Respiratory system (thorax) cancers

Respiratory System body diagram

Lung cancer

Facts and figures

Lung cancer is the 2nd most common cancer in the UK, with over 40,000 new cases diagnosed every year in the UK. Age related, being rare in those under 40 years of age and most commonly diagnosed in those 70+ years.

Higher incidence in men, the male to female ratio being 12:10. Main risk factor is tobacco smoking which accounts for approximately 86% of cases, further 3% attributed to passive smoking.

Other causes include exposure to certain substances such as asbestos, silica, arsenic and coal. Air pollution and family history of lung cancer are also risk factors.

There are two main types of lung cancer, the most common type are non-small cell carcinomas which account for approximately 87% of cases and these can be divided into 3 groups, the most common being squamous cell carcinomas then adenocarcinomas, the incidence of which is increasing and also undifferentiated large cell; there are a few cases where the tumours are mixed. The other type is small cell carcinomas which account for approximately 12% of cases.

Symptoms may include:

  • Persistent cough.
  • Shortness of breath.
  • Chest pain/ Aches and pains when breathing or coughing.
  • Blood in sputum (haemoptysis).
  • Recurring chest infections (not responding to anti-biotics).

Diagnosis

Investigations may include:

  • Physical examination.
  • Blood tests.
  • Chest x-ray.
  • Liver function tests.
  • Bronchoscopy- tissue samples may be taken for biopsy.
  • Endobronchial ultra sound -tissue samples may be taken for biopsy.
  • CT scan.
  • PET-CT scan.
  • Mediastinoscopy.
  • Percutaneous lung biopsy-– local anaesthetic is used, tissue sample is acquired by putting needle through the skin into the lung using CT scan or ultrasound to guide the needle.
  • MRI scan (not often used to diagnose primary tumour but brain MRI or CT scan may be performed to ascertain if there is any spread of disease to the brain).
  • Bone scan (used for staging, investigating if disease has spread to the bones).
  • Neck node biopsy- if CT scan indicates changes in neck lymph nodes, these may be biopsied to investigate if there are any cancer cells in the lymph nodes).

Treatment

Depends on several factors:

  • The type of lung cancer.
  • The position of the tumour in the lung.
  • The stage of the cancer.
  • General health.

Treatment for small cell lung cancer

Surgery

Surgery is not often recommended for small cell tumours unless diagnosed at a very early stage. It is only suitable if there is no sign that the cancer has spread to the lymph nodes in the centre of the chest. Unfortunately, the disease has usually spread beyond the lung at diagnosis.

Chemotherapy

Chemotherapy is the main treatment for small cell lung cancer, sometimes in combination with radiotherapy. Small cell tumours tend to respond well to chemotherapy and it will treat any disease which may have spread outside of the lungs.

Radiotherapy

Radiotherapy may be given after chemotherapy or at the same time (concomitant chemoradiation). Also, if the chemotherapy is effective and shrinks the tumour, radiotherapy to the brain may be recommended (prophylactive radiotherapy) to kill any cells that may have already spread but are too small to detect and are not causing any symptoms. This has been found to reduce the risk of brain secondaries from 54% to 30% at 2 years after diagnosis.

Treatment for non-small cell carcinoma

Surgery

In early stage, surgery will normally be used to remove part of the affected lung (lobectomy) or the entire lung (pneumonectomy).

Chemotherapy

Chemotherapy may be recommended after surgery to reduce the risk of recurrence, particularly if cancer cells are found in the lymph nodes at surgery, it may be advised in combination with radiotherapy.

Radiotherapy

Radiotherapy is likely to be recommended if removal of the whole tumour was not possible at surgery. It may also be recommended if the position of the tumour and cancer cells or the general health of the patient excludes surgery. Radiotherapy may be given in combination with chemotherapy and if patients are fit enough and have small tumours they may be given at the same time (concomitant radiotherapy), giving these treatments together does increase the side effects.

Radiofrequency ablation (RFA)

If surgery is not an option, then RFA may be considered .It is given under local anaesthetic or general anaesthetic. A small probe goes through the skin and directly into the tumour. The treatment is usually done under CT scan guidance. An electrode in the probe then creates radiofrequency energy to produce heat and destroy the tumour cells.

Pleura (mesothelioma)

Not technically a type of lung cancer, mesothelioma develops in the pleura, which is the membrane that covers the surface of the lungs. It has two layers, the inner layer next to the lung and the outer layer which lines the chest wall.

Facts and figures

Pleura is the 17th most common cancer in the UK, although it accounts for more than 1% of the total male cancers. There is a much higher incidence in men, with a male to female ratio of 55:1.

Associated with exposure to asbestos, therefore increased incidence in industries such as shipbuilding and construction. Age related with 92% of cases arising in patients 60+ years. Poor prognosis, aim of treatment is usually to help with symptoms and control the disease.

Symptoms may include:

  • Shortness of breath.
  • Chest pain (pain tends to feel heavy, dull or aching).
  • Heavy sweating (often at night).
  • Fever.
  • Loss of appetite.
  • Weight loss.

Diagnosis

Investigations may include:

  • Chest x-ray.
  • CT scan.
  • Drainage of fluid and biopsies.

Treatment

Depends on several factors:

  • The stage of the cancer.
  • General health.

Surgery

Surgery is only suitable in a small number of cases.

Chemotherapy

Chemotherapy may be used to slow the growth and improve symptoms.

Radiotherapy

There is no proven role for radical radiotherapy. Prophylactive radiotherapy may be prescribed to the drain sites following thoroscopy. Palliative radiotherapy may be used to relieve pain or reduce chest wall masses.

Tracheal cancer

Facts and figures

Rare cancer accounts for only 0.1% of all cancers diagnosed each year in the UK. Most of the tumours are squamous cell carcinomas or adenonoid cystic carcinoma. Higher incidence of squamous cell carcinomas in men than women; age related as most common in men over 60+ years.

The incidence of adenoid cystic carcinoma is equal in men and women, giving a male to female ratio of 1:1, commonly occurring between the ages of 40-60 years. Smoking is known to be a risk factor in squamous cell carcinomas but the cause of adenoid cystic is unknown. Diagnosis may be delayed as it is sometimes mistaken for asthma or bronchitis.

Symptoms may include:

  • A dry cough.
  • Breathlessness.
  • Hoarse voice.
  • Difficulty in swallowing.
  • Fever, chills and recurrent chest infections.
  • Coughing up blood (haemoptysis).
  • Wheezing/noisy breathing.

Diagnosis

Investigations may include:

  • Chest X-ray.
  • CT scan.
  • MRI scan.
  • Bronchoscopy: tissue samples may be taken for biopsy.

Treatment

Depends on several factors:

  • The size of the tumour.
  • The position of the tumour.
  • The stage of the cancer.
  • General health.

Surgery

Surgery may be possible if the tumours are small and involves removal of the affected part of the trachea.

Chemotherapy

Chemotherapy may be used to help relieve symptoms, but rarely used for adenoid cystic tumours.

Radiotherapy

Radiotherapy may be used post-surgery to reduce the risk of recurrence (adjuvant radiotherapy). Radical radiotherapy may be prescribed in early low grade tumours where surgery is not possible. Palliative radiotherapy may be used to help relieve symptoms.

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