Lung cancer symptoms, diagnosis and treatment in Turkey

Lung cancer symptoms, diagnosis and treatment in Turkey through the latest available technologies, whether surgical, radiological, chemical or smart targeted treatments.

What is lung cancer?

Lung cancer is the most common cancer after prostate cancer and breast cancer.
Of course, it is known that the main cause of this cancer is smoking.

Nowadays, it is possible to treat this cancer, which is considered one of the most feared cancers, and life can be extended thanks to medical and technological developments.

Lung cancer is the most common cause of cancer-related death.
However, when it is caught at an early stage, the chance of a cure increases greatly.

Lung cancer begins when cells from normal lung tissue multiply out of control to form a cancerous mass.

Lung cancer is a very common cancer.
It accounts for about 12-16 percent of all cancers and 17-28 percent of cancer-related deaths.
Moreover, it ranks first in cancer-related deaths in both women and men.

Lung cancer types

• squamous cell carcinoma Squamous Cell CarcinomaIt arises from the squamous cells in the airway.
• adenocarcinoma Adenocarcinoma: It is formed by cells that secrete mucus and saliva.
• large cell carcinoma Large-Cell Carcinoma: The reason for this is because cancer cells appear as large cells when viewed through a microscope.
• squamous cell carcinoma Adenosquamous Carcinoma:  It arises from squamous cells, in which glandular cells also appear.
• Sarcomatoid or pleomorphic, or sarcomeric carcinoma: These are cancers in which other cell types form in the lung.
• Carcinoid tumor: Cancer that grows slowly and produces hormones that are released into the body when stimulated by nerve cells.

What are the symptoms of lung cancer?

• increased cough

Cough, which is considered the first symptom of lung cancer, is underestimated as it is caused by other causes.
However, a cough that lasts longer than two weeks, and a persistent cough that increases with no known cause, appears as a major indicator of lung cancer.

In addition, the presence of blood in the sputum or a dark brown color of the sputum is known as the most important symptom in lung cancer as this symptom occurs in about 25% of patients.
It also occurs if the cancer directly occupies the main airway.

• Source

However, chest pain, caused by many causes, is actually a major symptom of lung cancer.
If you experience chest pain while breathing deeply, coughing or laughing, it is essential to consult a doctor without wasting time.

• shortness of breath

Respiratory symptoms such as shortness of breath and wheezing can occur in all stages of lung cancer.

Shortness of breath, an important indicator of malignant lung cancer, is somewhat ignored.
While the elderly and the overweight attribute their shortness of breath to their aging, young people ignore going to the doctor due to the intensity of their work.
However, we should not forget that early diagnosis is essential for lung cancer.

In addition, hearing a whistling sound during inhalation and exhalation: indicates pressure on the main trachea called trachea. In addition, it is accompanied by shortness of breath, which may sometimes be diagnosed with a type of asthma.

• Loss of appetite and weight loss

Active smokers, especially, should consult a doctor if there is definitely a lack of appetite.
Also, unexplained weight loss is among the symptoms of lung cancer, and it should not be neglected at all.

• Hoarseness and difficulty swallowing

Hoarseness and difficulty swallowing, one of the symptoms of lung cancer, can be caused by many diseases, just like other symptoms.

• general weakness

In lung cancer, one of the symptoms of lung cancer that should not be ignored is a constant feeling of tiredness and weakness.
Especially if this weakness is starting to negatively affect daily life

• Fingers wobble

In diseases other than lung cancer, swelling occurs slowly and painlessly in the tips of the fingers and toes, but if it occurs quickly and painfully, it is a sign of lung cancer symptoms.

• body pain

It can be evaluated as a problem caused by working long hours at the computer.
However, in the case of spread of lung cancer, back pain, shoulder and arm pain may occur, which may sometimes be diagnosed as disc pain.

• frequent infection

Recurring and not healing respiratory infections such as bronchitis and pneumonia are also symptoms of lung cancer.

Screening is recommended once a year, especially for people who have smoked a pack of cigarettes a day for more than 15 years, or who have not quit smoking for 15 years.

• drooping eyelid

Eyelid drooping, pupil retraction, and absence of sweating on the same side of the face may also indicate lung cancer.
This condition is called Horner's syndrome in medicine.

• Lymph nodes and a palpable mass on the collarbone

In particular, growths in glands on the neck and above the collarbone indicate lung cancer.

• difficulty swallowing

It may be a symptom of lung cancer as it occurs as a result of pressure on the esophagus.

• epilepsy

It may occur as a result of the spread of a malignant tumor in the brain.

• Bone fractures

It occurs in 25% and indicates the spread of malignancy in the bone.

• Pain in the right side of the abdomen

due to liver injury.

If you have one or more of these symptoms, see a pulmonologist immediately.
These symptoms may indicate other conditions, not necessarily lung cancer, but the underlying cause should be investigated and treated.

If your doctor suspects lung cancer, he or she will make a diagnosis with advanced screening methods.
With lung cancers diagnosed at an early stage, the chance of cure is 85-90%.

scientific studies; They reveal that lung cancer can be diagnosed early with low-dose computed tomography of the lung in people aged 55 to 74 with a history of heavy smoking.

While the success rate can be as high as 80-90 percent with treatment in the early stage, called stage 1, people who have smoked for many years should have regular checkups even if they have no complaints.

What causes lung cancer?

• smoking:

80-90% of lung cancer patients have a history of smoking which is one of the factors that increase the likelihood of developing lung cancer.
Risk of developing cancer: related to the age of starting smoking, the duration of smoking, the type of cigarettes smoked (eg filtered, unfiltered, cigars, low tar and nicotine content, etc.) and the amount of cigarettes consumed per day.

Smoking increases the risk of cancer 10-30 times compared to non-smokers. This risk increases significantly, especially after 20 packs/year. It is calculated by this equation:

Number of years of smoking * Number of packets smoked per day = Number of packets smoked in one year. If the number is greater than 20, the incidence of cancer increases significantly.

Exposure to secondhand smoke also increases the risk of lung cancer.
It was also found that cigarette smoking is directly related to lung cancer in 90% of women and 79% of men.

Quitting smoking does not completely eliminate the risk of developing cancer, but it does reduce this risk.

Read more about The relationship of smoking to lung cancer

• The environment:

  Industrial and environmental factors are important for the development of lung cancer.
  It was found that lung cancer is strongly associated with exposure to substances such as radon, asbestos, air pollution, radioactive isotopes, heavy metals, and mustard gas.

• Heredity:

  Genetic factors are believed to be of great importance in the development of lung cancer. If there is a family member with lung cancer, the risk of developing it in other people is 2-4 times higher.

• Viruses:

  Lung cancer is more likely to occur in people with HIV infection.

• radiation:

  Radiation from any source can damage lung tissue, damage the structure of bronchial cells, and cause cancer.

Lung cancer diagnosis

Can cancer be prevented by early diagnosis of lung cancer?

It can take several years for symptoms of lung cancer to appear, and sometimes it can develop malignantly without any symptoms, so it is a type of cancer that cannot be evaluated in screening programs.

Imaging methods in lung cancer

What are the methods of diagnosing lung cancer?

First, the radiological examinations

• X ray.
• Computed tomography (computed tomography).
• Magnetic resonance imaging.

Second: Nuclear medicine exams

• 1ET-CT.
• Bone scintigraphy scintigraphy.

Third: Methods of diagnosis through biopsy

• bronchoscopy
• mediastinoscopy
• Video thoracoscopy
• thoracentesis
• sputum examination

Lung cancer biopsy methods

The biopsy may be taken from the lung directly, either through the skin or through the endoscope if the cancer has not spread, but if the disease has spread, the biopsy may be taken from the lymph nodes or the places it has moved to.

In most cases, even if the cancer has spread, a lung biopsy will often be taken to find out the exact type of this cancer.
This biopsy has no effect on the possibility of the cancer spreading or the disease getting worse.

Methods used to obtain the biopsy:

1. Bronchoscopy:

Where the airways are examined and samples of small tissues are taken through an endoscope inserted from the mouth into the bronchi.

2. Percutaneous biopsy:

A biopsy of neoplastic tissue is done with a needle inserted through the skin into the lung mass with a CT scan.

3. thoracentesis:

If there is fluid around the lung, a portion of this fluid will be taken and examined under a microscope.

4. Sputum examination application:

The sputum that comes out of the lung is examined.

How is lung cancer diagnosed?

Lung cancer is divided into two main groups, small cell and non-small cell, and these two types have different genetic characteristics.

In the case of suspected lung cancer, after taking the full medical history and knowing whether the patient smokes, what is the percentage of radiation exposure, and whether any family member has cancer.

 A low-density CT scan of the lung is then taken to see the anatomical structure of the mass if any sign of cancer is seen on an X-ray.

The information obtained from the CT scan, such as the shape, density and location of the lump, gives important information to the doctor about the position of this lump and the possibility of it being cancerous.
Is it suitable for a biopsy?

• As if it is in the vicinity of the lung, the biopsy will be taken directly from the skin.
• If it is in the central areas, a biopsy will be taken through a bronchoscope.
• The biopsy will determine the type of cancer, whether it is small cell or non-small cell.
• If the possibility of the mass being cancerous, a PET-CT scan of the body (Positron Emission Tomography) will be performed to find out where the mass has spread and to know the condition of the lymph nodes and whether the cancer has spread to it.

lung cancer stages

First, the stages of non-small cell lung cancer

The anatomical stage of the disease is determined according to the information obtained from the TNM system, which will be discussed in detail below.

These are stages I to IV, and the small numbers indicate the early stages in which the cancer has spread poorly, that is, the tumor is small in size.
These stages are the most important determinants of the treatment plan.

1. The first stage: It is the stage when the tumor is only in one lung and not in the lymph nodes.
2. The second phase: This is the stage when the cancer has spread to the lymph nodes surrounding the lung where the tumor is located.
3. Stage Three A: This is the stage when the cancer has spread to the lymph nodes around the windpipe, chest wall, and diaphragm on the same side of the lung as the tumor.
4. third stage b: This is the stage when the cancer has spread to the lymph nodes in the other lung or neck.
5. The fourth stage: This is the stage when the cancer has spread (metastasized) to the rest of the body and other parts of the lungs.

Second, the stages of small cell lung cancer

over there two phases: Limited and diffuse in the chest (chest cavity).

• In the limited stage: The tumor is located in one lung and nearby lymph nodes.
• In its diffuse stage: The tumor has spread to the other lung as well as to other parts of the body.

Small cell lung cancer, in particular, tends to cause a malignant brain tumor.
Therefore, at the stage of staging the disease, an MRI of the brain must be performed and to check for the presence of the disease in the brain.

Lung cancer treatment methods in Turkey

In recent years, there have been very promising developments in the treatment of lung cancer.
Advances in molecular pathology and especially imaging technologies have made us better understand lung cancer and its pathology.

Especially in the past 15 years, new chemotherapy drugs have been developed, immunotherapy drugs discovered, surgical techniques improved, radiotherapy devices modernized, radiotherapy applications focused on 3D tumor tissue, and SBRT (stereotactic radiotherapy) for small and non-small tumors. It can be surgically removed.
In addition to the amazing techniques and methods in Interventional Radiology That burns and freezes the tumor, and the development of intensive treatment directly to the tumor from the arteries has made lung cancer more treatable.

While all these developments will make a very positive contribution to the patient, they will also remove confusion in the treatment sequence with proper treatment planning.

When planning treatment, many factors related to your disease are taken into account.

• The type of lung cancer you have.
• Where the cancer is located.
• The general health condition of the patient.
• The extent of the cancer and its relationship to critical organs (the stage of the cancer).
• Imaging results and blood tests.

After you have comprehensive information about treatment alternatives, your choice is very important in treatment planning.

Is the type of cancer important in the treatment of lung cancer?

Lung cancer is primarily screened in two groups, and treatment choice is evaluated separately in two subgroups.

Lung cancers are divided into small cell lung cancer and non-small cell lung cancer.
The treatment applied in non-small cell lung cancer differs from that of small cell lung cancer.

Small cell lung cancer is most often treated with chemotherapy and radiotherapy.

Surgery is rarely preferred in cases where the cancer hasn't spread to the lymph nodes (mediastinal lymph nodes) in the center of the chest and is very small.
When small cell lung cancer is diagnosed, it is usually noted that the cancer has spread.
For this reason, chemotherapy is often used as the main treatment for this type of lung cancer, and radiation therapy is also used as an adjunct to chemotherapy.

Non-small cell lung cancer is treated with surgery, chemotherapy, or radiotherapy sequentially or simultaneously, depending on the stage of the disease when the disease is diagnosed.
In some patients with advanced lung cancer, targeted smart drugs may also be given.

 Expression of non-small cell lung cancer includes 4 main groups that differ from small cell types, divided into subgroups in order of prevalence:

1. glandular carcinomas;
2. squamous cell carcinoma;
3. Large cell carcinomas.
4. And cancers of the mixed type.

They are all treated the same way in the early stage (stages 1-3). While in the advanced stages it is treated separately according to the type of cancer.

Small cell lung cancer treatment - according to its stage

Patients diagnosed with small cell lung cancer usually receive early stage Chemotherapy before/or in conjunction with radiotherapy.
Chemotherapy and radiotherapy (chemoradiotherapy) may be given at the same time to patients whose health, spread, stage and test results are appropriate.

The most common sites of this type of cancer spread to the brain. Therefore, in patients whose tumors are regressed with chemotherapy, radiotherapy is generally recommended to the area of the lung and brain where the primary tumor is.
Usually given after chemotherapy is complete even if the radiographs are intact, this radiotherapy aims to kill potential cancer cells that have spread to the brain that are too small to be seen on imaging tests. This method is called Cranial prophylactic radiotherapy or PKI.

If the cancer is in early stage It has not spread to the lymph nodes in the mediastinum of the chest The cancer is surgically removed from the lung, and radiotherapy is applied at the same time However, most of the time when small cell lung cancer is diagnosed, it has usually spread and is unlikely to be applied surgery.

In metastatic small cell lung cancer that has spread to the lymph nodes or other parts of the body, chemotherapy, radiation therapy or palliative care may be applied to relieve symptoms.

If chemotherapy is successful in shrinking a tumor in the lung, radiation therapy will likely be applied to the brain to kill cancer cells that have spread to the brain.

Significant improvements in small-cell lung cancer survival and treatment options have not been made for nearly 30 years.
Although a large number of smart molecules have been examined in this disease, they have not contributed to changing life expectancy.
Led treatment strategies presented at eminent conferences for this type of cancer.
In particular, the new generation immunotherapy drug (pembrolizumab) has become a hope for patients with small cell lung cancer.

Additionally, while preventive radiotherapy was applied to the brain only after chemotherapy.

After new studies, it was found that the application of radiation to the location of the area where the cancer arose in patients led to a prolongation of the life of these patients.
In recent years the usefulness of applying radiology to the brain has been re-examined and examined more closely in recent years.

We will follow new developments in this area and will continue to inform you.

Treatment of non-small cell lung cancer - according to its stage

1. Lung cancer stage I

Stage I is rare in non-small cell lung cancer.

At this point, part of the lung (lobectomy) or all of it (pneumonectomy) is surgically removed.

Studies in recent years show that the results of SBRT (Stereotactic Radiotherapy), a specific target-oriented radiotherapy modality in the treatment of early-stage lung cancer, may have similar and perhaps superior results to surgery, especially in patients who cannot Or they don't want surgery because of additional problems or diseases.

Another option for patients with small tumors that cannot be operated on is radiofrequency ablation (RFA).

2. Lung cancer stage II

Surgery may be recommended for stage 2 non-small cell lung cancer.

Depending on the location of the tumor, a portion of the lung may be removed (lobectomy) or complete (pneumonectomy).

If all of the cancer is removed, you may be offered Chemotherapy prophylactic for the patient.
Chemotherapy aims to reduce the risk of cancer recurrence.
This chemotherapy practice is called adjuvant chemotherapy.

It is important that the doctor informs the patient about the side effects and benefits of chemotherapy before treatment.
If the tumor cannot be completely removed, the patient may receive radiation therapy after surgery.

Radiation therapy or a combination of chemotherapy and radiotherapy (chemoradiotherapy) may be recommended for patients who cannot have surgery due to other health problems.
This treatment aims to completely eradicate the cancer.

3. Lung cancer stage III

• This stage is divided into two groups as 3a and 3b, these two groups are divided into two subgroups, each of which is of vital importance and determines the treatment strategy.

In stage 3a: The lymph node in the thoracic cavity is examined, and it is further divided into two groups:

1. The group in which the invasion of the lymph nodes is within (minimum of N2):

In this group, the cancer has spread to the lymph nodes but was not detected from the images because of mild spread, which means that it is detected by taking biopsies from the lymph nodes and detecting them microscopically.

At this point, surgery after chemotherapy is an important option for surgically qualified patients.
However, radiotherapy and simultaneous chemotherapy are the most effective method in patients unsuitable for surgery.

At this stage, our patients are offered the option of intra-arterial chemotherapy, which is one of the innovative treatment applications in Turkey. With treatment applied through the arteries, intensive chemotherapy can be applied to the tumor and the response rate to treatment can be greatly increased, thus increasing the chance of successful surgery.

2. The group called Bulky N2:

Since there are many metastases to the lymph nodes in the chest cavity in this group.
As it shows clearly in the imaging, surgery is not the preferred method in the world.

For patients whose general condition is suitable, radiotherapy is the only preferred method to be used simultaneously with chemotherapy.

• Stage 3b is examined in two groups within itself.

1. First, the tumor was in close contact with critical organs, but there was no mediastinal lymph node invasion (contralateral lymph node involvement); Some patients in this group can operate directly by some competent surgeon, or sometimes, surgery is performed after a dose of chemotherapy has been administered.
2. If there is a large spread to the lymph nodes, then surgery is not possible, and the correct treatment is radiotherapy with chemotherapy after measuring the general condition of the patient.

3. Lung cancer stage 4

The main treatment for stage 4 lung cancer is chemotherapy.
However, after 2015, new generation immunotherapy drugs also became part of the standard treatment for this stage of lung cancer.

Additionally, targeted smart drugs should be considered in patients for whom tumor genetic characteristics are appropriate. In the treatment of stage 4 non-small cell lung cancer, this treatment aims to shrink the tumor in order to control the cancer for as long as possible and reduce symptoms.

In the fourth stage, the surgical method is rarely preferred.
Rarely, in cases appropriate for surgery, patients are examined extensively to reduce the error rate.
In very few cases, surgery may be preferred in stage IV lung cancer.
If the primary tumor is not very large and there is no invasion of adjacent organs and has not spread to the lymph nodes in the chest cavity, and there is a single spread to the opposite lung, adrenal gland or brain, it can be surgically removed.

These decisions should be made at this stage through detailed examination by doctors of different specialties. These decisions are very serious and require different opinions and cannot be made by a single doctor.

Patients with cancer cells that contain certain proteins (receptors) may be treated with a targeted medication called erlotinib (Tarceva), gefitinib (Iressa), or crizotinib (Xalkori).

For patients receiving chemotherapy whose spread of cancer cannot be controlled, the chemotherapy drugs are re-changed if their condition is appropriate.

If there is a mutation (change) of the EGFR receptor in the cancer, erlotinib therapy may be recommended.

If there is a change in the ALK gene, a targeted drug called Xalkori is preferred.

Treatment plan for newly diagnosed stage IV non-small cell lung cancer - summary

Radiation therapy may be applied to control symptoms such as coughing or pain.
If the tumor is in one of the main airways (the right or left windpipe), other treatments in addition to radiation therapy can relieve or prevent symptoms.
These treatments can be listed as follows:

• Internal radiation therapy (brachytherapy).
• Laser treatment.
• Freezing the tumor (cryotherapy).
• Using a rigid tube (stent) to keep the airway open.
• Light therapy (phototherapy).
• Lung cancer vaccine treatment.

There have been serious developments in recent years in the treatment of lung cancer.

The most important of these developments, which mostly relate to patients with stage IV lung cancer, is smart therapy (immunotherapy)Also known as the lung cancer vaccine.
Immunotherapy means that the patient uses the immune system to kill cancer cells.
For this reason, it has fewer side effects than other chemotherapy
. Until recently, immunotherapy was performed when chemotherapy was unsuccessful.
At the present time, patients with stage 4 lung cancers in both America and Europe can be treated with this vaccine from the moment it is diagnosed.

In order to know whether the lung cancer vaccine can be used, some of these tests are first required
. Depending on the type of lung cancer, it is determined whether a patient is an appropriate candidate for this vaccine.

If the patient is suitable for vaccination, the lung cancer vaccine can be started from the time of first diagnosis.
Although the vaccine does not have many side effects such as nausea or vomiting, it may cause temporary inflammation of the intestine and thyroid.

Because the vaccine is only used in the fourth stage, therefore, the area of its use today includes only extending life and not treating it completely.

What are the ways to prevent lung cancer?

Lung cancer cannot be attributed to a single factor, as there are several factors that play a role in the development of the disease, such as tobacco use or exposure to radiation, and lung cancer is not considered contagious.

However, some people may be more susceptible than others.

The risk of developing cancer increases in the following cases:

• The effect of cigarettes on the lung:

Smoking is one of the main causes of lung cancer.
As the carcinogens in tobacco destroy the cells of the lungs.

Over time, these irritations can eventually cause cancer to form. If the patient is a smoker.
The age at which cigarettes were started, the duration of smoking, the number of cigarettes smoked per day, and how deeply the cigarette was inhaled all affect the concentration of carcinogens in the lung.
Of course, quitting smoking significantly reduces the risk of lung cancer.

• Cigars, pipes and lung cancer:

The use of cigars and pipes increases the risk of cancer more than regular smoking methods.

Asbestos increases the likelihood of developing lung cancer. It is a group of minerals that occurs naturally in the form of fibers and is used in some industries as an insulating material.
Asbestos fibers tend to break into particles and stick to clothing as they travel through the air.
When these particles are inhaled, they settle in the lungs. This damages lung cells and thus increases the risk of cancer.

Studies have shown that workers exposed to asbestos are 3-4 times more likely to develop lung cancer than those who were not exposed to it.
This increase is greater for those who work in industries such as shipbuilding, asbestos mining, insulation work and brake repair.
The risk of lung cancer is greater if asbestos workers smoke.
Asbestos workers should use the protective equipment provided by their employer and follow recommended work and safety warnings.

• Air pollution and lung cancer

A relationship has been found between lung cancer and exposure to air pollution.

But this relationship has not been clearly described and more research is needed.

• lung diseases

Some lung diseases, such as tuberculosis, increase a person's risk of developing cancer. Lung cancer tends to develop more in areas affected by tuberculosis.

• patient story.

  A person who has previously had lung cancer is more likely to develop lung cancer again than a person who has never had it before. Stopping smoking after a diagnosis of lung cancer can prevent the development of a second lung cancer.

you can contact us In Bimaristan company to learn about the best ways to treat lung cancer