The Diagnosis Of Lung Cancer

Doctors use a wide limits of diagnostic procedures and tests to diagnose lung cancer. It includes:

• History and physical examination may reveal the presence of symptoms or signs suspicious for lung cancer. In addition to questions about the symptoms and risk factors of developing lung cancer, doctors may detect signs of breathing difficulties, airway obstruction, or infections in the lungs. Cyanosis, a color of the skin and mucous membranes are bluish caused by insufficient oxygen in the blood, suggesting that lung function dikompromiskan. Likewise, changes in the fundamentals of nail tissue, known as clubbing, may also indicate lung disease.
• Chest X-ray is the first diagnostic step if the most common symptoms of lung cancer where it is present. Chest x-ray procedure often involves a picture of the back to the front of the chest and also a picture from the side. Procedures such as x-ray anywhere, chest x-ray exposes the patient briefly in a small amount of radiation. Chest x-rays may reveal suspicious areas in the lungs but was unable to determine whether these areas are cancerous. Especially, calcifying nodules in the lungs or benign tumors called hamartomas may be identified on a chest x-ray and mimicking lung cancer.
• CT (computerized axial tomography scan, or CAT scan) scans might be conducted on the chest, abdomen, and / or brain to examine both tumor and primary tumor spread. A CT scan of the chest may be ordered when x-rays are negative or do not get enough information about the extent or location of a tumor. CT scans are procedures for x-ray that combines various images (multiple images) with the help of a computer produces cross-sectional images of the body. The pictures are taken by an x-ray machine is a large donut-shaped at different angles around the body. An advantage of CT scans is that they are more sensitive than standard chest x-rays in detecting lung nodules. Sometimes contrast material into the blood given before the procedure to help describe the organs and their positions. A CT scan exposes the patient to a very small amount of radiation. The most common side effect is an adverse reaction to the contrast material is introduced into the blood that may have been given before the procedure. May occur itching, rash, or itching red spots and swelling (hives) is generally disappear fairly quickly. Anaphylactic reactions are severe (allergic reactions to life-threatening breathing difficulties) to the contrast material is rare. CT scans of the abdomen may identify cancers that spread within the liver or adrenal glands, and CT scans of the head may be ordered to reveal the presence and extent of cancer spread (metastatic cancer) in the brain.
• A technique called a low-dose helical CT scan (or spiral CT scan) is sometimes used in screening (screening) lung cancers. This procedure requires a special type of CAT scanners and has been demonstrated as an effective tool for detecting cancer-small lung cancer in smokers and former smokers. However, has not been proven whether the use of these techniques actually save lives or reduce the risk of death from lung cancer. Heightened sensitivity of this method is actually one of the sources of its shortcomings, because lung nodules that require further evaluation will be seen in approximately 20% of people with this technique. Of nodules identified by low-dose helical screening CTs, 90% is not cancerous but require up to two years of tests and follow-ups are expensive and often not fun. Experiments are underway to further ensure the use of spiral CT scans in screening (screening) of lung cancer.
• Magnetic resonance imaging (MRI) scans might be proposed if the exact details about the location of the tumor required. MRI technique uses magnetism, radio waves, and a computer to produce images of body structures. As with CT scanning, the patient is placed on a moveable bed that is inserted into the MRI scanner. No side effects are known from an MRI scan, and there is no exposure to radiation. The image and resolution produced by MRI is quite detailed and can detect tiny changes of structures within the body. People with hyper-pacemaker (heart pacemakers), for investments of metal (metal implants), artificial heart valves (artificial heart valves), and structures that can not be surgically implanted in the scan with an MRI because of the risk magnet may move the metal parts of these structures.
• Positron emission tomography (PET) scanning is a specialized imaging technique that uses radioactive elements that have short life to produce color images of three-dimensional elements that function in the body. Where CT scans and MRI scans look at anatomical structures, PET scans measure metabolic tissue function and activity. PET scans can determine whether a tumor tissue is actively growing and can assist in ensuring the type of cells in a particular tumor. In PET scanning, patients receiving a drug that is a short-lived radioactive half and received roughly the amount of radiation exposure such as with two chest x-ray. Drugs issued positrons from anywhere they are used in the body. When the positrons encounter electrons within the body, a reaction producing gamma rays occurs. A scanner records these gamma rays mapped dam areas where the drug is placed. For example, combining glucose (a common source of energy in the body) with a radioactive element will show where glucose is being used in a growing tumor.
• Bone scans are used to create images of bones on a computer screen or on film. Doctors may order a bone scan to determine whether a lung cancer has spread to the bones. In a bone scan, a small amount of radioactive material is injected into the bloodstream and collects in the bones, especially in abnormal areas as involved by spreading tumors (metastatic tumors). Radioactive material is detected by a scanner, and the images of the bones is recorded on a special film for permanent observation.
• Sputum cytology: The diagnosis of lung cancer always requires confirmation of malignant cells by a pathologist, even when the symptoms and studies x-rays suspicious for lung cancer. The simplest method to establish the diagnosis is sputum examination under a microscope. If a tumor is found centrally and has invaded the streets of the air, this procedure, known as an examination of sputum cytology, may allow visualization of the tumor cells for diagnosis. It is a network diagnostic procedure least risky and expensive, but its value is limited because tumor cells are not always present in the sputum, even if it was a tumor is present. Also, the cells are not cancerous you may occasionally run perubahn-change in response to inflammation or injury that makes them look like cancer cells.
• Bronchoscopy: Examination of the airway by bronchoscopy (visualization of airways through a thin tube inserted through the nose or mouth) may reveal areas of tumor that can be sampled for pathological diagnosis. A tumor in the central areas of the lung or arising out of the streets larger air can be accessed to sample using this technique. Bronchoscopy may be implemented using a fiberoptic bronchoscope premises rigid or flexible and can be implemented indoors for outpatient bronchoscopy on the same day, an operating room, or a hospital room. The procedure can be unpleasant and require sedation or anesthesia. Where this procedure is relatively safe, this procedure must be performed by a lung specialist (pulmonologist or surgeon) who is experienced in this procedure. If a tumor has been visualized and taken quite example, an accurate diagnosis of cancer is usually possible. Some patients may cough up dark brown blood for one to two days after the procedure. Complications are more serious and rarely include a greater amount of bleeding, decreased levels of oxygen in the blood, and cardiac arrhythmias as well as complications from sedatives and anesthesia.
• Needle biopsy: Fine needle aspiration (FNA) through the skin, most commonly performed with radiological images for guidance, it may be worthwhile to get the cells back to the diagnosis of tumor nodules in the lung. Needle biopsies are helpful especially when lung tumors located around the lung and is not accessible to sampling by bronchoscopy. A small amount of local anesthetic is administered before insertion of a thin needle through the chest wall into the area of abnormal lung. Cells are sucked into the atomizer (syringe) and examined under a microscope for tumor cells. This procedure is generally accurate when the tissue of the affected area in the sample (sampled) to taste, but in some cases, adjacent areas, or who are not involved in the sample of the lung may be wrong. A small risk (3% -5%) of air leaks from the lung (called a pneumothorax, which can be easily treated) accompanies this procedure.
• Thoracentesis: Sometimes lung cancers involve the lining tissue of the lungs (pleura) and lead to an accumulation of fluid in the space between the lung and the chest wall (called a pleural effusion). Aspiration of a sample of this fluid with a thin needle (thoracentesis) may reveal cancer cells and determine the diagnosis. Just as needle biopsy, a small risk of a pneumothorax associated with this procedure.
• Primary Operating Procedures: If none of the above methods produce a diagnosis, methods of operation must be done to obtain tumor tissue for diagnosis. It can include mediastinoscopy (examining the chest cavity between the lungs through a surgically inserted examination by biopsy of the tumor mass -massa or lymph nodes) or (surgical opening of the chest wall with removal of the tumor as much as possible). Thoracotomy are rarely able to fully lift a lung cancer, and both mediastinoscopy and thoracotomy carry the risks of major surgical procedures (such as bleeding complications, and the risks of anesthesia and drugs). This procedure is performed in an operating room, and the patient must stay in the hospital.
• Blood tests-ice: When routine blood tests alone can not diagnose lung cancer, they may reveal abnormalities or metabolic-biochemical kelaianan in the body that accompany cancer. Contohna, calcium levels or enzymes increased alkaline phosphatase may accompany cancer that spreads to the bones. Likewise, the levels of certain enzymes that are normally present in liver cells increased, including aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT), signal liver damage, possibly through the presence of tumor spread.

Increased Lung Cancer

The level of a tumor refers to the extent of a cancer has spread in the body. Increased involves both the evaluation of the size of a tumor and the presence or absence of dissemination areas in the lymph nodes or to other organs. The increase is important for determining how a particular tumor to be treated, since lung cancer therapies matched to the level of tumor-specific level. Increased tumor is also critical in estimating the prognosis of a patient, with tumors higher levels generally have a worse prognosis than tumors of lower level.

Doctors may use several tests to accurately load levels of a lung cancer, including laboratory tests (blood chemistry), x-rays, CT scans, bone scans, and MRI-scans.tes abnormal blood chemistry tests may indicates the presence of cancer spread places in bone or liver, and radiological procedures can document the size of a tumor and also the possible spread to other organs.

NSCLC are given a level of I to IV in order of severity:

• At level I, the cancer is confined to the lung.
• At level II and III, the cancer is confined to the chest (with tumors that are larger and more invasive are classified as level III).
• Level IV cancer has spread away from the chest to other parts of the body.

SCLC enhanced using a system composed of two:

• Level SCLC refers to cancer that is confined to a limited area of ​​origin within the chest.
• At the level of extensive SCLC, the cancer has spread beyond the chest to other parts of the body.

Caring for Lung Cancer

Treatment for lung cancer can involve surgical removal of the tumor, chemotherapy, or radiation therapy, as well as combinations of these methods. The decision about which treatments will be appropriate for a given individual must consider the location and size of the tumor as well as the overall health status of the patient.

As with other cancers, therapy may be prescribed with the intention of cure (removal or eradication of a cancer) or relieve / alleviate (actions that are not able to cure a cancer but can reduce pain / pain and suffering). More than one type of therapy may be prescribed. In such cases, the therapy that is added to magnify the effects of the primary therapy is referred to as adjuvant therapy. An example of adjuvant therapy is chemotherapy or radiotherapy were included after surgical removal of a tumor in order to ensure that all tumor cells have been eradicated.

Operation: The surgical removal of the tumor is generally performed for limited level (level I or level II sometimes) NSCLC and is the treatment of choice for cancer that has not spread beyond the lung. Approximately 10% -35% of lung cancers can be removed surgically, but removal does not always result in a cure, since the tumors may have spread and can recur at a later time. Among people who have an isolated lung cancers grow slowly and which has been removed, 25% -40% are still alive five years after diagnosis. Operation is not possible if the cancer terlau close to the trachea or if the person has other serious conditions (such as heart disease or lung weight) that would limit their ability to tolerate an operation. Surgery less often performed with SCLC because these tumors are less likely located in the area that can be removed.

The surgical procedure chosen depends upon the size and location of the tumor. Surgeons must open the chest wall and may perform a wedge resection of the lung (removal of a portion of one lobe), a lobectomy (removal of one lobe), or a pneumonectomy (removal of an entire lung). Sometimes lymph nodes in the region of the lungs are also removed (lymphadenectomy). Surgery for lung cancer is a major surgical procedure that requires general anesthesia, hospital stay and follow-up care for weeks to months. After the surgical procedure, patients may experience difficulty breathing, shortness of breath, pain, and weakness. The risks of surgery include complications due to bleeding, infection, and complications of general anesthesia.

Radiation: Radiation therapy may be done as a treatment for both NSCLC and SCLC. Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells that divide / split. Radiation therapy may be given as a therapeutic cure (curative therapy), therapy that alleviates (palliative therapy) or as adjuvant therapy to surgery or chemotherapy. Radiation given externally, to make use of a machine that directs radiation at the cancer, or internally through placement of radioactive elements in the boxes are sealed within this area of ​​the body where the tumor is located. Brachytherapy is a term used to describe the use of a small grain of radioactive meteri placed directly into the cancer or into the airway near the cancer. This is usually done through a bronchoscope. A type of external therapy called the "gamma knife" is sometimes used to treat cancer spread places in a single brain. In this procedure, multiple beams of radiation focused on the tumor light for a few minutes to a few hours when the head is held in place by a rigid frame. Radiation therapy can be given if a person refuses surgery, if a tumor has spread to areas such as the lymph nodes or trachea making surgical removal impossible, or if a person has other conditions that make them too ill to perform major surgery . Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy, yet in 10% -15% of people it leads to cancer remission and long-term relief. Combining radiation therapy with chemotherapy can further increase the chances of survival when chemotherapy is administered. External radiation therapy can generally be carried out on an outpatient basis where internal radiation therapy requires a brief hospitalization. A person who has severe lung disease in addition to a lung cancer may not be able to receive radiotherapy to the lung.

For external radiation therapy, a process called simulation is necessary prior to treatment. Using CT scans, computers, and precise measurements, simulation map the exact location where the radiation will be given, called the treatment field. This process usually takes 30 minutes to two hours. External radiation treatment itself generally is done four or five days a week for several weeks.

Radiation therapy does not carry the risks of major surgery, but it can have side effects including fatigue unpleasant and lack of energy. A reduced white cell count (makes a person more susceptible to infection) and blood platelet levels are low (making blood clotting more difficult) can also occur with radiation therapy. If the digestive organs are in the field of radiation exposure, patients may experience nausea, vomiting, or diarrhea. Radiation therapy can irritate the skin in the treated area, but this irritation generally improves with time after treatment has been completed.

Chemotherapy: Both NSCLC and SCLC may be treated with chemotherapy. Chemotherapy refers to the administration of drugs that stop the growth of cancer cells by killing them or preventing them from splitting / dividing. Chemotherapy may be given alone, as an adjuvant to surgical therapy, or in combination with radiotherapy. Where a number of chemotherapeutic drugs have been developed, based on the drugs that platinum has been the most effective in treatment of lung cancers.

Chemotherapy is the treatment of choice for most SCLC, since these tumors are generally widespread in the body when they are diagnosed. Only half of people who have SCLC is still alive for four months without chemotherapy. With chemotherapy, their survival time is increased four to five times. Chemotherapy alone is not particularly effective in treating NSCLC, but when NSCLC has spread, it can prolong survival in many cases.

Chemotherapy may be given as pills, as an infusion administered intravenously, or as a combination of both. Chemotherapy treatments are usually given in an outpatient procedure. A combination of drugs is given in a series of treatments, called cycles, over a period of weeks to months, with breaks between cycles. Unfortunately, the drugs used in chemotherapy also kill cells that divide normally in the body, resulting in side effects were not fun. Damage to blood cells can result in increased susceptibility to infections and difficulties with blood clotting (bleeding or bruising easily). Other side effects include fatigue, weight loss, hair loss, nausea, vomiting, diarrhea, and mouth sores. The side effects of chemotherapy vary according to the dosage and combination of drugs used and may also vary from individual to individual. Drugs have been developed that can treat or prevent many of the side effects of chemotherapy. These side effects generally disappear during the recovery phase of the treatment or after its completion.

Brain prophylactic radiation: SCLC often spreads to the brain. Sometimes people with SCLC that is responding well to treatment are treated with radiation therapy to the head to treat very early spread to the brain (called micrometastasis) that is not yet detectable with CT or MRI scans and still not produce symptoms. Brain radiation therapy can cause problems of short-term memory, fatigue, nausea and other side effects.

Recurrence Treatment: Lung cancer returning after treatment with surgery, chemotherapy, and / or radiation therapy is called recurrence (recurrent or relapsed). If a recurrence of cancer is confined to one site in the lung, it may be treated with surgery. Relapsed tumors generally do not respond to chemotherapy drugs previously entered. Because of the drugs commonly used platinum-based chemotherapy in early of lung cancers, these agents are not useful in most cases of recurrence. A type of chemotherapy referred to as second line chemotherapy is used to treat recurrent cancers that have previously been treated with chemotherapy, and a number of ways the second line chemotherapy has been shown to be effective in the extension of survival. People with recurrent lung cancer who are well enough to tolerate therapy are also good candidates for experimental therapies, including clinical trials.

Targeted therapy: One alternative to standard chemotherapy is the drug erlotinib (Tarceva) which may be used in patients with NSCLC who are no longer responding to chemotherapy. He is what is called targeted drug ang (targeted drug), drug suau more specifically targeted / directed at cancer cells, resulting in less damage to normal cells. Erlotinib targets a protein called the epidermal growth factor receptor (EGFR) that helps cells to divide. This protein is found at high levels on the surface of some of abnormal types of cancer cells, including many cases of non-small cell lung cancer (NSCLC). Erlotinib is taken by mouth in pill form.

Other attempts at targeted therapy include drugs known as antiangiogenesis drugs, which block the development of new blood vessels within a tumor. Antiangiogenic drug bevacizumab (Avastin) has recently found to prolong survival in advanced lung cancer when it is added to the standard chemotherapy ways. Bevacizumab is given intravenously every two to three weeks. However, since this drug may cause bleeding, it is not suitable for use in patients who are coughing up blood, if the lung cancer has spread to the brain, or in people who are receiving therapy prevents clotting (anticoagulation therapy, blood thinning medications ). Bevacizumab is also not used in cases of squamous cell cancer, because it leads to bleeding from this type of lung cancer.

Photodynamic therapy (PDT): One newer therapy used for different types and stages of lung cancer (as well as some other cancers) is photodynamic therapy. In photodynamic treatment, a photosynthesizing element (such as a porphyrin, a naturally occurring element in the body) is injected into the bloodstream a few hours prior to surgery. During this time, these elements put himself selectively to cells that grow rapidly like cancer cells. A procedure then followed in which doctors use a light with a specific wavelength through a hand-held wand directly to the site of the cancer and surrounding tissues. The energy of the light activates the photosensitizing element, causing the production of a toxin that destroys the tumor cells. PDT has the advantages that it can precisely where the target of the location of the cancer, is less invasive than surgery, and can be repeated at the same place if necessary. Weaknesses of PDT is that it is only useful in treating cancers that can be reached with a light source and is not suitable for treatment of extensive cancers / extensive. Research is ongoing to further determine the effectiveness of PDT in lung cancer.

Experimental therapies: Since no therapy is currently available that is absolutely effective in treating lung cancer, patients may be offered a number of new therapies that are still in the experimental status, which means that doctors do not already have enough information to decide whether the therapy this -terapi forms must be received for treating lung cancer. New drugs or new combinations of drugs are tested in so-called clinical trials, which are studies that evaluate the effectiveness of new treatments compared with treatments that have been used extensively. Experimental treatments known as immunotherapies are being studied that involve the use of therapies related to vaccines or other therapies that attempt to use the body's immune system to fight cancer cells.

Lung Cancer Prognosis

The prognosis of lung cancer refers to the opportunity for healing and depending on the location and size of the tumor, presence of symptoms, lung cancer types, and circumstances of the patient's overall health.

SCLC has the most aggressive growth of all lung cancers, with a median survival time (figures are in the midst) of only two to four months after diagnosis if not treated. (It was at two to four months of half of all patients had died). However, SCLC is also the type of lung cancer most responsive to radiation therapy and chemotherapy. Because SCLC spreads quickly and is usually poured at the time of diagnosis, methods such as surgical removal or radiation therapy is effective in treating locally reduced this tumor type. However, when chemotherapy is used alone or in combination with other methods, survival time can be extended four to five times. Of all patients with SCLC, only 5% -10% are still alive five years after diagnosis. Most of those who survived (longer life) have a limited degree of SCLC.

In non-small cell lung cancer (NSCLC), the results of standard treatment are usually whole ugly but most localized cancers can be removed surgically. However, at the level I cancers that can be completely removed, the five-year survival rate can approach 75%. Radiation therapy can produce a cure in a minority of patients with NSCLC and leads to the liberation of symptoms in most patients. At the rate the disease progresses, chemotherapy offers improved survival time being, although the numbers overall survival ugly.

The overall prognosis for lung cancer is poor when compared with some other cancers. Survival figures for lung cancer are generally lower than those for most cancers, with an overall rate of five-year survival for lung cancer by 16% compared with 65% for colon cancer, 89% for breast cancer, and more of 99% for prostate cancer.


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