What is it and how often is it?
Lung cancer is a very serious disease that affects a vital organ for our body.
Epidemiology
Altogether it represents 11% of the overall diagnosed cancers.
Only in our country there are about 33, 000 deaths due to lung / bronchus and trachea cancer per year, of which about 25, 000 cases involve male individuals.
Risk factors
Cigarette Smoke
The main culprit is smoking, guilty of 85-90% of all new cases of lung cancer observed in Western countries.
The risk increases with the quantity of cigarettes smoked and with the duration of smoking.
- The relative risk of smokers compared to non-smokers has increased by about 14 times and is further increased up to 20 times in heavy smokers (over 20 cigarettes a day).
- Cigarette smoking cessation produces a significant reduction in risk.
The smoking habit is constantly increasing among women, while since the end of the 1980s there has been a slow regression in the number of male smokers. Currently about 1/3 of men smoke while among women the number of smokers is around 20%, a percentage clearly higher than in past decades.
This figure is in clear relation to the continuous increase in cases of lung cancer recorded in the fairer sex. At the base of this increase there could also be a greater predisposition of the female organism to the carcinogenic effect of cigarette smoke.
The reduction in the number of male smokers in the last twenty years has instead been accompanied by a clear reversal in the trend, recording a decrease in the number of men suffering from lung cancer.
Epidemiological studies have also shown a greater incidence of lung cancer among the disadvantaged social groups. In fact, the low socioeconomic condition correlates to a greater exposure to tobacco smoke and, to a lesser extent, to environmental pollutants and infectious agents (eg tuberculosis).
The main culprit is still smoking, due to which about 1/3 of the smokers die. Of these, just over half die of lung cancer. The relative risk is closely related to the number of cigarettes smoked, the duration in years of the smoking habit, the tar content of smoked cigarettes and the presence or otherwise of the filter.
- For a smoker the chances of getting lung cancer are 14 times higher than for a non-smoker. For heavy smokers (> 20 cigarettes / day) this probability rises to 20 times higher. The risk is therefore dose dependent (increases "only" by three times if you smoke 5 cigarettes a day)
- The earlier you start smoking and the greater the risk of developing lung cancer and other respiratory diseases. On the contrary, the sooner you stop and the smaller your chances will be.
- Respiratory function improves rather quickly after smoking cessation. The acquired cardiovascular risk is canceled in about a couple of years after the termination.
However in ex-smokers the increased risk of developing lung cancer is eliminated only 10-15 years after smoking cessation (cumulative risk). Only after this time the chances of getting sick are identical to those of a person who has never smoked. Despite having such long reduction times, the oncological risk begins to diminish, albeit slightly, immediately after the cessation.
- For ex-smokers the risk of getting lung cancer is on average 11.2 times higher than for non-smokers.
SOME DATA
The number of deaths due to lung cancer rose from 1% of deaths at the beginning of the last century to the current 10%. Similarly, the relative frequency compared to other cancers has increased from 3-5% before the Second World War to the current 11%. It is estimated that currently, in the course of life:
- 1 in 9 men and one in 37 women may develop lung cancer;
- one man out of 10 and one woman every 47 would run the risk of dying from lung cancer
- Lung cancer is the leading cause of cancer death in males (27% of total deaths) and the third leading cause in women, after breast and colorectal (11% of total deaths).
SURVIVAL
Over the past 20 years the survival of lung cancer patients has increased, but to a negligible extent.
- The percentage of 5-year survivors among lung cancer patients has moderately increased between the early 1990s and the end of the 2000s, going from 10 to 14% in males and from 12 to 18% in females.
Although therapeutic techniques have undergone considerable improvements in most cases, the disease is still diagnosed at an advanced stage, leaving little chance for the patient.
NOTE: although the incidence of lung cancer decreases in men, the total number of cases increases due to the aging of the population, the increased number of women smokers and the improvement in patient survival.
Symptoms
To learn more: Lung tumor symptoms
Lung cancer is a subtle disease that in many cases shows no signs of self until it reaches an advanced stage. In the presence of these symptoms, fortunately not always indicative of a lung tumor, do not hesitate to consult your doctor for tests, even very simple ones like a chest x-ray:
- chronic cough that becomes particularly insistent or changes its characteristics (intensity, duration and consistency of the sputum)
- breathing difficulties (dyspnea) even for not particularly intense efforts (walking briskly, climbing stairs)
- chest pain
- traces of blood in the sputum (hemoftoe)
- emission of a large amount of blood from the mouth (hemoptysis)
However, these symptoms vary depending on the type and location of development of lung cancer. In 6% of the cases the carcinoma is completely asymptomatic. Other times these symptoms are associated with: fever, asthenia (weakness), loss of body weight, pain in the shoulder or upper limb, slow resolution pneumonia or recurrent pneumonia, dysphonia and dysphagia (painful swallowing).
Risk factors
- Tobacco smoke
- Passive smoking (not only in the home but also in the workplace and in public spaces)
- Genetic factors and family inheritance (non-quantifiable): an increased incidence in family members of lung cancer patients with specific genetic abnormalities was observed
- Occupational factors
- Environmental pollution
- Age (50-60 years at maximum risk)
- Bronchopulmonary disorders such as COPD, TB outcomes, silicosis, sarcoidosis, idiopathic pulmonary fibrosis, scleroderma, bronchiectasis, anthraxis
The role of ENVIRONMENTAL POLLUTION in tumor development is all in all negligible. In fact it is estimated that the impact of environmental factors on the onset of lung cancer is only around 1 to 1.5% of all cases.
In Lombardy, for example, more men who live outside the large urban centers and more women living in the interior become ill with lung cancer.
Environmental pollution can cause other respiratory diseases such as asthma and chronic bronchitis.
Greater attention should instead be paid to professional exposure:
- the incidence of lung cancer increases by 8 times in workers in close contact with tar, pitch, soot, raw paraffin, lubricating oils
- In smokers exposed to asbestos the incidence of lung cancer is 80-90 times higher than that of non-exposed non-smokers
- Workers working closely with radioactive materials are particularly at risk
- Other dangerous chemical agents are arsenic, chromium, nickel, cadmium, silica, radon and fossil fuels
In many cases, smoking tends to increase the carcinogenic potential of these elements, once again proving to be the number one enemy of our lungs. The clear decrease in cases of lung cancer in young males confirms the importance of smoking prevention campaigns in our country.
Diet and lung cancer
A diet rich in fruit and vegetables provides the body with all the vitamins, fibers and minerals it needs.
According to an authoritative study, smokers tend to consume less vitamin C than non-smokers. Adding to the situation is the reduction in vitamin C levels caused by smoking regardless of the amount taken with the diet.
To prevent lung cancer, it is therefore very important to take the right doses of vitamin C (at least 60 mg / day, although to fully appreciate its antioxidant effects we strongly recommend higher doses, in the order of 200 mg / day).
Other natural antioxidants needed to counteract the free radicals produced by tobacco smoke are: vitamin A, C, E, selenium, carotenoids, lycopene, coenzyme Q-10 and lipoic acid. All these substances are naturally contained in most foods of vegetable origin (fruit and vegetables). Unfortunately, the administration of these substances at high doses through specific supplements has not shown appreciable benefits in reducing the incidence of lung cancer in smokers; indeed, in some cases (see the case of vitamin A), it still seems to increase the risk among smokers.
It is also important for a smoker not to abuse supplements of polyunsaturated fatty acids, which tend to produce free radicals aggravating the negative effects of smoking. It must however be considered that most of these harmful effects are neutralized by the presence of tocopherol, a vitamin naturally contained in vegetable oils and added to many supplements of polyunsaturated fatty acids. Furthermore, these potentially harmful effects are accompanied by other particularly beneficial ones as they are useful in preventing cardiovascular diseases.
Prevention and diagnosis
The only primary preventive action effective in reducing the incidence of lung cancer is the abolition of tobacco smoking .
Given that those over the age of 55 who stop smoking have a persistent increased risk of getting lung cancer, it is very important to implement the right secondary prevention standards.
Prevention and early diagnosis can indeed make a difference by allowing timely treatment of lung cancer.
The perfect recovery from lung cancer is all the more likely the sooner antitumor therapy can be implemented
X-ray and CT scan
Regarding screening or early diagnosis of lung cancer, the most useful exam is radiography, which must be completed with a CT scan anyway. The X-ray could in fact not be able to identify nodules of reduced dimensions or positioned in lung areas that are difficult to explore. The CT scan can also show small pulmonary nodules (over 5-6 mm) arriving where the traditional radiograph cannot reach.
A development of this diagnostic technique has allowed the development of the spiral or helical CT that allows the fast acquisition of images that are rather sharp and not very sensitive to cardiac and respiratory movements. It also does not require contrast injection into a vein and exposes the patient to a low dose of radiation.
Particularly useful in the diagnosis of lung cancer is the comparison with any previously made radiograms.
Bronchoscopy
Bronchoscopy allows you to see directly the state of health of the bronchi thanks to the aid of optical fibers. In the event of alterations such as to suspect the presence of a lung tumor during the examination, a small sample of tissue can be taken on which to perform the histological examination.
To these diagnostic investigations the examination of the sputum is often added in which the presence of possible tumor markers is sought.
Other instrumental examinations
OTHER TESTS useful for the diagnosis of lung cancer are: positron emission tomography (PET), needle biopsy with thin needle via transthoracica, mediastinoscopy, magnetic resonance.
Currently there are several studies in progress in our country to establish the effective preventive effectiveness of screening programs which, although with some new ones, have already proved particularly useful in reducing the incidence of other cancers such as breast cancer or cervix.
The major obstacles to implementing such a large-scale program stem from the aggressiveness of lung cancer and from the very high costs that should be incurred to examine the 1.5 million Italians at risk.
