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Symptoms and Treatment of Lung Cancer

According to statistics, lung cancer is the most common type of cancer affecting men in Turkey. In 2018 there were 3 million living with lung cancer worldwide and 1 million 76 deaths occurred the same year. Even though lung cancer is mostly seen in men in Turkey, its prevalence has been rapidly increasing among women. 

Smoking and even passive smoking are the most important underlying factors for lung cancer alongside environmental and occupational factors.

What is Lung Cancer?

Lung cancers are malignant tumors caused by the uncontrolled growth of abnormal cells originating from lung tissue.

It is one of the most common cancers worldwide and causes the most frequent cancer-related deaths in both men and women.

What Are the Types of Lung Cancer?

There are two types of lung cancer, “Small Cell” and “Non-Small Cell”. Treatment approaches to these two groups are completely different. 

Small Cell Lung Cancer has a much more aggressive course and spreads rapidly. the Primary treatment option is chemotherapy.  

Non-Small Cell Lung Cancer, on the other hand, has various sub-types, and treatment is determined by the stage of disease at the time of diagnosis. 

When treated early, surgical treatment successfully improves disease-free life expectancy and combination of chemotherapy, radiotherapy or-when necessary- immunotherapy, improves the effectiveness of treatment.

What are the Causes of Lung Cancer?

•    Smoking
•    Passive Smoking
•    Genetic Factors
•    Age
•    Family history
•    Metals: Arsenic (As) - Chrome (Sn) - Nickel (Ni)
•    Exhaust fumes,
•    Asbestos “The silicate minerals in fiber structure”
•    Silica “Silicone dioxide dust to which individuals can be exposed in mines, cement plants, and coal mines”.

Smoking associated and non-smoking associated lung cancers cause different pathologies in the lungs. Lung cancer can be seen in non-smokers due to exposure to environmental factors like air pollution, coal fire, radon gas, asbestos, etc. Thus, possible symptoms of lung cancer must not be neglected by wrongly assuming that only smokers can have lung cancer.

What Are the Symptoms of Lung Cancer?

The most common symptom of lung cancer is stubborn and persistent coughing and must not be overlooked as “just a smoker’s cough”

  • If cough persists for more than 3 weeks,
  • If there is a change in coughing pattern,
  • If there is blood in sputum along with cough

The presence of these symptoms must always suggest the possibility of underlying lung cancer and a physician should be consulted immediately.

Other symptoms seen in lung cancer are:

  • Dyspnea,
  • Wheezing,
  • Loss of appetite,
  • Weight loss,
  • Fever,
  • Hoarseness,
  • Chest pain,
  • Swelling on face and neck,
  • Shoulder and arm pain,
  • Back pain,
  • Difficulty swallowing
  • Headache and bone pain,
  • Tiredness and fatigue

These are common symptoms that can be seen in many other diseases and tend to be neglected.

Early diagnosis of lung cancer is critical because the spread of the disease into other organs can be very rapid.

Locations of Lung Cancer Metastases:

  • Bone
  • Liver
  • Adrenal Gland
  • Brain
  • The opposite side of the lung

Symptoms of lung cancer may be quite insidious and in about a quarter of patients, lung cancer develops silently without any complaints or symptoms. Most patients are diagnosed coincidentally when they go through investigations such as chest x-rays for other reasons. Routine controls are of utmost importance for early diagnosis and treatment.

Can Lung Cancer Be Prevented with Early Diagnosis?

Lung cancer can take several years to develop into a symptomatic disease; therefore, it is not possible to evaluate these insidious types through routine screening programs in the early stages of the disease.

How Often Should We Attend to Follow-up Examinations for Early Diagnosis and Treatment of Lung Cancer?

Frequency of follow up examinations for NON-SMOKERS 

Regardless of any family history of cancer, everyone older than 40 years of age must have routine check-ups once a year even in the absence of complaints. 

Check-up programs should include a chest x-ray. Chest x-rays provide information on the presence of a suspicious lesion in the lungs. 

Contact our Pulmonary Medicine or Thoracic Surgery clinics for control visits and follow-ups.

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Frequency of follow up examinations for SMOKERS

Routine follow-up examinations at least once a year is very important for early diagnosis for the individuals who are smokers and have no complaint.

Low dose tomography of the lung (CTI of thorax = Chest CTI = Thoracic CTI) is used for follow-up examinations of high-risk individuals regarding the determination of early-stage lesions.

Contact our Pulmonary Medicine or Thoracic Surgery clinics for control visits and follow-ups. 

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Diagnosis and Treatment Methods of Lung Cancer

What Are the Diagnostic Methods of Lung Cancer?

•    Radiologic Methods

1) X-ray

2) Tomography

3) MRI

•    Nuclear Medicine Tests


2) Bone Scintigraphy

•    Interventional Methods

1) Bronchoscopy

2) Mediastinoscopy

3) Video thoracoscopy

4) Thoracotomy

Diagnostic Methods for the Lung Cancer

Lung cancer has two main groups: small cell and non-small cell. These groups have different genetic traits. 

First and foremost, complaints of patients, personal history, family history must be recorded carefully, and a thorough physical examination must be performed.

The next step is the evaluation of the patient with x-ray, tomography, and MRI, PET-CT imaging methods. 

If there is suspicion of cancer, a tissue biopsy is performed of the lungs and/or lymph nodes. Sputum test (sputum cytology; microscopic examination of material produced with deep cough from the mucosa of the lungs) can also show the presence of cancerous cells in the lungs. This is a simple and beneficial test to determine lung cancer.

Stages of Lung Cancer

There are 4 stages of lung cancer.

Stage 1 Lung Cancer: The cancer is identified as Stage 1 if the cancer is in the lung tissue, but it has not spread outside the lung and lesion is smaller than 5 cm.

Stage 2 Lung Cancer: If cancer has spread from lungs to the nearby lymph nodes (N1) or it is located only in diaphragm or pleura, it is identified as Stage 2.

Stage 3 Lung Cancer: 

•    If the cancer is close to the bifurcation of trachea between two lungs (carina), or

•    If there is large vessel invasion, or

•    It has spread inside the lung; lung cancer is identified as Stage 3.

Stage 4 Lung Cancer: The cancer is identified as Stage 4 if there are metastases in organs that are not adjacent to the lungs (such as liver, adrenal glands, bones, etc.)

Treatment protocols vary for each stage of lung cancer.

What Are the Treatment Methods of Lung Cancer?

•  Surgery

1) Curative (Anatomic resection)

2) Palliative

•  Medical Oncology

1) Chemotherapy

2) Immunotherapy

3) Targeted Therapies

•  Radiation Oncology

Treatment Methods for the Lung Cancer

As is the case in all cancer types, lung cancer treatment plan depends on many factors such as: 

•    Overall status of the patient,

•    Stage of disease and

•    Cancer type etc. necessitating different treatment combinations for carefully personalized treatment plans.

The type of surgical intervention depends on the location of cancer in the lung.

Stage 1 lung cancer implies early diagnosed lung cancer and the success rate of treatment is high. As the diseases have not yet spread to lymph nodes, in the absence of metastasis,

Surgery is the best choice of treatment. Studies show that disease-free survival rates are higher in patients who undergo surgical treatment, compared to other treatment methods. However,

•    Location of the tumor,

•    Size of tumor

•    The spread of tumor or

•    Patient-specific other factors
may contraindicate surgery; for the inoperable patient group, chemotherapy, radiotherapy, and other treatments are available.

These treatment methods can be performed on their own or in combination.

Smart drugs, target-oriented drug administration is also part of current treatment methods depending on the tumor’s cellular structure and other microscopic features. 

A more recent therapy available is vaccination. It has proven to be useful especially in advanced lung cancer patients who have already benefit from medical treatment.

Which specialist should patients be consulting for diagnosis, assessment, and treatment of lung cancer?

Departments that lung cancer patients are referred to are:

•    Thoracic Surgery

•    Pulmonary Medicine

•    Medical Oncology

•    Radiation Oncology

Patients are recommended to present to Pulmonary Medicine and Thoracic Surgery clinics for diagnosis and treatment of lung cancer. 

In lung cancer, the most effective treatment with the highest disease-free survival rate is “surgery”. Therefore, patients who are diagnosed with Lung Cancer are first referred to a thoracic surgeon for assessment of their eligibility for surgical treatment. 

Depending on the stage of disease, size, and location of the tumor, a multidisciplinary treatment approach with Medical Oncology and/or Radiation Oncology departments may be considered when necessary.

Assistant Professor of Medicine
Cuneyt Aydemir
Thoracic Surgery
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