Dr. Ahmed Knowing your lung cancer stage is crucial. It reveals:
- Where in your lungs a tumour or cancer cells are placed
- The size of your tumour right now
- If your cancer has spread or is localised
The two main subtypes of lung cancer are small cell and non-small cell. Each has a unique staging.
Knowing the stage aids your doctor in deciding on the best course of therapy for you. They could use it to determine your odds of responding well to that treatment.
The stage of your lung cancer cannot predict how long you will live.
The TNM System of lung cancer staging: What Is It?
The most used cancer staging method is the TNM system. The TNM system is the primary means of reporting cancer in the majority of hospitals and medical facilities.
If you don’t have cancer for which a different staging approach is used, your pathology report will likely describe your condition using this staging system.
Blood malignancies and tumours in the brain and spinal cord are two examples of cancers with various staging methods.
The TNM stands for:
- The T denotes the size and scope of the primary tumour. Usually, the term “primary tumour” refers to the largest tumour.
- The N stands for the number of neighbouring lymph nodes that are cancerous.
- Whether the malignancy has spread is indicated by the letter M.This shows that cancer has progressed from the initial tumour to other internal organs.
These letters will help your doctor stage your tumour, and the digits 0-4 will help them be more specific.
Your tumour’s size will be quantified by measuring it in millimetres. The greater the number increases, the more your tumour has expanded or developed.
X could also be used by them as a number. This indicates that the tumour cannot be quantified or that the extent of its dissemination is unknown.
If your doctor declares that your lung cancer is “unresectable,” it cannot be removed by surgery.
Stages of non-small cell lung cancer (non-SCLC):
Stage 1:
- Cancer has been detected in the lungs, but in this stage, cancer has not spread or metastasized to other regions in the body yet
Stage 2:
- Cancer has been detected in the lungs and adjacent lymph nodes.
Stage 3:
- Cancer has affected lymph nodes found on the medial side and the lungs as well.
Stage 3A:
- The side of the chest where the cancer was originally detected, is the area where the lymph nodes are also affected by cancer.
Stage 3B:
- Cancer has now metastasized towards the area above the clavicle, affecting the lymph nodes there. Or it has affected the other side of the chest as well.
Stage 4:
- The final stage is where both of the lungs in association with various organs around the lungs have been affected by the cancerous cells.
Small cell lung cancer (SCLC) stages:
There are two phases in the SCLC process:
- Limited and
- Extensive.
At the restricted stage, cancer is only found in one lung or nearby lymph nodes on the same side of the chest.
The term “extensive stage” refers to when the illness has moved from one lung to the other lung, to the lymph nodes in the opposite lung, to the fluid around the lung, to the bone marrow, and to distant organs.
Symptoms of lung cancer:
The symptoms of lung cancer can be divided into two following categories:
Note:
The symptoms of non-small cell lung cancer and small cell lung cancer are quite similar when they are present.
Late Symptoms Of Lung Cancer:
Depending on where new tumours develop, lung cancer may exhibit other symptoms. Not every sign of advanced lung cancer will be present in every patient.
Late-stage signs might show up as:
- Bone masses in the neck or collarbone; back, ribs, or hip discomfort in particular
- Headaches
- Shrinking pupils and one eyelid drooping
- Shoulder ache and a lack of sweat on one side of the face
- Vertigo balance problems
- Tingling in the arms or legs
- Skin and eye yellowing (jaundice)
- Enlargement of the upper body and face
A hormone-like substance that is occasionally released by lung cancer tumours can also cause a number of symptoms collectively known as paraneoplastic syndrome.
These signs include:
- Muscular tremor
- Nauseous and dizzy
- Confusion
- Seizures
- Blood pressure is high.
- Elevated blood sugar
Early Symptoms Of Lung Cancer:
Lung cancer symptoms are not usually present in the earliest stages. Early symptoms might include both anticipated symptoms like back discomfort and warning indications like shortness of breath.
Back discomfort might develop when tumours impinge on your lungs, spread to your spinal cord, or affect your ribs.
Other early indications of lung cancer might be:
- A persistent or getting worse cough
- Chest discomfort becomes worse when you laugh, cough, or breathe deeply. Appetite loss and weight loss
- Pneumonia or bronchitis, which is frequent respiratory diseases
- Coughing up phlegm or blood.
- Hoarseness
- Gasping exhaustion and weakness
Stage 4 lung cancer symptoms of dying:
- At this stage, the person is very sick and is gasping for breaths. The respiratory rate is very high at this stage.
- The person develops paradoxical breathing. Paradoxical breathing is the inward movement of the chest and outwards movement of the abdomen followed by the outwards movement of the chest and inwards movement of the abdomen.
- The dying person becomes cyanosed. Cyanosis is the bluish discolouration of the lips and tongue.
- The blood pressure falls or is maintained only with the help of intravenous medications.
- Cough and hemoptysis (coughing out blood) are uncontrollable. The patient might become drowsy and not eat or drink.
Tests to diagnose lung cancer and stage it:
Despite the fact that a person’s symptoms and the results of particular tests may strongly suggest that they have lung cancer, the definitive diagnosis of lung cancer is made by examining lung cells in the lab.
From a questionable site, lung secretions (the mucus you cough up from the lungs), fluid gathered from the region around the lung, or lung secretions, the cells can be removed surgically or with a needle (biopsy). The scenario will determine the tests to use.
Thoracentesis:
Doctors can extract part of the fluid from a patient who has a pleural effusion to determine whether the fluid is the result of cancer spreading to the lining of the lungs (pleura). Infection or heart failure are two more illnesses that might be to blame for the development.
For thoracentesis, a hollow needle is inserted between the ribs, which numbs the skin before draining the fluid. In the lab, the fluid is examined for cancerous cells.
Malignant (cancerous) pleural effusions can occasionally be distinguished from those that are not by doing additional fluid testing.
A second thoracentesis to remove additional fluid may be performed if a malignant pleural effusion has been identified and is preventing the patient from breathing normally.
Needle biopsy:
Doctors routinely use a hollow needle to extract a little sample from an uncertain place (mass). One advantage is that needle biopsies may be conducted without requiring surgery.
The drawback is that they only collect a minute bit of tissue, and in some cases, this may not be enough to diagnose a patient or do additional testing on the cancer cells that would help doctors decide which anticancer drugs to prescribe.
Core Biopsy:
A larger needle is used to extract one or more small tissue cores. Core biopsies are commonly advised because they yield larger samples than small needle aspiration biopsies do.
Transthoracic Needle Biopsy:
If the suspected tumour is on the outer section of the lungs, the biopsy needle can be introduced through the skin on the chest wall.
Before inserting the needle, the area can be numbed with a local anaesthetic. The doctor will then manoeuvre the needle into the desired spot while seeing the lungs with fluoroscopy or CT scan, which is akin to an x-ray.
One possible adverse effect of this therapy is air leaking from the lung at the biopsy site into the space between the lung and the chest wall.
Pneumothorax is one illustration of this. It might cause breathing problems and the collapse of a lung section.
The majority of the time, a little air leak gets better on its own. To fix significant air leaks, a chest tube (a small tube entering the chest cavity) is employed.
Over the course of a day or two, it suctions out the air; thereafter, the leak frequently seals on its own.
Fine Needle Aspiration (FNA) Biopsy:
a doctor uses a very thin and hollow needle as well as a syringe in order to remove cells and small pieces of tissue. this biopsy is performed to detect any tumour found in the lymph nodes found in the centre of the lungs.
Transtracheal FNA or transbronchial FNA is carried out during bronchoscopy or endobronchial ultrasonography by passing the needle through the wall of the trachea (windpipe) or bronchi (the primary airways leading into the lungs) (described below).
When performing endoscopic oesophagal ultrasonography on some patients, an FNA biopsy is performed by passing the needle through the oesophagus wall (described below).
Bronchoscopy:
A bronchoscopy can be performed to examine a suspicious spot discovered through an imaging examination.
A biopsy can be performed on any abnormal regions of the airways identified by the bronchoscope to determine whether they are cancerous.
In order to collect the samples, long, thin tools like brushes, hollow needles, or tiny forceps (tweezers) are sent down the bronchoscope.
By using the bronchoscope to clear the airways with sterile saltwater and then sucking up the fluid, the doctor can also remove cells from the lining of the airways.
This method is known as bronchial washing. After that, the biopsy samples are examined in the lab.
Imaging tests to detect lung cancer:
These examinations use radioactive substances, magnetic fields, sound waves, or x-rays to take pictures of the inside of your body.
Imaging tests may be carried out both before and after receiving a lung cancer diagnosis for a number of reasons, including:
- To examine potential cancerous spots that are alarming
- To determine how far the disease may have progressed
- To assess the effectiveness of the treatment To search for any indications that cancer may return after treatment
Magnetic resonance imaging (MRI) scan:
similar to what a CT scan can do, an MRI scan can create extensive images of the soft tissues found in the body. The only difference found is the substitution of radio waves and magnetic waves with x-rays. most frequently, this scan assists in the detection of any tumours spread to the brain or spinal cord from the lungs.
Chest x-ray:
An X-ray machine uses radiation to create an image of the chest during a chest X-ray, which is then captured on a specialised film or a computer.
The heart, lungs, big blood veins, diaphragm, portion of the airway, ribs, collarbone, upper spine, and breastbone are among the organs and structures seen in this picture.
Computed tomography (ct) scan:
As compared to the conventionally used x-ray which is capable of taking one or two images, computed tomography can assist in taking multiple images.
These images are then combined by a computer to show the portions of the body that are being examined.
This CT scan produces fine-grained cross-sectioned images of your body. For this reason, lung cancer can be better detected by a CT scan as compared to an x-ray.
This scan is further capable of locating lymph nodes that are grown in size and are currently keeping cancerous cells inside, this scan may also indicate the size and location of tumours found in the lungs.
Another positive point is that this scan can assist in detecting the tumours that have spread to the liver, brain or adrenal glands from the lungs.
Bone scan:
a small amount of a reduced level radioactive material is inserted into the blood for a bone scan. this radioactive material typically gathers in odd bone locations.
In case of lung cancer has been spread to the bones, this bone scan will be helpful in detecting it. but this test is not occasionally used since a PET scan can be used to detect the same.
Positron emission tomography (pet) scan:
PET scans make use of a blood injection of FDG, a kind of sugar that is faintly radioactive and mostly concentrates in cancer cells.
PET/CT scan:
It is common practice to combine a PET scan with a CT scan using a specialised gadget that can do both functions concurrently.
The doctor may then contrast the areas with higher radioactivity from the PET scan with the more thorough image from the CT scan. This sort of PET scan is most usually performed on patients with lung cancer.
PET/CT scans have several uses.
- If a cancer diagnosis is made by your doctor but the exact site is unknown. They can show how the illness has progressed to the liver, bones, adrenal glands, or other organs. They are less useful for evaluating the brain or spinal cord.
- Their application to assess the success of therapy has not yet been shown, though. PET/CT scans are often not recommended for normal patient follow-up after lung cancer therapy, according to most medical authorities.
