What’s wrong with me?
Lung cancer is a non-hereditary tumour. Only a very small percent of the population inherit some degree of susceptibility. When your doctor mentions “genetic studies”, it is not a reference to each individual’s genetic characteristics but rather to studying the particular characteristics of each tumour in order to personalise each patient’s treatment. The best advice you can give to your family is to tell them to avoid exposing themselves to carcinogenic products such as tobacco smoke.
The initial stages of lung cancer do not produce any symptoms and it normally goes unnoticed. It is increasingly common for lung cancer to be diagnosed by chance while performing an X-ray to explore another complaint. The onset of symptoms generally occurs in advanced stages of the disease. The most common symptoms are: chronic cough or cough that differs from normal, shortness of breath, blood in sputum, and chest or shoulder pain, amongst others.
Research developments made at centres specialising in lung cancer are shared across the globe and so oncological treatments offer the same guarantees.
Stopping smoking is always a very good decision. Tobacco can increase the risk of developing lung infections and the treatment’s toxic effects on the lungs. Additionally, tobacco can decrease the effectiveness of chemotherapy and impede the recuperation of respiratory capacity following lung surgery. Quitting smoking will also decrease the risk of developing a second lung cancer.
What tests will I undergo
Spirometry is a quick, painless test which uses a manual device called a “spirometer” to measure the volume of air retained in a person's lungs (air capacity) and the inspiration and expiration rates during respiration (air flow rate).
Bronchoscopy is the examination of the airways, under a local anaesthetic, by introducing a flexible tube with a video camera on the end (called a bronchoscope) through the mouth and down into the bronchi. The bronchoscope displays a clear view of inside the airways on a monitor. Bronchoscopes also feature several internal channels through which different instruments can be introduced in order to carry out diagnostic procedures, such as the collection of a biopsy sample.
What treatments are available
Chemotherapy is the treatment most commonly applied to lung cancer. It is generally administered intravenously, but in some cases it may be taken orally.
Chemotherapy inhibits the growth of cells in the process of division. It affects both tumour and healthy cells which is what causes the symptoms associated with the treatment, known as adverse effects or side effects.
Chemotherapy may be administered as a two-drug combination or a monotherapy (one drug). Some of the most used medications include platinum-based compounds (cisplatin and carboplatin), antifolates (pemetrexed), taxanes (paclitaxel and docetaxel), vinorelbine, gemcitabine and etoposide.
Some of the symptoms that may appear are: tiredness, changes in dietary preferences, nausea, vomiting, hair loss, inflammation of the mouth’s mucous membrane, fever, constipation, abdominal and muscular pain, hives and nail lesions. You should always discuss any doubts you may have with your healthcare team.
Radiation therapy or radiotherapy uses high-energy X-rays to destroy cancer cells. It has many applications in lung cancer and can be administered alone or in combination with radiotherapy. It aims to reduce the size of the tumour prior to surgery or eliminate any remaining cancer cells after surgery, as well as to treat lung cancer that has spread to other parts of the body outside the lungs, such as the brain or bones.
Radiotherapy can be associated with skin irritation, inflammation of the oesophageal mucous membrane (oesophagitis) causing difficulty swallowing, weakness and pneumonitis (i.e., inflammation of lung tissue which usually appears months after completing treatment).
Treatment duration depends on the type of lung cancer and its stage. Chemotherapy is generally administered every 3–4 weeks and this period is called a cycle. In principle, patients require 4 to 6 cycles. There are other types of treatment that control immunity and which can be administered continuously for several months if they prove to be active and retard tumour growth.
Targeted molecular therapies involve medicines that specifically block certain mechanisms involved in tumour transformation and growth processes (neoplasm). Some of these drugs are administered orally. The side effects are generally milder than those associated with chemotherapy. The most common side effects involve the skin; dryness, face and chest acne, and nail lesions. Diarrhoea is another common side effect.
Biological therapy or immunotherapy is a treatment designed to stimulate the body's immune system to act against cancer cells. It is administered by infusion into a vein.
The side effects of these drugs stem from the immune system's activation and include intestinal, cutaneous, nerve and endocrine system toxicity.
Living with lung cancer
Any pain will primarily depend on the tumour's location and each individual's pain threshold. If you feel pain during any stage of the illness, then it is important that you don't just accept it as inevitable but rather you should inform your medical team. There is a wide range of drugs available that are very effective at alleviating pain. It is not true that opiates, e.g., morphine, lead to addiction, nor is their prescription synonymous with end-stage cancer.
One of the most typical side effects of chemotherapy is a decline in the body’s natural defences, leading to a greater risk of infection. Fever or a temperature of 38 °C or more is part of the body’s defence mechanism and is a sign of infection. If you have a high temperature or fever you should get in contact with your healthcare centre. They will take a blood test and chest X-ray to assess the cause of the fever and determine the state of your defences and, if necessary, administer an antibiotic treatment.
The chances of leading a normal life during treatment will depend on your overall health, the symptoms caused by the lung cancer and the side effects of the treatment itself. Chemotherapy and radiotherapy are normally administered as an out-patient service, i.e., patients usually return home after each session of treatment. There is no specific limitation on activities in association with the disease or its treatment. The most sensible thing to do is pay attention to what your body tells you; rest when tired and be active when you feel well.
The side effects of chemotherapy do not usually appear until 48 hours after administering the treatment. However, patients are always advised to take someone with them to their chemotherapy sessions because the drugs used can sometimes produce side effects during infusion (allergic reactions, etc.) and several of them are administered over long periods, meaning patients are usually very tired after therapy
Hair loss or alopecia can be partial or total and depends on the treatment and drugs prescribed – not all types of chemotherapy cause hair loss. Your medical team will inform you beforehand about the risk of alopecia associated with your planned treatment. Hair loss does not occur immediately after receiving chemotherapy, it tends to happen in the third or fourth week after administering the first dose of treatment. So there is enough time to receive personalised attention and choose your most aesthetically pleasing option to address the loss.
Chemotherapy-induced alopecia is reversible and your hair will begin to grow again 3–4 weeks after completing the final treatment cycle. It may regrow with a different colour and texture.
To prevent mouth sores (mucositis) it is vital that you maintain good oral hygiene and brush your teeth after every meal with a soft-bristled toothbrush. You should complement your oral hygiene with mouthwashes, alternating between a physiological solution and a sodium bicarbonate solution (1 cup of water + 1 teaspoon of bicarbonate). You can also rinse with a thyme infusion.
If you wear dentures and they cause you discomfort, then it is a good idea to stop wearing them.
Recommendations are to use soft shampoos and ammonia-free dyes.
It is also very important that you look after your skin while being treated as many cancer treatments can produce skin toxicity. You must shower daily with warm water using a soft, soap-free shower gel and always keep your skin hydrated. Do your utmost to avoid exposure to the sun and use sunscreen with a high sun protection factor (UVA/UVB). Wear loose, cotton or linen clothing and make sure no jewellery, zips or belts are rubbing against your skin.
As long as you feel well enough in general, then you can still practice sex. It is important to remember that you should take contraceptive measures to prevent pregnancy during treatment. You must bear in mind that you may experience sexual dysfunction or decreased sexual desire and this is a product of the disease and the treatment. Nevertheless, the effects are reversible once treatment has finished. Looking after your body image is important because it helps keep up your self-esteem and your perception of being accepted by your friends and family.
Viagra® can be indicated during treatment. But given the large number of drugs used to treat cancer, you must discuss it with your oncologist beforehand to rule out any possible drug-drug interactions or previous illnesses that contraindicate its use.
During treatment your doctor will request imaging tests (CT, PET, MRI, etc.) that help visualise the changes in the size of the tumour. These images are compared with those taken before starting treatment and used, therefore, to evaluate the effectiveness of the medication. Your doctor may define the treatment’s effectiveness using the following terms: complete remission (the tumour has disappeared), partial remission (the tumour has shrunk), progression (growth) or stable. The type of tests conducted and their frequency depends on the type of tumour and treatment being carried out.
Treatments known as complementary, alternative or integrative therapies (e.g., homeopathy, acupuncture, relaxation techniques, massage, Reiki, etc.) can have very beneficial effects, such as helping to treat the symptoms derived from the disease or its primary treatment. If you wish to take any oral complementary treatments, you should first discuss them with your doctor because some of them may interact with your cancer treatment.
Clinical studies and trials have investigated the therapeutic use of cannabinoids under specific medical conditions. They have shown that the main active substance in marijuana helps control the side effects of cancer treatments (it stimulates appetite, alleviates pain and is antiemetic, i.e., relieves nausea). The use of cannabis is currently prohibited in Spain and so any products containing extracts and concentrates are not regulated.
After completing treatment you will still need to undergo some regular check-ups with radiological tests, they will be indicated by your doctor based on the type of cancer. These check-ups are complemented with an appointment with your doctor and a blood test. This follow-up will provide early detection of any recurrence or reactivation of the tumour and so optimal treatment can be initiated before symptoms appear and the tumour starts to grow.
There are different therapeutic possibilities in such a situation (second-line chemotherapy, radiotherapy or surgery) depending on the location of the tumour, the previous course of treatment and the patient’s current state of health. You may also be offered the chance to participate in a clinical trial. These will give you access to promising new therapies which are not yet available in health centres. Your doctor will offer you the clinical trial with the greatest potential benefits for your individual case.
Thanks to the development of new medicines the survival of patients diagnosed with lung cancer has increased progressively. The prognosis for the illness depends on the type of cancer and the stage of the tumour. In stages I, II and III with localised cancer, treatment is considered to have a definitive purpose. When the disease is incurable, the aim is to control it and convert it into a chronic disease while maintaining an acceptable quality of life.
It is important to remember that statistics are only population estimates and each individual case often follows its own course.
It is an experimental evaluation of a drug in humans in order to assess its safety and effectiveness. When an experimental drug is compared with a drug that is already approved and used in routine clinical practice, a trial helps to determine if the drug under investigation offers more benefits than the already existing drug. Participation in a clinical trial is voluntary and you can withdraw from the study if you change your mind. The patients included in a trial must meet certain requirements, so for this reason not all patients can be included even though they wish to participate.
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