The top three cancers– breast, colorectal and lung cancers – contributed 43.9% of all cancers (excluding non-melanoma skin cancer). Cervical cancer was the fourth most common cancer in women, contributing 6.9% of the total number of new cases diagnosed in 2018.

The most common cancers in India are breast cancer, cervical cancer and oral. Breast Cancer is one of the leading diseases in India. Lung cancer, also known as lung carcinoma, is a malignant lung tumour characterized by uncontrolled cell growth in tissues of the lung. This growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body. Most cancers that start in the lung, known as primary lung cancers, are carcinomas.

The two main types are small-cell lung carcinoma (SCLC) and Non-small-cell lung carcinoma (NSCLC). The most common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest pains.
The three main subtypes of NSCLC are adenocarcinoma, squamous-cell carcinoma, and large-cell carcinoma.
The vast majority (85%) of cases of lung cancer are due to long-term tobacco smoking. About 10–15% of cases occur in people who have never smoked. These cases are often caused by a combination of genetic factors and exposure to radon gas, asbestos, second-hand smoke, or other forms of air pollution. Lung cancer may be seen on chest radiographs and computed tomography (CT) scans. The diagnosis is confirmed by biopsy which is usually performed by bronchoscopy or CT-guidance.

Signs and symptoms which may suggest lung cancer include:

* Respiratory symptoms: coughing, coughing up blood, wheezing, or shortness of breath
* Systemic symptoms: weight loss, weakness, fever, or clubbing of the fingernails
* Symptoms due to the cancer mass pressing on adjacent structures:
   chest pain, bone pain, superior vena cava obstruction, or difficulty swallowing

If the cancer grows in the airways, it may obstruct airflow, causing breathing difficulties. The obstruction can also lead to accumulation of secretions behind the blockage, and predispose to pneumonia.

Smoking

Tobacco smoking is by far the main contributor to lung cancer. Cigarette smoke contains at least 73 known carcinogens, including benzopyrene, NNK, 1,3-butadiene, and a radioactive isotope of polonium – polonium-210. Across the developed world, 90% of lung cancer deaths in men and 70% of those in women during the year 2000 were attributed to smoking. Smoking accounts for about 85% of lung cancer cases.

Investigations:

*  X-Ray Chest
*  CBC, LFT
*  HR-CT
*  CT guided biopsy
*  MRI brain
*  PET- scan
*  Lung- panel HER, MET, PDl-1

Classification:
 
Pie chart showing incidences of non-small cell lung cancers as compared to small cell carcinoma shown at right, with fractions of smokers versus non-smokers shown for each type.

Non-small-cell lung carcinoma

Nearly 40% of lung cancers are adenocarcinoma, which usually comes from peripheral lung tissue. Although most cases of adenocarcinoma are associated with smoking, adenocarcinoma is also the most-common form of lung cancer among people who have smoked fewer than 100 cigarettes in their lifetimes ("never-smokers") and ex-smokers with a modest smoking history. A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have a better long-term survival.

Squamous-cell carcinoma causes about 30% of lung cancers. They typically occur close to large airways. A hollow cavity and associated cell death are commonly found at the center of the tumor.

Nearly 9% of lung cancers are large-cell carcinoma. These are so named because the cancer cells are large, with excess cytoplasm, large nuclei, and conspicuous nucleoli.

Small-cell lung carcinoma

In SCLC, the cells contain dense neurosecretory granules (vesicles containing neuroendocrine hormones), which give this tumor an endocrine or paraneoplastic syndromeassociation. Most cases arise in the larger airways (primary and secondary bronchi).Sixty to seventy percent have extensive disease (which cannot be targeted within a single radiation therapy field) at presentation.

Management

Treatment for lung cancer depends on the cancer's specific cell type, how far it has spread, and the person's performance status. Common treatments include palliative care, surgery, chemotherapy, and radiation therapy. Targeted therapy of lung cancer is growing in importance for advanced lung cancer.

Chemotherapy

The chemotherapy regimen depends on the tumor type. SCLC, even relatively early stage disease, is treated primarily with chemotherapy and radiation. In SCLC, cisplatin and etoposide are most commonly used. Combinations with carboplatin, gemcitabine, paclitaxel, vinorelbine, topotecan, and irinotecan are also used. In advanced NSCLC, chemotherapy improves survival and is used as first-line treatment, provided the person is well enough for the treatment. Typically, two drugs are used, of which one is often platinum-based (either cisplatin or carboplatin). Other commonly used drugs are gemcitabine, paclitaxel, docetaxel, pemetrexed, etoposide or vinorelbine. Platinum-based drugs and combinations that include platinum therapy may lead to a higher risk of serious adverse effects in people over 70 years old.

Targeted and immunotherapy

Several drugs that target molecular pathways in lung cancer are available, especially for the treatment of advanced disease. Erlotinib, gefitinib and afatinib inhibit tyrosine kinase at the epidermal growth factor receptor. Denosumab is a monoclonal antibody directed against receptor activator of nuclear factor kappa-B ligand. It may be useful in the treatment of bone metastases.

Immunotherapy may be used for both SCLC and NSCLC.

Palliative care

Palliative care when added to usual cancer care benefits people even when they are still receiving chemotherapy. These approaches allow additional discussion of treatment options and provide opportunities to arrive at well-considered decisions. Palliative care may avoid unhelpful but expensive care not only at the end of life, but also throughout the course of the illness. For individuals who have more advanced disease, hospice care may also be appropriate.

Prognosis: Timeline of lung cancer

Lung cancer was uncommon before the advent of cigarette smoking; it was not even recognized as a distinct disease until 1761. Different aspects of lung cancer were described further in 1810. Malignant lung tumors made up only 1% of all cancers seen at autopsyin 1878, but had risen to 10–15% by the early 1900s. Case reports in the medical literature numbered only 374 worldwide in 1912, but a review of autopsies showed the incidence of lung cancer had increased from 0.3% in 1852 to 5.66% in 1952. In Germany in 1929, physician Fritz Lickint recognized the link between smoking and lung cancer, which led to an aggressive antismoking campaign. The British Doctors' Study, published in the 1950s, was the first solid epidemiological evidence of the link between lung cancer and smoking. As a result, in 1964 the Surgeon General of the United States recommended smokers should stop smoking.

Ayurvedic formulations help full in lung cancer

* Kanchnar Guggalu
* Sahajana (Moringa oleifera)
* Chitrak (Plumbago Zeylenica)
* Sariva (Hemidesmus Indicus)
* Ashwagandha (Withania Somnifera)
* Giloy (Tinospora Cordifolia)
* Bhui Amla Phyallantus Amarus)
* Mehandi (Lawsonia Inermis)
* Pashanbhed (Bergenia Ciliata)
* Atibala (Abutilon Indicum)
* Kankol (Piper Cubeba)
* Rohitaka (Tecomella Undulata)
* Kalmegh (Andrographis Peniculata)
* Neem Patra (Azadirecta Indica)
* Nagkeshar (Mesua ferrea)
* Shatavari (Asperagns Racemosus)
* Adusa (Adhatoda Vasica)
* Bhringraj (Eclipta Alba)
* Punernava (Boerhavia Diffusa)
* Mulethi (Glycyrhiza Glabra)
* Haldi (Curcumo Longa)
* Tulsi (Ocimum Sanctum )
* Pipal Chhal (Ficus religiosa)
* Manjistha (Rubia cardifolia)
* Makoi Chhal (Solanum nigrum)
* Gular Chhal (Ficus Racemosa)
* Vata Chhal (Ficus Benghalensis)
* Lodhra (Symplocos Racemosa)
* Sahdevi (Vernonia Cinerea)
* Van-Kakdt (Podophyllum hexanrum)
* Sada Pushpi (Cathauranthus Roseus)
* Trikatu
* Shilajeet (Asphaltum)
* Gojala liquid to make palatable sweetner base and permitted, Excipients and preservatives used.
* Gomutra
* Godugdha
* Swarn bhashma
* Rudra rasha

Written jointly with Rachana Tiwari MD scholar, Rog Nidan
and under guidance of
1. GUIDE -Dr. Sipra Sasmal (MD.), Professor and HOD.
2. CO-GUIDE- Dr. A.K.Singh(MD), Professor and Principal, Subdeep Ayurvedic College Indore MP