Is Lung Cancer Curable: The Journey Towards Hope

Many times, my Lung Cancer patients or their close ones ask me a rather poignant question: “Is lung cancer curable?” Today, in this blog post, I have decided to shed some light on the question of curability of Lung Cancer.  There is no easy answer to this question, and the answer has to be individualised based on a lot of parameters. Let me take you briefly through the journey from diagnosis to treatment of Lung Cancer. I hope to offer insight and instil hope for those affected by this formidable disease.

What type of Lung Cancer is the patient suffering from?

There are mainly two types of Lung Cancer: Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC). 

Non Small Cell Lung Cancer (NSCLC)

They constitute about 80% to 85% of lung cancers. The main subtypes of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These cancers subtypes are classified based on the cell of their origin and are grouped together as NSCLC because they share commont treatment plans and prognoses (outlooks). The different subtype of NSCLC include: 

• Adenocarcinoma: Lung adenocarcinoma starts in cells in the lung that make mucus, called epithelial cells. Adenocarcinoma is the most common type of non-small cell lung cancer. 
• Squamous cell Lung carcinoma: Squamous cell carcinoma starts in squamous cells, which are flat cells that line the inside of the airways in the lungs. 
• Large cell (undifferentiated) Lung carcinoma: Large cell carcinoma can appear in any part of the lung. It tends to grow and spread quickly, which can make it harder to treat. A relatively fast growing variant of Large Cell Lung Cancer is large cell neuroendocrine carcinoma (LCNEC) that is very similar to small cell lung cancer.
• Other subtypes: A few other subtypes of NSCLC, such as adenosquamous carcinoma and sarcomatoid carcinoma, are much less common.

Small cell lung cancer (SCLC)

About 10% to 15% of all lung cancers are SCLC. It groes rapidly and spreads faster and hence is usually detected at an advanced stage thereby displaying a relatively worse outcome than non small cell Lung Cancer. 

The type of Lung cancer affects the survival. In general, the 5-year survival rate of Non-small cell Lung cancer is 23% (overall, it depends on a lot of other factors like stage of disease, age and general health). In comparison, for small cell lung cancer, the overall 5-year survival rate is 8% for women and 6% for men. So patients with small cell lung cancer are less likely to achieve cure. 

What is the stage of Lung Cancer? Understanding Lung Cancer Survival:

The stage of Lung cancer tells us to what extent has the Lung cancer grown and whether it is still limited to lung or has spread to nearby or distant organs. Based on the three parameters which are Tumour Characteristics (size, location direct involment of nearby organs), Nodal Status (spread to lymph nodes within the lungs or distant lymph nodes) and Distant Spread  to other organs, Lung Cancer is divided into four stages. The lower the stage at the time of diagnosis and treatment, the higher is the survival rate and higher the chance of cure. 

Stage-Wise Survival Rates:

Stage I: Lung cancer is classified as stage 1 if it is limited to the lung. At this stage, the chances of achieving a cure for Lung cancer are highest. The five-year survival rate for stage I non-small cell lung cancer (NSCLC) can exceed 60-80% with appropriate treatment, including surgery, radiation therapy, or a combination of both.

Stage II: In stage 2 lung cancer, the disease has spread to nearby lymph nodes but is still confined to within the lung. The five-year survival rate in stage 2 Lung cancer ranges from 40-60%, depending on factors such as tumour size, location, and patient’s overall health. Treatment typically is multidisciplinary and involves surgery followed by adjuvant chemotherapy or radiation therapy.

Stage III: When Lung Cancer has involved adjacent organs or has spread to opposite side lymph nodes, it is considered as locally advanced and is classified as stage 3 Lung cancer. The five-year survival rate for stage III NSCLC ranges from 20-40%. Treatment options may include a combination of surgery, chemotherapy, radiation therapy, and targeted therapy.

Stage IV: Stage 4 is the final stage of Lung Cancer in which lung cancer has spread to distant organs and carries a poor prognosis. The five-year survival rate for stage IV NSCLC is typically less than 10%. At this stage cure is elusive and disease can only be controlled. The outlook, though, is improving with newer treatment approaches such as immunotherapy and targeted therapy showing promise and prolonging survival.

So Is Lung Cancer Curable?

The answer depends on the stage of Lung Cancer at the time of diagnosis coupled with appropriate and timely  treatment. For patients with very early screen-detected lung cancer the outcomes are excellent with long term survival  and cure achievable. 

So it is clear that key to surviving lung cancer is catching it in its earliest stages, when it is most treatable. For patients who have small, early-stage lung cancer, the cure rate can be as high as 80% to 90%. There is a precipitous drop in survival and cure rates as the tumor becomes more advanced and involves lymph nodes or other parts of the body. 

Improving Survival and Enhancing Treatment Outcomes:

The only thing that has shown to improve survival for lung cancer patient, is early diagnosis. The following strategies can help improve survival and enhance treatment outcomes:

Early Detection: 

Awareness of symptoms of Lung Cancer is important because of their non-specific nature. A high index of suspicion should be kept. Moreover, Lung cancer may not produce noticeable symptoms in the early stages, and most people with symptoms usually present at an advanced stage. So any person with persistent symptoms listed below should consult a healthcare provider:

• A new cough that does not go away
• Blood in cough
• Changes in a chronic cough
• Shortness of breath 
• Pain in the chest area
• Persistent wheezing
• A raspy or hoarse voice
• Unplanned weight loss
• Bone pain
• Worsening headaches

Regular screening with low-dose computed tomography (LDCT) can detect lung cancer at an early stage when it is most treatable, leading to better outcomes and higher survival rates. Lung cancer screening is recommended for people who meet these criteria:

• Have a 20 pack-year or more smoking history, and
• Smoke now or have quit within the past 15 years, and
• Are between 50 and 80 years old.

A pack-year is smoking an average of one pack of cigarettes per day for one year.

Multidisciplinary Care: Collaborative approaches involving thoracic surgeons, medical oncologists, radiation oncologists, and other healthcare professionals ensure comprehensive and personalised treatment plans tailored to individual patient needs. A multidisciplinary team approach is must for ensuring individualised treatment plan best suited for the patient. 

Advancements in Treatment: Emerging therapies like Minimally invasive chest surgery including Video-Assisted Thoracic Surgery for Lung Cancer and Robotic Surgery for Lung cancer, targeted therapy, immunotherapy, and precision medicine offer new avenues for treating lung cancer and improving survival rates, particularly in advanced stages of the disease.

Lifestyle Modifications: Encouraging patients to adopt healthy lifestyle habits such as smoking cessation, exercise, and a balanced diet can help mitigate risk factors and improve overall health, contributing to better treatment outcomes and prognosis.

Conclusion:

In conclusion, the question “Is lung cancer curable?” does not have a simple answer, as it depends on various factors including the stage of the disease, treatment approach, and individual patient factors. However, with advancements in early detection methods, innovative treatment modalities, and comprehensive multidisciplinary care, the outlook for lung cancer patients continues to evolve positively. As a thoracic surgeon committed to improving patient outcomes, I am dedicated to navigating this journey with compassion, expertise, and a relentless pursuit of hope.