rates:

for localized cancer: 64%

for regional cancer: 37%

for distant cancer: 8%

The overall average likelihood of living for at least another 5 years is 26%.

Small cell lung cancer

The ACS estimates the following 5-year survival rates for people with small cell lung cancer:

for localized cancer: 29%

for regional cancer: 18%

for distant cancer: 3%

The overall average likelihood of living for at least another 5 years after a diagnosis of small cell lung cancer is 7%.

Other factors that may affect survival rates include whether the cancer has come back after treatment and a person's age. Recurring cancer and advanced age can have a negative effect on survival rates.

There are two main types of lung cancer: small cell and non-small cell. Small cell lung cancer is less common and more aggressive.

Quitting smoking — or never smoking — can significantly reduce the risk of developing any type of lung cancer.

Read this article in Spanish.

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