By Dr Preyas Vaidya Consultant-Pulmonologist & Sleep Medicine Expert, Hiranandani Hospital, Vashi-A Fortis Network Hospital 

Lung Cancer is still the leading cause of Cancer deaths worldwide. In India, alone, Lung Cancer accounts for a majority Cancer burden, with 1 in 68 males falling victim to it. Moreover, several statistics state that around 80% of Lung Cancers are diagnosed at an advanced stage. Having said that, medical science and the healthcare fraternity has done a lot of progress to reduce the burden of Lung Cancer and to save as many lives as possible. There has been a rapid and exponential development in the modalities to manage Lung Cancer. Right from tools to augment early diagnosis, to targeted chemotherapies. To minimally invasives procedures to treat Cancer, healthcare today has a plethora of intervention that can help patients with Lung Cancer.

 But smoking remains the catalyst of higher risk of Cancer and the leading contributors to Lung Cancer in India. So, the question is how do we tackle the burden if India’s population continues to smoke death?

Quitting can completely reduce the risk multifold. But if you are already a smoker, how does one go about detecting lung cancer?

EARLY DIAGNOSIS OF LUNG CANCER IS INSTRUMENTAL: 

Smoking is gauged with the number of packets a person smokes per day, for the number of years smoked. In India, as the number of cigarettes per packet are less, a different tool like ‘smoking index’ is estimated. A low dose CT scan of the lungs is approved for screening of Lung Cancer in the west. As it has shown to improve survival by detecting the Cancer early. In India, people with high smoking index can discuss with their healthcare providers to see if they qualify for a screening CT scan. People suffering from COPD due to smoking are at higher risk. And can discuss the timing and need for getting a CT scan for Lung Cancer screening. Surgery or in some cases Stereotactic Body Radiation Therapy (SBRT) cures the Lung Cancer when detected early.

STAGING OF CANCER IS EQUALLY IMPORTANT TO DIRECT TREATMENT LINE:

 Once Lung Cancer is diagnosed, the next important step which guides the treatment appropriately is accurate staging. There are imaging techniques which can guide when and how a tissue can be acquired through biopsy for staging. And molecular testing. Stages in Lung Cancer range from stage one to four, with multiple substages as well, to prognosticate. And optimally treat the Cancer. A minimally invasive procedure called Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA) is now widely available around the country which helps in accurate staging with minimal risk. This procedure is done by a Pulmonologist usually after a PET CT.

It can also help in restaging of Cancer during the entire treatment course and after. There is molecular profiling carried out for the type of Lung Cancer. That includes checking for different genetic mutations that the tumor exhibits in the tissue acquired by biopsy. They can be EGFR, ALK, PDL1, ROS and so on. These help in guiding oral targeted chemotherapy to a particular mutation. These are better tolerated drugs which have shown to improve survival in patients with advanced Lung Cancer. The survival when treated appropriately has improved from months to years.

 TACKLING COMMON PROBLEMS IN LUNG CANCER: 

A common problem in advanced Lung Cancer is fluid accumulation in the pleural space. It is the space between lungs and the chest wall. This fluid prevents lung expansion and presents with breathlessness, a very uncomfortable symptom. There are multiple modalities to tackle this menace. Pleuroscopy – a medical Thoracoscopy can help in diagnosis and treatment of the Pleural Effusion in the same setting.

It is carried out under sedation and local anesthesia in an endoscopy suite. A procedure known as Pleurodesis where the space is obliterated by using an external agent helps prevent refilling of the fluid. And improves the quality of life tremendously. Also, small indwelling pleural catheters are available which stay secured in the chest wall. And help in ambulatory drainage of pleural fluid when refilling of the fluid occurs. These have replaced a lot of primitive more morbid modalities of treatment, helping the patients lead a better quality of life even with Cancers in an advanced stage.

 At the end, it is important to note that prevent is better than undergoing the pain & process of treatment. Quitting tobacco consumption  is effective. And there are different ways in which healthcare providers help people quit and lead a healthy life. But if you are smokers and experiences symptoms like a long-standing cough that gets worse. Chest infections that keep coming back, coughing up blood, pain when breathing or coughing and persistent breathlessness, you must speak to your doctor.

 By Dr Anshu Punjabi, Consultant-Pulmonologist & Sleep Medicine Expert, Fortis Hospital, Mulund 

 India is slowly witnessing a decline in smoking, owing to the pandemic. While this news brings a lot of hope, there is still a whopping 367 million tobacco users in India with7.7% ‘bidi’ smokers. So, a lot more people at still at risk of developing Cancer and other diseases related to smoking.

What’s worrying is that majority of the regular smokers of tobacco, marijuana, and bidi include young adults. Many teenagers and adolescents fall victim to smoking without being fully aware of the repercussions on their health. What starts as a feeling of ecstatic joy, eventually becomes and addiction and a lethal weapon.

Most adult smokers often begin smoking in their teens which is more harmful than those who take up smoking later. Many don’t realise that their lungs are still developing during adolescence, and tobacco only leads to decreased lung growth and function. Additionally, cigarettes have toxic substances like Nicotine and Cyanide that can kill a person slowly. It is often the cumulative impact of smoking over many years that leads to Lung Cancer.

 SECOND HAND SMOKING: When a non-smoking individual is around friends and family who smoke, they also indirectly fall prey to passive smoking. In densely populated metro cities, environmental factors like air pollution expose children to smoke and other toxins at a very young age. Inhaling secondhand smoke filled with Nicotine, toxic chemicals, and carcinogens is highly harmful to a person’s health. Secondhand smoking can lead to development of health concerns like Bronchitis, Chronic Obstructive Pulmonary Disease (COPD), Lung Cancer, etc.

 PASSIVE SMOKING AND LUNG CANCER: As a matter of fact, the number of Lung Cancer cases among non-smokers is on the rise in India with around 51% of Lung Cancer patients being passive smokers.  This primarily because of increase air pollution within the country. Polluted air and smoke cause changes at a molecular level in the lungs, giving rise to such critical conditions. Secondhand or passive smoking, i.e. being around peers and partners who smoke, is another reason for this rising incidence.

 ARE E-CIGARETTES BETTER? These devices are pretty popular amongst youngsters for the past ten years. A lot of young adults are under the wrong assumption that e-cigarettes are less harmful than traditional bidi or a cigarette. In reality, they are equally dangerous. They might not contain tobacco but have ultrafine particles that can be deeply inhaled into the lungs. These electronic objects also contain flavourings and chemicals like Diacetyl which are harmful. Apart from these, one of the main components of an e-cigarette is Nicotine, which is responsible for addiction. The long-term effects and link with Lung Cancer of e-cigarettes are not accurately known yet. However, in the USA, many e-cigarette users have reported acute respiratory diseases and, in extreme cases, death.

 HOOKAHS: Hookahs are not safe either. The smoke that comes through it is unfiltered and detrimental to health, even if it feels good with the cooling sensation and different flavours.

 OTHER HEALTH HAZARDS: Smoking, in general, be it active or passive, increases the chances of a heart attack, COPD, Stroke and Cancer. The chemicals in the smoke harm blood vessels and the heart leading to a Stroke. For most heart attack cases in young adults, smoking is a dominant factor. Some short-term effects in youngsters also include various respiratory ailments, lousy stamina, higher risk of COVID infection, Kidney and Bladder issues, high blood pressure, amongst others. Therefore, quitting is the most effective way in which you can save your own life and others.

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