Lung cancer: signs, symptoms, causes and treatment

Lung cancer unfortunately is one of the most
common causes of cancer in the UK. The most common symptoms of lung cancer are having
a cough that often lasts for more than three weeks, coughing up blood, feeling breathless
while having a severe pain in the chest. In addition, sometimes patients with lung cancer
have a loss of appetite and because of this, can also lose a considerable amount of weight.
It is important to know however that it is perfectly possible to have a lung cancer without
any symptoms at all. In the UK, approximately 85% of cases of lung
cancer are directly linked to exposure to tobacco. So smoking is still unfortunately
one of the commonest causes of lung cancer. In addition, exposure to dust such as asbestos
and in particularly the gas radon also predisposes to lung cancer.
What we’re increasingly recognising however is that people who have never smoked or have
no obvious exposure to either asbestos or radon are also developing lung cancer. And
this proportion of patients who have never smoked in developing lung cancer appears to be increasing. Unfortunately in my clinical practice, far too often I hear that lung cancer is a death
sentence. This is very much not the case with modern treatments. If we’re able to detect
lung cancer early enough, we can offer treatments such as surgery and high doses of radiotherapy
which have been shown to cure lung cancer in the majority of patients. The key however
is detecting the disease at a stage that is early enough for those treatments to be applied. In the UK, it’s very common for patients to have a CT scan carried out of their
neck, chest and upper abdomen as an initial investigation. They will then commonly see
a respiratory specialist like myself who would take a history from the patient to clarify
what their risk factors may be for lung cancer and importantly to learn about their symptoms
and also their wishes as a patient. We would then as the next step want to carry
out a biopsy test. This will tell us exactly first of all whether it is a lung cancer and
secondly, if it is a lung cancer, what type of lung cancer it may be. We may then want
to do a third test which would be a PET CT scan which may help to clarify the extent
to which the cancer has spread if at all. Once we have all of this information together
including the extent to which the cancer has spread along with the type of cancer we’re
dealing with, it is then important to sit down and discuss the treatment options with the
patient. The endobronchial ultrasound or EBUS has become
a very important procedure for the diagnosis and staging of lung cancer. It is now routinely
performed to obtain biopsies on patients in the UK and worldwide for diagnosing lung cancer.
The procedure itself is relatively straightforward. It is done in an outpatient setting with the
patient receiving an injection as a sedative. This means that they are very calm and relaxed
but still easily rousable. A spray is usually applied to the back of the throat to make
the throat numb and then a small telescope is introduced via the mouth into the lungs.
This is not a painful procedure. There is coughing involved but this is mitigated by
the operator using local anesthetic. Once the telescope is inside the lungs, the operator
is able to take an ultrasound probe and have a close look at all lymph nodes within the
centre of the chest. Once they have identified an area that they wish to sample, under direct
vision of the ultrasound, they’re able to take biopsies from the lymph nodes within
the centre of the chest. A procedure will take typically 30-40 minutes
and is generally well-tolerated. The patient would then recover for an hour or two within
the hospital unit before being discharged home. The results from the procedure are generally
extremely good. And we would expect a positive answer from at least 9 out of 10 procedures.
The procedure is also extremely safe and well tolerated and complications are extremely