Lung Cancer: First Steps

Lung cancer normally has no early symptoms. Early lung cancer may not cause any noticeable symptoms and may only be discovered when an x-ray is done for other reasons such as diagnosing pneumonia, emphysema or COPD which have similar symptoms of shortness of breath, chest pain, wheezing, or a cough that doesn't go away.

Though the major cause of lung cancer is cigarette smoking, other causes are high levels of air pollution, high levels of arsenic in drinking water, radon gas, asbestos, lung radiation therapy, family history of lung cancer, and exposure to uranium, nickel chromates, coal products, mustard gas, gasoline, and diesel exhaust.

There are two types of lung cancer '" non-small cell lung cancer, which is the most common type that grows and spreads slowly and has the highest cure rate, and small cell lung cancer, which is an aggressive cancer that spreads quickly. In order to be able to treat lung cancer, the type of cancer and staging must be determined. Staging involves the evaluation of the cancer's size and amount of penetration into surrounding tissues.

In the absence of symptoms requiring an x-ray, many otherwise healthy patients may go years without knowing they have lung cancer. Once an abnormality appears on an x-ray, your doctor may order a follow-up x-ray several weeks later to see if the "spot" disappears, which may indicate that it had been a lung infection. If the abnormality exists on the 2^nd x-ray, there are other tests that can be given. One is sputum cytology which tests phlegm for cancer cells. A chest CT scan is performed to verify the size and shape of what was seen on the x-ray. A PET scan is fairly conclusive in detecting cancer cells because of the use of a glucose radioisotope that gravitates towards any cancer cells in the body. If there is no cancer, the glucose radioisotope doesn't show up on the scan.

When cancer is suspected, a lung biopsy should promptly be done to determine what type and stage of cancer is involved to start treatment. There are five main types of lung biopsy that are used today: a bronchoscopy with biopsy, a Pleural biopsy, a CT Scan-directed needle biopsy, a mediastinoscopy which use lung tissue samples, and an open lung biopsy done in which a surgeon removes a small piece of lung for evaluation instead of just some lung tissue.

I had a mild case of pneumonia in April, and my pulmonologist sent me for a follow-up x-ray in May to make sure it was cured by medication. There was a cloudy spot on the lower left lung that seemed not to clear up, so he sent me for another follow-up x-ray in early June. By that time, the cloudy spot cleared up, but there was a definite solid-looking spot in the same area, which he showed to me on his office computer. My doctor then sent me for a CT scan in mid-June. The solid-looking spot was still there and he suspected cancer. Though he wanted me to have a lung biopsy, he had to confer with my cardiologist who had put me on the antiplatelet medication Plavix after a stent placement in February. Normally, heart attack patients with stent placement must be on Plavix 6 months to a year to prevent the stent from closing. Plavix is a potent blood thinner that could cause hemorrhage during surgery, including a biopsy.

When my cardiologist refused to take me off Plavix just for 7 days, I had to refuse the biopsy. I suggested, and my pulmonologist agreed, to have a PET scan done instead. I was hopeful that the glucose radioisotope would not find any cancer to adhere to. In mid-July, the PET scan results were in and there was a strong indication cancer was present. In order to treat the cancer, I still needed the biopsy and my lung doctor convinced my cardiologist to pull me off Plavix a week before the procedure.

I had a CT scan-directed needle biopsy done July 29^th at the local hospital. I have to admit I was extremely nervous, especially because there is always a chance a lung can collapse during the procedure. And, after receiving a mild sedation and enduring the approximate 1 hour procedure, my lung did collapse. After a tube was inserted to re-inflate my lung and drain excess blood, I was admitted to a private room for over 2 days. On the first day, it felt like a baby elephant was laying on my chest. The pain upon inhaling finally subsided, the tube was removed on the 31^st, and I was discharged. I'll get the biopsy results when I see my oncologist on August 3^rd.

Much as I didn't want to go through with the biopsy, and as much as I wanted to believe I'm cancer free, this early intervention has given me the chance to fight "the fight" the way it should be fought.