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The Lungs Your lungs are a pair of large organs in your chest. They are part of your respiratory system. Air enters your body through your nose or mouth. It passes through your windpipe (trachea) and through each bronchus, and goes into your lungs. When you breathe in, your lungs expand with air. This is how your body gets oxygen. When you breathe out, air goes out of your lungs. This is how your body gets rid of carbon dioxide. Your right lung has three parts (lobes). Your left lung is smaller and has two lobes. Inside the chest are two thin layers of tissue (the pleura). One layer covers the lungs and the other layer lines the inside of your chest. Cancer Cells Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the lungs. Normal cells in the lungs and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor. Tumors in the lung can be benign (not cancer) or malignant (cancer): ■ Benign tumors: • Are rarely a threat to life • Don’t invade the tissues around them • Don’t spread to other parts of the body • Usually don’t need to be removed ■ Malignant tumors (lung cancer): • May be a threat to life • Can invade nearby organs and tissues • Can spread to other parts of the body • Often can be removed but may grow back Lung cancer cells can spread by breaking away from a lung tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. When lung cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if lung cancer spreads to the bones, the cancer cells in the bones are actually lung cancer cells. The disease is metastatic lung cancer, not bone cancer. For that reason, it is treated as lung cancer, not bone cancer. Types of Lung Cancer In 2012, more than 226,000 Americans will be diagnosed with lung cancer. The most common types are named for how the lung cancer cells look under a microscope: ■ Small cell: The cells of small cell lung cancer look small under a microscope. About 1 of every 8 people with lung cancer has small cell lung cancer. ■ Non-small cell: The cells of non-small cell lung cancer are larger than the cells of small cell lung cancer. Most (about 7 of every 8) people diagnosed with lung cancer have non-small cell lung cancer. It doesn’t grow and spread as fast as small cell lung cancer, and it’s treated differently. Staging Tests After you learn that you have lung cancer, you may need staging tests to help with decisions about treatment. Staging tests can show the stage (extent) of lung cancer, such as whether cancer cells have spread to other parts of the body. When lung cancer spreads, cancer cells are often found in nearby lymph nodes. Lung cancer cells can spread from thelung to almost any other part of the body, such as the brain, bones, other lung, liver, or adrenal gland. Staging tests may include… ■ CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your chest, abdomen, brain, or other parts of your body. You’ll receive contrast material by injection into a blood vessel in your arm or hand. For a CT scan of the abdomen, you may receive contrast material by mouth also. The contrast material makes abnormal areas easier to see. The pictures from a CT scan can show the lung tumor’s size. The pictures can also show cancer that has spread to your liver, adrenal glands, brain, or other organs. ■ PET scan: Your doctor may use a PET scan to get a better view of the tumor in the lung or to find cancer that has spread. You’ll receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in the body. Because cancer cells use sugar faster than normal cells, areas with cancer cells look brighter on the pictures. ■ MRI: A strong magnet linked to a computer is used to make detailed pictures of your head or spine. An MRI can show whether cancer has spread to these areas. Sometimes contrast material is used to make abnormal areas show up more clearly on the picture. ■ Bone scan: A small amount of a radioactive substance will be injected into a blood vessel. The radioactive substance travels through your bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of your bones. Because higher amounts of the radioactive substance collect in areas where cancer is present, the pictures can show cancer that has spread to the bones. Other tests may be needed. For example, your doctor may remove samples of lymph nodes or other tissues to see whether lung cancer has spread. Stages The stage of lung cancer depends mainly on… ■ The size of the lung tumor ■ How deeply the tumor has invaded nearby tissue, such as the chest wall ■ Whether lung cancer cells have spread to lymph nodes or other parts of the body Stages of Non-small Cell Lung Cancer Doctors describe the stages of non-small cell lung cancer using the Roman numerals I, II, III, and IV. Stage I is early-stage cancer, and Stage IV is advanced cancer that has spread to other parts of the body, such as the bones. Occult Stage Lung Tumor Tumor cells are found in sputum, but CT scans and other imaging tests don’t show a lung tumor. Stage 0 Lung Tumor Abnormal cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A Stage 0 tumor is also called carcinoma in situ. It is not an invasive cancer. Stage I Lung Cancer The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is surrounded by normal tissue, and it doesn’t invade nearby tissues, such as the chest wall. The tumor is no more than 5 centimeters (about 2 inches) across. Cancer cells are not found in nearby lymph nodes. Stage II Lung Cancer The lung tumor is smaller than 7 centimeters across, and cancer cells are found in nearby lymph nodes. Or, cancer cells are not found in nearby lymph nodes. The lung tumor is more than 5 centimeters across, or it invades nearby tissues, such as the chest wall, diaphragm, pleura, main bronchus, or tissue that surrounds the heart. More than one malignant tumor may be found within the same lobe of the lung. Stage III Lung Cancer The tumor may be any size. More than one malignant tumor may be found within the lung. Cancer cells may be found in lymph nodes on either side of the chest or the neck. The tumor may have invaded nearby organs, such as the heart, esophagus, or trachea. Stage IV Lung Cancer Malignant tumors are found in both lungs. Or, the lung cancer has spread to other parts of the body, such as the brain, bones, liver, or adrenal glands. Or, cancer cells are found in fluid between the two layers of pleura. (See page 1 for picture of pleura.) Stages of Small Cell Lung Cancer Most doctors describe the stages of small cell lung cancer with two stages: • Limited stage: Cancer is found only on one side of the chest. ■ Extensive stage: Cancer is found in the lung and also in tissues on the other side of the chest. Or, lung cancer is found in distant organs, such as the brain, or in fluid between the two layers of pleura. (See page 1 for picture of pleura.) Instead of limited and extensive stage, some doctors describe the stages of small cell lung cancer using the Roman numerals I, II, III, and IV (see Stages of Non-small Cell Lung Cancer). Treatment People with lung cancer have many treatment options. Treatment options include… ■ Surgery ■ Radiation therapy ■ Chemotherapy ■ Targeted therapy The treatment that’s right for you depends mainly on the type and stage of lung cancer. You may receive more than one type of treatment. Doctors Who Treat Lung Cancer Your health care team will include specialists. There are many ways to find doctors who treat lung cancer: ■ Your doctor may be able to refer you to specialists. ■ You can ask a local or state medical society, or a nearby hospital or medical school for names of specialists. Your health care team may include the following specialists: ■ Chest surgeon: A chest surgeon (thoracic surgeon) specializes in surgery on the lungs and other organs inside the chest. You may wish to find an expert in lung cancer surgery. ■ Thoracic surgical oncologist: A thoracic surgical oncologist is a surgeon who specializes in surgeries on lung tumors and other tumors found inside the chest. ■ Medical oncologist: A medical oncologist is a doctor who specializes in treating cancer with drugs, such as chemotherapy and targeted therapy. ■ Radiation oncologist: A radiation oncologist is a doctor who specializes in treating cancer with radiation therapy. Your health care team may also include an oncology nurse, a social worker, and a registered dietitian. If you have trouble breathing, your doctor may refer you to a pulmonologist (lung specialist) or a respiratory therapist. Your health care team can describe your treatment options, the expected results of each option, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for everyone, and they may even change from one treatment session to the next. You and your health care team can work together to develop a treatment plan. Lung cancer is hard to control with current treatments. For that reason, many doctors encourage people with this disease to consider taking part in a research study (clinical trial) of new treatment methods. Research studies are an important option for people with any stage of lung cancer. Second Opinion Before starting treatment, you might want a second opinion about your diagnosis and treatment options. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some insurance companies actually require a second opinion. If you get a second opinion, the second doctor may agree with your first doctor’s diagnosis and treatment recommendation. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you’ve looked at all of your options. It may take some time and effort to gather your medical records and see another doctor. In most cases, it’s not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with lung cancer need treatment right away. For example, a doctor may advise a person with small cell lung cancer not to delay treatment more than a week or two. Surgery Surgery may be an option for people with early-stage lung cancer. The surgeon usually removes only the part of the lung that contains cancer. Most people who have surgery for lung cancer will have the lobe of the lung that contains the cancer removed. This is a lobectomy. In some cases, the surgeon will remove the tumor along with less tissue than an entire lobe, or the surgeon will remove the entire lung. The surgeon also removes nearby lymph nodes. After lung surgery, air and fluid will collect in the chest. A chest tube that was inserted during surgery will allow the fluid to drain. Also, a nurse or respiratory therapist will teach you coughing and breathing exercises. You’ll need to do these exercises several times a day. The chest tube will be removed a few days after surgery. The time it takes to heal after surgery is different for everyone. Your hospital stay may be a week or longer. It may be several weeks before you return to normal activities. Medicine can help control your pain after surgery. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief. Radiation Therapy Radiation therapy is an option for people with any stage of lung cancer: ■ People with early lung cancer may choose radiation therapy instead of surgery. ■ After surgery, radiation therapy can be used to destroy any cancer cells that may remain in the chest. ■ In advanced lung cancer, radiation therapy may be used with chemotherapy. ■ Radiation therapy can be used to help shrink a tumor that is blocking the airway. ■ Radiation therapy can be used to help relieve pain from lung cancer that has spread to the bones or other tissues. ■ Radiation therapy is often used to treat lung cancer that has spread to the brain. The radiation comes from a large machine. The machine aims high-energy rays at your body to kill cancer cells. The treatment affects cells only in the area being treated, such as the chest area. You’ll go to a hospital or clinic for treatment. Treatments are usually 5 days a week for about 6 weeks. Each treatment session usually lasts less than 20 minutes. Although radiation therapy is painless, it may cause other side effects. The side effects depend mainly on how much radiation is given and the part of your body that is treated. Ask your health care team to describe the side effects that you might expect during or after radiation therapy. Radiation therapy aimed at the chest may cause a sore throat, cough, or shortness of breath. When you try to swallow, you may feel a lump in your throat or burning in your chest or throat. Your health care team can suggest ways to manage these problems. The problems usually go away when treatment ends. It’s common for the skin in the chest area to become red and dry and to get darker. Sometimes the skin may feel tender or itchy. Check with your doctor before using lotion or cream on your chest. After treatment is over, the skin will heal. You’re likely to become tired during radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga. Chemotherapy Chemotherapy may be used alone, with radiation therapy, or after surgery. Chemotherapy uses drugs to kill cancer cells. The drugs for lung cancer are usually given directly into a vein (intravenous) through a thin needle. You’ll probably receive chemotherapy in a clinic or at the doctor’s office. People rarely need to stay in the hospital during treatment. The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly: ■ Blood cells: When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells. ■ Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed. ■ Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. Other possible side effects include hearing loss, joint pain, and tingling or numbness in your hands and feet. When radiation therapy and chemotherapy are given at the same time, the side effects may be worse. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends. Targeted Therapy People with non-small cell lung cancer that has spread may receive a type of treatment called targeted therapy. Several kinds of targeted therapy are used for non-small cell lung cancer. One kind is used only if a lab test on the cancer tissue shows a certain gene change. Targeted therapies can block the growth and spread of lung cancer cells. Depending on the kind of drug used, targeted therapies for lung cancer are given intravenously or by mouth. The drug enters the bloodstream and can affect cancer cells all over the body. During treatment, your health care team will watch you for side effects. You may get a skin rash, diarrhea, or mouth sores, or you may feel very tired. Other possible side effects include shortness of breath, belly pain, high blood pressure, vomiting, and swollen feet and hands. The side effects usually go away after treatment ends. Nutrition Eating well is important before, during, and after cancer treatment. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy. Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don’t taste as good as they used to. In addition, poor appetite, nausea, vomiting, mouth blisters, and other side effects of treatment can make it hard for you to eat. Follow-up Care You’ll need regular checkups (such as every 6 months) after treatment for lung cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, contact your doctor. Lung cancer may come back after treatment. Your doctor will check for the return of cancer. It may return in the chest or it may return in another part of the body, such as the bones. Checkups also help detect health problems that can result from cancer treatment. Checkups may include a physical exam, blood tests, or CT scans. Sources of Support Learning that you have lung cancer can change your life and the lives of those close to you. These changes can be hard to handle. It’s normal for you, your family, and your friends to need help coping with the feelings that a diagnosis of cancer can bring. Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities. Here’s where you can go for support: ■ Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities. ■ Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support. ■ Support groups can also help. In these groups, people with lung cancer or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.
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Primarni rak jetre započinje u hepatocitima (stanicama jetre). Ovaj tip raka naziva se hepatocelularnim karcinomom ili malignim hepatomom. Djeca mogu razviti hepatocelularni karcinom ili hepatoblastom. Kada se rak jetre širi (metastazira) izvan jetre, stanice raka imaju tendenciju širenja u obližnje limfne čvorove, kosti i pluća. Kada se to dogodi, novi tumor ima istu vrstu abnormalnih stanica kao i primarni tumor u jetri. Primjerice, ako se rak jetre raširi u kosti, stanice raka u kostima zapravo su stanice raka jetre. Bolest je metastatički rak jetre, ne rak kosti. Tretira se kao rak jetre, a ne kao rak kosti. Slično, rak koji se iz drugih organa proširi na jetru različit je od primarnog raka jetre. Stanice raka u jetri, u tom slučaju, su kao stanice u originalnom tumoru. Kada se stanice raka rašire s drugog organa (debelo crijevo, pluća ili dojku) na jetru, liječnici mogu tumor u jetri nazvati sekundarnim tumorom. U SAD-u su sekundarni tumori jetre češći nego primarni tumori. Rak jetre ponekada se naziva tihom bolešću zbog toga što u ranim fazama često nema simptoma, ali kako rak napreduje mogu se pojaviti sljedeći simptomi: Bol u gornjem dijelu abdomena na desnoj strani. Bol se može širiti u leđa i ramena. · Otečeni abdomen (nadutost) · Gubitak na težini · Gubitak apetita i osjećaji sitosti · Oslabljenost ili osjećaj umora · Vrtoglavica i povraćanje · Žuta koža i oči i tamni urin od žutice · Povišena tjelesna temperatura Navedeni simptomi nisu siguran znak raka jetre. Druge bolesti jetre i drugi zdravstveni problemi također mogu uzrokovati simptome. Osoba s navedenim simptomima trebala bi posjetiti liječnika. Samo liječnik može postaviti dijagnozu i liječiti bolest. Ukoliko pacijent pokazuje navedene simptome raka jetre liječnik može provesti jednu ili više pretraga: Tjelesni pregled – liječnik opipava abdomen kako bi provjerio, odnosno, utvrdio kvržice ili promjene u veličini na jetri, slezeni i drugim organima. Liječnik također provjerava prisustvo ascitesa (abnormalne nakupine tekućine u abdomenu). Liječnik može pregledati kožu i oči u potrazi za znakovima žutice. · Krvne pretrage · CT · Ultrazvuk · MRI · Angiogram · Biopsija Stadij raka jetre Ukoliko se dijagnosticira rak jetre, liječnik treba znati stadij ili razmjer bolesti kako bi isplanirao najbolji tretman za pacijenta. Utvrđivanje stadija bolesti zapravo je pokušaj određivanja veličine tumora, da li se bolest proširila i ukoliko je – na koje dijelove tijela, da li se tumor može odstraniti operacijom. Tretman Mnogi pacijenti s rakom jetre žele imati aktivnu ulogu pri odlučivanju o tretmanu. Žele naučiti sve što mogu o svojoj bolesti i odabiru tretmana. Međutim, šok i stres koji pacijenti dožive kada čuju dijagnozu otežava im razmišljanje o svemu što bi željeli pitati liječnika. Često pomaže sastaviti listu pitanja prije susreta s liječnikom. Kako bi zapamtili sve što liječnik kaže, pacijenti mogu uzimati zabilješke ili povesti člana obitelji. U današnje vrijeme se rak jetre može izliječiti samo ukoliko se otkrije u ranoj fazi (prije nego što se proširi) i samo ako je pacijentovo opće zdravstveno stanje dovoljno dobro da podnese operaciju. Međutim, osim operacije postoje i drugi tretmani koji mogu pomoći u kontroli bolesti, pomoći da se pacijenti bolje osjećaju i produžiti im život. Lokalizirani operabilni rak Lokalizirani operabilni rak jetre je rak koji se može odstraniti tijekom operacije te nema dokaza da se rak proširio na obližnje limfne čvorove ili druge dijelove tijela, a laboratorijski testovi ukazuju na dobru funkciju jetre. Operacija kojom se odstranjuje dio jetre naziva se hepatektomija. Opseg operacije ovisi o veličini, broju i lokaciji tumora i o tome koliko jetra dobro radi. Liječnik može odstraniti dio tkiva koje sadrži tumor, cijeli režanj ili veći dio jetre. Kod djelomične hepatektomije kirurg odstranjuje tumor do granice normalnog tkiva koje preuzima funkciju jetre. Kod nekih pacijenata opcija može biti transplantacija jetre. Kod ove procedure kirurg odstranjuje cijelu jetru i zamjenjuje je zdravim organom od donora. Transplantacija jetre je opcija samo ako se bolest nije proširila izvan jetre i samo ako se može pronaći odgovarajući donor. Lokalizirani neoperabilni rak Lokalizirani neoperabilni rak ne može se odstraniti operacijom iako se nije proširio na obližnje limfne čvorove ili druge dijelove tijela. Operacija nije moguća zbog ciroze (ili drugih stanja koja dovode do oslabljene funkcije jetre), lokalizacije tumora unutar jetre ili drugih zdravstvenih problema. Pacijenti s lokaliziranim neoperabilnim tumorom mogu biti pogodni za druge oblike tretmana kojima se nastoji kontrolirati bolest i produžiti život. Uznapredovali rak Uznapredovali rak je rak koji se nalazi u oba jetrena režnja ili koji se proširio na druge dijelove tijela. Iako se uznapredovali rak ne može izliječiti neki pacijenti primaju terapiju kojom se nastoji usporiti progresija bolesti. Drugi pacijenti, nakon razmatranja dobrobiti i štete od terapije odlučuju kako ne žele terapiju. Tretman uznapredovalog raka uključuje kemoterapiju i/ili radioterapiju. · Kemoterapija – predstavlja upotrebu lijekova koji ubijaju stanice raka. Pacijent može primiti jedan lijek ili kombinaciju lijekova. · Radioterapija – koriste se visoko-energetske zrake kako bi se ubile stanice raka. Radioterapija je lokalna terapija, odnosno, djeluje na stanice raka koje se nalaze u tretiranom području. Recidivirajući rak Recidivirajući rak predstavlja bolest koja se vraća nakon inicijalnog tretmana. Čak i kada se čini da je rak u jetri u potpunosti odstranjen ili uništen bolest se ponekad vraća zbog neopaženih stanica raka koje su ostale negdje u tijelu nakon tretmana. Rak se najčešće ponovno pojavljuje u periodu od dvije godine od tretmana