pulmonology

Lung cancer has emerged as one of the commonest cancer these days. We are aware of World Lung Cancer Day which takes place on August 1^st every year. This day is symbolic to create awareness not only to early diagnosis and management needs to the lung cancer but more importantly to shoo away the things which can be and are causative of lung cancer. It is the day to talk of healthy lungs and strategies for maintain lung health and not just talk of cancer but to prevent cancer. But the point is that whether really, we do not know that smoking causes lung cancer and health-related issues. We all know! Smoking remains one of the commonest reasons for lung cancers in almost 80% of the patients. All know – SMOKING HARMS! Then why create awareness. If we indulge in activities that harm us despite knowing that it harms, then what to do! We do create awareness during November as well for lung cancer awareness month. Yes, despite all these, there remains the importance of further creating awareness. However, such “day” also needs to create a positive hope among patients suffering from lung cancers. We need to assure all these patients of the support from curative and palliative intent as well.

Lung cancer management strategies have seen many improvements in recent times. Not only the diagnostic modalities have improved but also the treatment strategies including surgery and medical therapy have found a significant improvement in the recent past. Early identification remains the key to appropriate and optimal management. It also becomes prudent to understand that early identification before it spreads remains essential and thus the patient must not ignore symptoms that persist for some time without any explained reason. Timely screening is important, and this awareness must be created in addition to preventive strategies like quit smoking.

At this juncture, it also becomes essential to support the patients, who present in advanced stages of lung cancer. These patients do require medical support and many things can be offered to them for palliative support to improve their quality of life. These patients with advanced cancers have many symptoms like pain, difficulty in breathing, cough, blood in cough,  and so forth. Despite advanced cancers, these symptoms can be optimized to make the patient comfortable. Many strategies are available like the use of medicines (analgesics) and other interventions like removing the fluid from the chest due to cancer and using techniques like pleurodesis which decreases the formation of fluid in the chest and thus makes the patients comfortable by reducing the symptoms due to advanced cancer.

Hoping this World Lung Cancer Day brings a bright ray of happiness by igniting the lamp of creating an aura of positive energy leading to the promulgation of a healthy lifestyle and creating awareness of timely screening and optimal management of lung cancers.

Interestingly Covid crisis has led to more diagnosis of lung cancers thanks to the usage of HRCT for the management of Covid Pandemic. Globally, Lung cancer is one of the commonest cancers and cause of cancer related deaths. It accounts for almost 15 per cent of all new cancer cases and 20 percent of cancer related deaths worldwide. Over 2 million new lung cancer cases are estimated every year in India. Lung cancer constitutes almost eight per cent of all new cancer cases and 10 percent of all cancer related deaths in India.

The worrisome trend is that majority of lung cancers are detected in late stages (70% in third or fourth stage). Smoking is one of the primary reasons for lung cancer. Others are pollution and inherited lung diseases.

The risk factors for development of lung cancer are smoking of tobacco-Both Active and Passive smoking, Pollution, exposure to Radon, asbestos, lung diseases like copd or a family history of lung cancer.

The presenting symptoms of lung cancer are cough which is persistent and doesn’t resolve with routine medication, associated with blood in expectorated sputum or mucus, respiratory symptoms like wheeze, difficulty in breathing, shortness of breath, pain in the thorax and loss of weight.

Robotic surgery or Robotic assisted thoracic surgery is a newer technique in management of lung cancer and other thoracic malignancies. The patients undergoing surgery by robotic approach have smaller incisions and can minimize the risk of lung complications compared to traditional open surgeries which are done by long incisions and spreading the ribs. The vision is magnified, crisp and three dimensional. Though it is called robotic, the surgeon is the commander for this technology and is always controlling the machine by hand and foot movements which in turn is mimicked by the robot. By this paradigm shift in management of lung cancer by robotic technology, the recovery is earlier, pain lesser and hospital stay is shorter.

The use of CT scan annually for early diagnosis of lung cancer has been recommended in high risk patients which is called as screening. However the awareness is limited in our country and it is not being routinely used. If detected early the management of such lung cancers can be curative by surgery and as the disease advances it can be managed by addition of chemotherapy, Immunotherapy and radiation. The surgical stress of patients can be minimized by newer technologies like robotic surgery which has proven to be a boon to patients undergoing surgery for lung cancer.