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Posted at: Nov 30, 2019, 12:59 AM; last updated: Nov 30, 2019, 12:59 AM (IST)

Breathing in toxicity

Air pollution has emerged as one of the major causes of lung cancer among non-smokers
Breathing in toxicity

Dr Harinder Singh Bedi

Lung cancer is among the five types of cancers leading to overall cancer mortality causing 1.3 million deaths per year globally. In India, this number is 75,000 deaths annually, according to WHO. Among Indian men, it is the leading cause of cancer mortality (10.8 per 100,000 men), accounting for 13 per cent of all cancer deaths. 

Causes

It is commonly associated with smoking. Certain people, however, may have a genetic predisposition to cancer. Even non-smokers exposed to passive or second-hand smoking may fall prey to lung cancer. In recent years, air pollution has emerged as a major cause for lung cancer among non smokers. Several workplace substances have also been associated with an increased risk for lung cancer, including arsenic, asbestos, beryllium, silica, radon, etc. 

Treatment options

An early diagnosis can increase chances of cure.  For those diagnosed with lung cancer, surgery along with radiation and/or chemotherapy, remains the preferred mode of treatment, depending upon the stage of the cancer. 

For patients at early stage of lung cancer, surgical removal of the cancerous tumour and the lung tissue surrounding it is the standard procedure. If the tumour is too large for surgery at diagnosis, many patients are given radiation or chemotherapy (neo-adjuvant chemotherapy) in an attempt to shrink the tumour before the surgery can be performed. 

The type of surgery performed depends upon the location and size of the tumour. Targeted chemotherapy has shown great promise in treatment. 

The decision for surgery is made by the cardio vascular and thoracic surgeon along with a tumour board taking several factors into consideration. These include over-all medical condition and lung function, size of the tumour, its location,  whether there is any sign of spread to lymph nodes and the type of tumour. The surgery may be done by an incision or by a key hole technique . The operation is a time tested procedure and has the most optimal results as far as complete removal of the cancer is concerned. 

Frequent querries about surgery

How much of the lung is removed during surgery?

There are three lobes, or segments, of the right lung and two lobes of the left lung. A lobectomy involves removing the tumour along with the lobe of the lung from which the tumour has arisen. Sometimes, entire tumour can’t be removed by lobectomy. In such cases, entire lung may need to be removed. In some cases only a segment of lung or a wedge may be removed.

Is it possible to breathe normally after part of a lung is removed?

Patients with healthy lungs will be able to breathe normally after removal of a lobe, or even an entire lung. Pulmonary function tests are used to determine how much lung can be removed without limiting the patient’s ability to breathe. Well-known Indian classical singer, Kumar Gandharva, had only one functional lung. 

What can be expected during and following surgery?

Most patients remain in the hospital for four to five days. But patients are generally out of bed and walking the first day after the operation. A yoga therapist and physiotherapist instruct patients about deep breathing and coughing exercises, which are important to help prevent lung infection. 

How long is the recovery period? Will help be needed at home?

After patients are discharged following lung surgery, they are able to walk on their own and breathe without difficulty. Patients are advised not to drive until they don’t require pain medication every day. Some help may be needed for the first week or two. However, there is no need for nursing care at home. 

What steps are needed to increase a patient’s chances of living a normal life after lung surgery?

No smoking, eating a nutritious diet and exercising (walking for 30 minutes to an hour daily). 

Any treatment needed after surgery?

This question can be answered once the stage of the lung cancer is known. In some patients, the stage is known before surgery, especially in those who get preoperative chemotherapy treatment. These patients usually continue treatment after surgery. When the disease is at an early stage, additional information after the operation can determine the need for additional treatment. It depends upon the size of tumour, if it is invading anything, if the lymph nodes have tumour in them, etc.

What does the rehabilitation consist of?

Formal pulmonary rehabilitation consists of professionally monitored sessions, occurring three-four days per week for one to two hours daily. Use of yoga therapy has also shown great success rate. This has specially made a difference in borderline cases.

As air pollution increases, young non-smokers in their late twenties have been diagnosed with lung cancer. Strict measures are needed by the government as well as society to reduce pollution for better public health. 

What is the rate of survival after lung cancer surgery?

Without proper treatment, more than 50 per cent patients will die within a year of diagnosis. Life expectancy depends on the stage of the cancer at the time of diagnosis, as well as patient's age, overall health, etc. 

The five-year survival rate for lung cancer is 56 per cent for cases detected when the disease is still localised (within the lungs). However, only 16 per cent of lung cancer cases are diagnosed at an early stage. For distant tumours (spread to other organs) the five-year survival rate is only five per cent. In such cases, surgery is generally not advocated anyway

 —   The writer is director, cardio vascular, endovascular & thoracic sciences, Ivy Hospital, Mohali.

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Preventive measures

There’s no sure way to prevent lung cancer, but you can reduce your risk if you:

Are a non-smoker, have quit smoking and don’t use tobacco in any form i.e cigarette, cigar, bidi, loose tobacco. 

Avoid second-hand smoke.

Avoid going out in polluted areas. If you have to go in such areas, wear a mask.

Avoid carcinogens at work e.g. dust, smoke, asbestos etc. Use a good-quality mask if you can’t avoid. 

Eat a nutritious diet including fruits and vegetables. 

Exercise at least six days.

Practice breathing exercises, as these help in improving the breathing capacity. Many lung cancer patients experience shortness of breath and difficulty in breathing. 

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Signs and symptoms

Most patients will have one or more of the following symptoms:

  • Persistent cough and coughing up of blood
  • Wheezing and shortness of breath
  • Discomfort during breathing
  • Chest pain
  • Symptoms associated with pneumonia such as a fever and mucus-producing cough
  • Discomfort while swallowing
  • Hoarseness of voice
  • Weight loss and poor appetite

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