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Cancer from A to Z

Types of cancer, how to prevent them, diagnosis and treatment.

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Lung Cancer


Lung cancer occurs when cells in the lung grow and multiply uncontrollably, damaging surrounding tissue and interfering with the normal function of the lung. The cells can spread to other parts of the body. When the disease spreads, it is still called lung cancer.

Lung Cancer Types
Non-small cell lung cancer (NSCLC) accounts for 80% of all lung cancers. Non-small cell lung cancers include adenocarcinoma, squamous cell carcinoma and large cell carcinoma. They generally spread very slowly to other organs in the body, and can be hard to detect in the early stages.

Small cell lung cancer is responsible for about 20% of all lung cancers. Also known as “oat cell” cancer, it spreads very quickly through the lungs to other parts of the body.

Lung Cancer symptoms vary from person to person and may include:

  • A cough that will not go away and gets worse over time
  • Constant chest pain, or arm and shoulder pain
  • Coughing up blood
  • Shortness of breath, wheezing or hoarseness
  • Repeated episodes of pneumonia or bronchitis
  • Swelling of the neck and face
  • Loss of appetite and/or weight loss
  • Fatigue
  • Clubbing of fingers

Many of these symptoms are not cancer, but if you notice one or more of them for more than two weeks, see your doctor.

News
Events
Campaña de concienciación en prevención y diagnóstico precoz.
Conferencia coloquio: "Moonshot: Un proyecto de investigación internacional en Cáncer de Pulmón" En colaboración con La Fundación Siglo Futuro.
El cáncer de pulmón: conoce más sobre este cáncer y el punto de vista del paciente. Deshabituación tabáquica.
Teaching

At the moment there are no courses of Lung Cancer

Clinical trials
Ensayo de fase III, abierto y multicéntrico de avelumab (MSB0010718C) frente al doblete con base de platino como tratamiento de primera línea del cáncer de pulmón no microcítico PD-L1+ recurrente o en estadio IV
Ensayo de fase 1a/2a, abierto y multicéntrico, para investigar la seguridad, tolerabilidad y actividad antitumoral de dosis repetidas de Sym015, una mezcla de anticuerpos monoclonales dirigida frente al receptor MET, en pacientes con tumores malignos sólidos en fase avanzada
Ensayo de fase II de un único grupo para investigar Tepotinib en adenocarcinoma pulmonar en estadio IIIB/IV con alteraciones por omisión del exón 14 de MET (METex14) tras fallar, como mínimo, un tratamiento activo anterior, incluido uno con doblete de platino.
Estudio clínico de fase III multicéntrico, abierto, randomizado para comparar Doxorubicina en combinación con Lurbinectedin (PM 1183) frente a CAV (Doxorubicina + Ciclofosfamida + Vincristina) o Topotecan en pacientes con cáncer de pulmón microcitico que han recibido solo una línea de tratamiento basado en Platino.
PRIMER ESTUDIO EN EL SER HUMANO DE LA ADMINISTRACIÓN REPETIDA DE REGN2810, UN ANTICUERPO MONOCLONAL, TOTALMENTE HUMANO FRENTE A LA PROTEÍNA DE MUERTE CELULAR PROGRAMADA 1 (PD-1), EN MONOTERAPIA Y EN COMBINACIÓN CON OTROS TRATAMIENTOS ANTINEOPLÁSICOS, EN PACIENTES CON TUMORES MALIGNOS AVANZADOS
Estudio fase IIIB, prospectivo, randomizado, abierto que evalúa la eficacia y seguridad de Heparina/Edoxaban versus Dalteparina en tromboembolismo venoso asociado con cáncer.
Estudio randomizado de fase III que compara la combinación de ganetespib con docetaxel versus docetaxel solo en pacientes con adenocarcinoma de pulmón no microcítico avanzado
Ensayo clínico de fase II , multicéntrico, randomizado, abierto que compara Veliparib con carboplatino y paclitaxel versus quimioterapia estándar a elección del investigador como tratamiento de primera línea para CPNM no escamoso metastásico o avanzado en pacientes fumadores o ex-fumadores
Ensayo clínico fase I, multicéntrico, abierto y farmacocinético que estudio la combinación del PM01183 con doxorrubicina en pacientes pretratados con ciertos tumores sólidos avanzados
Estudio de fase III, multicéntrico, aleatorizado de LDK378 oral frente a QT estándar en pacientes adultos con CPNM no escamoso con reordenamiento de ALK (ALK-positivo) estadio IIIB o IV, que no han sido tratados previamente
ARCHER 1050: ESTUDIO EN FASE III, ALEATORIZADO, ABIERTO, SOBRE LA EFICACIA Y SEGURIDAD DE DACOMITINIB (PF‑00299804) FRENTE A GEFITINIB, EN EL TRATAMIENTO DE PRIMERA LÍNEA DEL CÁNCER DE PULMÓN NO MICROCÍTICO LOCALMENTE AVANZADO O METASTÁSICO EN PACIENTES CON MUTACION(ES) ACTIVADORA(S) DEL RECEPTOR DEL FACTOR DE CRECIMIENTO EPIDÉRMICO (EGFR)
Tumores sólidos. Antiemesis Estudio fase III, multicéntrico, aleatorizado, doble ciego, con control activo para evaluar la seguridad y eficacia de Rolapitant en la prevención de náuseas y vómitos por la quimioterapia (NVIQ) en pacientes que reciben quimioterapia altamente emética (QAE). A phase III, multicenter, randomized, double blind, placebo controlled study of the safety and efficacy of Rolapitant for the treatment of Chemotherapy-induced nausea and vomiting in subjects receiving highly Emetogenic Chemotherapy (HEC)
Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos.
Ensayo de fase 3 multicéntrico, aleatorizado y doble ciego para comparar la eficacia de ipilimumab en combinación con paclitaxel y carboplatino frente a placebo en combinación con paclitaxel y carboplatino en pacientes con cáncer de pulmón no microcítico (CPNM) en stadio IV/recidivante.
Ensayo clínico de fase IIIb abierto, randomizado, para evaluar la eficacia y la seguridad del tratamiento estándar +/- tratamiento de mantenimiento con bevacizumab en pacientes con cáncer de pulmón no microcítico no escamoso (NSCLC) avanzado que han experimentado progresión de la enfermedad (PE) tras tratamiento de primera (1ª) línea con bevacizumab en combinación con un régimen de quimioterapia que contenía un doble compuesto de platino.
Estudio en fase 3, aleatorio y a doble-ciego de Docetaxel y Ramucirumab frente a Docetaxel y Placebo en el Tratamiento del Cáncer de Pulmón No microcítico (CPNM) en Estadio IV tras una progresión de la enfermedad después de una Terapia Previa basada en Platinos.

Many factors may influence the development of lung cancer, including:

Smoking - This is by far the most important risk factor. Smoking is responsible for 91% of death related to lung cancer in men and 77% in women. Also at higher risk are individuals who smoke cigars and pipes.

Family history - Research is beginning to show that a family history of lung cancer may be a risk factor.

Personal history - A person with a previous lung cancer diagnosis is more likely to develop a second lung cancer.

Occupational or environmental exposure – People who are routinely exposed to radon or asbestos are at increased risk for developing lung cancer — particularly if they are smokers.

Radiation exposure - People who are routinely exposed to radiation from occupational, medical and environmental sources are at increased risk.

Industrial exposure - People who are exposed to certain industrial substances like arsenic could be at high risk.

Air pollution - The byproducts from the combustion of fossil fuels can put people at risk.

Environmental tobacco smoke - People who live with or who are routinely around smokers are at higher risk.

Lung diseases - People with lung diseases such as tuberculosis (TB) are at higher risk.

Reducing Your Risk
You can take action to reduce your risk of developing lung cancer. MD Anderson suggests:

eliminating tobacco use
using protective equipment when exposed to dangerous substances and pollutants
avoiding secondhand smoke
Take time to discuss your own risks with your health care provider who can best advise you on the screening exams and risk-reduction strategies that are right for you.

Screening
Cancer screenings are medical tests that are performed when a person has no symptoms. There presently are no effective screening tests to find lung cancer early. X-rays and/or laboratory analysis of the cells in phlegm and fiber optic screening are limited in detecting lung cancer before it spreads. CT scans may be able to detect lung cancer earlier, but their ability to improve long-term survival has not been proven.

Although there are currently no screening tests for lung cancer, there are many procedures that can be used to diagnose lung cancer. Some of these tests may be used in combination to obtain the most accurate diagnosis possible.

  • Chest X-rays: A common method that photographs the lungs. Specialists can spot abnormal areas that may indicate the presence of cancer.
  • CAT scans: A specialized X-ray machine which uses radiographic beams to create precise computerized pictures of the lung
  • Bronchoscope: A thin flexible tube with a tiny camera, which is inserted through the nose or mouth and down into the lungs. A bronchoscope can also take a small tissue sample for biopsy.
  • Fine Needle Aspiration (FNA): A thin needle attached to a syringe is inserted through the chest into the lung tissue and cells are drawn out for examination under a microscope
  • Positron Emission Tomography (PET) uses a special type of scanner and a form of sugar that contains a radioactive atom. This sugar is injected into a vein, and the scanner rotates around the patient's body and records the sugar as it moves through the body and collects in organs. Cancer cells show up brighter in the pictures because they absorb more sugar than normal cells.
  • Sputum cytology: Cells taken from mucus expelled by coughing are analyzed for the presence of cancer.
  • Thoracentesis: Fluid from around the lungs is drawn out with a needle for examination.
  • Video Assisted Thoracoscopic Surgery (VATS): VATS can be used to aid in the diagnosis of thoracic cancers. Using a limited number of tiny incisions, small diameter video-thoracoscopes can allow examination of the entire thoracic cavity. Biopsies of the lining of the chest cavity (pleura), lung nodules, mediastinal masses and pleural fluid can easily be obtained for diagnosis.


Stages of Non-Small Cell Lung Cancer
- from the National Cancer Institute

Doctors describe non-small cell lung cancer based on the size of the lung tumor and whether cancer has spread to the lymph nodes or other tissues. A staging system, below, is used to characterize the tumors. Staging is very important when deciding the best form of treatment for each patient.

Early stage lung cancer is considered to be any tumor classified as stage 0 through stage IB, in which the cancer is still localized and hasn't spread to nearby lymph nodes.

 

Occult stage: Lung cancer cells are found in sputum or in a sample of water collected during bronchoscopy, but a tumor cannot be seen in the lung.

 

Stage 0: Cancer cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A stage 0 tumor is also called carcinoma in situ. The tumor is not an invasive cancer.

 

Stage IA: The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no more than three centimeters across (less than 1 ¼ inches). It is surrounded by normal tissue and the tumor does not invade the bronchus. Cancer cells are not found in nearby lymph nodes.

 

Stage IB: The tumor is larger or has grown deeper, but cancer cells are not found in nearby lymph nodes. The lung tumor is one of the following:

 

  • The tumor is more than three centimeters across
  • It has grown into the main bronchus
  • It has grown through the lung into the pleura

Stage IIA: The lung tumor is no more than three centimeters across. Cancer cells are found in nearby lymph nodes.

 

Stage IIB: The tumor is one of the following:

Cancer cells are not found in nearby lymph nodes, but the tumor has invaded the chest wall, diaphragm, pleura, main bronchus or tissue that surrounds the heart
Cancer cells are found in nearby lymph nodes, and one of the following:The tumor is more than three centimeters across
It has grown into the main bronchus
It has grown through the lung into the pleura
Stage IIIA: The tumor may be any size. Cancer cells are found in the lymph nodes near the lungs and bronchi, and in the lymph nodes between the lungs but on the same side of the chest as the lung tumor.

 

Stage IIIB: The tumor may be any size. Cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumormay have invaded nearby organs, such as the heart, esophagus or trachea. More than one malignant growth may be found within the same lobe of the lung. The doctor may find cancer cells in the pleural fluid.

 

Stage IV: Malignant growths may be found in more than one lobe of the same lung or in the other lung. Cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver or bone.

Surgery
The standard operation for lung cancer includes removal of the lobe of the lung in which the tumor resides (lobectomy) and dissection and removal of the mediastinal lymph nodes (MLND). This procedure is usually performed through an incision on the back and requires the ribs to be spread apart (right).

Advances in minimally invasive surgery are improving treatment outcomes for many lung cancer patients. Video Assisted Thoracoscopic Surgery (VATS), a minimally invasive technique, is resulting in better outcomes and decreased recovery times. VATS lobectomy can accomplish the same cancer operation as the traditional open procedure, but requires only three or four small incisions and does not involve spreading of the ribs. VATS is an option for selected lung cancer patients, particularly those have a small tumor in the outer regions of the lung .

Radiation Therapy
External beam radiation treatment is most often used in conjunction with surgery, but it can also be combined with chemotherapy as an alternative to surgery.

The following types of radiation therapy are used with this disease:

  • Virtual CT simulation
  • Intense modulated Radiation Therapy (IMRT)
  • Volumetric Modulated Arc Therapy (VMAT)
  • Image guided radiation therapy (IGRT)
  • Stereotactic Body Radiation Therapy (SBRT)
  • Gating/4D CT

We have been pioneers in radiosurgical treatments of lung tumors since 2001 and have accumulated extensive experience having treated a great many patients, achieving a high rate of success in lesions treated (99% local control) with very low toxicity rates (1%).

Chemotherapy
Chemotherapy, the use of drugs to destroy tumors, is usually used along with surgery in lung cancer patients. Chemotherapy can make the tumormore manageable before surgery, or to destroy lingering cancer cells at the tumor site after surgery.

Photodynamic Therapy (PDT)
Photodynamic therapy involves a light-sensitive chemical injected into the body, where it remains longer in cancer cells than it does in normal cells. The chemical is activated with a laser that initiates the destruction of cancer cells. PDT is best used on very small tumors, or to reduce some symptoms of lung cancer.