Treatments of Lung Cancer

Sometimes a lung tumor contains more than one type of cancerous cell. So the treatment should be based on the type of lung cancer, the size, location and extent of the tumor and the general health of the patient. There are many treatments, which may be used alone or in combination. The most widely used therapies for lung cancer are surgery, chemotherapy, and radiation therapy. Chemotherapy and radiation are very effective at relieving symptoms.

Surgery
An operation for lung cancer is major surgery. Depending on the type and stage of the cancer, surgery may be used to remove the tumor and some of the lung tissue around it. Removing only a small part of a lobe (section) of the lung is called a wedge resection. If a entire lobe of the lung is removed, the surgery is called a lobectomy. If the entire lung is removed, the surgery is called a pneumonectomy.

Surgery is of two types aggressive surgery and palliative procedures.

Aggressive surgery (long-term control) : Aggressive surgery involves removal of the pleura, the lung, the diaphragm and the pericardium through a procedure known as extra pleural pneumonectomy. This surgery is highly complicated and carries a high risk of fatality within a month. Extra pleural pneumonectomy is therefore performed only on younger patients who are in good health and can tolerate the surgery.

Palliative Procedures (relief of symptoms) : Palliative procedures are performed when the cancer is in its advanced form. These procedures are performed to allay or control the symptoms rather than cure them. Pleurectomy (also decortications) is the surgical removal of the pleura. This reduces the pain caused by the tumor mass and may also prevent the recurrence of pleural effusion (fluid collection that causes breathlessness).

Video-assisted chest surgery is a new kind of surgery done for people with early stage lung cancer. A tiny camera can be placed through a small hole in the chest to help the surgeon see the tumor. Only small incisions are needed and it is most often used for tumors smaller than about 2 inches.

Side Effects : The side effects of surgery are pain, weakness, fatigue, and shortness of breath. Most have problems moving around, coughing, and breathing deeply. Other possible problems include bleeding, wound infections, and pneumonia. The recovery period can be several weeks or even months.

Chemotherapy
Chemotherapy is the treatment using anti-cancer drugs to destroy cancer cells throughout the body. The drugs can be swallowed in pill form or can be injected directly into a vein or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. These drugs enter the bloodstream and reach throughout the body, making this treatment useful for cancer that has spread (metastasized) to organs beyond the lung. The amount of chemotherapy a patient receives depends on the type of cancer, the drugs, and the patient’s overall response to treatment. Therapy may be given daily, weekly, or monthly, and can continue for months or even years.

Side Effects : Drugs used in chemotherapy can damage some normal cells, causing side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment. The possible side effects are nausea and vomiting, hair loss, fatigue or shortness of breath caused by low red blood cell counts, loss of appetite, diarrhea or constipation, mouth sores, bruising or bleeding caused by a shortage of blood platelets, higher risk of infection caused by a shortage of white blood cells. Most side effects disappear when your course of treatment ends. Some drugs will damage the nerves and this may cause numbness in the fingers and toes, and sometimes the arms and legs may feel weak.

Radiation Therapy
Radiation therapy alias radiotherapy is the treatment using a beam of high-energy rays or particles to destroy cancer cells. It may be used before surgery to shrink a tumor, or after surgery to destroy any cancer cells that remain in the treated area. The radiation may come from outside the body (external radiation) or from radioactive materials placed into or next to the tumor (internal radiation). External type of radiation is most often used to treat a primary lung cancer or its metastases to other organs.

Radiation is mainly for patients who are not healthy enough to have surgery. For others, it might be used after surgery to kill small areas of cancer that can't be seen and removed during surgery. It can also be used to relieve symptoms such as pain, bleeding, trouble swallowing, or problems caused by the cancer spreading to the brain.

Brachytherapy uses a small pellet of radioactive material placed directly into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope.

A special kind of radiation (called the gamma knife) can be used instead of surgery if the cancer spreads to the brain in only one spot. In this method, several beams of radiation are focused on the tumor over the span of a few minutes to hours. The head is held in place with a stiff frame.

Side Effects : The side effects of radiation include vomiting, diarrhea, fatigue, nausea, mild skin problems and tiredness. Chest radiation may cause lung damage and trouble breathing or swallowing. Side effects of radiation therapy to the brain usually become most serious after 1 or 2 years. They could include memory loss, headaches, trouble with thinking, and less sexual desire.

Targeted Therapy
Targeted therapies use medications or antibodies used to block growth factors that allow some tumors to grow. These drugs taken in the form of pills attack special parts of cancer cells and leave most normal cells alone. Not all lung cancers respond to these drugs.

Side Effects : These drugs seems to cause few side effects than chemotherapy and it include diarrhea, rash, eye problems, nausea, vomiting, loss of appetite, and feeling tired.

Photodynamic therapy (PDT)
This laser therapy using a special chemical which is injected into the bloodstream, leaves normal cells but remains in cancer cells for a longer time. A laser light aimed at the cancer activates the chemical, which then kills the cancer cells that have absorbed it. PDT is used to treat very small tumors in patients for whom the usual treatments for lung cancer are not appropriate. It is also used to control bleeding or to relieve breathing problems due to blocked airways when the cancer cannot be removed through surgery.

After Treatment

Follow-up care after treatment for lung cancer is very important. Regular checkups should be performed so that any recurrence can be identified as early as possible. Checkups may include physical exams, chest x-rays, or lab tests. A person who has undergone surgery should be checked every 3-4 months for the first 2 years and every 6-12 months thereafter.

Lung cancer remains a highly preventable disease because 85% of lung cancers occur in smokers or former smokers. The best way to prevent lung cancer is to quit smoking. Lung cancer takes many years to develop. But changes in the lung can begin almost as soon as a person is exposed to cancer-causing substances.

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Colorectal Cancer

Colorectal cancer is the cancer in the large intestine and rectum. It occurs when some of the cells that line the colon or the rectum become abnormal and grow out of control. The abnormal growing cells create a tumor, which is the cancer. Cancer that begins in the colon is called colon cancer and in the rectum is called rectal cancer. It is common in both men and women .The risk of developing colorectal cancer rises after age 50.

The colon, the longest part of the large intestine or large bowel, is a long muscular tube shaped organ connecting the small intestine to the rectum. It extends from the end of the small bowel to the anus, twisting and turning through the abdomen (belly). It is divided into four sections namely, the ascending colon, transverse colon, descending colon, and sigmoid colon. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. The rectum is lower part of the colon that connects the large bowel to the anus. The rectum’s primary function is to store formed stool in preparation for evacuation.

Colon along with the rectum is called the large intestine. Cancers affecting either of these organs also may be called colorectal cancer. Most colorectal cancers arise in the sigmoid colon which is the portion just above the rectum. They usually start in the innermost layer and can grow through some or all of the several tissue layers that make up the colon and rectum. Most colorectal cancers grow slowly over a period of several years, often beginning as small benign growths called polyps. Removing these polyps early, before they become malignant, is an effective means of preventing colorectal cancer.

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Causes of Colorectal Cancer

The exact reason of colorectal cancer is unknown. But there are certain factors that make cancer more likely. They are age, colorectal polyps, family history, genetic alterations, personal history, drug effects, cigarette smoking etc. Not all polyps become cancerous, but nearly all colon cancers start as polyps.

Eating a diet which is low in fiber is also a risk factor for developing colorectal cancer. Research shows that women with a history of cancer of the ovary, uterus, or breast have an increased chance of developing colorectal cancer. People who have a sedentary lifestyle are more likely to develop cancer than people who take regular physical exercise.

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Symptoms of Colorectal Cancer

Colorectal cancer may occur without any symptoms therefore it is very important to have regular examinations called colorectal screenings, to detect early problems. One of the earliest signs of colon cancer is bleeding, which may be painless. Sometimes the blood is found only during chemical testing of the stool.


When tumors have grown larger, other symptoms may develop. These symptoms may include

Blood on or in the stool

Constipation

Bowel obstruction, causing nausea, vomiting and abdominal distention

Diarrhea

Anemia

Stools that are narrower than usual

Loss of appetite

General abdominal discomfort like stomach or gas pain

Weight loss with no known reason

Fatigue

Constant tiredness

Pelvic pain

For colorectal cancer patients, early diagnosis and treatment can be a life-saver. So if any of these symptoms are found, better consult a physician to ensure proper diagnosis and treatment.

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Diagnosis of Colorectal Cancer

The physician will perform a physical examination for any signs or symptoms of colorectal cancer. Some screening guidelines are used to detect polyps, cancer, or other abnormalities in the colon and rectum. These include:

Fecal occult blood test (FOBT):
FOBT examines the stool for blood not easily noticed by the naked eye. In this test a small amount of stool is placed on a special paper and the physician applies a chemical to it to see if blood is present in the stool sample. If it detects blood, other tests are needed to find the source of the blood.

Sigmoidoscopy:
Sigmoidoscopy is a procedure to detect polyps using sigmoidoscope which is a long, flexible instrument about 1/2 inch in diameter. The physician can view the lining of the rectum and lower (sigmoid) colon through sigmoidoscope. If polyps are found, it is removed and the procedure is called polypectomy.

Colonoscopy:
It is an endoscopic test. The rectum and the inside of the entire colon are examined in colonoscopy, using a long, flexible tube with a tiny camera on the end called colonoscope. If polyps are found, it is removed.

Air contrast barium enema or Double-contrast barium enema (DCBE):
This is a series of X-ray examination of the entire colon and rectum. Before the x-ray is taken, the patient is given an enema with a barium solution. Barium is a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up solid on x-rays. The liquid is introduced into the colon and rectum through the anus. The liquid contains barium, which shows up solid on x-rays. Air is pumped gradually into the colon by a rectal tube to improve visualization. The barium and air outline the colon and rectum on the x-rays. Polyps may show up on the x-ray.

Digital Rectal Exam (DRE):
It is a part of the routine physical examination. The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas in the lower part of the rectum. If an abnormality is detected by a digital rectal examination, then an endoscopy is performed for further evaluation of the cancer.

After initial diagnostic tests, if colorectal cancer is suspected, a biopsy, removal of cells or tissues, is performed by a pathologist. If cancer cells are detected in biopsy, further tests are recommended to know the extent (stage) of the disease. These may include:

Blood test for CEA:
Carcinoembryonic antigen (CEA) is a protein normally found in trace amounts in the bloodstream. People who have colorectal cancer or other conditions or who smoke have a high CEA level. CEA is referred to as a tumor marker.

Endoscopic Ultrasound (EUS) or Endorectal ultrasound :
An endoscopic ultrasound is used to detect the depth of the cancer growth. An ultrasound probe at the tip of an endoscope is inserted into the rectum. The probe sends out sound waves that people cannot hear. The waves bounce off the rectum and nearby tissues, and a computer uses the echoes to create a picture. The picture shows how deep a rectal tumor has grown or whether the cancer has spread to lymph nodes or other nearby tissues.

Chest x-ray:
X-rays of the chest can show whether cancer has spread to the lungs.

CT scan:
An x-ray machine linked to a computer takes a series of detailed pictures of areas inside the body. The patient may receive an injection of dye. Tumors in the liver, lungs, or elsewhere in the body show up on the CT scan.

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Stages of Colorectal Cancer

Colon cancer and rectal cancer are staged much the same way. But the treatment options may vary because the tumor is much lower down in the colon.

Stage 0: The cancer is found only in the innermost lining of the colon or rectum. Carcinoma in situ is another name for Stage 0 colorectal cancer.

Stage I: The cancer has grown into the inner wall of the colon or rectum. The tumor has not reached the outer wall of the colon or extended outside the colon.

The tumor has broken through the inner lining of the rectum but has not made it past the muscular wall. Dukes A is another name for Stage I colorectal cancer.

Stage II: The tumor extends more deeply into or through the wall of the colon or rectum. It may have invaded nearby tissue, but cancer cells have not spread to the lymph nodes. Lymph nodes are small, bean-shaped structures that are found throughout the body that are part of the body's immune system. The cancer may have invaded other organs, like the bladder, uterus or prostate gland. Dukes B is another name for Stage II colorectal cancer.

Stage III: The cancer has spread to nearby lymph nodes, but not to other parts of the body. Dukes C is another name for Stage III colorectal cancer.

Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs. Dukes D is another name for Stage IV colorectal cancer.

Recurrent cancer: This is cancer that has been treated and has returned after a period of time when the cancer could not be detected. The disease may return in the colon or rectum, or in another part of the body.

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Treatments of Colorectal Cancer

Colorectal cancer is highly curable when found in its early stages. The specialists who treat colorectal cancer include gastroenterologists (doctors who specialize in diseases of the digestive system), surgeons, medical oncologists, and radiation oncologists. The treatment mainly depends on the location of the tumor in the colon or rectum, size and the stage of the disease. Treatment methods for colorectal cancer are surgery, radiation therapy or chemotherapy. Some have a combination of these treatments.

Surgery:

It is the most common treatment for colorectal cancer. A colonscope is used to remove small malignant polyp. For larger cancer, surgeon makes an incision into the abdomen to remove the tumor and after that the two open ends are joined together. When a section of the colon or rectum is removed, the surgeon can usually reconnect the healthy parts. If it is not possible, then a colostomy may be needed.

Colostomy - The surgeon makes an opening (a stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. This operation to create the stoma is called colostomy. It is the opening into the colon from the outside of the body. A bag is worn over the stoma to collect the stool. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed.

Side Effects - Patients feel tiredness and uncomfortable and to control their pain, medicines are given. Surgery sometimes causes bleeding, constipation or diarrhea. People who have a colostomy may have irritation of the skin around the stoma.

Chemotherapy:
Chemotherapy uses anticancer drugs to kill cancer cells. They are usually given through a vein, but some also may be given by mouth. These drugs enter the bloodstream and can affect cancer cells throughout the body. The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Chemotherapy before surgery may shrink a large tumor and it is called neoadjuvant therapy. Adjuvant therapy, i.e. chemotherapy after surgery, can destroy any remaining cancer cells and prevent the cancer from coming back in the colon or rectum, or elsewhere.

Side Effects - Side effects of chemotherapy vary from patient to patient and it depends mainly on the specific drugs and doses received. Chemotherapy drugs can affect blood cells resulting in bruising, bleeding, weakness and feeling tired. Other possible side effects are hair loss, poor appetite, nausea, vomiting, diarrhea, mouth and lip sores. Most side effects can be controlled with drugs and will disappear when treatment ends.

Radiation Therapy:
Also called radiotherapy, it uses high-energy rays to kill cancer cells. Radiation therapy affects cancer cells only in the treated area. Some patients may have radiation therapy before surgery to shrink the tumor and others may have it after surgery to kill cancer cells that may remain in the area. External radiation and internal radiation or implant radiation are the two types of radiation therapy used for the treatment of colorectal cancer

External radiation: Radiation is produced by a machine outside the body. The machine targets a concentrated beam of radiation directly at the tumor area. This form of therapy is usually spread out in short treatments given 5 days a week for 5-7 weeks. In some cases, external radiation is given during surgery.

Internal radiation: The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. During the entire treatment, the patient must stay in the hospital and the implants generally remain in place for several days. When the treatment is done, they are removed. Once it is removed, no radioactivity is left in the body.

Side Effects - The side effects of radiation mainly depends on the dose and the part of the body where the radiation is given. Common effects include extreme tiredness, vomiting, increased susceptibility to infections, hair loss, easy bruising or bleeding. Radiation therapy to the abdomen and pelvis may cause nausea, vomiting, diarrhea, bloody stools, rectal leakage, or urinary discomfort. Apart from these, the skin in the treated area may become red, dry, and tender.

Colon cancer and rectal cancer are sometimes treated separately.

Most patients with colon cancer are treated with surgery. But some have chemotherapy along with surgery. A colostomy is seldom needed for people with colon cancer. Radiotherapy is not commonly used to treat colon cancer, but it is used to relieve pain and other symptoms.

Surgery is the most common treatment for rectal cancer. Most rectal cancer patients need a permanent colostomy. Some patients receive the combination of all the treatments. Some patients may have radiation therapy during surgery and it is called IORT (Intraoperative radiation therapy).

After Treatment:

If undetected cancer cells remains somewhere in the body, there are possibilities for the return of the disease. Follow-up care after treatment is very important. Checkups may include a physical exam, lab tests, colonoscopy, x-rays, CT scans, or other tests. The patients should visit their physician between regular scheduled and if any health problems appear.

Getting regular check-ups may be the best way to prevent colorectal cancer.

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