Lung cancer is the most common cancer in the world. Its incidence increases at a rate of 0.5% per year.

In Portugal, in 2018 (WHO data), approximately 5 284 new cases of lung cancer were diagnosed, representing the third most common cancer in the country.

In Portugal it is the leading cause of death from cancer, with an estimated 4 671 deaths in 2018.

Most patients are diagnosed at an advanced stage, as the tumor can grow for a long time without symptoms. However new treatments are emerging and giving new hope to these patients.

Tobacco is the main risk factor for lung cancer. 85% to 90% of lung cancer new cases are detected in smokers. The only definite way to reduce lung cancer cases is by eliminating tobacco use.

It is now known that one of the substances in tobacco smoke, nicotine, can cause addiction, making it difficult for smokers to quit. There is an extensive network of smoking cessation consultations in the country to help smokers quit.

It is never too late to stop, even in patients with lung cancer, as this effort will reduce complaints of coughing, shortness of breath and tiredness, improve nutritional status, will allow better tolerance to treatments, and prevent the appearance of other diseases such as bronchitis, strokes and other cancers.

Environmental contamination, genetic factors or molecular changes can also be risk factors for lung cancer, although in a very small percentage of cases.

Lung cancer can grow for a long time without causing any symptoms or signs, which makes it difficult to diagnose in the early stages.

The warning symptoms for lung cancer are several and many are common to benign diseases, which makes diagnosis difficult.

• In a person with a smoker's cough, this becomes irritating and persistent.
• Bleeding from the mouth or dark sputum.
• Chest, shoulder or arm pain.
• Respiratory distress
• Wheezing or sizzle in the chest
• Hoarseness and voice tone change
• Difficulty swallowing, swelling of the face and neck
• Fatigue, loss of appetite and weight loss.
• Bone pain.

A person with these symptoms should see a doctor quickly.

 

To choose the most appropriate treatment for each patient, it's necessary to know the type of lung cancer (histological diagnosis) and its extension in the body (staging). The tests chosen to make the diagnosis and staging may vary from case to case.

To stage the disease, several tests are performed, such as radiographs, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) to determine which locations in the body are affected by the tumor. Staging is called TNM. The T stands for the tumour (size, location, invasion of neighboring structures); the N stands for the lymph nodes (they are the first defense, trying to contain the tumour cells and therefore increasing in size; the N varies according to the number and location of the affected ganglia in the chest); the M indicates whether or not there are metastases, their number and location. According to T, N and M we will obtain a stage of the disease, which can be I, II, III or IV.

It is necessary to have a tumour sample to make the histological diagnosis and determine its characteristics. Various techniques can be used, the most frequent being those that collect material from the lung, namely bronchoscopies and transthoracic biopsies. It may also be necessary to collect material from other lesions outside the lung.

 

The choice of treatment depends on the diagnosis, the stage of the disease and the condition of the patient. A multidisciplinary team composed of oncologists, pulmonologists, surgeons, imaging specialists, pathologists and radioncologists decides the most appropriate protocol for each case.

This is how we decide which treatment or combination of treatments is most appropriate for each patient.

Treatments available are surgery, radiation therapy, chemotherapy, target treatments and immunotherapy.

The control of disturbing symptoms is always essential for a good quality of life.

 

1. LUNG CANCER IS HEREDITARY

FALSE: Some people inherit mutations that may increase their risk of developing some cancers, but in the case of lung cancer, no inherited mutations have been identified that could alone lead to the disease.

 

2. LUNG CANCER IS CONTAGIOUS

FALSE: Lung cancer is not transmitted by any type of contact between two people.

 

3. LUNG CANCER IS A MEN'S DISEASE

FALSE: Lung cancer is currently the third most common tumor among women, after breast and colorectal cancer, and the second largest responsible for mortality, just after breast cancer.

 

4. LUNG CANCER ONLY APPEARS IN SMOKERS

FALSE: Although almost 90% of lung cancers are related to smoking, there may be other risk factors, including environmental contamination, genetic factors or molecular changes.

 

5. IT IS POSSIBLE TO PREVENT LUNG CANCER

FALSE: There are several agents under study that could later be used to prevent the onset of cancer in general, but currently no substance is known to prevent the onset of lung cancer.

We know that smoking is responsible for almost 90% of all lung cancer cases, and that exposure to indoor smoke can also cause lung cancer.

In conclusion, the most effective way to prevent lung cancer is to stop smoking.

 

6. IF I SMOKE 3 OR 4 CIGARETTES A DAY IT'S OK

FALSE: Tobacco consumption is directly related to the onset of lung cancer

 

7. SMOKING IS BECOMING AN ADDICTION FROM THE PAST

FALSE: Although there has been a decrease in smoking in adults, it has been increasing among young people. The emergence of new forms of nicotine consumption (electronic cigarettes, heated tobacco) has been widely accepted by young people.

 

8. I CAN AVOID THE DISEASE IF I DO REGULAR TESTS

FALSE: Recent studies show that screening tests in risk populations can detect the disease earlier, but do not prevent its onset. The only way to prevent it is not to smoke.

 

9. IF I GO ABROAD I HAVE ACCESS TO MORE INNOVATIVE TREATMENTS

FALSE: International clinical guidelines for the diagnosis, staging and treatment of lung cancer are produced, reviewed and issued on a regular basis.

In Portugal there are several reference centers where these standards are followed.

There are national and international studies and trials being held in Portugal

 

10. CANCER DIAGNOSIS IS A DEATH SENTENCE

FALSE: Tumors diagnosed at an early stage are treated with good results. Nowadays we have more effective therapies to treat tumours diagnosed at later stages, that have significantly improved the perspectives of these patients. A large number of promising treatments are being developed for all cases of lung cancer.

Recognizing stigma

The stigma experienced by lung cancer patients is undeniable, but it is so deeply rooted in the history of the disease that it may not even be recognized as such, by most people. In its essence, a stigma is born out of a negative perception associated with a certain behavior and, in this case, it exists due to the strong link between the disease and smoking.

The stigma in lung cancer manifests itself in two ways: on the one hand, there is the public stigma and, on the other hand, the stigma inflicted by the patient himself or “self-stigma”. The public stigma translates into the widespread belief that lung cancer patients have a disease that they have caused themselves by smoking. It can be demonstrated by anyone, from strangers, friends, family members or even health professionals, who at some point, think, say or do things that judge and blame the lung cancer patient, making him feel that he deserves to have the disease . Self-stigma, on the other hand, results from the internalization by the patient of negative stereotypes, which translates into feelings of shame, guilt and self-recrimination. For most, this guilt adds a great emotional burden to an already overwhelming situation.

In a research by the Global Lung Cancer Coalition that surveyed more than 16,000 people in 16 countries, the investigators found that up to 29% of people admitted to feel less sympathy for lung cancer patients compared to those suffering from other types of cancer, due to its association with tobacco. This facet of stigma of discouraging compassion, is one of the most relevant aspects of this problem.

The origin of stigma

Although the relationship between smoking and lung cancer is unquestionable, this association has resulted in a one-dimensional view of the disease in public opinion. The vast majority of anti-smoking campaigns generalize the false belief that smoking is the only cause of lung cancer, and the misconception that non-smokers are free from risk. Although the aim of the media is to inhibit people from smoking, an unforeseen consequence is the stigmatization of this group.

It is necessary to point out that many people who today live with lung cancer are those who started smoking at a time when tobacco was not only accepted, but also considered a factor of social promotion, and the long-term harmful effects of this habit were not known. Many have quit smoking in the meantime, sometimes several decades ago, but despite this, they are the target of the same blaming messages, instead of receiving the deserved praise for having overcome their addiction. The fact that great smokers often have visible physical marks of their habit that are seen as "disgusting" by most non-smokers (such as yellow teeth or finger burns, eg) makes it even easier to materialize the stigma. But ultimately, the problem exists because the public continues to view smoking as a bad habit, and not as the serious addiction it is.

In fact, the stigma is so deeply rooted that even patients who have never smoked tend to be held responsible. When they share their diagnosis, these patients often hear the question "But did you smoke?" Instead of the usual comfort messages that are addressed to any other cancer patient. This results in a particularly strong feeling of hurt, injustice and anger in this group.

Consequences

Stigma adversely affects not only the patient but also his family and friends, conditioning the way they deal with the disease and communicate with each other and with society. It is well documented that stigma is associated with negative psychosocial and medical outcomes:

• Loss of self-confidence, guilt and shame

• Fear of disclosing one´s diagnosis

• Avoidance of social situations and isolation

• Increased stress, difficulty cooping, depression

• Delay in seeking medical care

• Less adherence or refusal of treatment and potential sources of support

• Poorer quality of life

• Shorter survival

• Threats to economic opportunities and financial problems

Despite being by far the deadliest, lung cancer is also one of the least funded.

Compared to others such as breast and prostate cancer, lung cancer has received much less investment, which is undoubtedly linked to the strong stigma surrounding the disease. This trend begins to show signs of change, with the recent appearance of innovative and profitable therapies for the industry. But to move forward in a truly positive way, it is necessary to end the stigma surrounding lung cancer.

Anti-stigma strategies

Education is the key to changing public perception and reducing this unfounded stigma. It is necessary to inform, providing precise facts:

• Smoking is not a bad habit. In fact, smoking is one of the most difficult addictions to overcome.

• Genetic factors can predispose certain individuals to lung cancer, or protect them.

• Other factors can cause the disease, including exposure to radon, asbestos, secondhand smoke or environmental pollution.

• Up to 20% of lung cancer patients have never smoked.

Through communication, education and strategic campaigns, public opinion can be shaped. There are two key messages that have to be passed on:

1. Anyone can get lung cancer.. In addition to tobacco, there are many mechanisms for developing the disease.

2. Nobody deserves to have lung cancer. Nem mesmo os fumadores, que sofrem de uma dependência difícil de vencer. Em vez de culpar o fumador, a sociedade tem que se unir contra a indústria tabaqueira por vender um produto altamente viciante.

Sensitizing the public to the psychosocial suffering that stigma imposes on patients and their caregivers is also an important step in encouraging a change in mentalities and compassion.

Scientific communities have to work along with the media to lead them to create balanced campaigns, which educate about risks, without fostering stigma.

Since there has been an increase in cases in non-smokers in recent years, it is also necessary to reorient messages in the media to align with this demographic change. Focusing lung cancer campaigns on survivors' stories is another way to change the negative burden associated with this diagnosis.

Finally, efforts must be made to support patients. Education is essential to end self-inflicted stigma. They should be encouraged to be honest about how stigma makes them feel, to share their experience, and to seek support from other patients, family, friends and health professionals. Also, it can never be overemphasized the role of smoking cessation, which among other benefits, can improve the self-esteem of patients living with lung cancer.