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<div class="editorbox"> '''Original Editor '''- [[User:User Name|Sarah Hansford]] and [[User:User Name|Kaden Johnson]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
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== Definition/Description ==
'''Original Editor '''- [[User:User Name|Sarah Hansford]] and [[User:User Name|Kaden Johnson]]  
[[Image:Lung anatomy nci 407.jpg|thumb|right|Lung Anatomy]]Lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs and arises from the cells of the respiratory epithelium.<ref name="p1" /> Cancer that is formed initially in the lungs is known as primary lung cancer and cancer that begins in another area of the body but then spreads to the lungs is called secondary lung cancer.<ref name="p1" /> Primary lung cancer is divided into two types which are classified as small cell lung cancer and non-small cell lung cancer. The classification of these two types of primary lung cancer is established by the type of cells in which the cancer starts.<ref name="p1">Yoder LH. An overview of lung cancer symptoms, pathophysiology, and treatment. Medsurg Nurs. 2006;15(4):231–4.</ref>  Non-small-cell lung cancer is the most common type of primary lung cancer, as it accounts for more than 80% of cases.<ref name="p2">McMaster Pathology Review. Lung Cancer. www.dh.gov.uk/PolicyAndGuidance/fs/en (accessed 22 May 2015).</ref> It is further divided into 3 subtypes: squamous cell carcinoma, adenocarcinoma and large-cell carcinoma  Squamous cell carcinoma<div>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
*Located 2/3 central and 1/3 periphery of the lung<ref name="p2" />
</div>  
*Arises from large airway epithelial cells
== Introduction ==
*Strong association with cigarette smoking
[[Image:Lung anatomy nci 407.jpg|right|Lung Anatomy|frameless|450x450px]]Lung [[Oncology|cancer]] refers to tumors originating in the [[Lung Anatomy|lung]] parenchyma or within bronchi. It is:
*Tends to create obstruction and cause distal atelectasis<ref name="p2" />  
* A broad term referring to the main histological subtypes of primary lung malignancies that are mainly linked with inhaled carcinogens, with [[Smoking Cessation and Brief Intervention|cigarette smoke]] being a key culprit.<ref name=":0">Radiopedia [https://radiopaedia.org/articles/lung-cancer-3 Lung cancer] </ref>
*Best prognosis</div>
* The most common cancer worldwide, with  2 million new cases in 2018<ref>World cancer research fund [https://www.wcrf.org/dietandcancer/cancer-trends/lung-cancer-statistics Lung cancer] Available from:https://www.wcrf.org/dietandcancer/cancer-trends/lung-cancer-statistics (last accessed 7.9.2020)</ref>. 
 
* One of the leading causes of cancer-related deaths in the United States.  
==== Adenocarcinoma ====
Due to the aetiology of lung cancer, the older age of patients, and presence of multi-morbidities, people with lung cancer constitute a complex patient population to manage.<ref name=":2" />
<div>
* At the beginning of the 20th century, lung cancer was a relatively rare disease. Its dramatic rise in later decades is mostly attributable to the increase in smoking among both males and females<ref name=":1">Siddiqui F, Siddiqui AH. [https://www.ncbi.nlm.nih.gov/books/NBK482357/ Cancer, lung]. InStatPearls [Internet] 2020 Apr 12. StatPearls Publishing.</ref>
*Located in the periphery of the lung<ref name="p2" />
*Arises from small airway epithelial cells and type II alveolar cells<ref name="p2" />
*Most common type of lung cancer in non-smokers and more prevalent in women<ref name="p3">Alberg AJ, Samet JM. Epidemiology of Lung Cancer Epidemiology of Lung Cancer. 2007</ref></div>
 
==== Large-cell carcinoma ====
<div>
*Located in the periphery of the lung<ref name="p2" />
*Similar to adenocarcinoma but the lesions tend to be larger<ref name="p2" /></div>
 
== Stages of Non small cell Lung Cancer ==
<div>
{| width="700" border="1" cellpadding="1" cellspacing="1"
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Occult
 
Cancer cant be seen by bronchoscopy or imaging scans, Instead the cancer is in the sputum or the bronchial airways&nbsp;<ref name="National Cancer Institute">http://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq#section/_134</ref>
 
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Stage 0
 
Abnormal cells are found in the lining of the airway&nbsp;<ref name="National Cancer Institute" />
 
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Stage IA/IB
 
Stage IA - Cancer is found only in the lung  
 
Stage IB - The cancer has not spread to the lymph nodes however one of the following is present 1) tumor is larger than 3cm 2) cancer has spread to the main bronchus 3) cancer has spread to the inner membrane that covers the lung 4) part of the lung has developed pneumonitis or collapsed&nbsp;<ref name="National Cancer Institute" />  
 
| <br>[[Image:Stage 1.jpg]]
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Stage IIA (Two senarios)
 
1) Cancer has spread to the lymph nodes on the same side of the chest as the tumor. One or more of the following is also true - the tumor is not &gt;5cm, cancer has spread to the main bronchus and is 2cm below where the trechea joins, cancer has spread to the inner membrane of the lung,&nbsp;part of the lung has developed pneumonitis or collapsed
 
2) Cancer has not spread to the lymph nodes and one or more of the following is true - the tumor is &gt;5cm but &lt;7cm,&nbsp;cancer has spread to the main bronchus and is 2cm below where the trechea joins,&nbsp;cancer has spread to the inner membrane of the lung, part of the lung has developed pneumonitis or collapsed&nbsp;<ref name="National Cancer Institute" />
 
| [[Image:Stage 2.jpg|thumb|Stage IIA]]<br>
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Stage IIB (Two scenarios)
 
1) Cancer has spread to the lymph nodes on the same side of the chest as the tumor. One or more of the following is also true - the tumor is &gt;5cm, cancer has spread to the main bronchus and is 2cm below where the trechea joins, cancer has spread to the inner membrane of the lung, part of the lung has developed pneumonitis or collapsed<br>2) Cancer has not spread to the lymph nodes and one or more of the following is true - the tumor is &gt;7cm, cancer has spread to the main bronchus and is 2cm below where the trechea joins, the chest wall, diaphragm or the nerve that controls the diaphragm. Cancer has spread to the membrane around the heart or lining the chest wall, the whole lung has developed pneumonitis or collapsed&nbsp;<ref name="National Cancer Institute" />  
 
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<br>[[Image:Stage 2b.jpg|thumb|Stage IIB]]
 
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Stage IIIA
 
This stage is divided into 3 subsections depending on the size of the tumor, where it is, and which lymph nodes have cancer <ref name="National Cancer Institute" /><br>
 
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<br> [[Image:Stage 3a.jpg|thumb|Stage IIIA (1)]][[Image:Stage 3aa.jpg|thumb|Stage IIIA (2)]] <br>[[Image:Stage 3aaa.jpg|thumb|Stage IIIA (3)]]
 
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Stage IIIB
 
This stage is divided into 2 subsections depending on the size of the tumor, where it is, and which lymph nodes have cancer&nbsp;<ref name="National Cancer Institute" />
 
|
<br>[[Image:Stage 3b.jpg|thumb|Stage IIIB (1)]][[Image:Stage 3bb.jpg|thumb|Stage IIIB (2)]]
 
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Stage IV
 
In this stage the cancer can be any size and may also have spread to the lymph nodes. One or more of the following may also be true a) there is one or more tumors in both lungs b) the fluid that surrounds the lungs and heart also contains cancer c) the cancer has spread to other areas of the body including, but not limited to the liver, brain, kidneys, adrenal glands, and bone&nbsp;<ref name="National Cancer Institute" />  
 
| [[Image:Stage 4.jpg|thumb|Stage IV]]<br>
|}


<br>Small-cell lung cancer is a less common type that accounts for about 15-20% of cases and usually spreads faster than non-small-cell lung cancer.<ref name="p2" /> It is often at a more advanced stage when it is diagnosed. This type of lung cancer, which has the strongest association with cigarette smoking, leads to the worst prognosis due to it’s rapid growth.<ref name="p3" />&nbsp;
</div>
== Epidemiology  ==
== Epidemiology  ==
 
* Is a leading type of cancer, equal in prevalence with [[Breast Cancer|breast cancer.]]
Lung cancer is one of the most common and serious types of cancer. It is the second highest cancer incidence in both males and females, following prostate cancer in men and breast cancer in women.<ref name="p4">Cancer Research UK. Lung Cancer Statistics. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer (accessed 17 May 2015)</ref> It is diagnosed in over 41,000 people every year in the UK and is the leading cause of cancer death around the world.<ref name="p4" /> In 2008, lung cancer contributed to 13% or 1.6 million of total cancer cases and 18% or 1.4 million cancer-related deaths worldwide.<ref name="p4" /> Lung cancer incidence and mortality rates are highest in the United States and developed countries and almost 9 in 10 lung cancer cases occur in people aged 60 years or older.<ref name="p4" />  
* Is the leading cause of cancer mortality worldwide; accounting for ~20% of all cancer deaths<ref name=":0" />
* Is dramatically rising with nearly half of new cases, 49.9%, diagnosed in the underdeveloped world.
* In the United States, mortality is high in men compared to women.
* Overall, there is no difference between blacks and whites, but age-adjusted mortality is higher in black males than their white counterparts<ref name=":1" />.


== Aetiology  ==
== Aetiology  ==
Smoking is the most common cause of lung cancer.
* It is estimated that 90% of the cases of lung cancer are attributable to smoking.
* The risk is highest in males who smoke.
* The risk is further compounded with exposure to other carcinogens, such as asbestos<ref name=":1" />.


==== Smoking ====
== Risk Factors ==
Cigarette smoking is the leading cause of lung cancer and accounts for about 85% of diagnosed lung cancer patients. Smoking is also most strongly associated with small cell lung cancer and squamous-cell carcinoma.<ref name="p2" /> Risk for lung cancer increases with how long a person has been smoking, the amount they smoke and the depth of smoke inhalation. Second-hand smoking also causes lung cancer, but is less strongly associated compared to active smoking. Cigarettes contain more than 60 carcinogens that have been shown to induce cancers. Nicotine causes addiction to cigarette smoking and has been shown to inhibit apoptosis, proliferate cells, and cause angiogenesis in lung tumours.<ref name="p5">Dela Cruz CS, Tanoue LT, Matthay R a. Lung Cancer: epidemiology, etiology and prevention. Clin Chest Med. 2011;32(4):1–61.</ref> Cigar and pipe tobacco smoking produces relatively large particles that only reach the upper airways, where cigarette smoking reaches the distal airways because it produces fine particles.<ref name="p5" /> Therefore, the risk of lung cancer is lower with cigar and pipe smoking. Smokers of all ages will benefit from the cessation of smoking, but the risk of developing lung cancer will still be increased compared to never smokers. Never smokers are individuals who smoked fewer than 100 cigarettes in their lifetime but this still accounts for 25% of lung cancers worldwide.<ref name="p5" />
* There is no correlation between lung cancer and the number of packs smoked per year due to the complex interplay between smoking and environmental and genetic factors.  
* The risk of lung cancer by passive smoking increases by 20% to 30%.  
* asbestos: 5x increased risk
* occupational exposure: uranium, radon, arsenic, chromium
* diffuse [[Pulmonary Fibrosis|lung fibrosis]]: 10x increased risk
* [[Chronic Obstructive Pulmonary Disease Rehabilitation Class|chronic obstructive pulmonary disease]]<ref name=":0" />


==== Occupational and Environmental Exposure  ====
== Lung Metastases ==
A number of environmental risk factors have been identified, most of which often relates to occupational exposures such as asbestos, tar, soot, and a number of metals such as arsenic, chromium, and nickel. Air pollution has also been linked to increased risk of lung cancer.<ref name="p5" /> Radon gas has been posed as a significant risk factor for lung cancer as well.<ref name="p5" />  Genetics There is a genetic susceptibility which increases the risk of lung cancer among first-degree relatives.<ref name="p5" />
The lungs are one of the most common metastatic disease target organs. Lung metastases are most commonly caused by cancers of the head and neck, breast, stomach, pancreas, kidney, bladder, male and female genitourinary tract, and sarcomas.  The presence of pulmonary nodules, lymphangitic carcinomatosis, endobronchial tumours, and pleural involvement indicates pulmonary metastatic disease. Nonetheless, the differential diagnosis is critical, especially in patients with solitary pulmonary nodules and systemic disease. <ref name=":3">Herold CJ, Bankier AA, Fleischmann D. [http://dx.doi.org/10.1007/bf00187656 Lung metastases]. Eur Radiol. 1996;6(5). </ref>


==== Other factors There are several other factors that increase the risk of developing lung cancer, and they include: ====
Plain [[X-Rays|chest radiography]] is typically used for detection and therapeutic monitoring; however, [[CT Scans|CT scans]] is increasingly being used for these purposes. Spiral CT scans appears to be the most sensitive imaging technique for detecting metastases at the moment, as it detects a greater number of pulmonary nodules than other techniques. <ref name=":3" />
*Gender (men more predisposed than women)
*Dietary factors
*Individuals with chronic obstructive pulmonary disease
*Ethnicity


== Investigations  ==
== Investigations  ==
The overall goal is a timely diagnosis and accurate staging. 


==== Chest X-ray ====
Only 26% and 8% of cancers are diagnosed at stages I and II, whereas 28% and 38% are diagnosed at stages III and IV respectively. Hence curative surgery is an option for a minority of patients<ref name=":1" />.
[[Image:X-ray.jpg|thumb|right|''Chest X-ray'']]A chest X-ray is usually the first step in diagnosing lung cancer. Tumours usually appear as white/grey masses.<ref name="p6">National Health Services. Lung Cancer Diagnosis http://www.nhs.uk/Conditions/Cancer-of-the-lung/Pages/Diagnosis.aspx (accessed 26 May 2015)</ref> Chest X-rays do not always give a clear enough diagnosis, due to the fact that they can’t distinguish between multiple conditions (ex. consolidation and lung abscess)
 
==== CT scan  ====
A CT scan or Computerised (axial) tomography scan, usually carried out after a chest X-ray, takes a series of x-rays at different angles and through the use of computer processors produces a series of cross-sectional images of specific areas of a scanned object, allowing the user to see inside the object.<ref name="p6" /> This scan gives a very accurate picture of where a tumour is and its size. Before having a CT scan, you will be given an injection of a contrast medium. This is a liquid containing a dye that makes the lungs show up more clearly on the scan. The scan is painless and takes 10-30 minutes to complete.<ref name="p6" />


==== PET-CT scan ====
'''Lung cancer evaluation can be divided in 2 ways:'''
A PET-CT or Positron Emission Tomography computerised tomography,is usually conducted if the results of a CT scan show an early stage cancer. the PET-CT is able to identify where there are active cancer cancer cells<span style="font-size: 13.2799997329712px; line-height: 19.9200000762939px;">.</span><ref name="p6" /><span style="font-size: 13.2799997329712px; line-height: 19.9200000762939px;">&nbsp;</span>These results are quite useful in helping with diagnosis and treatment.Before undergoing a PET-CT the individual is injected with a slightly radioactive material. The scanner then works by detecting the radiation given off by the injected radiotracer. <ref name="p6" /> <span style="font-size: 13.2799997329712px; line-height: 19.9200000762939px;">&nbsp;</span>{{#ev:youtube|lk-VzATcv4M|300}}<ref>CancerResearchUK. Cancer Stages and Having a PET Scan. Cancer Research UK. Available from: https://www.youtube.com/watch?v=lk-VzATcv4M [last accessed 7/6/15]</ref><br>
# [[X-Rays|Radiological]] staging
# Invasive staging


==== Bronchoscopy and Biopsy  ====
=== Goals of Initial Evaluation ===
A bronchoscopy is a procedure that allows a physician to remove a small sample of cells from the inside of the lung using a bronchoscope.<ref name="p6" /> The bronchoscope is a small tube like device which is passed through the mouth or nose and down through the throat into the airways.<ref name="p6" /> This procedure is slightly uncomfortable however it is relatively quick and only takes a few minutes.&nbsp;[[Image:Broncho.jpg|thumb|right|Bronchoscopy]]
* Clinical extent and stage of the disease
* Optimal target site and modality of 1st tissue biopsy
* Specific histologic subtypes
* Presence of co-morbidities, para-neoplastic syndromes
* Patient values and preferences regarding therapy


Other types of biopsies include:  
=== Radiologic Staging ===
 
Every patient suspected of having lung cancer should undergo the following tests:
*Percutaneous needle biopsy
* Contrast-enhanced [[CT Scans|CT]] chest with extension to upper abdomen up to the level of adrenal glands.
*Thoracoscopy
* Imaging with PET or PET-CT directed at sites of potential metastasis when symptoms or focal findings are present or when chest CT shows evidence of advanced disease.<ref name=":1" /><br>
*Mediastinoscopy
*Screening
 
<br>According to the NHS there is currently no national screening program for lung cancer in the UK.<ref name="p6" /> The lack of a National screening program is due to the complexity of the tests required to identify lung cancer. No simple, and quick test sensitive enough to outweigh possible risks associated with screening is yet available (ex. radiation exposure during x-rays). <br>  


== Clinical Manifestations  ==
== Clinical Manifestations  ==
Patients with lung cancer may be asymptomatic in up to 50% of cases. 
* Cough and [[dyspnoea]] are rather non-specific symptoms that are common amongst those with lung cancer.
* Central tumours may result in haemoptysis
* Peripheral lesions may result in pleuritic chest pain.
* [[Pneumonia]], [[Pleural Effusion|pleural effusion]], wheeze, [[Lymphatic System|lymphadenopathy]] may be present.
* Other symptoms may be secondary to metastases (bone, contralateral lung, brain, adrenal glands, and liver particularly) or [[Paraneoplastic Syndrome|paraneoplastic syndromes]].


Clinical manifestations that may be presented include:
== Treatment/Prognosis  ==
[[File:Stage 4.jpg|right|frameless|450x450px]]
Treatment and prognosis vary not only with stage but also with cell type.In general, surgery, [[Chemotherapy Side Effects and Syndromes|chemotherapy]], and [[Radiation Side Effects and Syndromes|radiotherapy]] are offered according to the stage, resectability, operability, and functional status.<ref name=":0" />
* Despite all the advances, the outcomes for lung cancer remain abysmal. The key reason is that most patients are diagnosed with advanced-stage disease. To improve outcomes, an interprofessional team approach with close communication between the members may perhaps lead to earlier diagnosis and treatment.
* The definitive diagnosis and management of lung cancer is done by the thoracic surgeon with collaboration with the radiologist and pathologist.
* After surgery, the patients are usually monitored by nurses for [[Oxygen Therapy|oxygenation]], [[Ventilation and Weaning|ventilation]], and [[Cancer Pain|pain]]. Since many of these patients are smokers, they also have other comorbidities like [[Coronary Artery Disease (CAD)|heart disease]] and [[Peripheral Arterial Disease|peripheral vascular disease]], which often presents with symptoms in the post-operative period.
* After surgery, patients need prolonged rehabilitation. Some may need chemotherapy and radiation.
* Lung cancer is not curable and all clinicians should urge patients to quit smoking; screening may be useful in selective patients.


'''Cough'''
== Physiotherapy  ==
 
Physiotherapy interventions vary depending on the stage in disease trajectory and timing relative to treatment.
*Presence of mass irritates the cough receptors in the airway<ref name="p2" />
* The cornerstone of physiotherapy management in lung cancer should be prescription and delivery of [[Therapeutic Exercise|exercise]] intervention.
*Release of sputum&nbsp;
* [[Physical Activity|Physical activity]] and exercise are vital components targeting three main aspects of the cancer continuum: prevention, mortality and morbidity.
*More common in squamous cell carcinoma and small cell lung cancer (more commonly found in the central airways)
* The American Cancer Society recommends that adults with cancer engage in at least 150 minutes of moderate-intensity aerobic exercise and two sessions of resistance exercise per week, which is the same as the guidelines for the general adult<ref name=":2">Granger CL. [https://www.researchgate.net/publication/298433271_Physiotherapy_management_of_lung_cancer/fulltext/56e9aa3b08ae3a5b48cc8aac/Physiotherapy-management-of-lung-cancer.pdf?origin=publication_detail Physiotherapy management of lung cancer.] Journal of physiotherapy. 2016 Apr 1;62(2):60-7.</ref>.
*Obstruction from central airway could also lead to post-obstructive pneumonia and distal atelectasis<ref name="p2" />
 
<br>'''Weight loss'''
 
*Cancer induced proteolysis and lipolysis leads to loss of muscle and adipose tissue.<ref name="p2" />
*Loss of appetite also contributes to weight loss&nbsp;
 
<br>'''Hemoptysis'''
 
*Tumor in the central airway
*Tumor-induced angiogenesis result in blood vessels that are leaky and twisted, leading to easy ruptures and causing hemoptysis<ref name="p2" />
 
<br>'''Dyspnea'''
 
*Obstruction of Airway leading to shortness of breath
*Mechanoreceptors and chemoreceptors are activated in the lungs due to cachexia or hypoxemia/acidosis<ref name="p2" />
 
'''Chest pain'''
 
*Tumor involving pleural surface causing pleuritic chest pain<ref name="p1" />
 
'''<br>Pleural effusion (chest pain, dyspnea)'''
 
*Benign pleural effusion may be due to lymphatic obstruction, post-obstructive pneumonitis, or atelectasis<ref name="p2" />
*Malignant pleural effusion occurs when malignant cells and present in pleural fluid<ref name="p1" />
 
'''Other signs and symptoms include''':
*Wheezing
*Nausea/Vomiting
*Swelling of face and arms
*Fatigue
*Bone pain
*Clubbing
*Headache
*Seizures &nbsp;
 
== Physiotherapy and Other Management  ==
 
==== Physiotherapy management  ====
It has been shown that hydration, autogenic drainage, gentle suctioning, postural drainage, chest physiotherapy, and external oscillation applications can be useful for patients with lung cancer.<ref name="p7">Ozalevli S. Impact of physiotherapy on patients with advanced lung cancer. Chron Respir Dis [Internet]. 2013;10(4):223–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24177683</ref>  Smoking cessation Smoking cessation is a very important form of management with lung cancer patients. In addition to education, counselling and support on quitting smoking, there are three main interventions that are used which include:
#Nicotine replacement therapy (NRT): Available in many forms including gum and a transdermal patch. All forms of nicotine replacement increases the rate of quitting by 50-70%.<ref name="p2" />
#Antidepressants: bupropion and nortriptyline are as effective as nicotine replacement therapy<ref name="p2" />  
#Nicotine receptor partial agonist: varenicline is more effective than bupropion and NRT.<ref name="p2" />


==== Exercise  ====
==== Exercise  ====
Aerobic exercise and resistance training have a positive impact on lung functioning including a reduction in airflow obstruction and clearing of airways therefore the improved functional capabilities increase energy levels and the release of sputum.<ref name="p7" /> Exercise programs should be supervised by the treating clinical team and should also be discussed with the general practitioner before participating in any exercise program.   Surgery Surgery involves a resection of the tumor and some normal tissue around it. This is the first line of choice of treatment for non-small cell lung cancer patients who are medically fit to undergo surgery.<ref name="p1" />
* Aerobic exercise and resistance training have a positive impact on lung functioning including a reduction in airflow obstruction and clearing of airways therefore the improved functional capabilities increase energy levels and the release of sputum.<ref name="p7">Ozalevli S. [http://www.ncbi.nlm.nih.gov/pubmed/24177683 Impact of physiotherapy on patients with advanced lung cancer.] Chron Respir Dis [Internet]. 2013;10(4):223–32. </ref>
 
* [[Pulmonary Rehabilitation|Pulmonary Rehabilitation programs]]  is tailored to the individual who has recently had eg lung surgery, with the aim of optimizing their respiratory function and therefore their [[Quality of Life|quality of life]] (QOL) and participation in their everyday lives.
==== Radiation Therapy  ====
* Exercise following surgery or treatment aims to restore physical status (addressing loss of functional capacity and muscle strength, which may occur during treatment) and to maximise function, physical activity, psychological status and health-related quality of life in the long term<ref name=":2" />
Radiation therapy is a form of treatment that is indicated for patients with stage I, II or III of non-small cell lung cancer.<ref name="p1" /> With respect to lung cancer, stages I, II, and III determine various sizes of primary tumor and lymph node involvement without distant metastasis and any distant metastasis is automatically stage IV.<ref name="p1" /> It is also used in combination with surgery for non-small cell lung cancer and with chemotherapy for small cell lung cancer.  Chemotherapy The first line of treatment for small cell lung cancer, which are often spread upon clinical presentation.<ref name="p1" /> It is also indicated for patients with more advanced stage of non-small cell lung cancer to improve prognosis, disease control or for palliative care.<ref name="p2" />
* Research shows positive results of physical exercises on cancer-related fatigue, physical function, symptom distress, sarcopenia and health-related quality of life (HRQoL)<ref>Edbrooke L, Granger CL, Denehy L. [https://pubmed.ncbi.nlm.nih.gov/32233342/ Physical activity for people with lung cancer.] Australian Journal of General Practice. 2020 Apr;49(4):175.</ref>.
 
<br>''Recent Updates and News''
 
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== Prevention ==
== Prevention ==


==== Smoking cessation ====
* Smoking cessation: The best way to prevent lung cancer is to quit smoking. The risk of getting diagnosed with lung cancer will decrease the sooner an individual quits smoking. After 10 years of not smoking, the chance of developing lung cancer decreases to half that of someone who smokes.<ref name="p5">Dela Cruz CS, Tanoue LT, Matthay R a. Lung Cancer: epidemiology, etiology and prevention. Clin Chest Med. 2011;32(4):1–61.</ref>
The best way to prevent lung cancer is to quit smoking. The risk of getting diagnosed with lung cancer will decrease the sooner an individual quits smoking. After 10 years of not smoking, the chance of developing lung cancer decreases to half that of someone who smokes.<ref name="p5" />   Diet Research suggests that eating a low-fat, high-fibre diet, including at least five portions of fresh fruit and vegetables and whole grains every day, can help reduce the risk of developing lung cancer, as well as other types of cancer and heart disease.<ref name="p8" />


==== Physical Activity/Exercise    ====
* Diet: Research suggests that eating a low-fat, high-fibre diet, including at least five portions of fresh fruit and vegetables and whole grains every day, can help reduce the risk of developing lung cancer, as well as other types of cancer and heart disease.<ref name="p8" />
Studies show that higher levels of physical activity may lower lung cancer risk.<ref>Lee IM. Physical activity and cancer prevention--data from epidemiologic studies. Medicine and science in sports and exercise. 2003 Nov;35(11):1823-7.</ref> It is important to exercise regularly, attempting to perform at least 150 minutes of moderate intensity aerobic activity each week and incorporate muscle strengthening activities two days per week.<ref name="p8">National Health Services. Lung Cancer Prevention. http://www.nhs.uk/Conditions/Cancer-of-the-lung/Pages/Prevention.aspx (accessed 6 May 2015)</ref>  


==== Aspirin ====
* [[Physical Activity]]/Exercise: Studies show that higher levels of physical activity may lower lung cancer risk. <ref>Lee IM. Physical activity and cancer prevention--data from epidemiologic studies. Medicine and science in sports and exercise. 2003 Nov;35(11):1823-7.</ref> It is important to exercise regularly, attempting to perform at least 150 minutes of moderate intensity [[Aerobic Exercise|aerobic activity]] each week and incorporate muscle strengthening activities two days per week.<ref name="p8">[https://www.nhs.uk/conditions/lung-cancer/prevention/ Lung cancer - Prevention] [Internet]. nhs.uk. </ref>  
Some research has found that taking aspirin may reduce the risk of getting lung cancer.<ref>Rothwell PM, Wilson M, Price JF, Belch JF, Meade TW, Mehta Z. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. The Lancet. 2012 Apr 28;379(9826):1591-601.</ref> Other studies have found that aspirin may only reduce risk in people who take aspirin daily or may only reduce the risk in men.<ref name="p5" /> It is important to check with a doctor before taking aspirin every day as it can damage the lining of the stomach and potentially cause bleeding.


== References  ==
== References  ==


1. Yoder LH. An overview of lung cancer symptoms, pathophysiology, and treatment. Medsurg Nurs. 2006;15(4):231–4.<br>2. McMaster Pathology Review. Lung Cancer. www.dh.gov.uk/PolicyAndGuidance/fs/en (accessed 22 May 2015).<br>3. Alberg AJ, Samet JM. Epidemiology of Lung Cancer Epidemiology of Lung Cancer. 2007<br>4. Cancer Research UK. Lung Cancer Statistics. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer (accessed 17 May 2015)<br>5. Dela Cruz CS, Tanoue LT, Matthay R a. Lung Cancer: epidemiology, etiology and prevention. Clin Chest Med. 2011;32(4):1–61.<br>6. National Health Services. Lung Cancer Diagnosis. http://www.nhs.uk/Conditions/Cancer-of-the-lung/Pages/Diagnosis.aspx (accessed 26 May 2015)<br>7. Ozalevli S. Impact of physiotherapy on patients with advanced lung cancer. Chron Respir Dis [Internet]. 2013;10(4):223–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24177683<br>8. National Health Services. Lung Cancer Prevention. http://www.nhs.uk/Conditions/Cancer-of-the-lung/Pages/Prevention.aspx (accessed 6 May 2015)<br>9. Hanrahan EO, Glisson B. Lung Cancer: [Internet]. Current. 2010. 395-434 p. Available from: http://www.springerlink.com/index/10.1007/978-1-60761-524-8<br>
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10.&nbsp;Youtube. Can the Herpes Virus Kill Cancer?. https://www.youtube.com/watch?v=qXxMffXHBnQ (accessed 3 June 2015)<br>11.&nbsp;Youtube. Cold Sore Virus Could Treat Skin Cancer, Says Scientists. https://www.youtube.com/watch?v=7PHc-dFtNJ0 (accesssed 3 June 2015)<br>
 
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Latest revision as of 01:09, 2 December 2023

Original Editor - Sarah Hansford and Kaden Johnson Top Contributors - Sarah Hansford, Kaden Johnson, Lucinda hampton, Kim Jackson, Vidya Acharya, Admin, WikiSysop, 127.0.0.1, Mariam Hashem, Michelle Lee, Adam Vallely Farrell, Kapil Narale and Aya Alhindi

Introduction[edit | edit source]

Lung Anatomy

Lung cancer refers to tumors originating in the lung parenchyma or within bronchi. It is:

  • A broad term referring to the main histological subtypes of primary lung malignancies that are mainly linked with inhaled carcinogens, with cigarette smoke being a key culprit.[1]
  • The most common cancer worldwide, with 2 million new cases in 2018[2]. 
  • One of the leading causes of cancer-related deaths in the United States.

Due to the aetiology of lung cancer, the older age of patients, and presence of multi-morbidities, people with lung cancer constitute a complex patient population to manage.[3]

  • At the beginning of the 20th century, lung cancer was a relatively rare disease. Its dramatic rise in later decades is mostly attributable to the increase in smoking among both males and females[4]

Epidemiology[edit | edit source]

  • Is a leading type of cancer, equal in prevalence with breast cancer.
  • Is the leading cause of cancer mortality worldwide; accounting for ~20% of all cancer deaths[1]
  • Is dramatically rising with nearly half of new cases, 49.9%, diagnosed in the underdeveloped world.
  • In the United States, mortality is high in men compared to women.
  • Overall, there is no difference between blacks and whites, but age-adjusted mortality is higher in black males than their white counterparts[4].

Aetiology[edit | edit source]

Smoking is the most common cause of lung cancer.

  • It is estimated that 90% of the cases of lung cancer are attributable to smoking.
  • The risk is highest in males who smoke.
  • The risk is further compounded with exposure to other carcinogens, such as asbestos[4].

Risk Factors[edit | edit source]

  • There is no correlation between lung cancer and the number of packs smoked per year due to the complex interplay between smoking and environmental and genetic factors.
  • The risk of lung cancer by passive smoking increases by 20% to 30%.
  • asbestos: 5x increased risk
  • occupational exposure: uranium, radon, arsenic, chromium
  • diffuse lung fibrosis: 10x increased risk
  • chronic obstructive pulmonary disease[1]

Lung Metastases[edit | edit source]

The lungs are one of the most common metastatic disease target organs. Lung metastases are most commonly caused by cancers of the head and neck, breast, stomach, pancreas, kidney, bladder, male and female genitourinary tract, and sarcomas. The presence of pulmonary nodules, lymphangitic carcinomatosis, endobronchial tumours, and pleural involvement indicates pulmonary metastatic disease. Nonetheless, the differential diagnosis is critical, especially in patients with solitary pulmonary nodules and systemic disease. [5]

Plain chest radiography is typically used for detection and therapeutic monitoring; however, CT scans is increasingly being used for these purposes. Spiral CT scans appears to be the most sensitive imaging technique for detecting metastases at the moment, as it detects a greater number of pulmonary nodules than other techniques. [5]

Investigations[edit | edit source]

The overall goal is a timely diagnosis and accurate staging.

Only 26% and 8% of cancers are diagnosed at stages I and II, whereas 28% and 38% are diagnosed at stages III and IV respectively. Hence curative surgery is an option for a minority of patients[4].

Lung cancer evaluation can be divided in 2 ways:

  1. Radiological staging
  2. Invasive staging

Goals of Initial Evaluation[edit | edit source]

  • Clinical extent and stage of the disease
  • Optimal target site and modality of 1st tissue biopsy
  • Specific histologic subtypes
  • Presence of co-morbidities, para-neoplastic syndromes
  • Patient values and preferences regarding therapy

Radiologic Staging[edit | edit source]

Every patient suspected of having lung cancer should undergo the following tests:

  • Contrast-enhanced CT chest with extension to upper abdomen up to the level of adrenal glands.
  • Imaging with PET or PET-CT directed at sites of potential metastasis when symptoms or focal findings are present or when chest CT shows evidence of advanced disease.[4]

Clinical Manifestations[edit | edit source]

Patients with lung cancer may be asymptomatic in up to 50% of cases.

  • Cough and dyspnoea are rather non-specific symptoms that are common amongst those with lung cancer.
  • Central tumours may result in haemoptysis
  • Peripheral lesions may result in pleuritic chest pain.
  • Pneumonia, pleural effusion, wheeze, lymphadenopathy may be present.
  • Other symptoms may be secondary to metastases (bone, contralateral lung, brain, adrenal glands, and liver particularly) or paraneoplastic syndromes.

Treatment/Prognosis[edit | edit source]

Stage 4.jpg

Treatment and prognosis vary not only with stage but also with cell type.In general, surgery, chemotherapy, and radiotherapy are offered according to the stage, resectability, operability, and functional status.[1]

  • Despite all the advances, the outcomes for lung cancer remain abysmal. The key reason is that most patients are diagnosed with advanced-stage disease. To improve outcomes, an interprofessional team approach with close communication between the members may perhaps lead to earlier diagnosis and treatment.
  • The definitive diagnosis and management of lung cancer is done by the thoracic surgeon with collaboration with the radiologist and pathologist.
  • After surgery, the patients are usually monitored by nurses for oxygenation, ventilation, and pain. Since many of these patients are smokers, they also have other comorbidities like heart disease and peripheral vascular disease, which often presents with symptoms in the post-operative period.
  • After surgery, patients need prolonged rehabilitation. Some may need chemotherapy and radiation.
  • Lung cancer is not curable and all clinicians should urge patients to quit smoking; screening may be useful in selective patients.

Physiotherapy[edit | edit source]

Physiotherapy interventions vary depending on the stage in disease trajectory and timing relative to treatment.

  • The cornerstone of physiotherapy management in lung cancer should be prescription and delivery of exercise intervention.
  • Physical activity and exercise are vital components targeting three main aspects of the cancer continuum: prevention, mortality and morbidity.
  • The American Cancer Society recommends that adults with cancer engage in at least 150 minutes of moderate-intensity aerobic exercise and two sessions of resistance exercise per week, which is the same as the guidelines for the general adult[3].

Exercise[edit | edit source]

  • Aerobic exercise and resistance training have a positive impact on lung functioning including a reduction in airflow obstruction and clearing of airways therefore the improved functional capabilities increase energy levels and the release of sputum.[6]
  • Pulmonary Rehabilitation programs is tailored to the individual who has recently had eg lung surgery, with the aim of optimizing their respiratory function and therefore their quality of life (QOL) and participation in their everyday lives.
  • Exercise following surgery or treatment aims to restore physical status (addressing loss of functional capacity and muscle strength, which may occur during treatment) and to maximise function, physical activity, psychological status and health-related quality of life in the long term[3]
  • Research shows positive results of physical exercises on cancer-related fatigue, physical function, symptom distress, sarcopenia and health-related quality of life (HRQoL)[7].

Prevention[edit | edit source]

  • Smoking cessation: The best way to prevent lung cancer is to quit smoking. The risk of getting diagnosed with lung cancer will decrease the sooner an individual quits smoking. After 10 years of not smoking, the chance of developing lung cancer decreases to half that of someone who smokes.[8]
  • Diet: Research suggests that eating a low-fat, high-fibre diet, including at least five portions of fresh fruit and vegetables and whole grains every day, can help reduce the risk of developing lung cancer, as well as other types of cancer and heart disease.[9]
  • Physical Activity/Exercise: Studies show that higher levels of physical activity may lower lung cancer risk. [10] It is important to exercise regularly, attempting to perform at least 150 minutes of moderate intensity aerobic activity each week and incorporate muscle strengthening activities two days per week.[9]

References[edit | edit source]


  1. ↑ 1.0 1.1 1.2 1.3 Radiopedia Lung cancer
  2. ↑ World cancer research fund Lung cancer Available from:https://www.wcrf.org/dietandcancer/cancer-trends/lung-cancer-statistics (last accessed 7.9.2020)
  3. ↑ 3.0 3.1 3.2 Granger CL. Physiotherapy management of lung cancer. Journal of physiotherapy. 2016 Apr 1;62(2):60-7.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Siddiqui F, Siddiqui AH. Cancer, lung. InStatPearls [Internet] 2020 Apr 12. StatPearls Publishing.
  5. ↑ 5.0 5.1 Herold CJ, Bankier AA, Fleischmann D. Lung metastases. Eur Radiol. 1996;6(5).
  6. ↑ Ozalevli S. Impact of physiotherapy on patients with advanced lung cancer. Chron Respir Dis [Internet]. 2013;10(4):223–32.
  7. ↑ Edbrooke L, Granger CL, Denehy L. Physical activity for people with lung cancer. Australian Journal of General Practice. 2020 Apr;49(4):175.
  8. ↑ Dela Cruz CS, Tanoue LT, Matthay R a. Lung Cancer: epidemiology, etiology and prevention. Clin Chest Med. 2011;32(4):1–61.
  9. ↑ 9.0 9.1 Lung cancer - Prevention [Internet]. nhs.uk.
  10. ↑ Lee IM. Physical activity and cancer prevention--data from epidemiologic studies. Medicine and science in sports and exercise. 2003 Nov;35(11):1823-7.
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