The question I am researching is ‘How the treatment of non-small cell lung cancer is decided and how effective is it?’. The aim of this project is for me to gain a better understanding of what non-small cell lung cancer is and how it is treated. My researching of this project has been a fascinating extension of my A level biology and chemistry, which are particularly important to me, due to the fact I am looking into a future involving one or both of these subjects.
As a result of the complexity of the disease, there are multiple treatments available, however not all of them are equal in effectiveness. In some cases, the most effective treatment may not be chosen due to the disadvantages of the treatment outweighing the positives, and this is something I aim to explore throughout my project. I chose to study non-small cell lung cancer as 87% of lung cancer are non-small cell lung cancer (Cancerresearchukorg, 2017), meaning it affects a large number of people. The three main types of non-small cell lung cancer are Adenocarcinoma, Squamous cell carcinoma and Large cell carcinoma. The treatment for all these subtypes of non-small lung cancer are virtually the same and is why I have not focused on a particular subtype. The treatments I have focused on are chemotherapy, surgery and radiation therapy as they are the most common and most widely used treatments available.
This research topic is also topical as research by the Royal College of Physicians, proves that there has been a 7% increase in diagnosed patients surviving more than 1 year compared to data presented in 2010 (Royal college of physicians, 2017). The increased success in the treatment of lung cancer made me more confident that my area of research was one of significance. The article also confirmed to me that the treatments I decided to focus my research around are as commonly used as my original source claimed, as according to the National Lung Cancer Audit report taken in 2016, 60% of lung cancer patients undergo chemotherapy, radiation therapy or surgery.
In respect to the word ‘effective, I acknowledge it is a controversial word as it is not measurable or quantifiable. I have decided to discuss the improvements in the health of the patient. A completely effective treatment is one that can cure the cancer with no chance of it returning. I will compare the advantages and disadvantages of each treatment and this will allow me to draw a conclusion of which treatment is the best out of those I have focused on.
The sources of information I plan to use are mostly cancer research websites and these were particularly beneficial to me as they are mostly non-profit organisations, and their goal is to simply inform and educate their readers. There is no benefit to them of forging or twisting information to manipulate readers. However, a drawback of these websites, is that since they are created with the intention that everyone can understand, they lack scientific vigour, as this is where my other, more scientific sources are used.
The report is laid out with…
Non-small cell lung cancer
Non-small cell lung cancer accounts for 87% of lung cancers (Cancerresearchukorg, 2017). They are grouped together due to the similarity in the treatment. There are three subtypes of non-small cell lung cancer, Adenocarcinoma, Squamous cell carcinoma and Large cell carcinoma, are all similar in treatment but have slightly different qualities. Adenocarcinoma non-small cell lung cancer is found in the outer region of the lung and is most common. Squamous cell carcinoma is prevalent in smokers and is found in the central part of the lung whilst Large cell carcinomas are found in any part of the lung but tend to grow and spread at a faster rate (Cancer Treatment Centers of America, 2017).
There are factors that contribute to and can increase the likelihood of developing non-small cell lung cancer, such as smoking or the exposure to secondhand smoke, radon or asbestos. Symptoms of non-small cell lung cancer range from a cough that won’t go away to unexpected weight loss to joint pains (Jaime Herndon, 2017). Symptoms such as those mentioned are the reason why non-small cell lung cancer is so difficult to diagnose at an early stage. The symptoms of this disease such as the ones I mentioned can be misdiagnosed as a number of other diseases or illnesses, and by the time it is correctly identified the cancer has developed to an advanced stage.
Non-small cell lung cancer, along with all cancers are easiest and have a better chance of being successfully treated if they are diagnosed as early as possible. This is because as the cancer becomes more advanced the cancer cells begin to grow and reproduce rapidly around the body making it increasingly difficult to treat. However, due to the nature of non-small cell lung cancer, by the time it has been diagnosed, more often than not, the cancer has reached an advanced stage where treatment is not as simple. Lung cancer is also difficult to detect at an early stage because symptoms rarely show up on scans until the cancer become advanced and less treatable (Neal Chuang, 2017).
Non-small cell lung cancer can be diagnosed by; a bone scan, imaging test, phlegm examination and or a biopsy of the lung. If the patient is then diagnosed with cancer, the doctor will consider what stage the cancer has reached. The stages of non-small cell lung cancer range from 0 to 4, 4 being the most severe and hardest to treat.
Chemotherapy uses cytotoxic drugs to target cancer cells (Macmillan, 2015). The goal of chemotherapy is to stop the growth of cancer cells and kill them, however if this is not possible it is to slow the growth of and shrink cancer cells. This information suggests that chemotherapy is most suitable in early stages of non-small cell lung cancer as if it early enough along, it is possible to kill all the cancer cells and prevent it from remerging in the future. Once the cancer becomes more advanced it is not possible for the chemotherapy treatment to destroy all the rapidly reproducing cancer cells, however as chemotherapy is a palliative treatment it can still be used to treat advanced case of non-small cell lung cancer. In case where the cancer has reached an advanced stage, chemotherapy can still be used to shrink a painful tumour, which would improve the patient’s quality life (American Cancer Society,2016). In these situations, it is difficult to determine the effectiveness of chemotherapy as there is no way to measure or quantify how much a patient’s quality of life has increased by. The way the treatment is delivered changes depending on the stage non-small cell lung cancer is at in the patient.
When is it chosen?
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Chemotherapy is a systematic treatment, meaning it affects the whole body (What is chemotherapy? (c2016). The implication of this is that during the treatment process will not only destroy and stop the growth of cancer cells, it will affect the bodies normal, healthy body and nerve cells, and this consequence is unavoidable. Doctors and patients therefore need to make the decision whether chemotherapy is a worthwhile treatment option as with particularly weak or unhealthy patients, the damage to their cells will only worsen their condition and in these cases the disadvantages may outweigh the advantages to non-small cell lung cancer patients. However, this is only the case if the chemotherapy is taken orally or via injection. Regional chemotherapy results in a more focused treatment that only affects cancer cells in the area, whereas systematic chemotherapy that enter the bloodstream and effect healthy and cancer cells. Therefore, the effects should be less severe and are consequently, less harmful to the patient. By stage iv, the most advanced stage of non-small cell lung cancer the cancer cells have spread to other parts of the body, such as the brain, and away from the tumour and therefore cannot be located easily on the scans. Since chemotherapy is mostly used in isolation for non-small cell lung cancer patients in stage iii or iv, as by stage iii survival is extremely unlikely with 6% possibility, and once the cancer reaches stage iv, majority of patients don’t survive for more than 2 years after diagnosis (Cancer Research UK, 2017). In these cases, chemotherapy is used to increase the patient’s quality of life. Systematic chemotherapy is an effective treatment in this case as it can travel through the bloodstream and affect cancer cells that are too small or not in close proximity to the tumour and eliminate cancer cells that scans cannot pick up on.
Chemotherapy is often prescribed for Stage iv non-small cell lung cancer (American cancer society, 2016) because although by this stage non-small cell lung cancer cannot be cured, the goal is to increase the patient’s quality of life. It is normally referred to as combination chemotherapy as a combination of drugs are used. Cisplatin and carboplatin are the most common to be used in combination with a second drug, however the use of these drugs introduce a lot of side effects. Cisplatin and carboplatin increases the risk of the patient getting an infection (Cancer Research UK, 2017). As a result of the weakened immune system, your bone marrow no longer makes white blood cells and means your body becomes vulnerable to pathogens, including those that wouldn’t normally be harmful to a human body. Infections could be particularly harmful to non-small cell lung cancer patients as they would affect cancer patients a lot more drastically than they would affect the average healthy person. Because of a decreased neutrophil white blood cell count that cancer patients already suffer from (Cancerorg, 2015), the addition of cisplatin or carboplatin increasing the risk of infection would mean that as a result of this treatment patients would be incredibly vulnerable to infections and could cause a lot of complication for the operating doctors and nurses in the future treatment of this patient. //The drugs used in chemotherapy also have a level of toxicity which means that the level of dosage is especially important as too low will make the entire treatment process obsolete as the treatment will be ineffective however too high would have toxic side effects such as nausea and diarrhoea (John P. Cunha, 2017). Cisplatin can also cause temporary infertility in men, and if all sperm cells are killed by the chemotherapy treatment it can become permanent, if after 4 years the patient is not producing sperm, it is unlikely to return (American cancer
There are main types of surgery for non-small cell lung cancer including Lobectomy, Pneumonectomy, Sleeve resection and Segmentectomy (American cancer society, 2016). Pneumonectomy is the removal of an entire lung and involves multiple lobes being removed. Despite the misconception that would cause breathing issues, breathlessness will only affect a patient if this was a problem for them before the surgery took place. Lobectomy is the removal of one lobe if the cancer hasn’t spread to other lobes or parts of the body this treatment is desirable. Wedge resection, Segmentectomy and Sleeve resection is the removal of a small section of the lung. They are only really used if the cancer is detected and diagnosed very early and is contained in a very small area (Cancer research UK, 2017).
Before the surgery takes place, the patient’s health and heart need to be checked to determine whether the patients overall healthy enough to undergo. If the tests show positive results, it is safe for the patient to be surgically operated on. The tests include; general health checks, blood test and chest x-rays. In cases where the chosen surgery is a Pneumonectomy, then the patient will also be examined for any breathing difficulties.
When is it chosen?
Lobectomy can be thought of as the most effective type of surgery, and involves removing an entire lobe of the lung.
American Cancer Society has decided the most effective treatment for non-small cell lung cancer to be surgery, “if surgery can be done” (American cancer society,2016). This is of interest as although surgery may be a very effective treatment, its only in certain situations and is not possible in all instances. Surgery is a rarely selected treatment choice once non-small cell lung cancer reaches the advanced stages as it is most effective if the tumour is in a small area and by stage iii or iv the cancer has spread to other parts of the lungs and the body. In cases where surgery has been used and the cancer cells have spread to other places of the body or metastasized, what would happen is the cancer would re-emerge. This makes surgery ineffective on its own around stage iii and iv due to the fact the cancer is not being cured.
From the same article, American Cancer Society have mentioned that surgery can be used to remove the cancer “often along with other treatments” (American cancer society,2016). This is noteworthy because surgery is often used in combination with chemotherapy, and this is called adjuvant therapy, and can have very good outcomes (Cancernet, 2017). The surgery can kill the bulk of the cancer cells and the chemotherapy is used to target cancer cells that have reached other parts of the body. This makes the treatment much more effective and reduces the chance of the cancer reemerging.
The pitfalls of adjuvant therapy, would be the same as the pitfalls of the second treatment chosen. In cases where chemotherapy is used to compliment surgery, alongside the disadvantages of surgery, patients will also suffer from the chemotherapy side effects and negatives that come with the treatment. Another issue surrounding adjuvant therapy is that if adjuvant therapy is used unnecessarily administered the patient will suffer from the side effects but not reap any benefits, however if doctors are reluctant to treat patients this way, the cancer has a chance of reemerging. This is the reason, surgery and chemotherapy are not recommended for patients with stage iA non-small cell lung cancer, but for patients with stage iB, (Cancernet, 2017) as by this stage the cancer has become more advanced and therefore needs the chemotherapy to decrease the chance that the cancer will reemerge.
The time taken to recover from lung surgery is reliant on how much of the lung was removed and the patients’ health before the treatment, however there are side effects that can prolong the time it takes for the patient to recover. If there are no complications, most patients will recover from surgery in the timespan of weeks and months, however in some cases the surgery can cause excess bleeding, infections and pneumonia (American cancer society, 2016). These are very severe side effects and would not only decrease the patient’s quality of life during the recovery period, but also could lead to more treatment for the patient. Depending on the severity of the case pneumonia is not usually a life-threatening disease and can be treated. However, due to the fact that non-small cell lung cancer patients have a weakened immune system and a lower neutrophil white blood cell count, these patients are particularly vulnerable to developing a serious case of pneumonia along with other harmful infections. In Larry Nichols, Rachel Saunders and Friendrich D Knollmann’s research regarding ‘The Causes of Death of Patients with Lung Cancer’, they concluded that in 30 cases that “Infection was the immediate cause of death for 20 patients, including … 12 with pneumonia” (Larry Nichols, Rachel Saunders & Friedrich D. Knollmann, 2012). Although the sample group is incredibly small, this data showcases how severe of a matter it is when a cancer patient becoming infected by any disease, even more so when it is pneumonia.