Chest and lung tumours: Oncology and chest surgery group
OVERVIEW
Lung cancer is one of the three commonest forms of cancer, causing the death of one man in every ten in Belgium. It is becoming more frequent in women and, in the vast majority of cases, it is caused by smoking.
In Belgium, about 6,000 new cases occur every year.
There are two principal types of lung cancer, namely non-small-cell cancer and small-cell cancer. They need to be distinguished, as their treatment and prognosis are very different.
The division is about 80% for non-small-cell cancer and 20% for small-cell cancer. Small-cell cancer, which is generally more aggressive, has become less common in the last twenty years.
All lung cancer cases treated at the Cancer Centre in Cliniques Universitaires Saint-Luc are discussed during weekly multidisciplinary meetings. This group includes pneumologists, medical oncologists, anatomopathologists, medical imaging specialists whose task is to determine the precise extent of the tumour, surgeons, radiotherapists, oncology care co-ordinators, etc. This skill-sharing approach allows each patient to be treated in the best possible way, in keeping with recent progress made in medicine.
Lung cancer is the commonest cause of cancer-related death.
RISK FACTORS
Smoking is undoubtedly the main risk factor in lung cancer, being implicated in 90% of cases. Environment also plays a role; some cancers are caused by exposure to asbestos.
SYMPTOMS
Symptoms of lung cancer often show late, and can be deceptive. Certain symptoms normally associated with smoking, such as coughing or difficulty in breathing, may become worse. The appearance of bloodstained sputum is often a worrying symptom. In the early stages, the patient’s general state sometimes remains unchanged. Lung cancer is often discovered by accident, during an X-ray examination.
Current studies assessing the importance of chest screening in subjects at risk (smokers aged over 40), but the benefit of this strategy has not, as yet, been clearly demonstrated. This stresses once more the importance of prevention.
The best way to minimise the risk of lung cancer is: don’t smoke.
DIAGNOSIS
Major progress has recently been made in approaches to diagnosing lung cancer. Modern imaging techniques are very efficient, allowing the extent of the tumour to be determined very precisely and thus leading to suitable treatment. The PET scan, one such technique, involves intravenous injection of a product that reveals cancer cells. At Cliniques Universitaires Saint Luc, it is carried out together with the CT scan (combined PET-CT), allowing a still more accurate diagnosis. Bronchial echo-endoscopy also determines the extent of a tumour, by performing an ultrasound with a mini-probe introduced into the bronchi. Carried out under local anaesthetic, it does not require admission to hospital.
Endobronchial endoscopy reduces the need for a mediastinoscopy, a surgical procedure involving examination of the region between the lungs using a camera introduced into the chest under a general anaesthetic.
Efficient and relatively non-invasive imaging techniques accurately determine the extent of the tumour and ease the choice of the most suitable treatment.
PET-CT combiné
TREATMENT
Treatment of lung cancer depends on its histological type and stage of advancement.
Some cancers limited to the lungs can be treated with surgery, which aims to remove the tumour completely. Early stages have a good prognosis, improved still further by post-operative chemotherapy. The operation usually involves removal of a lung or pulmonary lobe. In patients whose pulmonary function has been compromised by smoking, the extent of the operation can sometimes be limited, requiring complex and delicate procedures such as re-implantation of bronchi following removal of a central tumour.
When the disease is loco-regional in its extent but has not yet metastasised anywhere, treatment is multi-modal. In other words, includes both chemotherapy and radiotherapy. In some cases, this combined treatment can be further combined with surgical removal.
Finally, extended or metastatic cancers are treated with chemotherapy. A new class of drugs has recently appeared: targeted treatments, so called because they act directly on tumours without producing the side effects of conventional chemotherapy. Targeted treatments are currently used when chemotherapy fails, although current studies are assessing the importance of using them initially in some cases.
These studies are held in reference institutions. Our centre is involved in them, working with other hospitals in Europe and the United States.
Small-cell cancer is mainly treated with chemotherapy, sometimes in combination with radiotherapy. Surgery to treat this type of cancer is very rare.
