What Is Lung Cancer And Its Treatment

By Author: Dr. Albert Roy
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Methods of Treatment

Cancer can be treated by any or all the following methods depending upon the site and the stage of the disease.

1. Surgical removal

2. Radiation therapy

3. Chemotherapy

4. Hormonal therapy

Which method should be used in a particular case, depends essentially on:

1. The type of cancer, and

2. The stage of the disease when diagnosed

It is necessary to see and recognize the cancer cell before a decision can be taken about the method of treatment. Some Cancer cells respond to radiation, others don't; some cancer cells respond to one drug, others to another; many cancer respond better to a combination of drugs.

The stage of the disease at which a patient presents himself the doctor, is very important in deciding the line of treatment. This is because survival rates are better for cancers that are localized or at primary stage than for those which have spread or at secondary stage.

The internationally recognized staging system is known as the TNM classification in which T defines the extent of the primary (t) umour, N defines ...
... the extent of the regional lymph (n) ode involvement, and M defines the presence or absence of (m) etastases.

The patient's history and physical examination provide a starting-point for planning treatment. It is usually necessary to perform specialized investigations to determine the type of cancer and extent of its dissemination or spread prior to selecting the treatment process.

Surgery

Surgery is usually indicated in cases of localized cancers. It may be done either alone or in combination with other lines of treatment such as radiation and chemotherapy.

If the cancer has not infiltrated into the surrounding areas and has not spread from the original site to different areas, then surgery may be all that is necessary. All the cancerous tissue has to be removed. In the process, even if a doubtful normal adjacent part is to be excised or surgically removed, this is done for the sake of safety and to prevent the recurrence of the cancer. The lymph glands enlarged or even suspicious, draining the area of cancer, are also resected or surgically removed.

Surgery is also resorted to in cases where the cancer is inoperable because of spread. This is done in order to remove any obstruction in a vital part of the body such as the intestines or bronchi of the lungs.

Surgery is also undertaken sometimes so that the patient is saved from very severe pain.

Radiation

Radiation involves the exposure of a selected area of the body to a source of ionizing radiation or X-rays under carefully controlled conditions. Treatment planning involves accurate localization of the cancer and calculation of the total radiation dose to be given and dividing the same into daily fractions over a period of some days or weeks so that there is optimum response and minimum side-effects.

The calculation is done by the radiation therapist by taking care of all the facts of the case, including how sensitive to radiation are the cancer cells of a particular patient as diagnosed by a pathologist from a biopsy specimen. The measurement of the radiation given is counted in units called rads (radiation absorbed dose), i.e. the radiation absorbed by the tissues.

Small fractions of radiation given in divided doses over a period of many days or weeks, do less harm to the normal cells.

Radiation damages cells by interaction with DNA present in the nucleus of the cells thus preventing the normal reproduction of that cell. Fast-dividing cancer cells are more susceptible to being killed than the normal cells. The normal cells are also damaged in the process to some extent.

Side-effects of Radiation Treatment

A feeling of fatigue and diminished appetite are the commonest side effects, though not observed in all the patients.

Redness of the skin exposed to X-rays is not uncommon. When radiation is given over the abdomen, the patient may develop some amount of diarrhea.

Radiation in the region of head and neck may cause difficulty in swallowing.

Radiation effects on the bone marrow may occur if larger areas are treated. Minor decreases in lymphocyte count are common, but a frequent check on the peripheral blood is made throughout; the treatment to adjust this if significant marrow suppression occurs.

Maintenance of adequate hemoglobin is important to the outcome of therapy since less oxygen in the blood (hypoxia) may render the cancer mass less sensitive to renditions on damage.

Chemotherapy

Chemotherapy is the prevention or treatment of disease by use of chemical substances. The term is sometimes restricted to the treatment of infectious diseases with antibiotics and other drugs or to the control of cancer with antmetabolites (that prevent cell growth) and similar drugs.

During the Second World War, research into the various aspects of the action of mustard gas which is ordinarily poisonous showed that this along with sulphur could destroy dividing cells in lymph nodes and the bone marrow. This harmful effect was harnessed to man's use for treating some lymphomas with nitrogen mustard. Thus was discovered the first cytotoxic drug against cancer, which damages or destroys cancer cells by inhibiting cell division.

Thereafter many naturally occurring substances were tested for anti-cancer activity on experimental animals resulting in the present availability of some 30 effective anticancer drugs.

Anti -cancer drugs are the treatment of choice for many widely disseminated cancers and serve as adjuncts to surgery and radiation in the treatment of localized ones.

The success of the various combinations of chemotherapy agents used in the treatment of some cancers has brought hope to the patients.

Unfortunately, these drugs also affect normal cells particularly in bone marrow, skin, stomach lining, and fetal tissue and damage or destroy them, to some extent, resulting in many side-effects which are fairly serious. That is why the search for ideal anti-cancer drugs continues.

Categories of Anti-cancer Drugs

Various anti -cancer drugs developed over a period of three decades, can be grouped into different categories depending upon what function of the cancerous cells they disturb so as to kill them.

Alkylating Agents: They react chemically with DNA, the genetic material of the cell, which controls its division and function. Examples are, Busulphan, Chlorambucil, and Cyclophosphamide.

Antmetabolites: They interfere with DNA production.

Examples are, 5-Fluro-uracil, Methotrexate,

6-Mercaptopurine, Cytocine arbinoside.

Mitotic Inhibitor: They are plant alkaloids. They interfere directly with cell division. Examples are Vincristine, Vinblastine, and Vindesine.

Antibiotics: They are derived from different strains of bacteria. They can kill cancer cells. Examples are Adriamycin, Actinomycin-D, Bleomycin, and Mitomycin C.

Miscellaneous: These are drugs that work on cancer cells in ways different from the above categories. Examples are; Asparaginase, Hexamethylmelamine, Hydroxyurea.
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