Lung cancer is the most common cancer in men and the second most common overall in India. It is the most common cause of cancer-related deaths worldwide claiming more lives yearly than breast, colon, and prostate cancers combined. Every year August 1 is observed as World Lung Cancer Day to raise awareness about lung cancer issues.
Statistics show that more than 90 per cent of lung cancers in men and more than 80 per cent of lung cancers in women develop in smokers. Causes/risk factors of lung cancer are smoking, exposure to second-hand smoke, radon gas, asbestos, other carcinogens, air pollution, arsenic in drinking water, previous radiation to lungs and personal or family history of lung cancer.
According to Dr Subhakar Nadella, Consultant Clinical & Interventional Pulmonologist KIMS Hospital, Kondapur, most of the time no symptoms are seen in the early stages of lung cancer leading to diagnosis at late stages of the disease, making their treatment more problematic. “Subsequently, this delay in diagnosis significantly reduces the overall lung cancer survival rate. If lung cancer is caught before it spreads, the likelihood of surviving five years or more improves to 55 per cent, and the five-year survival rate for those diagnosed before the cancer has spread rises from 18 out of every 100 people to 55 out of every 100 (3 times increase in survival rate) implying that early screening helps in better survival. As TB is endemic in India, the challenge lies in differentiating TB and lung cancer in the early stages,” he said.
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There are some classic symptoms of lung cancer that are generally not a cause for worry but should be evaluated in old age. Persistent cough, shortness of breath, hoarseness, chronic bronchitis, chest pain, unexplained weight loss, bone pain. In patients between the ages of 50 and 80 years, smoking pack years of more than 20, ex-smokers up to the past 15 years, and with environmental or occupational exposure to harmful gases, air pollution should have awareness about lung cancer and should be screened periodically.
Recent advances in lung cancer evaluation and management like Biomarkers, Liquid biopsy, Immunotherapy, Robotics, Stereotactic Radiation, etc have improved treatment outcomes and quality of life. Dr. Bharath Janapati, Consultant Pulmonologist, Century Hospitals said, “By the time patients in India present to a doctor, lung cancer is usually in an advanced stage when nothing much can be done.
Some early signs of lung cancer are cough with or without sputum, breathlessness, weakness, lack of strength, and poor appetite for more than two weeks. Chest pain and blood on coughing can also be present. Advanced signs include excess fatigue, unintentional weight loss, headache, bone pain, and muscle weakness.
Although several advances have been made in diagnosis and treatment, the overall outcome for lung cancer patients in India is still poor, largely due to late presentation. Hence, a detailed understanding of the risk factors, cause of the condition and preventive measures can impact patients and communities.
Lung cancer usually starts in the cell lining of lungs and airways. Lifestyle factors such as tobacco smoking, cooking with bio-mass fuels like firewood, cow dung, coal etc., air pollution, exposure to radiation, certain industrial exposures involving asbestos, in addition to genetic factors are some of the causes. Even though non-smokers can develop lung cancer, smokers are at 10 times more risk and also develop the more aggressive forms.”
According to Dr NVS Ramakrishna, Sr. Consultant – Medical Oncology, SLG Hospitals, the current graph of lung cancer in India seems similar to the Western demographic. This is broadly classified into two categories. Non-small cell lung cancers- NSCLC and Small Cell Lung Cancers- SCLC.
“Most of the lung cancers begin in the bronchi lining and grow in different ways. Non-small cell lung cancer is the most predominant lung cancer in India. It accounts for 80% lung cancer cases, it spreads and grows slowly compared to other types of cancer. On the other hand, small-cell lung cancer is less common and spreads swiftly. This type of cancer can be fatal because it can grow in different body parts. Usually, smokers get affected by this type of cancer. SCLC is also called the ‘oat cell carcinoma.’ In India, men have more incidences of lung cancer than women. Indian females rank seventh in terms of mortality. The ratio of male: female is 4:5:1 which progressed steadily till 51-60 years and then has not increased.”
Dr. G. V. Lakshmi, Consultant Pulmonologist, Amor Hospitals points out that lung cancer treatment hospitals in India are globally recognized. There are renowned hospitals providing world-class medical care to all patients. Recent numbers have shown increased incidences among men and women having lung cancer making it the country’s leading cause of cancer.
“Majority of lung cancer treatment hospitals in India also have cancer research centers. By understanding this epidemic and its cause, it can also help improve cancer care and research options. India is the second largest tobacco consumer, making it the highest prone area to risks of lung cancer.
Chemotherapy, targeted therapy, radiation therapy, and surgery are some widely preferred treatment options that are used during the early stages to identify and remove cancer cells. The majority of these treatments are either used independently or are combined to treat the precise stage of cancer. Palliative care and support groups are available for patients going through this crucial journey. These groups provide emotional and social assistance during the treatment,” she said.
Although mortality due to lung cancer started to decline, its prevalence in India seems to be increasing. Prevention is the key to reducing incidences of lung cancer. Avoiding tobacco, maintaining a healthy diet, and engaging in exercise will reduce the risk of lung cancer.