​What you need to know about lung cancer

Lung cancer
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Many Jordanians smoke. That is a known fact. A 2019 survey by the Ministry of Health found that 70.3 percent of men between the ages of 18–44 are current smokers. And given that smoking is the biggest risk factor for lung cancer, it is no surprise that lung cancer and other associated respiratory cancers are the second most common form of cancer in Jordanian men (12.2 percent) and women, although the prevalence is significantly lower. Respiratory cancers account for 3.2 percent of all cancer types in women, making it the seventh most common form of cancer locally. اضافة اعلان

Despite being the second most common form, lung cancer is the leading cause of death due to cancer by a large margin locally.

Types of lung cancer
Cancer results from cells in the body growing and dividing uncontrollably (a gene mutation) and then spreading to other parts of the body. In lung cancer, the origin of cancerous tissue begins in the cells that make up the lungs. Lung cancer can be divided into two main types, each with its own prevalence rate and methods of treatment.

The first main type is small cell lung cancer (SCLC), often referred to as oat cell cancer due to the cell’s shape under a microscope. SCLC accounts for approximately 10–15 percent of all lung cancer cases, but unfortunately, it is quite aggressive. It is characterized as fast-growing and spreading, so much so that 70 percent of patients will have had the cancer spread by the time of diagnosis. This cancer type does respond well to traditional treatment; however, in most people the cancer will likely return.

The second main type of lung cancer is known as non-small cell lung cancer (NSCLC). NSCLC accounts for 80–85 percent of all lung cancer cases and has many subtypes. The three main subtypes are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Adenocarcinomas are typically found in the outer parts of the lungs and are more likely to be found before they spread. As a result, individuals with this subtype have a better prognosis than other lung cancer types. Squamous cell carcinoma starts in the flat cells that line the inside of the lungs, known as squamous cells. It is more commonly found in the central portion of the lungs near the bronchus (i.g., the main airway of the lungs). Large cell carcinomas are more difficult to treat. Similar to SCLC, they grow and spread quickly and can be found in any part of the lung.

Causes and risk factors
Smoking is the leading cause of lung cancer. This is because tobacco products contain various chemicals that can cause cancer, known as carcinogens. It is estimated that 80 percent of lung cancer deaths can be attributed to smoking. According to the Centers for Disease Control and Prevention, a smoker is 15–30 times more likely to have lung cancer or die from lung cancer compared to nonsmokers.

SCLC is almost exclusive to cigarette smokers and is very rare in nonsmokers. Additionally, adenocarcinoma and squamous cell carcinoma are most commonly seen in current smokers or those with a smoking history. The more years you smoke and the more cigarettes per day you smoke, the greater your risk.

This risk carries among different types of smoking, including cigars, pipes, and “light” cigarettes (cigarettes that have less tobacco tar than a regular cigarette). Additionally, menthol tobacco products increase the risk even more since the menthol allows for smoke to be inhaled deeper into the lungs. Unfortunately, simply being around smoke can also increase your risk of developing lung cancer. This is commonly referred to as secondhand smoke and is estimated to be responsible for 7,000 deaths from lung cancer each year.

There are many other causes of lung cancers: Radon is a naturally occurring radioactive gas resulting from uranium breaking down in the soil and rocks. In the US, radon is considered the second most common cause of lung cancer. Concentrations outdoors are believed to be low enough not to cause harm, however radon tends to accumulate in higher concentrations in homes and buildings, especially in basements.

A 2020 study found that radon levels in Jordan have increased in the past 30 years and are projected only to increase further as urban areas continue to expand and awareness of the issue is sorely lacking. Other carcinogens that can lead to lung cancer include asbestos, inhaled chemicals such as arsenic, and diesel exhaust.

Should you screen for lung cancer?
The American Cancer Society (ACS) has developed screening guidelines for lung cancer because symptoms do not usually appear until the cancer is in its advanced stages. The earlier lung cancer is caught, the better chances of remission are.

A test known as a low-dose computed tomography scan is used to screen those who are considered at high risk for lung cancer. Those who are high risk are predicated on three factors, and all three must apply to be eligible for screening as per ACS guidelines. They are as follows: age, the individual should be 50–80 years old and in fairly good health; if the individual is a current smoker or has quit within the past 15 years; and smoking history, the guideline is to have at a 20 packs per year smoking history. The way to calculate this is by multiplying the number of packs of cigarettes smoked per day by the number of years you have been smoking.

For example, those who smoke half a pack a day for 40 years are considered to have a 20-pack-year smoking history (i.g., 0.5 x 40 = 20). If all of these conditions apply to you, speak to your primary care physician about lung cancer screening.

Prognosis and prevention
Lung cancer is a difficult form of cancer to treat, and survival is relatively low. Comparatively speaking, NSCLC has a higher survival rate compared to SCLC.

The best way to fight lung cancer is to prevent it. By reducing the risk factors, you can greatly reduce the risk of getting lung cancer. It is never too late for smokers to quit, especially for those still relatively young. Although the risk for lung cancer will still be higher than those who have never smoked, the risk steadily decreases the longer you quit. This also applies to those who live or are around someone who smokes since secondhand smoke can lead to lung cancer.

There is a wide range of nicotine replacement therapies which include gums, lozenges, and patches. If you need help deciding the best approach to quit, speak to your doctor or local pharmacist. Additionally, you cannot see, taste, or smell radon gas, so if you have concerns, consider having your home tested and treated if necessary.

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