LUNG CANCER

What is lung cancer?

Lung cancer is cancer that forms in tissues of the lung, usually in the cells that line the air
passages. It is the leading cause of cancer death in both men and women.
There are two main types: small cell lung cancer and non-small cell lung cancer. These two
types grow differently and are treated differently. Non-small cell lung cancer is the more
common type.

Who more likely to develop lung cancer?

Anyone can develop lung cancer, but certain factors raise your risk of getting it:

 Smoking. This is the most important risk factor for lung cancer. Tobacco smoking causes about
9 out of 10 cases of lung cancer in men and about 8 out of 10 cases of lung cancer in women.
The more years you smoke and the more cigarettes you smoke each day, the more your risk goes
up. Your risk is also greater if you smoke a lot and drink alcohol every day or take beta carotene
supplements. If you have quit smoking, your risk will be lower than if you had kept smoking.
But you will still have a higher risk than people who never smoked.
 Secondhand smoke, which is the combination of the smoke that comes from a cigarette and the
smoke breathed out by a smoker. When you breathe in secondhand smoke, you are exposed to
the same cancer-causing agents as smokers, although in smaller amounts.
 A family history of lung cancer.

 Being exposed to asbestos, arsenic, chromium, beryllium, nickel, soot, or tar in the workplace.
Being exposed to radiation, for example from:
 Radiation therapy to the breast or chest
 Radon in the home or workplace
 Certain imaging tests such as CT scans
 HIV infection. Your risk is higher if you have HIV. However, smoking rates are higher in
people who have HIV, so it's not clear whether the increased risk is from the HIV infection or
from smoking.
 Air pollution. Studies show that living in areas with higher levels of air pollution increases your
risk of lung cancer.
 What are the symptoms of lung cancer?
Lung cancer may not cause any signs or symptoms until the cancer is advanced. Sometimes the
cancer is found during a chest x-ray done for another condition.
The symptoms of lung cancer may include:

 Chest pain or discomfort

 A cough that doesn't go away or gets worse over time
 Coughing up blood

 Trouble breathing
 Wheezing

 Hoarseness

 Loss of appetite

 Weight loss for no known reason

 Feeling very tired

 Trouble swallowing
 Swelling in the face and/or veins in the neck

How is lung cancer diagnosed?

To find out if you have lung cancer, your health care provider:

 Will take your medical history, which includes asking about your symptoms

 Will ask about your family history

 Will do a physical exam

 May order certain imaging tests, such as a chest x-ray or chest CT scan

 May order lab tests, including tests of your blood and sputum

 May do a procedure to take a biopsy of the lung

If you do have lung cancer, your provider will do other tests to find out if it has spread through
the lungs, lymph nodes, and the rest of the body. This is called staging. Knowing the type and
stage of lung cancer you have helps your provider decide what kind of treatment you need.
 If you have small-cell lung cancer, your provider may also do genetic testing to look for certain
gene changes (variants) in your cancer cells. The results of the testing may help guide treatment.

What are the treatments for lung cancer?

For most patients with lung cancer, current treatments do not cure the cancer.

Your treatment will depend on which type of lung cancer you have, how far it has spread,
your overall health, and other factors. You may get more than one type of treatment.

The treatments for small cell lung cancer may include:

 Surgery.

 Chemotherapy.
 Radiation therapy.

 Immunotherapy.
 Laser therapy, which uses a laser beam to kill cancer cells.

 Endoscopic stent placement. An endoscope is a thin, tube-like instrument used to look at tissues
inside the body. It may be used to put in a device called a stent. The stent helps to open an
airway that has been blocked by abnormal tissue.

The treatments for non-small cell lung cancer may include:

 Surgery.

 Radiation therapy.

 Chemotherapy.

 Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less
harm to normal cells.

 Immunotherapy.

 Laser therapy.

 Photodynamic therapy (PDT), which uses a medicine and a certain type of laser light to kill
cancer cells.

 Cryosurgery, which uses an instrument to freeze and destroy abnormal tissue.

 Electrocautery, a treatment that uses a probe or needle heated by an electric current to destroy
abnormal tissue.

Can lung cancer be prevented?

Avoiding the risk factors may help prevent lung cancer. For example, you can:

 Quit smoking. And if you don't smoke, don't start.

 Lower your exposure to hazardous substances at work.

 Lower your exposure to radon. Radon tests can show whether your home has high levels of
radon. You can buy a test kit yourself or hire a professional to do the test.
 EMPHYSEMA
What is emphysema?
Emphysema is a type of COPD (chronic obstructive pulmonary disease) that damages the
air sac of the lungs making it hard to breathe. COPD is a group of lung diseases that make it
hard to breathe and get worse over time. The other main type of COPD is chronic bronchitis.
Most people with COPD have both emphysema and chronic bronchitis, but how severe each type
is can be different from person to person.
Emphysema affects the air sacs in your lungs. Normally, these sacs are elastic or stretchy.
When you breathe in, each air sac fills up with air, like a small balloon. When you breathe
out, the air sacs deflate, and the air goes out.

In emphysema, the walls between many of the air sacs in the lungs are damaged. This causes
the air sacs to lose their shape and become floppy. The damage also can destroy the walls of the
air sacs, leading to fewer and larger air sacs instead of many tiny ones. This makes it harder for
your lungs to move oxygen in and carbon dioxide out of your body.

What causes emphysema?

The cause of emphysema is usually long-term exposure to irritants that damage your lungs
and the airways. In the United States, cigarette smoke is the main cause. Pipe, cigar, and
other types of tobacco smoke can also cause emphysema, especially if you inhale them.
Exposure to other inhaled irritants can contribute to emphysema. These include secondhand
smoke, air pollution, and chemical fumes or dusts from the environment or workplace.
Rarely, a genetic condition called alpha-1 antitrypsin deficiency can play a role in causing
emphysema.

Who is at risk for emphysema?

The risk factors for emphysema include:

 Smoking. This the main risk factor. Up to 75% of people who have emphysema smoke or used
to smoke.
 Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and
chemical fumes and dusts from the environment or workplace.
 Age. Most people who have emphysema are at least 40 years old when their symptoms begin.
 Genetics. This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also,
smokers who get emphysema are more likely to get it if they have a family history of COPD.

What are the symptoms of emphysema?

At first, you may have no symptoms or only mild symptoms. As the disease gets worse, your
symptoms usually become more severe. They can include:

 Frequent coughing or wheezing

 A cough that produces a lot mucus

 Shortness of breath, especially with physical activity

 A whistling or squeaky sound when you breathe

 Tightness in your chest

Some people with emphysema get frequent respiratory infections such as colds and the flu. In
severe cases, emphysema can cause weight loss, weakness in your lower muscles,
and swelling in your ankles, feet, or legs.

How is emphysema diagnosed?

Your health care provider may use many tools to make a diagnosis:

 A medical history, which includes asking about your symptoms

 A family history

 Other tests tests, such as lung function tests, a chest x-ray or CT scan, and blood tests

What are the treatments for emphysema?

There is no cure for emphysema. However, treatments can help with symptoms, slow the
progress of the disease, and improve your ability to stay active. There are also treatments to
prevent or treat complications of the disease. Treatments include:

 Lifestyle changes, such as

 Quitting smoking if you are a smoker. This is the most important step you can take to treat
emphysema.
 Avoiding secondhand smoke and places where you might breathe in other lung irritants
  Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask
about how much physical activity you can do. Physical activity can strengthen the muscles that
help you breathe and improve your overall wellness.

 Medicines, such as
 Bronchodilators, which relax the muscles around your airways. This helps open your airways
and makes breathing easier. Most bronchodilators are taken through an inhaler. In more severe
cases, the inhaler may also contain steroids to reduce inflammation.
 Vaccines for the flu and pneumococcal pneumonia, since people with emphysema are at higher
risk for serious problems from these diseases
 Antibiotics if you get a bacterial or viral lung infection
 Oxygen therapy, if you have severe emphysema and low levels of oxygen in your blood.
Oxygen therapy can help you breathe better. You may need extra oxygen all the time or only at
certain times.
 Pulmonary rehabilitation, which is a program that helps improve the well-being of people who
have chronic breathing problems. It may include
 An exercise program

 Disease management training

 Nutritional counseling

 Psychological counseling

 Surgery, usually as a last resort for people who have severe symptoms that have not gotten
better with medicines. There are surgeries to
 Remove damaged lung tissue

 Remove large air spaces (bullae) that can form when air sacs are destroyed. The bullae can
interfere with breathing.

 Do a lung transplant. This is might be an option if you have very severe emphysema.
If you have emphysema, it's important to know when and where to get help for your symptoms.
You should get emergency care if you have severe symptoms, such as trouble catching your
breath or talking. Call your health care provider if your symptoms are getting worse or if you
have signs of an infection, such as a fever.
Can emphysema be prevented?
Since smoking causes most cases of emphysema, the best way to prevent it is to not smoke. It's
also important to try to avoid lung irritants such as secondhand smoke, air pollution, chemical
fumes, and dusts.
 HYPERTHYROIDISM

Hyperthyroidism is a condition in which the thyroid gland makes TOO MUCH thyroid
hormone. The condition is often called overactive thyroid.

Causes

The thyroid gland is an important organ of the endocrine system. It is located at the front of the
neck just above where your collarbones meet. The gland makes the hormones that control the
way every cell in the body uses energy. This process is called metabolism.

Many diseases and conditions can cause hyperthyroidism, including:

 Graves disease (most common cause of hyperthyroidism)

 Inflammation (thyroiditis) of the thyroid due to viral infections, some medicines, or after
pregnancy (common)

 Taking too much thyroid hormone (common)

 Noncancerous growths of the thyroid gland or pituitary gland (rare)

 Some tumors of the testes or ovaries (rare)

 Getting medical imaging tests with contrast dye that has iodine (rare, and only if there is already
a problem with the thyroid)

 Eating too much of foods that contain iodine (very rare, and only if there is already a problem
with the thyroid)

Symptoms

Common symptoms include:

 Anxiety

 Difficulty concentrating

 Fatigue
 Frequent bowel movements

 Goiter (visibly enlarged thyroid gland) or thyroid nodules

 Hair loss

 Hand tremor
 Heat intolerance
 Increased appetite
 Increased sweating
 Irregular menstrual periods in women

 Nail changes (thickness or flaking)

 Nervousness

 Pounding or racing heart beat (palpitations)

 Restlessness
 Sleep problems

 Weight loss (or weight gain, in some cases)

Other symptoms that can occur with this condition:

 Breast development in men

 Clammy skin

 Diarrhea

 Feeling faint when you raise your hands

 High blood pressure

 Itchy or irritated eyes

 Itchy skin

 Nausea and vomiting

 Protruding eyes (exophthalmos)

 Skin blushing or flushing

 Skin rash on the shins

 Weakness of the hips and shoulders

Exams and Tests

The health care provider will do a physical exam. The exam may find the following:

 High systolic blood pressure (the first number in a blood pressure reading)

 Increased heart rate

 Enlarged thyroid gland

 Shaking of the hands

 Swelling or inflammation around the eyes

 Very strong reflexes
 Skin, hair, and nail changes

Blood tests are also ordered to measure your thyroid hormones TSH, T3-thyroxine, and T4-
triiodothyroxine.
You may also have blood tests to check:

 Cholesterol levels

 Glucose
 Specialized thyroid tests like Thyroid receptor antibody (TRAb) or Thyroid Stimulating
Immunoglobulin (TSI)
Imaging tests of the thyroid may also be needed, including:

 Radioactive iodine uptake and scan

 Thyroid ultrasound (rarely)
Treatment

Treatment depends on the cause and severity of symptoms. Hyperthyroidism is usually treated
with one or more of the following:

 Antithyroid medicines (propylthiouracil or methimazole) which reduce or block the effects of the
extra thyroid hormone

 Radioactive iodine to destroy the thyroid gland and stop the excess production of hormones

 Surgery to remove the thyroid

If your thyroid is removed with surgery or destroyed with radioactive iodine, you must take
thyroid hormone replacement pills for the rest of your life.

Medicines called beta-blockers may be prescribed to treat symptoms such as fast heart rate,
tremor, sweating, and anxiety until the hyperthyroidism can be controlled.

Outlook (Prognosis)
 Hyperthyroidism is treatable. Some causes may go away without treatment.

Hyperthyroidism caused by Graves disease usually gets worse over time. It has many
complications, some of which are severe and affect quality of life.

Possible Complications

Thyroid crisis (also called thyroid storm) is a sudden worsening of hyperthyroidism

symptoms that may occur with infection or stress. Fever, decreased alertness, and
abdominal pain may occur. People need to be treated in the hospital.

Other complications of hyperthyroidism include:

 Heart problems such as fast heart rate, abnormal heart rhythm, and heart failure

 Osteoporosis

 Eye disease (double vision, ulcers of the cornea, vision loss)

Surgery-related complications, including:

 Scarring of the neck

 Hoarseness due to nerve damage to the voice box

 Low calcium level due to damage to the parathyroid glands (located near the thyroid gland)

 Hypothyroidism (underactive thyroid)

Tobacco use may make some complications of hyperthyroidism worse.

 THYROID CANCER
Thyroid cancer is a cancer that starts in the thyroid gland. The thyroid gland is located in the
front of your lower neck.

Causes
 Thyroid cancer can occur in people of any age.
 Radiation to the thyroid increases the risk of developing thyroid cancer. Exposure may
occur from:

 Radiation therapy to the neck (especially in childhood)

 Radiation exposure from nuclear plant disasters

Other risk factors are a family history of thyroid cancer and chronic goiter (enlarged thyroid).
Being overweight or having obesity may be a risk factor for papillary carcinoma of the thyroid.

Types of thyroid cancer:

 Anaplastic carcinoma (also called giant and spindle cell cancer) is the most dangerous form of
thyroid cancer. It is rare, and spreads quickly.
 Follicular carcinoma is more likely to come back and spread.

 Medullary carcinoma is a cancer of non-thyroid hormone-producing cells that are normally

present in the thyroid gland. This form of thyroid cancer tends to occur in families.
 Papillary carcinoma is the most common type, and it usually affects women of childbearing age.
It spreads slowly and is the least dangerous type of thyroid cancer.

Symptoms
Symptoms vary depending on the type of thyroid cancer, but may include:

 Cough

 Difficulty swallowing
 Enlargement of the thyroid gland

 Hoarseness or changing voice

 Neck swelling

 Thyroid lump (nodule)

Exams and Tests

Your health care provider will perform a physical exam. This may reveal a lump in your thyroid
or swollen lymph nodes in your neck.

The following tests may be done:

 Calcitonin blood test to check for medullary thyroid cancer

 An examination of the airway with a fiberoptic scope (laryngoscopy) may show a paralyzed
vocal cord.
 Thyroid biopsy, which may include genetic testing of the cells obtained in the biopsy

 Thyroid scan
 TSH, free T4 (blood tests for thyroid function)
 Ultrasound of the thyroid and the lymph nodes of the neck
 CT scan of the neck (to determine the extent of the cancerous mass)
 Positron emission tomography- PET scan

Treatment
Treatment depends on the type of thyroid cancer. Treatment of most thyroid cancer types is
effective if diagnosed early.

Surgery is most often the initial treatment. All or part of the thyroid gland may be removed. If
your provider suspects that the cancer has spread to lymph nodes in the neck, these will also be
removed. If some of your thyroid gland remains, you will need follow-up ultrasound and
possibly other studies to detect any regrowth of thyroid cancer.
 Radiation therapy may be done with or without surgery. It may be performed by:

 Taking radioactive iodine by mouth

 Aiming external beam (x-ray) radiation at the thyroid

After treatment for thyroid cancer, you must take thyroid hormone pills for the rest of
your life. The dosage is usually slightly higher than what your body needs. This helps keep the
cancer from coming back. The pills also replace the thyroid hormone your body needs to
function normally.

If the cancer does not respond to surgery or radiation, and has spread to other parts of the
body, chemotherapy or targeted therapy may be used. These are only needed by a small number
of people.
Support Groups
You can ease the stress of illness by joining a cancer support group. Sharing with others who
have common experiences and problems can help you not feel alone.

Possible Complications
Complications of thyroid cancer may include:

 Injury to the voice box and hoarseness after thyroid surgery

 Low calcium level from accidental removal of the parathyroid glands during surgery

 Spread of the cancer to the lungs, bones, or other parts of the body

When to Contact a Medical Professional

Contact your provider if you notice a lump in your neck.

Prevention
Awareness of risk (such as previous radiation therapy to the neck) can allow earlier diagnosis
and treatment.
Sometimes, people with family histories and genetic mutations related to medullary thyroid
cancer will have their thyroid gland removed to prevent cancer.