Lung Cancer: Treatment & Care in Türkiye

Lung cancer develops when cells in the lungs grow and divide uncontrollably and abnormally. In its early stages, lung cancer often causes no symptoms. As the disease progresses, symptoms such as coughing, shortness of breath, chest pain, weight loss, and fatigue may appear. Small cell lung cancer is especially notable for its rapid growth and early tendency to spread to other parts of the body.

Lung Cancer

To understand the challenges lung cancer presents, it's important to know that it involves the uncontrolled growth of abnormal cells in the lungs. Lung cancer is a serious disease that usually begins in the lungs and is often associated with smoking, though non-smokers can also be affected. There are two main types: non-small cell lung cancer (NSCLC), which is more common and tends to grow slowly, and small cell lung cancer (SCLC), which is less common but more aggressive. Symptoms can include a persistent cough, chest pain, shortness of breath, and unexplained weight loss. Early detection is difficult because symptoms often do not appear until the cancer is advanced. Treatment options vary according to the stage and type of cancer and may include surgery, chemotherapy, radiation therapy, and targeted therapies.

Symptoms of Lung Cancer 

In its early stages, lung cancer may not cause noticeable symptoms. Some people might experience mild signs that are easy to overlook or mistake for other conditions. Unfortunately, early signs of lung cancer are often absent, making early detection difficult. Common early-stage lung cancer symptoms include:

• A persistent cough that doesn't go away or gets worse
• Mild chest pain or discomfort, especially when coughing or taking deep breaths
• Shortness of breath during physical activity or even at rest
• Fatigue or feeling unusually tired
• Wheezing or a raspy-sounding voice
• Hoarseness
• Unexplained weight loss (more noticeable in later stages)
• Coughing up small amounts of blood or blood-streaked sputum (in some cases)

Recognizing signs of lung cancer, such as a persistent cough or unexplained weight loss, is essential for early detection and effective treatment. If you notice any concerning symptoms, like a persistent cough or chest pain, it is important to consult a doctor as soon as possible.

Advanced-Stage Symptoms of Lung Cancer

As lung cancer advances and spreads, symptoms often become more severe and noticeable. Advanced-stage symptoms may include:

• Severe chest pain that may be constant or worsen with breathing or coughing
• Increased coughing or coughing up larger amounts of blood
• Shortness of breath that gets worse over time, even at rest
• Facial swelling, often due to a tumor obstructing blood flow (commonly associated with superior vena cava syndrome)
• Shoulder or upper back pain, caused by tumors pressing on nerves or other structures
• Loss of appetite and significant, unexplained weight loss
• Fatigue and weakness that significantly impact daily activities
• Difficulty swallowing, especially if a tumor is growing in or near the esophagus
• Swelling in the neck or face as the cancer spreads
• Frequent respiratory infections, such as pneumonia or bronchitis

These symptoms usually occur when cancer has spread to other organs or structures, which can complicate treatment. Anyone experiencing these advanced symptoms should seek immediate medical evaluation.

Stages Of Lung Cancer

Understanding lung cancer stages is essential for deciding on the most effective treatment and predicting outcomes. Cancer staging is based on how far the disease has spread, which helps doctors select appropriate treatments and estimate a person's prognosis.

• Stage 0: Cancer cells are confined to the upper layer of the lung or bronchus and have not spread to other parts of the lungs or beyond.
• Stage I: Cancer cells are localized within the lungs and have not spread to nearby lymph nodes. Symptoms in early stage 1 may include a persistent cough, sputum production, mild shortness of breath, chest pain, bloody sputum, weight loss, and fatigue.
• Stage II: The cancer has spread to nearby lymph nodes within the lung, or there are multiple tumors within the same lobe of the lung.
• Stage III: Cancer has spread to nearby lymph nodes or other structures within the chest, or there are multiple tumors in different lobes of the same lung. Symptoms may include severe shortness of breath, intense pain, frequent lung infections, weakness, and weight loss, although these can vary.
• Stage IV: Cancer has spread to both lungs, to the pleura (the fluid around the lungs), pericardium (the fluid around the heart), or to distant organs. Symptoms often include severe shortness of breath, intense pain, frequent pneumonia or lung infections, weakness, and weight loss. While understanding the survival rates at this stage can be helpful, it's important to remember that these are averages and individual prognoses may vary significantly.

There are two main types of lung cancer, each with its own staging system:

Non-small cell lung cancer (NSCLC)

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer, making up about 85% of cases. It is staged using the TNM system, which takes into account the size of the tumor (T), whether the cancer has spread to nearby lymph nodes (N), and if it has spread to distant parts of the body (M). NSCLC stages range from I to IV, with stage IV representing the most advanced disease.

Small cell lung cancer (SCLC)

Small cell lung cancer (SCLC) is less common, making up about 15% of lung cancer cases. It is a fast-growing and often more aggressive type than NSCLC. SCLC is classified into two stages: limited, where the cancer is confined to one lung and possibly nearby lymph nodes, and extensive, where it has spread beyond one lung to other parts of the body.

• Limited stage: The cancer is limited to one lung and may involve nearby lymph nodes.
• Extensive stage: The cancer has spread beyond one lung to the other lung, lymph nodes on the opposite side of the chest, or distant organs.

Metastatic lung cancer

Metastatic lung cancer is lung cancer that has spread from the lungs to other parts of the body. This can happen at any stage of lung cancer, but it is more common in advanced stages. The most common sites of metastasis for lung cancer include the brain, bones, liver, and adrenal glands.

The symptoms of metastatic lung cancer can vary depending on where the cancer has spread. For example, if the cancer has spread to the brain, it can cause headaches, seizures, or weakness. If it has spread to the bones, it can cause pain or fractures.

Treatment for metastatic lung cancer depends on the type of lung cancer, the extent of the spread, and the person's overall health. Treatment options may include chemotherapy, radiation therapy, targeted therapy, immunotherapy, or surgery.

Diagnosis of Lung Cancer

Diagnosing lung cancer typically involves reviewing medical history, a physical exam, imaging tests, biopsies, and molecular testing. This comprehensive approach helps determine if cancer is present, identify its type and stage, and analyze genetic features to guide treatment decisions.

Imaging Tests

Imaging tests are typically the initial step in diagnosing lung cancer. Common types include:

• Chest X-ray: A common first test used to detect abnormalities in the lungs.
• CT Scan: Produces detailed images of the lungs and surrounding areas to identify tumors, determine their size, and look for signs of metastasis.
• PET Scan: A specialized imaging technique that shows whether cancer has spread to other areas of the body.
• MRI: Frequently used to check if the cancer has spread to the brain or spine.

Biopsy Methods

Once lung cancer is suspected, a biopsy is necessary to confirm the diagnosis and determine the type of cancer. Several different biopsy techniques may be used:

• Bronchoscopy: A thin, flexible tube is passed through the mouth or nose into the lungs to collect tissue samples from a tumor.
• Endobronchial Ultrasound (EBUS): Combines bronchoscopy with ultrasound to visualize tumors and obtain tissue samples from lymph nodes or other areas within the chest.
• Needle Biopsy: A fine needle is inserted through the chest wall to remove tissue from the lung or nearby lymph nodes.
• Mediastinoscopy: A surgical procedure involving a small incision at the base of the neck to collect samples from lymph nodes near the lungs.
• Pleural Biopsy: If there is fluid buildup around the lungs (pleural effusion), a sample of this fluid is taken for testing.

Molecular Testing

Beyond confirming a lung cancer diagnosis, molecular tests help identify genetic mutations in the tumor that can guide treatment choices. Important mutations and biomarkers that may be tested include:

• KRAS: Often found in non-small cell lung cancer (NSCLC), especially among smokers. Targeted therapies for KRAS are still being developed.
• EGFR (Epidermal Growth Factor Receptor): Commonly mutated in NSCLC, particularly in non-smokers; treated with EGFR inhibitors.
• ALK (Anaplastic Lymphoma Kinase): ALK gene rearrangements can occur in lung cancer, especially in younger, non-smoking patients. ALK inhibitors are available as targeted treatment.
• ROS1: Gene rearrangements similar to ALK, found in some lung cancers (more common in non-smokers), also treatable with targeted therapies.
• BRAF: Mutations seen in a small subset of lung cancer patients; BRAF inhibitors may be effective for these cases.
• RET: RET gene fusions appear in a small percentage of lung cancers and can be addressed with specific targeted therapies.
• MET: Amplifications or mutations of the MET gene are detected in some patients with advanced NSCLC, with MET inhibitors available for treatment.
• HER2: Mutations may be present in some lung cancers, paralleling HER2's role in breast cancer, and targeted therapies are available.
• NTRK (Neurotrophic Tyrosine Receptor Kinases): Rare gene fusions that can be targeted with therapies designed to block the NTRK pathway.

Molecular tests are performed on biopsy tumor samples to identify specific mutations, enabling doctors to tailor treatment plans with targeted therapies or lung cancer immunotherapy.

Blood Tests

Blood tests help support the diagnosis and track the progression of lung cancer. Their main purposes include:

• Blood Biomarkers: Tests check for substances (tumor markers) produced by lung cancer cells, like CEA (Carcinoembryonic Antigen) and CYFRA 21-1. These markers provide information about the cancer's behavior and help monitor treatment effectiveness.
• Liquid Biopsy: This advanced technique analyzes blood for circulating tumor DNA (ctDNA) or RNA. It can detect mutations such as EGFR or KRAS, and is especially useful for monitoring treatment resistance in advanced cancer.
• Complete Blood Count (CBC): Assesses overall health and can identify anemia, infections, or other problems related to cancer or its treatment.

Additional Diagnostic Considerations

In certain situations, doctors may use additional diagnostic techniques depending on a patient's symptoms, medical history, and results from other tests:

• Sputum Cytology: Examining mucus (phlegm) coughed up from the lungs to detect cancer cells.
• Thoracoscopy: A minimally invasive procedure that lets doctors view the chest cavity directly and collect tissue samples from the lung or nearby areas.

By combining these diagnostic methods, doctors can accurately diagnose lung cancer, determine its type and stage, and develop a personalized treatment plan based on the tumor's molecular characteristics.

Treatment of Lung Cancer

Although a complete cure for lung cancer isn't always possible, advances in treatment continue to offer hope. Whether lung cancer is curable depends on its type, stage, the patient's overall health, and the presence of specific genetic mutations. Major treatment options include surgery, radiation therapy, chemotherapy, targeted drug therapy, and immunotherapy. In advanced cases, alternative and palliative care can help manage symptoms. While understanding survival rates is useful, it's important to note that these rates are averages and individual outcomes can differ significantly.

Surgery

Surgery is commonly recommended for early-stage lung cancer”especially non-small cell lung cancer”when the tumor is localized and has not spread. Surgical options include:

• Lobectomy: Removal of one of the lobes of the lung.
• Pneumonectomy: Removal of an entire lung.
• Segmentectomy or Wedge Resection: Removal of a small portion of the lung where the tumor is located.

Surgery is often combined with additional treatments, such as chemotherapy or radiation therapy, depending on the stage of the cancer.

Radiation Therapy

Radiation therapy uses high-energy rays to target and destroy cancer cells. It is frequently used alongside surgery or chemotherapy, or as a primary treatment when surgery is not feasible due to the tumor's location or the patient's overall health. Radiation therapy may be used for:

• Locally advanced lung cancer (often combined with chemotherapy)
• Palliative care to relieve symptoms caused by metastasis, such as shrinking tumors that cause pain or blockages
• Stereotactic body radiation therapy (SBRT): a precise, high-dose radiation treatment for small tumors in locations where surgery isn't possible

Chemotherapy

Chemotherapy is a systemic treatment that uses drugs to destroy cancer cells or prevent them from growing. It is most commonly used for:

• Advanced stages of lung cancer (especially when surgery is not an option)
• Neoadjuvant therapy (before surgery) or adjuvant therapy (after surgery) to kill any remaining cancer cells
• Small cell lung cancer (SCLC), which is more responsive to chemotherapy

Common chemotherapy drugs for lung cancer include cisplatin, carboplatin, paclitaxel, and docetaxel.

Targeted Drug Therapy

Targeted therapy involves drugs that specifically address molecular changes or mutations present within cancer cells. These treatments are designed to block cancer cell growth while minimizing harm to healthy cells. Targeted therapies are most often used for non-small cell lung cancer (NSCLC) with identifiable genetic mutations. Key examples of targeted therapies include:

• EGFR inhibitors: Drugs such as erlotinib, gefitinib, and osimertinib target EGFR gene mutations.
• ALK inhibitors: Crizotinib and alectinib are used to treat cancers with ALK gene rearrangements.
• KRAS inhibitors: Drugs like sotorasib are developed to target KRAS gene mutations.
• ROS1 inhibitors: Agents such as crizotinib are used for tumors with ROS1 gene rearrangements.
• BRAF inhibitors: Treatments like dabrafenib are effective for tumors with BRAF mutations.
• MET inhibitors: Capmatinib targets MET gene amplifications or mutations.

These therapies are often highly effective for patients with certain genetic mutations and may be used in combination with chemotherapy or immunotherapy.

Immunotherapy

Immunotherapy enhances the body's immune system to help it recognize and attack cancer cells. It is most often used for advanced-stage lung cancer and has demonstrated promising results in improving survival rates for some patients. Common immunotherapy drugs include:

• PD-1 inhibitors  (e.g., pembrolizumab, nivolumab): These drugs block the PD-1 pathway, helping the immune system detect and destroy cancer cells.
• PD-L1 inhibitors  (e.g., atezolizumab): Target the PD-L1 protein on tumor cells, enhancing the immune system's response against cancer.
• CTLA-4 inhibitors (e.g., ipilimumab): Help activate T-cells to fight cancer.

Immunotherapy can be used alone or in combination with chemotherapy, depending on the cancer's characteristics.

Alternative Treatment Methods

Some lung cancer patients may consider alternative or complementary treatments to help manage symptoms or support standard medical care. One such option is radiofrequency ablation (RFA):

• Radiofrequency Ablation (RFA): A minimally invasive procedure that uses heat to destroy cancer cells. RFA is often recommended for patients who are not eligible for surgery or have tumors in hard-to-reach locations. It may be utilized for small tumors or for cancers that have spread (metastasized) to the lungs.

While not a curative treatment, RFA can help reduce tumor size and manage symptoms like pain or obstruction in some cases.

Palliative Care

Palliative care aims to enhance the quality of life for patients with advanced lung cancer, particularly when the disease is no longer curable. These treatments focus on relieving symptoms, managing pain, easing breathing difficulties, and addressing other cancer-related issues. Options include:

• Pain management: Relieving pain with medications such as opioids or non-opioid analgesics.
• Oxygen therapy: Assisting patients with breathing difficulties to maintain healthy oxygen levels.
• Pleural effusion management: Providing relief through procedures like thoracentesis (removal of excess lung fluid) or pleurodesis (preventing fluid buildup).
• Radiation therapy for pain or obstruction: Shrinking tumors that cause discomfort or block airways.
• Nutritional support: Helping patients maintain proper nutrition during treatment and illness.

Palliative care can be offered alongside curative treatments, or it may become the primary focus when a cure is no longer possible..

Chemotherapy

Chemotherapy uses medication to destroy cancer cells throughout the body. It is often used to treat lung cancer that has spread beyond the lungs, or in cases of small cell lung cancer.

Side effects of chemotherapy:

Chemotherapy can cause a number of side effects, including:

• Fatigue
• Nausea and vomiting
• Hair loss
• Mouth sores
• Loss of appetite
• Diarrhea
• Constipation
• Increased risk of infection
• Easy bruising or bleeding
• Anemia

Targeted chemotherapy drugs:

Targeted chemotherapy drugs are designed to attack specific weaknesses in cancer cells. These medications can be more effective and less toxic than traditional chemotherapy. Examples of targeted chemotherapy drugs used to treat lung cancer include::

• Bevacizumab (Avastin)
• Cetuximab (Erbitux)
• Erlotinib (Tarceva)
• Gefitinib (Iressa)
• Crizotinib (Xalkori)
• Ceritinib (Zykadia)
• Alectinib (Alecensa)
• Brigatinib (Alunbrig)
• Entrectinib (Rozlytrek)
• Larotrectinib (Vitrakvi)

Immunotherapy

IImmunotherapy helps the body's immune system identify and attack cancer cells. It can be used to treat certain types of lung cancer, including non-small cell lung cancer.

Immunotherapy side effects:

Immunotherapy can lead to various side effects, including:

• Fatigue
• Itchy rash
• Diarrhea
• Nausea and vomiting
• Joint pain
• Flu-like symptoms
• Pneumonitis (inflammation of the lungs)
• Colitis (inflammation of the colon)
• Hepatitis (inflammation of the liver)
• Thyroid problems

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It can be used alone or in combination with other treatments, such as surgery or chemotherapy.

Side effects of radiation therapy:

Radiation therapy can cause several side effects, including:

• Fatigue
• Skin irritation
• Hair loss in the treated area
• Sore throat
• Difficulty swallowing
• Cough
• Shortness of breath
• Loss of appetite

It is important to note that the information provided here is not a substitute for medical advice. If you have any questions or concerns about lung cancer treatment, please talk to your doctor.

Types of Lung Cancer

Lung cancer is classified into two main types based on how the cells look under a microscope: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). These types vary in their growth patterns, spread, and treatment methods.

Non-Small Cell Lung Cancer (NSCLC)

Non-small cell lung cancer (NSCLC) makes up about 80“85% of all lung cancer cases. It typically grows and spreads more slowly than small cell lung cancer (SCLC). There are several subtypes of NSCLC:

• Adenocarcinoma: The most common subtype, usually found in the outer regions of the lungs. It's often seen in non-smokers, though smoking is still a risk factor. Subtypes include:
  • Adenocarcinoma in situ (AIS): A pre-invasive form.
  • Minimally invasive adenocarcinoma (MIA): Small, limited spread.
  • Invasive adenocarcinoma: Can spread to other parts of the body.
• Squamous cell carcinoma: Often associated with smoking and typically located in the central airways of the lungs
• Adenosquamous carcinoma: A rare mixed subtype with features of both adenocarcinoma and squamous cell carcinoma
• Large cell carcinoma: A fast-growing type that can develop anywhere in the lung
  • Large cell neuroendocrine carcinoma: A more aggressive subtype
• Other NSCLC subtypes: Less common, including sarcomatoid carcinoma, unclassified NSCLC, and others

Small Cell Lung Cancer (SCLC)

Small cell lung cancer (SCLC) accounts for about 10“15% of lung cancer cases. It is strongly linked to smoking and tends to grow and spread rapidly. SCLC is typically classified into two main stages:

• Limited stage: Cancer is confined to one lung and nearby lymph nodes.
• Extensive stage:  Cancer has spread beyond one lung, possibly affecting the other lung, lymph nodes on the opposite side of the chest, or distant organs.

Metastatic Lung Cancer

Metastatic lung cancer occurs when cancer cells have spread from the lungs to other areas of the body. Common sites for lung cancer metastasis include:

• Brain: May cause symptoms such as headaches, seizures, weakness, or personality changes.
• Bones: Can result in bone pain, fractures, or spinal cord compression.
• Liver: May lead to abdominal pain, jaundice (yellowing skin and eyes), and abnormal liver function tests.
• Adrenal glands: Usually does not cause symptoms, but can sometimes affect hormone production.

Other possible sites of metastasis include the lymph nodes, pleura (lining of the lung), and other organs.

Risk Factors for Lung Cancer

Understanding risk factors for lung cancer”such as smoking and radon exposure”is essential for prevention and early detection.

• Smoking: The primary cause of lung cancer; both current and former smokers are at higher risk.
• Secondhand smoke: Breathing in smoke from others raises the risk.
• Radon: A naturally occurring radioactive gas that can build up indoors; the second leading cause of lung cancer.
• Asbestos: Exposure to this group of minerals”especially with smoking”greatly increases risk.
• Air pollution: Inhaling certain air pollutants can elevate risk.
• Family history: A family history of lung cancer increases the likelihood of developing it.
• Other workplace exposures: Contact with substances like arsenic, beryllium, cadmium, chromium, nickel, and silica can also increase risk.

Does Vaping Cause Lung Cancer?

The long-term effects of vaping are still being researched, but concerns about its link to lung cancer are valid. While vaping is likely less harmful than smoking, it is not risk-free, as it exposes users to various chemicals. Some studies suggest vaping may contribute to lung damage and other health issues, though more research is needed to fully understand the risks. For optimal lung health, it is best to avoid both smoking and vaping.

Prevention and Screening

Lung cancer prevention mainly involves reducing risk factors: quitting smoking, avoiding secondhand smoke, limiting exposure to environmental toxins like radon and asbestos, and minimizing air pollution. For individuals at high risk, early detection through screening is crucial. The U.S. Preventive Services Task Force (USPSTF) recommends yearly lung cancer screening with low-dose CT scans for adults aged 50 to 80 with a 30-pack-year smoking history (one pack a day for 30 years, or two packs a day for 15 years) who currently smoke or have quit within the past 15 years. Screening is generally not advised for those outside these criteria, as the risks may outweigh the benefits in lower-risk groups. Adhering to screening guidelines can help detect lung cancer early and improve treatment outcomes.

Our Multidisciplinary Tumor Board Approach

At Liv Hospital, we use a multidisciplinary tumor board approach for lung cancer treatment. This means a team of specialists from various fields works together to create the most effective treatment plan for each patient. Liv Hospital is recognized as one of the top hospitals for lung cancer care in Türkiye, offering advanced technology and a collaborative approach.

How the Tumor Council Works

The tumor council, or multidisciplinary team (MDT) meeting, is a regular gathering where specialists discuss complex cancer cases. The team typically includes:  

• Thoracic surgeons: Experts in lung surgery
• Medical oncologists: Physicians who treat cancer with medications such as chemotherapy, targeted therapy, and immunotherapy
• Radiation oncologists: Specialists in treating cancer using radiation therapy
• Pulmonologists: Doctors who specialize in lung diseases
• Pathologists: Professionals who diagnose diseases by analyzing tissue samples
• Radiologists: Experts in interpreting medical images such as X-rays, CT scans, and MRIs
• Other specialists: Depending on patient needs, the team may also include cardiologists, neurologists, or pain management specialists

Case-Based Decision-Making

During the tumor board meeting, each patient's case is presented and discussed in detail. The team reviews the patient's medical history, imaging results, pathology reports, and other relevant information. Each specialist offers their expertise and insights. Together, the team considers all available treatment options, including surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, and clinical trials.  

The goal is to reach a consensus on the most appropriate and personalized treatment plan for the individual patient, considering the specific type and stage of lung cancer, the patient's overall health, and their preferences. This collaborative approach ensures that patients receive comprehensive and well-coordinated care.

Why Choose Turkey for Lung Cancer Treatment?

Many international patients choose Türkiye for lung cancer treatment because it offers high-quality care at a more affordable cost compared to many other countries. Patients benefit from consulting experienced Turkish lung cancer specialists and can access advanced treatments, including innovative therapies and clinical trials. As a result, Turkey has become an increasingly popular destination for medical tourism, particularly for lung cancer treatment, for several reasons:

• Oncology treatment success: Turkish hospitals, especially Liv Hospital, have high cancer treatment success rates comparable to top international centers. Many oncologists trained internationally, ensuring expert and personalized care for the best outcomes.
• Advanced medical technology: Hospitals in Turkey offer state-of-the-art diagnostic and treatment options, including advanced imaging, robotic surgery, and AI-assisted tools.
• International accreditations: Many hospitals, including Liv Hospital, hold accreditations such as JCI (Joint Commission International), ensuring top standards of quality and patient safety.
• Cost-effectiveness: Lung cancer treatment in Turkey is often more affordable than in many other countries, while maintaining high-quality care. This provides an attractive option for patients seeking cost-effective solutions.

Liv Hospital is committed to providing comprehensive, compassionate care for lung cancer patients. Our multidisciplinary team, advanced technology, and patient-centered philosophy ensure we deliver the best possible treatment and support..

* Liv Hospital Editorial Board has contributed to the publication of this content .
* Contents of this page is for informational purposes only. Please consult your doctor for diagnosis and treatment. The content of this page does not include information on medicinal health care at Liv Hospital .

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