With the shocking rise in both pollution levels and the number of smokers across genders, lung cancer has become common across households. A study by Sir Ganga Ram Hospital along with the Lung Care Foundation, says that lung cancer is no longer limited only to smokers as many non-smokers too are falling prey to it.

The study also revealed that air pollution has emerged as a major factor for lung cancer in India, especially among those below the age of 40.

With industries, transportion, construction as well as burning of crop stubble releasing a lot of gasses and dust particles, the PM 2.5 + level pollution in the air is almost equivalent to smoking one cigarette a day. Delhi’s air quality has already been rated as one of the most hazardous in the world by international agencies, including the WHO.

WHO study

As per the World Health Organization (WHO) study, it is estimated that in 2012, 14 per cent of outdoor air pollution-related deaths were due to lung cancer, and these numbers are rising. Tobacco use is also one of the leading risk factors accounting for 22 per cent of cancer deaths. However, a significant proportion of patients diagnosed with adenocarcinoma (cancer expressing first in the outer portion of the lungs), have been non-smokers.

And, therefore, newborns and sensitive age groups inhaling such poor quality of air have higher chances of being diagnosed for lung cancer. This is why doctors and care providers are recommending more regular check-ups. It is the need of the hour.

There are two types of lung cancer — small cell (SCLC) and non-small cell (NSCLC). Small cell cancer is usually found in non-smokers and it metastasises faster than the non-small cell. Small cell tumours are considered to be inoperable and pose a great risk to lives. Non-small cell can affect both smokers and non-smokers alike. Non-small lung cancer accounts for 85 per cent of the cases.

Research has progressed at a very rapid pace in unravelling the molecular complexity of lung cancer. This has improved our understanding of managing lung cancer patients more effectively. This has also allowed medical science to develop different tests and targeted treatment for each type of lung cancer in order to derive better outcomes.

Tissue biopsies are the gold standard in lung cancer diagnosis. However, the recent discovery that cancer cells release proteins, nucleic acid and other cancerous cells have heralded the era of liquid biopsies wherein a simple blood test can provide invaluable real-time information about both, the tumour burden and the tumour’s mutational landscape.

Liquid biopsies are slowly becoming the standard of care in lung cancer patients, where obtaining enough tissue specimen to carry out all the required testing is a challenge. Liquid biopsies, which are minimally invasive and painless, have significant advantages over tissue biopsies — the ability to study the tumour’s rapidly evolving mutational landscape in real-time, the ability to detect all the mutations in the tumour and the ability to perform repeat biopsies are perhaps the most important of all.

We recently had a stage IV metastatic non-small cell lung cancer patient, whose tissue specimen was just enough to confirm the diagnosis. A repeat biopsy was not possible in her case as obtaining a repeat sample would entail undergoing an invasive and painful surgery and despite undergoing a repeat surgery, there was no guarantee that the surgical oncologist would be able to extract sufficient tumour sample for further molecular sub-typing. A liquid biopsy was performed and the patient was found to be ALK-positive. Based on the findings of liquid biopsy, the patient was administered Alectinib. Soon, her tumours shrunk and she is presently doing very well.

A few years ago, before the advent of liquid biopsies, there was a good chance that the patient would have gotten chemotherapy, instead of targeted therapy (Alectinib) due to exhaustion of the tissue specimen to carry further analysis.

Not only is chemotherapy associated with unwanted side effects, but is also associated with a lower survival rate. This case is an example of how modern research and the advent of newer and improved technologies are helping revolutionise cancer treatment.

Early detection

Governments and care providers all over the world are striving to create a better understanding of lung cancers but they go undetected due to lack of awareness. The major problem lies in the negligence. Researchers/doctors report that most of their patients with lung cancers come to the clinic when the disease has already progressed beyond repair. Lung cancer like most other cancers can be managed when detected at an early stage, however as the cancer progresses, the survival chances drop significantly. This is why it is advisable for everyone to screen for lung cancer as a standard practice. It would help in terms of early detection, leading to higher cure rates.

Common symptoms like persistent cold, lingering cough, accompanied by sputum or blood and signs of breathlessness certainly call for doctor’s attention and most importantly — the affected patient’s attention. But these conditions are often attributed to changing weather, prompting home remedies or over-the-counter antibiotics. This delays the visit to a doctor, thereby reducing the chances of timely detection.

Lung cancer is commonly treated with chemotherapy, which is administered orally or intravenously. While chemo is often the most effective form of treatment for lung cancer in smokers and non-smokers, newer options are available. For example, some patients with Stage III or Stage IV lung cancer may benefit from targeted therapy and immunotherapy instead of, or in conjunction with, chemotherapy.

The study by Sir Ganga Ram Hospital also says that 30 per cent of patients, studied for the report, had been initially misdiagnosed as tuberculosis and were treated for the same for many months before starting cancer treatment. Late diagnosis continues to be one of the primary reasons for the high number of deaths associated with the disease.

Therefore, it is hugely important for doctors to understand lung cancer and what drives them to determine the best-suited or individualised treatments for the patients.

Targeted therapy is a potential future treatment. Additionally, integrated decision-making for lung cancer patients by physicians, surgeons, radiation and medical oncologists, radiologists, pathologists, and palliative care and lung cancer specialist nurses can go a long way in managing these patients more effectively. Also, a timely detection is the key to a better treatment since the prognosis and outlook for lung cancer depend upon the cancer stage.

The writer is Product Manager, CORE Diagnostics.

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