The use of radiation therapy in the treatment of small cell lung cancer

Lung cancer: types, causes
Lung cancer is a pathology that begins with damage to the parenchyma or bronchi.

The main symptoms of this disease are:

• Dyspnea;
• Cough with blood and sputum;
• Chest pain;
• Temperature;
• Thinness;
• Pulmonary hemorrhage;
• Pericarditis;
• Pleurisy.

To find out the exact diagnosis, you need to do a computed tomography of the lungs, radiography, bronchoscopy, study sputum and pleural exudate, and do a biopsy.

Treatment usually involves complex therapy: surgery, radiation therapy and chemotherapy.

This type of cancer is of epithelial origin. It develops from the mucous membrane of the bronchi and their glands or from the pulmonary alveoli. The mortality rate with it is quite high.

The development of the disease will be directly influenced by the histological structure of the tumor:

• Differentiated squamous cell carcinoma progresses slowly;
• Undifferentiated cancer progresses rapidly and metastasizes;
• Small cell cancer also develops rapidly, but unnoticed, and metastasizes.

It was revealed that cancer forms more often in the right lung than in the left. It also forms more often in the upper part of the lung than in the middle and lower parts due to the entry of more carcinogens into the upper part.

Metastasis occurs in three ways:

• Lymphogenic;
• Implantation;
• Hematogenous.

The lymphogenous route is the most common. Metastases go to various types of lymph nodes:

• Pulmonary (affected first);
• Bronchopulmonary (affected after them);
• Tracheobronchial;
• Paraesophageal;
• Bifurcation.

With hematogenous germination through the blood, metastases occur:

• Into the adjacent lung;
• Brain;
• Kidneys and liver;
• Spine.

Metastases

Germination of an implantation nature occurs along the pleura.

The main causes of lung cancer are:

• Tobacco smoking;
• Bad air;
• Radiation.

Based on histology, lung cancer is of four types:

• Glandular;
• Squamous;
• Small cell;
• Large cell.

Central lung cancer

This cancer is located in the large bronchus. It has early symptoms due to the fact that the bronchial mucosa is irritated, the ventilation and patency of this part of the lung is impaired. Due to the fact that the nerve trunks are irritated, pain and pleurisy occur. Metastasis causes pain in other organs. When the tumor grows into the bronchus, a cough with hemoptysis and sputum appears.

Cancerous pneumonia then develops, causing shortness of breath and purulent discharge. Pneumonia of this nature is suppressed by anti-inflammatory drugs, but then reappears. Sometimes with such pneumonia, hemorrhagic pleurisy may occur.

Due to further growth of the tumor, the vocal muscles are paralyzed and the voice becomes hoarse. Paralysis of the diaphragm may occur due to tumor penetration into the phrenic nerve.

When the tumor grows into the pericardium, pericarditis can form. If the lesion occurs in the superior vena cava, then the lymphatic and venous outflow of blood from the upper part of the body is disrupted. Because of this, the face swells, hyperemia occurs, veins swell in the arms, chest, neck, headaches and shortness of breath occur, and vision problems appear.

Diagnostic methods

The stage of lung cancer is determined in accordance with the TNM classification, which takes into account the characteristics of the primary tumor, the condition of regional lymph nodes and the presence or absence of distant metastases. However, for each type of cancer, the characteristics of the primary lesion may differ. Generally speaking, there are stages 3A and 3B, which are determined based on the results of a comprehensive diagnosis. The following methods may be included:

1. General clinical tests.
2. X-ray of the chest organs.
3. CT and MRI.
4. Fiberglass bronchoscopy.
5. Diagnostic videothoracoscopy.
6. PET-CT.
7. Determination of the level of tumor markers in the blood.
8. Lung biopsy followed by histological examination, etc.

If there are signs of spread of the tumor process, which are often detected in late stages, additional methods may be included in the examination plan to help assess the patient’s condition and plan further actions.

Does radiotherapy have long-term side effects?

Long-term side effects from radiation therapy are rare; Chronic disorders due to radiation treatment are practically non-existent . One of the unlikely scenarios is receiving a large dose of radiation to a small tumor, which may result in lung pathologies. If the tumor reaches a small size, the radiation oncologist, as a rule, is not even involved in treatment, because radiation in this case would be inappropriate due to excessive damage to surrounding healthy tissue. If such situations occur, patients experience increased breathing difficulties. This can be said to be the only long-term side effect .

Another relatively vulnerable organ is the thyroid gland , which is located higher in the neck and can be damaged by radiation directed at the upper chest. If the thyroid gland is indeed damaged as a result of exposure to radiation, the patient may develop hypothyroidism, a disorder consisting of deterioration in the function of the organ. Usually the doctor is aware of such risks, but the patient should also be aware of the potential danger and examine the thyroid gland after completing the course of radiation therapy.

In general, radiation therapy is very well tolerated and causes minimal side effects . Undesirable effects of radiation are almost always minor problems that can be easily treated.

Targeted drugs and immunotherapy

Targeted drugs and immune drugs are modern, relatively new groups of drugs that can be used for non-small cell lung cancer. Targeted drugs block substances that activate angiogenesis, the process of growth of new blood vessels that supply oxygen and nutrients to tumors.

Two drugs are used: Bevacizumab and Ramicirumab. Among the immunotherapy drugs used for lung cancer are checkpoint inhibitors: Atezolizumab and Nivolumab.

Normally, the immune system uses certain substances for self-control - so-called checkpoints . They help curb the immune response and protect the body's own tissues from attack. Sometimes cancer cells use this mechanism to protect themselves, to “hide” from the immune system. Checkpoint inhibitors help remove the blockage and “free up” the immune system so it can attack the cancer.

Sometimes targeted drugs and immunotherapy drugs are prescribed as first-line therapy in combination with chemotherapy drugs.

Prevention

• eliminate smoking, alcohol abuse and systematic contact with carcinogens;
• lead a healthy lifestyle, balance your diet;
• promptly treat acute respiratory diseases;
• undergo regular screenings.

To consult with a specialized specialist in St. Petersburg, make an appointment using the form on the website.

Sources:

1. World Cancer Report 2014. World Health Organization. 2014.
2. Travis WD, et al. The 2015 World Health Organization Classification of Lung Tumors. J. Thorac. Oncol. 2015. Vol.10, No.9, P. 1243-1260.
3. Masters GA, Temin S, Azzoli CG, et al. Systemic Therapy for Stage IV NonSmall0Cell Lung Cancer. American Society of Clinical Oncology. Clinical Practice Guideline Update. J Clin Oncol 2015; 33:3488-3515
4. Howlader N., et al. SEER Cancer Statistics Review, 1975-2013. Natl. CancerInst. 2021.

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Forecast

The Israel Cancer Society provides statistics showing how many people can expect to live another 5 years or more after being diagnosed with cancer at each stage.

NSCLC

The average chances of surviving 5 years or more with NSCLC are:

• 60% when it is localized
• 33% when it is regional
• 6% when he is far away
• 23% overall

MRL

The chances of surviving another 5 years or more are equal:

• 29% when it is localized
• 15% when it is regional
• 3% when he is far away
• 6% overall

Find out if the treatment is prescribed correctly

Price lists for foreign citizens

Basic medical services related to the diagnosis of lung cancer:

*Note: Prices are for foreign citizens. Citizens of the Republic of Belarus can receive medical services without charging a fee. Read more...

Type of medical research	Amount, BYN	Amount, USD	Amount, RUB
X-ray computed tomography of the chest cavity (lungs and mediastinum) without contrast enhancement	364,39	180,00	11 352,42
X-ray computed tomography of the chest cavity (lungs and mediastinum) with contrast enhancement	576,95	285,00	17 974,64
CT angiography	688,30	340,00	21 443,70
Tracheobronchoscopy	141,71	70,00	4 414,92
PET/CT with “2-[l8F]-Fluorodeoxyglucose” whole body	1 315,86	650,00	40 995,08
Sequencing of exons 19, 21 of the EGFR gene (each subsequent)	232,81	115,00	7 253,10
Determination of ALK gene rearrangement using fluorescence in situ hybridization (FISH)	657,93	325,00	20 497,54

*Prices are indicative, because Payment for services is made in Bel. rub. *You can view all types of services and exact prices on the page

Calculate an exact estimate

Is the effect of radiation on healthy organs great?

Unfortunately, radiation energy in general is destructive and can damage not only cancerous tissue, but also normal, healthy tissue. As radiation penetrates the body - that is, first through the skin, then through layers of tissue towards the lung - it can partially dissipate into healthy tissue located near the affected organ. Very important organs are located near the lungs. This includes the esophagus, the heart, and normal lung tissue. All of them are at risk of minor damage. Usually the harm is relatively minor and almost unnoticeable, but some patients sometimes experience, for example, difficulty swallowing - especially if they are nearing the end of their course of radiotherapy.

Conducting radiation therapy according to compulsory medical insurance

At the Sofia Cancer Center, some types of treatment are carried out under the compulsory medical insurance policy. You can obtain detailed information on this issue from an oncologist or from our registry specialists.

The service is provided under compulsory medical insurance

You can receive FREE medical care at the Oncology Center under the State Guarantee Program of Compulsory Medical Insurance (Compulsory Medical Insurance) and High-Tech Medical Care.

The service is valid for all Russian citizens.

You can find out details on which nosologies and services this program works here.

For consultation and making an appointment, call +7 or use the form below.

Treatment

In most cases, doctors treat stage 3 lung cancer with a combination of treatments:

Chemotherapy : effective in treating lung cancer.

Radiation therapy : May be helpful in some cases. It can shrink swelling before surgery.

Surgery : May help in situations where the cancer has not yet spread widely. The surgeon may remove the entire lung or just part of it and any nearby lymph nodes where the cancer has spread.

Targeted therapy : These are drugs that affect specific factors in the body. These factors, which can be genes or proteins, stimulate the growth of cancer cells. Blocking them can prevent or slow the spread of cancer.

Immunotherapy : This is a new type of treatment. The doctor prescribes medications that can strengthen the immune system's fight against cancer.

Laser therapy : Uses a laser beam to kill cancer cells.

Endoscopic stenting : If a tumor is blocking the airway, the surgeon may use an endoscope to place a stent. This will help keep your airways open.

Some people choose to participate in clinical trials. Such trials can give patients access to new drugs and treatments that were previously unavailable.

Researchers only conduct clinical trials if scientific evidence suggests the treatment may be safe.

Palliative care and symptom management

A patient with stage 3 lung cancer may experience pain or discomfort caused by the cancer or the treatment they are receiving. Many people also experience depression and anxiety.

Patients should talk to their doctor about these concerns. They may, for example, prescribe medication or recommend counseling or a local support group that can help.

Additional treatments

Some complementary treatments may improve a patient's health and help them feel more comfortable during treatment.

These include:

• Quitting smoking and completely eliminating passive smoking
• healthy eating
• exercises
• relaxation techniques such as massage and yoga

Any patient diagnosed with cancer must follow their treatment plan and their doctor's instructions. There is no scientific evidence that any supplement, diet, or other therapy can cure cancer.

Anyone considering taking dietary supplements or making another significant change to their lifestyle should first talk to their doctor.

Making the right dietary choices can improve a patient's health even when diagnosed with stage 3 cancer.

Factors influencing treatment decisions

The treatment plan for each patient will depend on various factors, including:

• cancer stage
• type of cancer
• age and general health of the person
• personal preferences

Many patients with stage 3 lung cancer will undergo the most aggressive form of treatment, as this may improve their chances of survival. At this point, the doctor will discuss the pros and cons of the available options.

Risk factors

• Smoking is a major risk factor, the influence of which is beyond doubt today. The risk of developing a tumor in men who smoke is over 17%, while in non-smokers it is just over 1%. The harm of inhaling tobacco smoke by non-smokers has also been proven. Their risk of developing a tumor increases.
• Inhalation of radon is the second largest factor that increases the likelihood of developing lung cancer. Radon is a radioactive gas that is released from the ground and, in a certain concentration, can be a component of the general background radiation. Increasing radon concentrations increases the risk of carcinoma.
• Chronic obstructive pulmonary disease. Lung cancer is more common in patients with COPD.

In addition, constant contact with dust, especially industrial dust, such as asbestos, also carries risks.