Evaluating the Most Effective Strategies for Preventing and Treating Non-Small Cell Lung Cancer

What is the most effective prevention and intervention method in the treatment of non-

small cell lung cancer?

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Introduction

Cancer is the uncontrolled proliferation of cells (Sanja et al., 2009). Lung cancer is one of the

highest causes of death in men and women in the United States. There are two types of Lung

cancer; they are small cell and non small cell lung cancer. Small cell lung cancer was

identified in 1926 by Barnard who termed as Oat cell carcinoma. The small cell lung

carcinoma is characterized by malignancy of epithelial cells with the scant cytoplasm in the

small cells that possess irregular borders and these cells also possess granular chromatin and

nucleus is absent or inconspicuous in most of the cases. Necrosis is also seen high with the

large mitotic count. Moreover, apart from small cells, some amounts of non small cells are

also seen in many histological studies.

Non-Small cell lung cancer is characterized by various sizes and shapes of malignant cells

located within the lungs. Most of the lung cancers for about 85 percent to 90 percent are non

small cell lung cancers. There are three subdivisions in this type of carcinoma upon

reviewing the cells under the microscope.

Types of Non-Small Cell Lung cancer

Squamous cell carcinoma: This accounts for 25 percent to 30 percent of lung cancers. These

types of cancers are prominently seen among smokers. Initially, cancers arise as flat cells

located in the lining of airways and can be seen in the middle of lungs near the bronchus.

Adenocarcinoma: Approximately 40 percent of the lung cancers are usually

Adenocarcinomas. Generally, these carcinomas start as mucus secreting cells and progresses

through later stages by metastasizing to adjacent organs. This case is mostly observed in the

former and current smokers also. This type of cancer is more common in women rather than

men and seen in young adults than elderly. This is the highest type of cancers which is

observed among the non smokers than smokers.

Adenocarcinomas are greatly seen in the exterior parts of the lungs. This grows very slower

than other types of lung carcinomas and has high probability to spread outside the lungs than

other kinds of lung cancers.

Large cell carcinoma or undifferentiated carcinoma: These types of lung cancers are observed

only 10 to 15% among people. It is significantly noted that this type of can appear at any part

of the lungs. When compared to other types of cancer, this spreads very quickly and also very

hard to treat. It is a type of endocrine related cancer and also known as large cell endocrine

carcinoma.

Besides the above three subtypes, adenosquamous carcinomas and sarcomatoid carcinomas

of lungs are also seen but is very less common among individuals. Lung carcinoid tumors are

seen for only 5% in world population and also adeno cystic carcinomas and hamartomas,

lymphomas, sarcomas also arise in lungs at a very rare condition. Cancers that metastasizes

from other organs of the body to the lungs are also seen among arid cases.

Epidemiology of Non-Small Cell Lung cancer

Many epidemiological studies reveal that lung cancer is second most common cancer in the

world (Eva et al 2013). Molina and her coworkers (2008) also state that lung cancer is one of

the causes of the cancer associated mortality not only in the United States but also all over the

world. In case of United States, Kentucky and Utah holds the highest as well as lowest

incidence of non small cell lung cancer are observed. Also author suggests that smoking

prevalence reflects the incidence of cancer. It is also seen in developing countries like China

since the percent of smoking population is high in the China.

The incidence of non small cell is observed to be increased from 2 out of 1000000 men to 80

out of 1000000 men round the globe and also 1 in 1000000 women to 39 in 1000000 women

in the world was stated by Peters et al (2012). According to SEER (2011), the incidence of

lung cancers are dropping from the year 2005 to 2011. Black has higher incidence of lung

cancer than white population in the United States of America.

Black men are more likely to get lung cancers for 20% higher than that of white men and also

black women has 10% low rate of incidence than white women. Both black women and white

women are less likely to develop non small cell lung cancer than corresponding male

population.

Survival rates are often used by doctors as a standard way of discussing a person’s prognosis

(outlook). The 5-year survival rate refers to the percentage of patients who live at least 5

years after their cancer is diagnosed. Of course, many of these people live much longer than 5

years.

To get 5-year survival rates, doctors look at people who were treated at least 5 years ago.

Improvements in treatment since then may result in a more favorable outlook for people now

being diagnosed with non-small cell lung cancer.

The rates below are based on the stage of the cancer at the time of diagnosis. When looking at

survival rates, it’s important to understand that the stage of a cancer does not change over

time, even if the cancer progresses. A cancer that spreads or comes back is still referred to by

the stage it was given when it was first found, but more information is added to explain the

current extent of the cancer. (And of course, the treatment plan is adjusted based on the

change in cancer status.)

The numbers below are survival rates published in 2007. They are calculated from the

National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database,

based on people who were diagnosed with non-small cell lung cancer between 1998 and

2000. Although they are based on patients diagnosed several years ago, they are the most

recent published for survival by the current AJCC staging system.

These survival rates are for observed survival. Patients with cancer can die of other things,

and these don’t take that into account.

Stage 5-year Observed

Survival Rate

IA 49%

IB 45%

IIA 30%

IIB 31%

IIIA 14%

IIIB 5%

IV 1%

Survival rates are often based on previous outcomes of large numbers of people who had the

disease, but they cannot predict what will happen to any person. Knowing the type and the

stage of a person’s cancer helps estimate their outlook. But many other factors can also affect

outlook, such as the genetic changes in the cancer cells, the treatment received, how well the

cancer responds to treatment, and a person’s overall health. Even when taking these other

factors into account, survival rates are at best rough estimates.

According to the cancer research UK (2014) has revealed that only 30% of the men survive

after getting lung cancer at least for a year. Also, nearly 8% of male population survives for

up to 8 years of diagnosis. Upon looking into the condition of women, 35% of survival rate

have been observed for year which is slightly higher when compared to male in UK.

One-, Five- and Ten-Year Net Survival (%), Adults Aged 15-99, England & Wales

1-Year Survival (%)

5-Year Survival (%)

10-Year Survival (%)

Men

Net Survival 30.4 8.4 4

95% LCL 30.1 7.5 2.8

95% UCL 30.7 9.3 5.5

Women

Net Survival 35.1 11.6 6.5

95% LCL 34.8 10.5 4.9

95% UCL 35.3 12.6 8.4

Adults

Net Survival 32.1 9.5 4.9

95% LCL 31.9 8.8 3.9

95% UCL 32.3 10.2 6.1

Moreover, age of the patients pose another important aspect in the survival rate of non small

cell lung cancers. 5 years of survival rate has been observed among the youngest male and

female with the non small cell lung cancer which is the highest recorded data with 38%, only

5% of aged population survives from lung cancer for 5 years.

Signs and Symptoms of NSLC

Usually, signs and symptoms of the non small cell lung cancer are presented evidently when

the cancer spreads to the later stages. Few patients experience the signs and symptoms that

are presented below evidently

• Persistent cough that does not go away

• Chest pain that gets worse while coughing, laughing and deep breathing

• Hoarseness in the voice

• Sudden weight loss that stays up to several months and loss of appetite

• Coughing with blood or presence of red colored tinges in the sputum of the patients

• Sudden shortness of breath

• Always feeling tired and weak with numbness

• Experiencing trouble during the swallowing food

• Swelling of face, neck and veins that connects to the neck

• Frequent infections in lower respiratory tract such as bronchitis and pneumonia

• Sudden occurrence of wheezing

Apart from these symptoms, few signs like pain in bones, joints and knee as well as

neurological transformations such as seizures, dizziness, jaundice and inflammatory

lumps in the epidermis and dermis and also neck also indicate the later stages of non

small cell lung cancer.

Etiology of non small cell lung cancer

Many research studies suggest that use of tobacco causes 90% of the lung cancer.

Moreover, 80% of the death associated with the lung cancer is due to the persistent

smoking and former use of tobacco. According to Cancer Research UK (2014) suggesting

that smoking and use of tobacco is one of the strongest factor for the non small cell lung

cancer. Studies also depicts that constant smoking of marijuana also accounts for one of

the reasons for NSLC in the developed countries such as UK, US, Australia etc. Exposure

to the asbestos, radiation and paints can also enhance the level of lung cancer (Medline

Plus 2015).

Risk factors

Risk factor can be termed as the substance which affects an individual that increases the

probability of getting cancer. Each type of cancer has its own risk factor which varies greatly

and in this case smoking is the greatest risk factor.

Use of Tobacco

Smoking is so far-flung the primary risk feature for lung cancer especially non small cell lung

cancer. Within the early years of 20th century, lung cancer was to a great extent very common

than few other kinds of malignant carcinomas. All these malformed once contrived cigarettes

became gladly offered and this initiated the habit of smoking. To the minimum 80% of lung

cancer associated mortalities is consideration to effect from smoking. The risk for lung cancer

amid chain smokers is several times elevated than amid non-smokers. The longer a person

smokes and the more packets smoked by an individual per day, the better is the risk. Cigars

as well as smoking in pipes are roughly as possible to root out as lung cancer as smoking with

light cigarettes. Smoking by means of the low-tar cigarettes enlarges lung cancer threat as

greatly as customary cigarettes. There is unease that menthol cigarettes possibly will amplify

the risk still more while the menthol allocates smokers to breathe in extra intensely.

Second hand smoke:

Among the non smokers, respiring in the smoke of the smokers (are also known as second

hand smoke or ecological smoking of tobacco) may also amplify the risk of budding of lung

cancer to the nearly 30 percent. Staffs that are highly exposed to smoking of tobacco in the

workplace are also further probable to diseased with the lung cancer. Second hand smoking is

also considered to ground for more than 7,000 deaths from lung cancer every year. Few

evidence recommends that some individuals are greatly vulnerable to the cancer-causing

consequence of smoke from the tobacco than others.

Radon

Radon is an unsurprisingly emitted radioactive gas that effects from the crash of uranium in

soil and rocks. According to the US Environmental Protection Agency (EPA), radon is the

second principal reason of lung cancer in United States, and is the important reason among

non-smokers. In the open air, there is so modest radon that it is not possible to be hazardous.

But indoors, radon may be extra intense. During the inhalation, this radon penetrates the

lungs, divulging them to little amounts of radiation. This possibly will amplify an

individual’s risk of lung cancer. The risk of getting lung cancer due to the radon is greatly

less than that from tobacco smoke. Nevertheless, the risk from radon is a great deal advanced

in individuals who smoke than in individuals who avoid smoking. Soil levels of Radon may

differ across the US, but they may be lofty almost wherever. It was observed that residences

in few regions of the United States constructed on high uranium deposits in soil that may

raise the level of the indoor radon levels greater (in particular in basements). Many research

studies from these locations in US have also observed that the risk associated with the lung

cancer is increased with the residents who have lived for many duration in a radon-

contaminated house.

Asbestos

Exposure to asbestos and its fibers is most significant risk factor for lung cancer. Studies have

identified that individuals who toil with asbestos (in few mines, mills, textile plants, places

where insulation is employed, shipyards, etc.) are numerous times more expected to expire

due to the lung cancer. In staffs exposed to asbestos who also smoke, the lung cancer risk is

escalated to the peak than yet totting up the risks from these exposures individually. It’s no

obvious to what degree low-level or short-term experience to asbestos vigorously lift the lung

cancer risk (Edwards et al 2006).

Both smokers and non-smokers who have barely exposed to asbestos also encompass a better

risk of getting diseased with mesothelioma, a kind of cancer that gets initiated in the pleura

(the exterior lining found to be surrounding the lungs). In current years, government policies

have seriously abridged the utilization of asbestos in both commercial and industrial products

(Wakelee 2007). Yet, it is still remains in most of the residences and other older buildings,

but this is not frequently measured injurious as stretched as it is not on the rampage into the

air by means of the deterioration, annihilation, or renovation.

Air pollution

In many metro cities, pollution in air (in particular near heavily trafficked roads) shows to

elevate the risk of lung cancer to some extent. This risk is far-flung fewer than the risk caused

by smoking, but some researchers guess that universally regarding 5% of all deaths from lung

cancer may be owing to outdoor serious pollution in air was reported by Wakelee (2007).

Radiation therapy to the lungs

Individuals who received earlier radiation treatments to the chest for other cancers are also at

increased risk for lung cancer, in specific those patients smoke; for instance, individuals who

have undergone treatment for Hodgkin disease or women who undergone the radiotherapy

after a mastectomy for breast cancer. Women who receive radiation therapy to the breast after

a lumpectomy do not obviously to have an advanced level than expected risk of lung cancer

(Edwards et al 2006).

Arsenic in drinking water

Studies of people in parts of Southeast Asia and South America with high levels of arsenic in

their drinking water have found a higher risk of lung cancer. In most of these studies, the

levels of arsenic in the water were so many times greater than those characteristically seen in

the United States, even in regions where the level of arsenic exceeds the normal level. For

most Americans who are on public water systems, drinking water is not a major source of

arsenic.

Personal or family history of lung cancer

Previous medical history with lung cancer of a patient poses higher risk of developing

another lung cancer. Brothers, sisters, and children of those who possess the same clinical

history of lung cancer may possess a slightly higher risk of lung cancer themselves,

particularly if the family member was diagnosed at a younger age (Edwards et al 2005). It is

not still vague to understand how much of this risk might be due to genetics and how much

might be from shared household exposures (such as tobacco smoke or radon). Researchers

have observed that genetics does seem to engage a role in few families with a sturdy history

of lung cancer. For instance, individuals who inherit some DNA mutations in a specific

chromosome (chromosome 6) are more expected to develop lung cancer, even if they don’t

smoke or only smoke a little.

Marijuana smoking

There are few reasons to consider that marijuana smoking might boost lung cancer risk.

Marijuana smoke includes tar and many of same cancer-causing substances that are in

tobacco smoke. (Tar is the sticky, solid material that remains after burning, and is thought to

contain most of the harmful substances in smoke.) Marijuana cigarettes (joints) are typically

smoked all the way to the end, where tar content is the highest. Marijuana is also inhaled very

deeply and the smoke is held in the lungs for a long time, which gives any cancer causing

substances more opportunity to deposit in the lungs. And because marijuana is often an

illegal substance, it may not be possible to control what other substances it might contain.

But those who use marijuana tend to smoke fewer marijuana cigarettes in a day or week than

the amount of tobacco consumed by cigarette smokers. For example, a light smoker may

smoke half of a pack (10 cigarettes) a day, but 10 marijuana cigarettes in a day would be very

heavy use of marijuana. In one study, most people who smoked marijuana did so 2 to 3 times

per month. The lesser amount smoked would make it harder to see and impact on lung cancer

risk.

It has been hard to study whether there is a link between marijuana and lung cancer because

marijuana was illegal in many countries for so long, and it is not easy to gather information

about the use of illegal drugs (Toh et al 2006). Also, in the studies that looked at past

marijuana use in people who had lung cancer, most of the marijuana smokers also smoked

cigarettes. This can make it hard to know how much of the risk is from tobacco and how

much might be from marijuana. More research is needed to know the cancer risks from

smoking marijuana