Text by Henrylito D. Tacio
WHAT do Hollywood actors John Wayne, Gary Cooper, and Humprey Bogart – all Oscar winners – veteran Asian journalist Albert Ramalingam, Filipino broadcaster Angelo Castro, Jr., Bangladeshi state minister of education Mohammad Yunus Khan, prominent Singaporean Christian leader Benjamin Chew, Malaysian diplomat Zain Azraai, and Singapore’s first chief minister David Marshall have one thing in common?
They all died of lung cancer, that’s what.
Lung cancer is one of the world’s deadliest diseases. Almost two million people worldwide are diagnosed with lung cancer each year. “Only about 250,000 of them (less than one in six) will remain alive five years later,” claimed Dr. Ted Hamilton, medical director of Florida Hospital Central Care in Orlando, Florida.
Although lung cancer strikes mostly men, women are not spared from it. Among those who died of lung cancer were modeling pioneer Wilhelmina Cooper and Hollywood actress Betty Grable. In the Philippines, lung cancer is the third leading cause of cancer among women – after breast and cervix.
Unknowingly, more and more Filipinos are now dying of lung cancer. According to the Philippine Society of Medical Oncology (PSMO), lung cancer leads among the top five cancers leading to death in the country. Out of 100,000 Filipinas diagnosed with lung cancer, 2,500 of them die.
Among men, lung cancer ranks as the number one cause of cancer among Filipino men, the Philippine Cancer Society, Inc. (PCSI) claims. “Lung cancer is killing more Filipino men than ever before,” the society deplores.
“Lung cancer is the most common cancer in both men and women,” says The Merck Manual of Medical Information. “More importantly, it’s the most common cause of death from cancer in both men and women.”
More than 90 percent of lung cancers start in the bronchi (the large airways that supply the lungs); such cancer is called bronchogenic carcinoma. The types are squamous cell carcinoma, small cell carcinoma, large cell carcinoma, and adenocarcinoma.
Alveolar cell carcinoma originates in the air sacs (alveoli) of the lung. Although this cancer can be a single growth, it often develops in more than one area of the lung at once, according to the Merck manual.
Less common lung tumors are bronchial adenoma (which may be cancerous or non-cancerous) and sarcoma (cancerous). Lymphoma is a cancer of the lymphatic system. It may start in the lungs or spread to them.
“Many cancers that start elsewhere in the body spread to the lungs,” the Merck manual notes. “Cancers spread to the lungs most commonly from the breast, colon, prostate, kidney, thyroid, stomach, cervix, rectum, testis, bone, and skin.”
Cigarette smoking is responsible for 85 to 90 percent of lung cancers, medical experts claim. The more cigarettes a person smokes, the greater the chances of this fellow having lung cancer. As early as 1964, the US Surgeon General’s office issued the link between smoking and lung cancer.
“Lung cancer is almost exclusively found in smokers,” the Mayo Foundation for Medical Education and Research, based in Rochester, Minnesota, explains. “Men who smoke are 22 times more likely to develop lung cancer than men who don’t smoke. Women who smoke are 12 times more likely to develop lung cancer than women who don’t smoke.”
What happens when a person smokes? “The instant you inhale cigarette smoke, your heart starts providing an extra 15 to 25 beats per minute,” points out the PCSI. “Your blood pressure goes up by 20 points. Cigarette smoke and tar affect the delicate membranes of your lips and palate. They deposit dangerous poisons in your stomach, kidneys, bladder and other organs. The nicotine in a cigarette causes the release of free fatty acids, which enhances clotting of the blood. Almost immediately, smoking makes breathing hard. Within a short time, it can also worsen asthma and allergies.”
Cigarette and cigar smoke contains more than 40 cancer-causing chemicals or carcinogens. Among these most noted carcinogens are tar, cyanide, formaldehyde, methanol, ammonia, acetone, carbon monoxide, and nitrogen oxide.
Aside from lung cancer, cigarette smoking is also associated with cancers of the tongue, mouth, upper respiratory tract, oral cavity, esophagus, pancreas, kidney, and urinary bladder.
Meanwhile, there are other, well-documented – but less frequent – causes of lung cancer, including exposure to asbestos, beryllium, and various other chemicals. But the combination of chemical exposure with cigarette smoking is particularly ominous, raising the risk of contracting the disease by 10 to 50 times.
The role of air pollution in causing lung cancer is still uncertain. Exposure to radon gas in homes may be important in a small number of lung cancer cases in the United States. Occasionally, lung cancers, especially adenocarcinoma and alveolar cell carcinoma, develop in people whose lungs have been scarred by other lung diseases, such as tuberculosis and fibrosis.
The symptoms of lung cancer depend on its type, its location, and the way it spreads. Usually, the main symptom is a persistent cough. “People with chronic bronchitis who develop lung cancer often notice that their coughing becomes worse,” the Merck manual says. “If sputum can be coughed up, it may be streaked with blood. If the cancer grows into underlying blood vessels, it may cause severe bleeding.”
The cancer may cause wheezing by narrowing the airway in which or around which it’s growing. Blockage of a bronchus may lead to the collapse of the part of the lung that the bronchus supplies, a condition called atelectasis. Another consequence may be pneumonia with coughing, fever, chest pain, and shortness of breath. If the tumor grows into the chest wall, it may produce persistent chest pain.
Symptoms that arise later include loss of appetite, weight loss, and weakness. Lung cancers often cause fluid accumulations around the lung that leads to shortness of breath. If cancer spreads within the lung, severe shortness of breath, low levels of oxygen in the blood, and heart failure may develop.
The Merck manual further discusses the other symptoms when it grows in other parts of the body: “The cancer may grow into certain nerves in the neck, causing a droopy eyelid, small pupil, sunken eye, and reduced perspiration on one side of the face. Cancers at the top of the lung may grow into the nerves that supply the arm, making the arm painful, numb, and weak. Nerves to the voice box may also be damaged, making the voice hoarse.
“A cancer may grow directly into the esophagus, or it may grow near it and put pressure on it, leading to difficulty in swallowing. Occasionally, an abnormal channel (fistula) between the esophagus and bronchi develops, causing severe coughing during swallowing because food and fluid enter the lungs.
“A lung cancer may grow into the heart, causing abnormal heart rhythms, an enlargement of the heart, or fluid in the sac surrounding the heart. The cancer may grow into or around one of the large veins in the chest. Obstruction of this vein causes blood to back up in other veins of the upper body. The veins on the chest wall enlarge. The face, neck, and upper chest wall – including the breasts – swell and become tinged with purple. The condition also produces shortness of breath, headache, distorted vision, dizziness, and drowsiness.
“Lung cancer may also spread to the bloodstream to the liver, brain, adrenal glands, and bone. This may occur early in the disease, especially with small cell carcinoma. Symptoms – such as liver failure, confusion, seizures, and bone pain – may develop before any lung problems become evident.”
“Lung cancer is not easily discovered in the early stages,” says Dr. Hamilton. “It often goes undetected until it is moderately advanced. By the time it is visible on a routine chest X-ray, it has often spread to nearby tissues or to organs outside the lung.”
But mind, lung cancer can be prevented. “Cancers that are closely linked to certain behaviors are the easiest to prevent,” points out Peter Crosta in an article he wrote for Medical News Today. “For example, choosing not to smoke tobacco or drink alcohol significantly lowers the risk of several types of cancer – most notably lung, throat, mouth, and liver cancer. Even if you are a current tobacco user, quitting can still greatly reduce your chances of getting cancer.”
Indeed, the most important preventive measure you can take to avoid lung cancer is to quit smoking. “Quitting smoking will also reduce your risk of several other types of cancer including esophagus, pancreas, larynx, and bladder cancer,” Crosta writes. “If you quit smoking, you will usually reap additional benefits such as lower blood pressure, enhanced blood circulation, and increased lung capacity.”