WHAT YOU SHOULD KNOW ABOUT LUNG CANCER
The diagnosis of lung cancer brings with it many questions and the need for clear and understandable answers. We hope that this booklet we have prepared will help our patients. The booklet contains information about some causes of lung cancers, ways of prevention, symptoms, emergence, diagnosis and treatment of the disease. Having this important information will help patients and their families fight the disease.
WHAT IS CANCER?
All types of cancer develop in our cells, which are the body’s main life unit. To understand cancer, it will be helpful to understand how normal cells turn into cancerous cells. Our body is made up of many types of cells. Normally, cells grow, divide and form more cells. Thus, they ensure the healthy functioning of the body. But sometimes this situation is disrupted and cells continue to divide and multiply even when new cells are not needed. These excess cells cause a tumor. Tumors can be benign or malignant.
Benign tumors are not cancer. They are usually surgically removed, and in most cases they do not recur. Cells in benign tumors do not spread to other parts of the body. Most importantly, benign tumors are very rarely life-threatening.
Malignant tumors are cancer, these cells are abnormal, they divide uncontrollably. These cancer cells can invade and destroy the surrounding tissue, and at the same time, the cancer cells can leave the malignant tumor and enter the bloodstream and lymphatic system (metastasis). This explains how cancer separates from the original tumor and forms new tumors in other parts of the body.
Lungs are part of our respiratory system and are sponge-like cone-shaped organs. The right lung has 3 divisions. These segments are called lobes and are slightly larger than the 2-lobed left lung. When we breathe, oxygen (O2), which is necessary for our cells to live and perform their normal functions, enters the lungs. When we exhale, the waste product carbon dioxide (CO2), which is formed as a result of the cells in our body burning oxygen, is expelled from the lungs.
Lung Cancer:
Cancers that start in the lungs are divided into two different types. Non-small cell lung cancer and small cell lung cancer. Differentiation of these cancers from each other is made according to the images of the cells under the microscope. Both types of cancer develop, spread, and are treated in different ways.
Non-Small Cell Lung Cancer
They are more common than small cell lung cancers and generally develop and spread more slowly. There are 3 main types of this cancer: There is no difference between these types in terms of treatment and life expectancy.
Small Cell Lung Cancer
This cancer is also sometimes called oat oat cell cancer. It is less common than non-small cell lung cancer. This type of cancer develops faster and spreads more to other parts of the body.
Cancers that start in the lungs are divided into 2 types. Non-small cell lung cancer and small cell lung cancer as viewed under the microscope. Each type of lung cancer grows, develops, and is treated differently.
Risk Factors in Lung Cancer;
Lung cancer formation cannot be attributed to a single cause. As a result of the researches, many causes of lung cancer have been found. Various factors may play a role in the formation of lung cancer. . Many of these are associated with tobacco use Cancer is not contagious. Some people have a greater risk of developing lung cancer than others. The risk of cancer increases in the following situations.
Smoking; Smoking causes lung cancer. Harmful substances (carcinogens) in tobacco damage cells in the lung. Over time, these harmful effects can cause cancer in the cells. a smoker’s lung cancer; At what age he started smoking, how long he has been smoking, the number of cigarettes he smokes per day, how deeply he inhales the cigarette. Quitting smoking greatly reduces a person’s risk of developing lung cancer.
Cigars and pipes; those who use cigars and pipes have a higher risk of developing lung cancer than those who do not use them. How many years a person has smoked a cigar or pipe, how many times a day he smokes and how deeply he inhales are the factors affecting the risk of cancer. Although they do not inhale, cigar and pipe smokers are also at risk for other types of lung and mouth cancer.
Passive smokers (exposed to tobacco smoke); The risk of developing lung cancer also increases in the case of passive smoking.
Asbestos; It is a group of minerals used in certain industries and naturally found in fibers. Asbestos fibers tend to break up into particles and circulate through the air and stick to clothing. When these particles are inhaled, they settle in the lungs and damage the lung cells there, thereby increasing the risk of developing cancer. Studies have shown that workers exposed to asbestos are 3-4 times more likely to develop lung cancer than those not exposed. This increase has been demonstrated by those working in industries such as shipbuilding, asbestos mines, insulation work, and brake repair.
Lung cancer risk is greater if asbestos workers smoke. Asbestos workers must use protective materials provided by their employers and follow recommended work and safety procedures.
Air Pollution; An association has been found between lung cancer and exposure to air pollution. But this relationship has not been clearly described and further 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’s history; A person who has had lung cancer once has a higher risk of developing a second lung cancer than a person who has never had cancer. Quitting smoking after a diagnosis of lung cancer can prevent the development of a second lung cancer.
Risky occupations; Miners, textile, insulation and shipyard workers, petro-chemistry, chimney cleaners, plastic industry workers, mine and welding workers, bleach manufacturers, glass ceramic, linoleum and battery workers, paint, foundries, steel workers
Lung The best way to prevent cancer is to quit smoking or not start at all.
AWARENESS OF FINDINGS
Signs and symptoms of lung cancer:
1- A persistent cough that gets worse over time
2- Persistent chest pain
3- Spitting up blood
4- Shortness of breath
5- Wheezing.
6- Frequent pneumonia or bronchitis and its persistence
7- Neck and facial swelling
8- Loss of appetite and weight
9- Fatigue
These findings may be due to lung cancer or less serious conditions. Findings need to be evaluated by a physician.
DIAGNOSIS OF LUNG CANCER
In order to help find the causes of the symptoms, the doctor can determine the diseases the person has, tobacco use (cigarette, pipe, cigar, etc.), environmental or occupational exposure to substances and other family members. He asks if he has cancer. He or she may order a chest X-ray and some tests. If he suspects lung cancer, he requests sputum examination (sputum cytology; examination of the material coming out of the mucous membrane of the lungs with a deep cough under a microscope). This examination is a simple and useful test to detect lung cancer. The doctor may need to examine the lung tissue to be sure of cancer.
Examining a small piece of tissue taken by biopsy by a pathologist doctor under a microscope shows whether the person has cancer.
There are several ways to get this piece of tissue.
1)Bronchoscopy: A thin and lighted tube (bronchoscope) is inserted through the mouth to see the airways, the airways are examined and a small piece of tissue is taken from it.
2)Needle aspiration: It is the process of removing a small piece of tissue from the tumor by inserting a needle into the chest.
3) Thoracentesis: It is the examination of this sample by taking a little of the fluid surrounding the lungs using a needle.
4)Thoracotomy: It is the surgical opening of the thoracic cage in order to take a piece of the tumor to recognize the cancer.
STAGES OF THE DISEASE:
If cancer is detected in the patient as a result of the examinations, the doctor will want to know at what stage the disease is. This staging is done to find out if the cancer has spread, if it has spread, to which part of the body it has spread.
Lung cancer usually spreads to the brain and bones. Knowing the stage of the disease helps the doctor plan treatment. Some of the tests used to find out if the cancer has spread are:
Computed tomography
Magnetic Resonance Examination
Bone scintigraphy; It indicates whether the cancer has spread to the bones. A small amount of radioactive material is given to the blood circulation and collects in the place where there is abnormal bone development. The device called the scanner measures the radioactive level in these areas and records it on the x-ray film.
Mediastinoscopy / Mediastinotomy: Mediastinoscopy shows whether the cancer has spread to the lymph nodes in the chest.
LUNG CANCER TREATMENT
Treatment depends on many factors. These are the type of lung cancer, the stage of the disease and the general health of the patient. Many different treatments and combinations of treatments are used in the treatment.
Additional treatment given to patients who have no visible, detectable cancer after surgery is called adjuvant therapy. Adjuvant therapy is given after surgery to kill a small number of cancer cells that are not visible to the naked eye but are likely to be left behind. The decision whether to give adjuvant treatment is determined by the characteristics of the pathology report, the age of the patient, and his general condition. Patients can receive chemotherapy alone or only radiotherapy or both chemotherapy and radiotherapy as adjuvant treatment after surgery. Sometimes, very early stage patients may not require post-operative adjuvant therapy.
Surgery: It is an operation to destroy the cancer. The type of surgical intervention depends on the location of the cancer in the lung. The operation to remove a small piece of the lung is called a ‘wedge’ or ‘segmental’ resection.
If the entire lobe is surgically removed (lobectomy), it is termed as either right or left lung removal (pneumonectomy). Some tumors cannot be operated due to their location, size and general health status of the patient.
Chemotherapy: it is the killing of cancer cells with drugs. It usually consists of more than one drug. Only nurses with special training in this field give chemotherapy. The number of chemotherapy is expressed as a cure (such as the 1st cycle, the 2nd cycle) and usually the same drugs are given by repeating every 21 or 28 days. Chemotherapy is most often given in the form of intravenous fluids in outpatient centers or as an oral pill. Sometimes, depending on the general condition of the patient, the drugs given or the way the drugs are given, patients may need to receive their treatment in the hospital. After each cure, patients are checked in the medical oncology outpatient clinic. In these controls, patients are examined, their complaints are listened to, the side effects of drugs are questioned, and some blood tests are requested to investigate whether they cause any harm to other organs in the body. Before each cycle, blood count should be done and this count should be shown to authorized nurses giving chemotherapy. The characteristics of the tumor in the pathology report determine whether a patient will receive chemotherapy after surgery and, if so, how many cures he will receive. However, the age and general condition of the patient also play an important role in making these decisions.
Chemotherapy is not suitable for patients whose general condition is poor enough to spend more than 12 hours in a day, as they cannot tolerate side effects. In patients who are planned to undergo chemotherapy, it is preferred to start chemotherapy within 3 weeks after surgery if they have had surgery.
Patients receiving chemotherapy should go through a doctor’s control in the medical oncology clinic approximately one week after each chemotherapy. In this control, the patients are examined, their complaints are listened, the side effects of chemotherapy are evaluated and the dose of the drug is adjusted if necessary.
Radiation therapy: It is also called radiotherapy. It is the use of high-energy rays to kill the cancer cell. It is applied to any limited area and affects cancer cells in that area. Radiotherapy can be applied before surgery to shrink a tumor or after an intervention to destroy the cancer cell. Doctors often use radiotherapy in conjunction with chemotherapy as the first alternative to surgical treatment. It can also be used to relieve symptoms such as shortness of breath.
Photodynamic therapy: This is the introduction of a special chemical into the bloodstream and its uptake by cells. This chemical quickly leaves normal cells. But it remains in cancerous cells for a longer period of time. Then, by applying laser light to these cells, the substance is activated and the cells are killed.
Treatment of non-small cell lung cancer:
Patients with non-small cell lung cancer can be treated in many different ways. The choice of treatment is related to the extent of the disease. Surgical intervention is the most common form of treatment. Radiotherapy and chemotherapy can also be used to slow the duration of the disease and control symptoms.
Small cell Lung cancer treatment:
Small cell lung cancer spreads rapidly. In many cases, the disease has spread to other parts of the body at the time of diagnosis. Doctors almost always use chemotherapy to reach cancer cells that have spread throughout the body. Treatment including chemotherapy can also be applied by targeting tumors in the lung or tumors in other parts of the body. Radiotherapy to the brain can be applied to some patients even if there is no cancer there. This treatment is called protective brain irradiation. This is given to prevent a tumor from forming in the brain. Surgical treatment is rarely used in small cell lung cancer.
SIDE EFFECTS
Side effects of cancer treatment depend on the type of treatment and may be different for each patient. Doctors and nurses explain possible side effects of treatment to patients. They suggest ways before and after treatment to avoid side effects.
Surgery is the mainstay of treatment for lung cancer. Air and fluid tend to accumulate in the chest after lung surgery. Patients often require assistance with turning around, coughing, and breathing deeply. These movements are important for treatment. Because it helps the remaining lung tissue to expand and excess air prevents fluid accumulation. Chest pain and shortness of breath are common side effects of lung surgery. Patients may need weeks-months to regain their old energy and strength.
The side effects of chemotherapy vary according to the drug given. As a general rule, chemotherapy affects rapidly proliferating cells. Blood cells that provide coagulation during bleeding, make our defense against diseases and carry oxygen to the organs in our body are cells that multiply rapidly. These blood cells decrease in number about 1 week and 10 days after receiving chemotherapy, and therefore there may be rapid bruising or bleeding after minor procedures such as tooth brushing. Normally, since our defense system is strong when they enter our body, microbes that do not cause disease can easily cause us to catch feverish diseases after chemotherapy, as the cells that provide our defense are reduced. During this period, you should avoid eating raw vegetables and fruits (such as salad) that we wash and eat for at least 10 days. It is not because of any effect of vegetables on your disease, but to avoid possible microbes that may remain on the vegetable or fruit you eat, no matter how clean you wash it. Make sure your food is cooked within this time frame. If you have a fever that exceeds 38.50C for more than an hour, you should definitely contact your doctor. If you have a fever and your blood cells are found to be low in the blood count, you will need to be treated with antibiotics. This decrease in the number of your blood cells will go away on its own within a week to 10 days and the cells will reach their normal numbers.
Another group of rapidly proliferating cells are digestive system cells and hair root cells. For this reason, after chemotherapy, hair usually falls out after the first week. Loss of appetite, nausea, vomiting, diarrhea and mouth sores may develop in patients, almost all of these side effects can be controlled with medication. These side effects are short-lived, the complaints of the patients disappear before the next chemotherapy starts
The severity of these side effects of chemotherapy varies from patient to patient. Long, lasting side effects are rare with modern chemotherapies today. However, some chemotherapy drugs can have negative effects on the heart, and in those who use such drugs, the doctor periodically asks for tests to see if your heart is affected. The chemotherapy drug doses and chemotherapy cycle numbers used today are not large enough to have a negative effect on the heart. There is a risk of developing blood cancer, or leukemia, years after taking certain chemotherapy drugs.
Also, some cancer drugs kill egg cells by affecting the ovaries, so that the ovaries cannot produce the female hormone estrogen and patients enter menopause. Menstruation may become infrequent or stop, and in this case, women cannot become pregnant. Especially over the age of 35-40, infertility caused by chemotherapy is permanent. In younger patients, periods that are interrupted during chemotherapy may return to normal after a while.
Health personnel explain possible side effects of treatment after chemotherapy and suggest ways to eliminate complaints.
Chemotherapy drugs are mostly given intravenously and they can damage the vein they are given over time, causing the vein to harden and become visible when viewed from the outside. You should inform your doctor immediately if redness, swelling and burning occur in the arm that you take the drug while you are receiving chemotherapy or the day after you take it.
If you need to use painkillers for any reason while receiving chemotherapy, consult your doctor. Because some painkillers can cause a decrease in the number or function of blood cells in the body. Apart from this, you can continue with your medicines that you use for your heart, lung and kidney disease and which are of vital importance during chemotherapy. It would be appropriate to show your doctor about these drugs that you have to use during your visits and ask if there is any harm.
Radiotherapy, like chemotherapy, affects both cancerous and normal cells. Patients should rest as much as possible while receiving radiotherapy.
The skin in the treated area may become red, dry, sensitive and itchy. Towards the end of the treatment, the same area becomes more wet and runny. This is a reaction of the skin to the light. This area should be in contact with the air as much as possible, tight underwear and clothes should be avoided during this period. During the period of radiation therapy, this area should not come into contact with water. No lotion or cream should be used for this area without asking the doctor. The effects of radiation therapy on the skin are temporary. But the degree of influence varies from patient to patient. Sometimes, the skin color in the area that has received radiation treatment may remain darker than normal.
In metastatic disease, especially in brain metastases, brain irradiation is performed. This process lasts for 1 week or 10 days, and side effects such as nausea and vomiting due to radiation therapy may develop. tells
Patients receiving radiotherapy to the brain may experience headache, skin changes, fatigue, nausea, vomiting, hair loss, memory and thinking problems. Many side effects pass over time.
Other common side effects of radiotherapy are dryness in the throat, pain, difficulty in swallowing, fatigue, tissue changes in the treated area and loss of appetite.
OTHER SIDE EFFECTS
Cancer can cause decreased appetite. Some patients experience an unpleasant taste in the mouth. Nausea, vomiting and mouth sores, which are mostly side effects of treatments, make it difficult for the patient to eat. But nutrition is very important. Meals must contain sufficient calories and protein. Thus, weight loss and tissue repair can be achieved. Patients receiving treatment will feel more energetic and better if they eat regularly and adequately, and the side effects of drugs will be less common.
What are the chances of recovery with the treatment given?
Sometimes patients want their chances of recovery expressed in numbers. In fact, in large studies, there are numerical percentage values about how long the patient at which stage can live on average. However, it should be noted that these statistical values are an average of values from thousands of patients, so it would not be accurate to use them to predict what will happen to any cancer patient. What will happen to two patients with cancer in the future is different from each other. Many factors that we do not yet know about the tumor and the patient himself are effective in the different course of two people with the same disease. Therefore, do not compare yourself with other patients
FOLLOW-UP OF PATIENTS AND THE IMPORTANCE OF FOLLOW-UP:
It is also very important to follow-up the patient after lung cancer treatment. Regular checkups reveal changes in health status. Thus, if the cancer recurs or new cancer occurs, it can be treated as quickly as possible. These checks include examination, chest x-ray, and various laboratory tests. Any health problems that occur between checkups should be reported to the doctor immediately.
There is no special diet recommended after treatment, balanced diet, avoidance of high-fat foods, regular exercise, that is, the rules that every healthy person should follow under normal conditions are also valid for you.
When you have weight loss, loss of appetite, extreme fatigue, nausea-vomiting, dizziness, abdominal pain and fullness, bone pain, cough lasting more than two weeks, headache, you should contact your doctor without waiting for your normal periodic control time.
It is okay to continue your sexual life as before during and after the treatment. Due to the mutagenic effects of chemotherapy on ovarian cells (serious abnormalities may occur in the baby), one of the birth control methods should be preferred to prevent pregnancy during the treatment. Most of the chemotherapy drugs given disrupt the functioning of the ovaries, but the degree of this effect varies from patient to patient. Young male patients may want their sperm to be stored before chemotherapy for future artificial insemination or in vitro fertilization. Since some chemotherapy drugs affect the senses in the peripheral nerves, they may prevent the ability to have an erection or to achieve and maintain an erection.
The physical and mental problems you experience with the post-diagnosis treatment plan may affect your feelings such as fatigue, feeling of weakness, desire and excitement in your sexual life, due to illness or treatment. Such problems with your sexual life will pass over time, as will other problems you experience during this period and pass after treatment.
Do not hesitate to tell the doctors and nurses in the chemotherapy unit that you are receiving treatment that you have concerns about your sexual life and that you would like help in this regard.
SUPPORTING CANCER PATIENTS
Living with a serious illness is not easy. Cancer patients have many worries, feelings and thoughts that make their lives difficult, let alone coping with medical and physical changes. Cancer patients are worried about being able to maintain their jobs, the future of their families, and their daily activities. Examinations, treatments, the need for hospitalization, treatment costs worry them. She needs help in coping with this emotional state. In fact, paying attention to this emotional state of a patient is part of the treatment. The support of health personnel, support groups, patient-to-patient relationships prevent the person from feeling less alone and make him/her less stressed. It improves the quality of their life. Cancer support groups provide safe environments for cancer patients to share and talk about their experiences. Patients can consult their healthcare professionals to find such a group.
Doctors, nurses, and other healthcare professionals assist them with questions about treatment, work, and other activities. In addition, associations, counselors, religious communities and their members can approach patients to relieve their concerns about their personal problems and future.
Friends and relatives can support patients. The patient can meet other cancer patients who will have a problem with him. Cancer patients can form support groups and share with them what they know about the effects of treatment and cancer. It should be kept in mind that every patient is different. Although both are the same cancer patient, the right treatment and approach for one patient may be wrong for another. It is always right to apply the recommendations of friends and other family members after consulting the doctor.
