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Medicine is to heal from the inside

Beware of Lung Cancer

Introduction
Lung cancer is a Cancer that forms in tissues of the lung, usually in the cells lining air passages or epithelial cells. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

Lung Cancer is the most common cancer worldwide nowadays, and also the leading cause of cancer death worldwide. It can be said that lung cancer is one the most challenging part of Oncology study since its high morbidity and mortality.

In 2007, lung cancer will account for approximately 15% of all cancer diagnoses and 28% of all cancer deaths. It is the second most diagnosed cancer in men and women (after prostate and breast, respectively), but it is the number one cause of death from cancer each year in both men and women. Because lung cancer can take years to develop, it is mostly found in older people. The average age of a person receiving a lung cancer diagnosis is 71 years.


Overall, lung cancer affects men more than women, but that gap is closing. The American Cancer Society's most recent lung cancer statistics in the United States for 2009 include an estimated 116,900 men and 103,350 women will be diagnosed with lung cancer and an estimated 88,900 men and 70,490 women will die from lung cancer.
Lung Cancer

Basic of Cancer
Until know, all the scientists agree that cancer is a genetic disease, thus leads to uncontrolled cell growth and proliferation with impaired cell function and invasiveness to surrounding tissues.


A cancer begins with an error, or mutation, in a cell's DNA. DNA mutations can be caused by the normal aging process or through environmental factors, such as cigarette smoke or breathing in asbestos.

Researchers have found that it takes a series of genetic changes to create a lung cancer cell. Before becoming fully cancerous, cells can be precancerous, which means they have some irregularities (mutations) but still function as lung cells. However, precancerous changes may signify progression toward cancer. When a cell with a genetic mutation divides, it passes along its abnormal genes to the two daughter cells, which then divide into four cells with errors in their DNA and so on. Once a cell has a genetic mutation, it may develop more. With each new mutation, the cell becomes more irregular and may not be as effective in carrying out their function in lung tissue. At a later stage of disease, some cells can migrate away from the main tumor and start growing in other parts of the body. These sites are called metastases.

Primary and Secondary Lung Cancer
Primary lung cancer starts in the lungs. The cancer cells are abnormal lung cells. Sometimes, people will have cancer from another part of their body travel, or metastasize, to their lungs. This is called secondary lung cancer, because the lungs are secondary compared to the original, primary, location of the cancer. Secondary lung cancer is not lung cancer, but rather the type of cancer from its original site, such as breast cancer. Secondary lung cancer will be treated differently than primary lung cancer, because it is a different disease. This web site focuses on primary lung cancer.

Risk Factor of Lung Cancer
Cigarette smoking is the cause of most lung cancers, but there are other factors, too. Exposure to asbestos, radon, environmental factors, or secondhand smoke can cause lung cancer. Sometimes, a person develops lung cancer and doctors do not know why. There are often internal factors (inherited or from our genes) as well as external or environmental factors (from outside of our bodies) involved in the development of any type of cancer.

Thus by identifying the risk factors, we can minimalized our chance to get lung cancer, also beware of having lung cancer.

The signs and symptoms of lung cancer
The signs and symptoms take years to develop and they may not appear until the disease is advanced. Since cancer at first time is about small size, and causing no impairment lung function, thus the patient will be asymptomatic and feeling just do well.
Thus also happens when patient experienced first symptoms such as cough, most of them will think this as usuall cough that will overcome by day. But when the cough seems untreated and the cancer keeps growing inside the body.

Some symptoms of lung cancer that are in the chest:
Coughing, especially if it persists or becomes intense
Pain in the chest, shoulder, or back unrelated to pain from coughing
A change in color or volume of sputum
Shortness of breath
Changes in the voice or being hoarse
Harsh sounds with each breath (stridor)
Recurrent lung problems, such as bronchitis or pneumonia
Coughing up phlegm or mucus, especially if it is tinged with blood
Coughing up blood
If the original lung cancer has spread, a person may feel symptoms in other places in the body. Common places for lung cancer to spread include other parts of the lungs, lymph nodes, bones, brain, liver, and adrenal glands.

Some symptoms of lung cancer that may occur elsewhere in the body:
Loss of appetite or unexplained weight loss
Fatigue
Headaches, bone or joint pain
Bone fractures not related to accidental injury
Neurological symptoms, such as unsteady gait or memory loss
Neck or facial swelling
General weakness
Bleeding
Blood clots
Smoking takes you to cancer

Screening
The goal of a screening program is to find cancer at an early stage when there are fewer symptoms. Treatment at early stages of cancer can lead to more treatment options, less invasive surgery, and a higher survival rate. For example, in recent years, the five-year survival rate of persons whose cancers were diagnosed when they were still localized (had not spread) was almost 50%. This drops to 2% for persons whose cancers were diagnosed after their cancers had spread distantly. Even though early detection can save lives, there is currently no approved screening test for lung cancer that has been proven to improve survival or detect localized disease. There are studies underway, though, to find appropriate screening tools.

Early detection of lung cancer is critical for improving survival of this disease because only 15% of lung cancers are found when they are localized. Since there are few or no symptoms in the early stages of the disease, the majority of lung cancers are diagnosed in the late stages of the disease. Symptoms of later-stage disease may include a persistent cough, sputum streaked with blood, chest pain, voice change, and recurrent pneumonia or bronchitis.

Testing people who are known to be at high risk for developing lung cancer may help find tumors at an earlier stage when they are small and more easily treated. People at high risk include men and women

Aged 60 years and older who currently smoke or have a history of smoking
- With previous lung tumors
- With chronic obstructive pulmonary disease (COPD)
- Possible screening techniques for lung cancer include

Microscopic analysis of cells in sputum
- Fiberoptic examination of bronchial passages (bronchoscopy)
- Low-dose spiral computed tomography (CT) scans
- Evaluation of molecular markers in sputum

Take Home Message
Early Detection of Cancer provides a good clinical outcomes and Prognosis.
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Non-smoking Has Different Type of Lung Cancer

Introduction
Cancer is disease that characterized by uncontrolled growth of cell grow and multiplication, and malfunction. Cancer is malignant, because its invasive behaviour. Cancer tissues are dangerous for host because they take oxygen, nutrients, and space from healthy cells and they invade and destroy or reduce the ability of normal tissues to function.

Basic of cancer pathogenesis is genetic transformation due to accumulation of genetic damage either hereditary and/or acquired. Most of cancer cases is acquired, or related to person lifestyle. Smoking habits has been associated with increased risk for having lung cancer.

Lung cancer is the leading cause of cancer deaths in women and men both in the world. Lung cancer has surpassed breast cancer as the leading cause of cancer deaths in women. In United States in 2009, about 159,390 people were projected to die from lung cancer, which is more than the number of deaths from colon and rectal, breast, and prostate cancer combined. The survival rates in lung cancer is very low, especially when it diagnosed at the later stage. About 2% of those diagnosed with lung cancer that has spread to other areas of the body are alive five years after the diagnosis. Although the survival rates for lung cancers diagnosed at the earliest stage are higher, with approximately 49% surviving for five years or longer.
Lung cancer awareness

New Concept
From Clinical observation of oncologist, they admit that lung cancer in non-smokers is different than the smokers. Compared to former and current smokers with lung cancer, non-smokers with lung cancer tend to be diagnosed younger, are more likely to be women and are more likely to have adenocarcinomas, while the smokers tends to have small cell lung cancer or squamous cell carcinoma.

This is suggesting there might be something different going on with tumors in never-smokers. "If we find out lung cancer in never-smokers is a different disease and we can identify what those differences are, maybe we can design specific therapies that target the genetic alterations in never-smokers and improve the prognosis,"said Kelsie Thu, a doctoral candidate at the British Columbia Cancer Research Centre in Vancouver in november 2010.

Then the research is done to evaluate that. From the latest research, scientists compared the genetic characteristics of lung cancer in 30 people who never smoked to tumors in 53 smokers or former smokers. The tumors of people who had non-smokers had twice as many DNA abnormalities as people who were current or former smokers. People who never smoked are also more likely to have a mutation in the epidermal growth factor receptor (EGFR) gene. Never-smokers with lung cancer were also less likely to have the KRAS mutation, which has also been shown in prior research.

In smokers group, it's believed that the tobacco and cigarettes contains carcinogens that cause DNA mutations that lead to the uncontrolled growth of cancer cells when it exposed to someone.
While in nonsmokers, the added genetic mutations suggest other mechanisms are driving the tumor growth. Then it's hypothesized that there is more genomic instability in the non-smokers than the smokers who have lung cancer, and that leads us to believe there may be some other molecular mechanism that is driving the tumor development.
Smoking and lung cancer
adopted from http://www.healthjockey.com/2008/04/03/id-gene-associated-to-lung-cancer-researchers

In never-smokers, the challenge is not only coming up with treatments that target the genetic mutations of their tumor, but in identifying people soon enough to help them, said Carbone, a member of the Lung Cancer Foundation of America's scientific advisory board. Nonsmokers tend to take longer to be diagnosed with lung cancer because few suspect they have it, he said. "We often see never-smokers present with advanced, incurable disease," he said.

Implications
Cancer knowledge is developed from time to time, thus impact in therapy and management of cancer. All of oncologist, scientist agree that cancer is best cured at early stage.
Today concept of Cancer Therapy is Individualized therapy, since the same cancer may have different genetic profiles, thus may give a different outcome if we treat with the same drugs.
As we seen in lung cancer, non-smokers tend to have adenocarcinoma type, and have EGFR mutation than smokers. Thus may have different outcome if we treat with same regiment with the smokers. EGFR targetted therapy has been developed, and is being used recently as therapy in advanced stage of lung cancer that have EGFR mutation. From the study, this therapy is promising in therapy of advanced stage of lung cancer.
Lung Cancer early detection
adopted from http://www.abbottdiagnostics.com.au/

Take home message
Human knowledge about cancer is developed from time to time. Primary prevention of cancer is important to lower the incidence of cancer. Early detection of cancer is important to lower morbidity and achieve cure. Individualized therapy is a new method and become promising therapy in cancer.


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