Cancer is defined as a group of diseases that are caused by an uncontrolled division of cells in a part of the body. Cells in the body’s affected part do not die when they become old. These cells further divide to form new cells without any requirement of these cells in the body’s part. This process again continues after the formation of the cluster of the old and the new cells. The formation of this cluster of cells is known as a tumor. These clusters of cells do not have any space in which they can occupy a small area of the body’s part. The lung is an important part of the body, and lung cancer is extremely harmful and fatal, so the essay provides complete information about this disease.
Lung carcinoma, in other words, known as lung cancer, is a group of a variety of diseases that affects the tissues of the lungs. Its major cause is the development of cancer cells in the human’s lungs. It is the most fatal of all the acute diseases and originates initially from the lungs. Malignant tumors tend to multiply rapidly and go to distant sites from the starting point to spread in the lungs and distant sites, which further in turn increases the risk of leading slide. Nevertheless, benign tumors can also originate in the lungs and remain limited to that organ. In comparison to these several types of lung cancers, “metastatic lung cancers” are known to have the capacity of entering the lungs from another part of the body and grow and multiply into the lungs. The cancer cells are transported to the bloodstream from the other major organs in the body, such as the colon, breast, etc., and spread to the lungs in this way. This “metastatically spread” type of cancer, which actually originates from another part of the body and slowly grows into the lungs as well as widely into another part of the body, functions that lungs are less likely to effectively operate for that purpose. It has been estimated that its chances to spread in the lungs are less than 1 percent.
Epidemiology of Lung Cancer
Lung cancer is a major public health problem in many parts of the world. Several factors make it an important target for epidemiological scrutiny. The incidence, prevalence, and distribution of lung cancer are of obvious interest. Detection of changes or trends in occurrence may also trigger the search for possible etiological factors. Many of the subdivisions of the problem relate to the distribution of lung cancer according to the variables of individual, time, place, and potential causal influence. Against a background of increasing knowledge about the disease, the importance of understanding its epidemiology is now clear for a new reason: lung cancer is the prime example of “preventable” cancer.
In terms of the “top twenty” site-specific cancer incidence by world region in 1990, lung cancer ranks twenty-fifth in sub-Saharan Africa and ranges from eighteenth in women to eleventh in men in the developed world. Seventy-five percent of the world’s lung cancer cases occur in men. Geographically, the incidence rates of lung cancer vary considerably, with rates in the developed, Western World often up to three times higher than those in the underdeveloped world. The current world lifetime risk of developing lung cancer is 8% in men and 3% in women. The incidence of lung cancer increases with age, reaching a peak in the 60-80 age group in males and slightly later for females. The age ranges found in lung cancer cases confirmed this in Scotland where the mean age at diagnosis was 69 years for men and 67 years for women in 1996-1998.
Causes and Risk Factors
Smoking and exposure to secondhand smoke: Smoking is the primary cause of lung cancer. There are several very toxic cancer-causing substances – carcinogens – in cigarette smoke. Lung cancer risk increases with the number of cigarettes smoked over time (pack years), but being a “light” or “social” smoker does not avoid the risk associated with cigarette smoke. And, the risk can extend for many years after stopping smoking, but is significantly reduced compared to a current smoker. Quit smoking as soon as possible. Electronic nicotine delivery devices (e-cigarettes) are smoke-free products in which liquid is turned into a mist or vapor that is inhaled by the user. The liquid is usually made of nicotine, propylene glycol, glycerin, and flavorings. The safety and long-term health effects of using e-cigarettes are not yet known. E-cigarettes have not been determined to be a safe alternative to smoking. In addition to not being considered a safe alternative, e-cigarettes may be just as dangerous as traditional tobacco products. Secondhand smoke harms children and adults. Secondhand smoke carries the same dangers as smoking, including an increased risk of cancer. Studies have estimated that nonsmoking women married to smoking spouses have a 20%-30% increased risk of lung cancers as compared to the similar cohort with nonsmoking spouses. People who currently smoke or used to smoke and have had long-term exposure to secondhand smoke are also at increased risk.
Environmental exposures: Ionizing radiation, especially exposure to radon gas, present the second leading cause of lung cancer. Shortly before and after the turn of the 20th century, radiation was used to treat many benign conditions, such as enlarged tonsils and adenoids, skin hemangiomas, and even acne. Few precautions were taken to protect the rest of the body. Cancers began to develop in these patients and, although physicians started to appreciate the danger, it took several decades to fully understand the seriousness of letting roentgen rays flare about so promiscuously. In 1900, about 1% of women in the United States died of lung cancer, and by 1933, only 3.8% of white people working in the lung cancer registry carried by the New York State Cancer Laboratory had the disease. But by 1938, about 40% of the cancer deaths in the same area were attributed to lung cancer. More than 95% of the radon emission is produced by the decay of 222Rn, and concentrations of the two daughters, 218Po and 214Po, are so low as to be negligible. Dose studies have shown that people living in high-radon areas and smokers are more susceptible to the effects of radon exposure. However, the risks attributed to radon are largely based on alpha particle epidemiologic studies of uranium workers. Most people are exposed to radon in the home, where the risk is highest for prolonged exposure to high concentrations of radon, usually in confined areas such as basements and crawl spaces.
Genetic susceptibility: People who are related to someone with lung cancer, especially an immediate family member, are more likely to get the disease. This implies that there may be a genetic link to lung cancer risk. These increased risks are more likely due to shared environmental concerns such as inhaling secondhand smoke; however, they could be due in part to inheritance of certain gene(s). Also, inheriting certain genetic attributes may either make your body more or less likely to develop cancer due to environmental exposure to known lung carcinogens. Although studies of familial aggregation and segregation analysis may provide evidence against a significant role for shared genetic susceptibility, mutations in any of the LFS genes may also be involved in susceptibility to tobacco smoke-related lung cancer.
Smoking and Secondhand Smoke
The main causes of lung cancer are our habits or occupation; up to 85% of the cases are attributed to toxic factors. This means that prevention is the best way to fight this disease. This subsection details two strong risk factors for lung cancer: tobacco and exposure to secondhand smoke. This is particularly important because these are the easiest and most direct risk factors to take action against.
Carbohydrate-rich foods, too much salt, high intake of red meat, animal fats, and processed meats are all positively associated with lung cancer. Inactivity and obesity increase the likelihood of contracting the disease.
The reason that tobacco smoke is important has a lot to do with the aforementioned fact that it is the main carcinogen identified and that the focus of this document is on endemic lung cancer. Smoke inhalation is also possibly the most direct route of exposure for most patients, meaning that understanding such an important risk can help with concrete prevention.
Tobacco smoke contains over 7000 chemical compounds, and of these, 250 are poisonous to humans and 69 are known to be carcinogenic and to have cancer-promoting properties, called initiators, promoters, or both. The three primary carcinogens in tobacco smoke are polycyclic aromatic hydrocarbons (PAHs), which are produced by the combustion of organic matter and eventually bind to DNA to cause mutations that can lead to cancer. Nicotine is not a carcinogen but has the potential to cause or promote cancer through its effects on cell proliferation and blood vessel formation.
Environmental Exposures
We are exposed to potentially carcinogenic mixtures in the air, including combustion products from road traffic, wood smoke, environmental tobacco smoke, industrial fires, and residential heating, as well as emissions from industries such as mining, gravel extraction, smelting, and pulp and paper production. Many occupational hazards, such as asbestos, silica, arsenic, hexavalent chromium, cadmium, nickel, second-hand smoke, and talc sensed in jobs such as mining, construction, metal production, heavy vehicle driving, and firefighting, have been established as underlying causes of lung cancer. Several other external agents have been classified as potential, probable, or possible causes of lung cancer, including diesel engine exhaust, gasoline engine exhaust, chlorinated solvents, rubber production, formaldehyde, engine exhaust, isopropyl alcohol, engine exhaust, engine exhaust protein, frying, welding fumes, textile production, formaldehyde for fur and leather production, radio frequency radiation, and welding fumes.
Many toxic substances have been identified as capable of initiating and promoting malignancy in the environment. Carcinogens are thought to affect a person’s lung cancer risk by inducing genetic alterations. In addition to these substances, the burnt diesel engine exhaust, which contains hazardous irritants, and long-term exposure to solvents emitted in industrial sectors, especially in the construction sites, has been found to be associated with high risk of lung cancer among construction workers. Evidence-based clinical guidelines for treating these lung cancer patients with radiotherapy have been investigated. Fully understanding environmental exposures and their potential effects on lung health is an important step toward reducing the burden, morbidity, and mortality of lung cancer. Consider the potential impacts of these exposures and assess the key facilitators of supportive change to reduce their time and reduce rates of lung cancer occurrence.
Genetic Predisposition
Family-based linkage studies are powerful tools for identifying loci that confer a genetic predisposition to disease, but classic Mendelian segregation analysis has shown that lung cancer is a polygenic disorder with incomplete penetrance, and hence is unlikely to be caused by single-gene mutations. The complex nature of the disease may be attributed to the interaction of multiple low-risk genetic loci with environmental mutagens, which all result in phenotypic (molecular and histological) heterogeneity. Nevertheless, genetic predisposition may be relevant to some smokers who, perhaps because of genetic differences in their metabolism, are more susceptible to the carcinogens inhaled via tobacco smoke. Non-smokers’ lung cancer may have more of a genetic contribution. There are both rare, high-penetrance mutations (major loci) and common, low-penetrance mutations (minor loci) (which appear to act additively) that can predispose individuals to lung cancer. Researchers have tried to identify “smoking-susceptibility genes,” which, in smokers only, can increase lung cancer risk.
Monogenic or Major Loci. There are a number of rare, inherited syndromes that are associated with a higher risk of developing lung cancer. Familial retinoblastoma was the first cancer to be associated with a clear genetic abnormality in the retinoblastoma suppressor gene; and families that inherit a mutant copy of the gene show a high bladder and lung cancer risk. For most populations, only 1% of lung cancer cases involve these rare, often high penetrant, susceptibility genes. Gene targets in familial-essential cancers are very likely to also be relevant to non-familial forms of the same cancer, and there have been case reports of individuals with non-small cell lung cancer with germline mutations in the BRCA2 gene. Furthermore, DNA synthesis genes, including the large tumor suppressor or BRCA2, are important in the development of lung cancer and might thus represent the long-sought candidate major susceptibility gene that would account for the familial aggregation of lung cancer. Population attributable risks for a large number of common gene polymorphisms may be extremely small but cumulatively could trigger lung cancer, especially when attuned by lifestyle and environmental carcinogens like tobacco smoking. Although the causes of the familial clustering in lung cancer can be environmental, they may also involve a genetic predisposition and an underlying susceptibility to other cancer risk factors. Genetic studies are therefore valuable and can be used to clarify the degree of individual genetic predisposition, as well as those of their involved relatives. Moreover, they could be used in the treatment of lung cancer, for instance, with chemopreventive strategies and individualization of a tailored molecular-targeted gene-treatment protocol.
Symptoms and Early Detection
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Lung cancer presents itself in a variety of ways, although symptoms showing up early are seldom seen. The earlier lung cancer is identified, the better chances there are at treating it, and maybe even curing it. Most of the symptoms shown by lung cancer are commonly due to other diseases. It is important to see your doctor if you are experiencing symptoms that are indicative of lung cancer but are being caused by something else, if not just to rule out cancer.
The more mild of the symptoms linked with lung cancer are the following: persistent cough (the most common symptom), blood-streaked sputum, chest pain, voice hoarseness, transient wheezing, frequent bouts of bronchitis or pneumonia, shortness of breath, swelling of the neck and face, pains in the arm, shoulder, body aches. The frequency of these symptoms and diseases should give one cause to wonder if they could be a sign of an underlying serious health issue. Early detection increases the chances of survival because research data indicates that more than 40 percent of the individuals whose lung cancer has reached stage 3/4/5 (advanced) at the time of death had stage 1/2, a potential cure. Your fate and life can largely depend on early tumor detection.
Symptoms that present themselves at a more advanced level of lung cancer are: onset of bone pain, loss of appetite, anorexia, as well as weight loss, intensive fatigue, weakness, clammy skin, marked breathing difficulties, overly enlarged neck veins, a group of trapped air and fluid in the chest cavity. More thorough investigation is necessary if there are symptoms that point to lung cancer. Have routine screenings if you are in a high-risk group (determined by your doctor) even if no symptoms of lung cancer are producing themselves. Early detection can help save your life.
Diagnosis and Staging
Some imaging tests used in diagnosing lung cancer include X-rays, CT scans, PET scans, MRI scans, bone scans, and angiograms, depending on the symptoms and the location of the suspected tumor. When a tumor is suspected, your doctor will have several diagnostic tests performed to find out. Your doctor should take a precise family history and detailed work history, and he or she may ask about lifestyle and other factors that may increase your risk of developing lung cancer. If lung cancer is possible, a physician may order further testing and refer the patient to a pulmonologist.
A diagnosis will be more definitive if the sample was obtained by biopsy or other surgical procedure. The doctor uses various tests to determine what kind of lung cancer has occurred when a diagnosis of lung cancer is made. Pathologic (biopsy) and cytologic (fine-needle aspiration) diagnoses, which require tumor or fluid samples, are two forms of lung cancer diagnosis. The very disease for which the tumor arose is what pathologic diagnosis decides. This definition may entail the sub-cell-type or cell type of the lung lesion. Cancer staging is a process that doctors and researchers use to figure out how far the cancer has spread. Based on surveillance and diagnostic examinations, lung cancer staging defines the amount of a person’s cancer and where it is spread (if at all). It can also suggest the amount of lung tissue affected or removed in an operation. The diagnosis of lung cancer is roughly based on the stage among other considerations.
Imaging Techniques
Pulmonary parenchymal lesions are often visualized on the chest X-rays of lung cancer patients. While the size, number, and margins of the pulmonary lesion provide valuable information about the tendency of the lesion to be malignant or benign, the lesion’s anatomical location can offer valuable information about the site of origin of the tumor. X-rays are the most commonly used imaging modality and are used to diagnose rounded lesions and also to guide and monitor tissue sampling when image-guided procedures are employed. The limitations of X-rays include their low sensitivity in identifying small metastases, which are false negatives, and the fact that a negative finding does not exclude chest pathology.
Computed tomography (CT) is the most sensitive and specific imaging modality for the detection and characterization of pulmonary lesions. This technique can be employed to visualize the margins of the expanding tumor, widening of the vessels at the tumor periphery as well as atelectasis, plural effusion, and pleural thickening. In patients with bronchioloalveolar carcinoma (BAC), the above features may relate to the prevalence of a ground glass or multilobular dissemination and the absence of nodal or distant metastases. It can also detect cavitations, an irregular margin, and large nodes that are mostly present in keratinizing tumors stage 3-4. Positron emission tomography (PET) is a diagnostic tool used to detect increasing metabolic activity within any tissue in the body. It is very useful for evaluating anatomic CT abnormalities when their significance is unknown as well as their progression or resolution. The indications for PET include solitary pulmonary nodules and pulmonary lesions greater than about 1.3-2 cm, which are standard for direct analysis using CT. PET and CT images can be fused (PET/CT) in order to integrate morphological and functional information into a single image. A recent study demonstrated that, compared to a CT-based staging strategy, 81% of patients with local extension of the tumor or regional nodal disease were appropriately upstaged when a staging strategy that included PET/CT was employed. Resistance of CT-guided biopsy or a small biopsy sample is also an indication for PET imaging. Extragravidic syndromes and fatigue are not confirmatory, so the indications of a PET study should only be based on findings from CT. Causes of false-positive PET are inflammatory diseases, ischemia, and infections.
Magnetic resonance imaging (MRI) is generally not performed for the accurate quantitative evaluation of the lung for either metastatic and relapsing disorders or lung cancer at this time, as there are superior modalities, i.e. CT and PET. However, for certain borderline conditions, MRI may be employed to deposit orthopedic implants in patients with a high probability of adverse sequelae. Furthermore, it may be used when chemotherapy is initiated in the initial scenario. The delivery of this technique should be carried out taking into account the expense of an MRI technology that is not universally accessible. MRI is also considered a heart disease for the evaluation of chest wall invasion of primary lung carcinoma, due to its superiority in the differentiation of creep from tumor. Considering the low sensitivity, it is primarily used for the evaluation of the mediastinum.
Biopsy Procedures
A biopsy is a procedure used to obtain small pieces of tissue for examination under a microscope, or to directly test with special stains and other laboratory tests. There are many ways that biopsy samples can be obtained from lung tumors. A high-quality biopsy sample that contains sufficient tumor tissue can enable a pathologist to form the most accurate diagnosis and a comprehensive assessment of the tumor’s characteristics.
Biopsy methods used to obtain small tissue samples for a diagnosis of lung cancer include fine-needle aspiration (FNA) or core biopsy (CNB). In patients with lung tumors that are identified close to or in the airways, flexible bronchoscopy can be performed to visualize the tumor and obtain small tissue samples for diagnosis. The Korean Clinical Practice Guideline for Lung Cancer: Diagnosis and Patient Management advocates that when a surgically resectable tumor is present, tissue should be obtained from the tumor at the time of the planned surgery. The recommended method for biopsy in these patients is core biopsy with fine needle aspiration. The tissue obtained should also undergo testing to access a diagnosis. The result of this testing may change the stage of the tumor and the type of surgical procedure performed, such as wedge resection versus lobectomy.
There are tests that must be performed on every biopsy to screen for certain genetic changes in the tumor. Lung cancers may have genetic changes or mutations that allow for the growth and spread of cancer, and have selective therapies/drugs that target these mutations. Unlike therapy-resistant mutations, not all lung cancers will have mutations for which we know a treatment. Biopsied tissue will undergo testing for a genetic mutation commonly found in lung cancer known as EGFR (epidermal growth factor receptor) if the patient has adenocarcinoma. Sufficient tumor samples are important for genetic testing as well as additional testing in the diagnosis of lung cancer. A dedicated biopsy known as a core needle biopsy has been recommended as part of the clinical practice guidelines.
Treatment Options
As a lung cancer diagnosis can impact any of the elements of lung function and overall health, we have several different treatment options to address a range of problems in either a single, synchronized approach or in sequential interventions. While the majority of treatment for patients involves targeted therapies or immunotherapies, there are several systemic treatments that can provide benefit to patients dealing with lung cancer. For example, in some cases of nonmetastatic lung cancer, a patient’s care plan may involve the use of surgery before treatment with radiation therapy.
Local-regional treatment modalities for NSCLC include surgery and radiation. While surgical treatment was once considered the primary option for most of those with early stage NSCLC, it is now widely recognized that the best approach for each person will vary and is best determined by a group of clinicians from various disciplines, sometimes referred to as a ‘tumor board’. The ‘tumor board’ is a team of VA employees who, operating under the directives of the American College of Surgeons Commission on Cancer, convene to discuss the evaluation and development of a treatment plan for cancer patients at the VCHS. The ‘tumor board’ may be attended by specialist clinicians and trainees in medical oncology, radiation oncology, surgery, radiology, pathology, and research. Given the nature of lung cancer and the need for case-by-case management, the ‘tumor board’ is an essential part of how we care for Veterans with lung cancer.
Surgery
Surgery is the preferred treatment for those who are able to have surgery, and studies show that surgery is the most effective when it is performed after a person receives treatment with systemic therapy (chemotherapy or immunotherapy) and radiation. The surgeons at Massachusetts General Hospital, who are experts in the treatment of lung cancer, will advise each person on the best course of treatment for them.
There are different types of lung cancer surgery; the choice of surgery is based on the size of the tumor, the location of the tumor, and the person’s overall health and physical conditioning. The surgeon will discuss the benefits and any concerns or risks for each type of surgery. Lobectomy is performed most often. It is the removal of one lobe of the lung. Pneumonectomy is the removal of an entire lung. Your surgeon will discuss pulmonary function after surgery. Sublobar or segmentectomy is the removal of a small section of the lung. This is performed for people who have small tumors and is the best treatment for them. It can be performed with the assistance of video-assisted technology. Removal of any of the mediastinal lymph nodes is recommended. In most people with lung cancer, only one or two lymph nodes have disease spread, while the majority of sampled lymph nodes are free of disease; however, this does not ensure that the rest of the chest, abdomen, or the entire body are free of disease. The sample of lymph nodes from each station is done to plan additional treatment after surgery.
Chemotherapy
The term ‘chemotherapy’ refers to the treatment of tumors using drugs that target cancer cells systemically. There are different individual chemotherapy agents, which are usually reserved for use in the treatment of lung cancer once other tumor characteristics, such as tissue diagnosis, patterns of spread, and molecular findings have been obtained. Chemotherapy kills tumor cells by interfering with the tumor’s ability to reproduce and grow. Chemotherapy agents are allocated to/taken up by (target) cells preferentially when they are dividing, and so move from the blood into the tumor where they are actively taken up into the tumor and exert their action.
Chemotherapy may be administered in different ways, e.g. a tablet, intravenous, intramuscular, subcutaneous, or intra-pleural (directly into the chest cavity). The drugs may be given on a daily basis, for one day, or a combination of two or more drugs may be given every 3-4 weeks. The side effects of chemotherapy are due to its action on normal rapidly growing tissues, such as the bone marrow, hair follicles, and digestive system. This can lead to a significant reduction in the patient’s ability to fight off infections; anemia, which can make the patient feel tired and breathless; and the most important side effect for lung cancer is nausea and vomiting while the drug administered is in the circulation. Chemotherapy is used for patients whose tumor cannot be cured completely at the time of diagnosis, i.e. as part of so-called palliative care. Chemotherapy may also be used in patients whose tumor can be removed completely at the time of diagnosis and is given in the form of tablets for a few days after operations to help kill off any cancer cells around the lung that may have been left. This is called adjuvant therapy.
Radiation Therapy
Radiation therapy uses high-energy rays or particles to kill cancer cells. External beam radiation is a type of radiation therapy used to treat lung cancer, which delivers radiation from outside the body by directing the rays to the tumor and surrounding normal tissue from different directions. Radiation therapy damages the cancer cells and although it can also affect the nearby normal cells, these have the ability to repair damage from radiation more effectively than cancer cells. The purpose of treatment is to continue to deliver the dose of radiation in fractions, to kill the cancer cells and so they are absorbed by the body, with minimal side effects while limiting the effects of the radiation on normal tissues.
Stereotactic body radiation therapy is an external beam radiation therapy that uses smaller, more focused radiation beams than standard radiation therapy to deliver a precise dose of radiation to a tumor in a short time span. Since its side effects, especially to the lungs, can be severe, this radiation therapy is best delivered to small lung tumors in patients that can limit their respiratory organ’s exposure to such toxicities. Brachytherapy might be used sometimes only if the cancer is causing airway blockage, to keep the airways open, or when the cancer has spread to the brain and they need symptom relief such as patients suffering from lung cancer where recurrent lesions have caused any types of complications. This therapy is mostly less common because for most patients the disease has already spread to other areas of the body. Radiation therapy’s role on its own is very limited when trying to cure primary lung cancer or locally advanced stages of lung cancers.
Immunotherapy
Immunotherapy is an innovative therapy for lung cancer, which uses drugs that stimulate the body’s immune system to recognize and attack cancer cells. The body’s immune system has mechanisms that prevent over-activity of the immune system, which can otherwise lead to autoimmunity. Cancer cells can take advantage of these same regulatory mechanisms and prevent the body’s immune system from acting against them. Immunomodulating agents act to target the immune response directly against the cancer cells. Immune checkpoint inhibitors are one type of immunomodulating therapy that are under development now for lung cancer treatment. Monoclonal antibodies that block the PD-1 and PD-L1 checkpoint have had the most extensive development in lung cancer. Currently, the FDA has granted ‘breakthrough status’ to PD-1 and PD-L1 therapy, thereby expediting the review process with the idea that these immunotherapy treatments—either alone or in combination with chemotherapy or other immunotherapies—have the potential to be a desirable treatment in lung cancer. Given this accelerated path for development, it is possible that these immune checkpoint inhibitors could receive regulatory approval for treating lung cancer in the near future.
Immunotherapies have the potential to revolutionize the treatment of lung cancer. By shattering the molecular handcuffs that stop the immune system from attacking cancer, the power of the patient’s own body can be harnessed to clobber the malignancy. Since 2012, a number of immunotherapies have reached the marketplace. The most successful of these utilize the body’s own brake—the molecule PD-1 or its ligand, PD-L1. When PD-1 molecules sit on the surface of a T cell – the white blood cells that orchestrate the immune system – they prevent it from becoming active until sufficiently strong signals to attack are received. The signals are provided by other molecules on the cancer cell surface that tell the T cell there is something wrong. PD-L1 is one such signal. Interruption of the PD-1/PD-L1 axis removes the brakes from the immune system just as the cancer cells deliver their distress signals.
Prevention Strategies
Lung cancer has one of the bleakest prognoses of all cancers, but it can be avoided. Over 80% of cases are attributable to smoking. A cornerstone strategy for reducing the global burden of lung cancer is to never take up smoking. Secondhand smoke exposure: stay in smoke-free environments, avoid exposure to radon, asbestos, diesel, and other fumes. Modify the home and workplace to prevent these exposures. Eat a healthy diet low in saturated fat and eat more fruits, vegetables, and whole grains. Make better food choices, such as those recommended by the American Cancer Society. Have regular exercise and maintain a healthy weight. Use a weight management plan that can help you do this with the help of your healthcare team. Avoid taking beta-carotene vitamin supplements, particularly in high dosages.
Endorphin production decreases with chronic smoking and quitting may lift a persistent cloud of gloom. Trigger management should be an integral part of quitting smoking. Identifying triggers and devising strategies to avoid them is especially critical during the initial period when an individual is most vulnerable to succumbing to the urge to light up. Communities must continue to support every smoker who wants to quit and provide resources and encouraging assistance to prevent smoking among young people. An “Adolescents Say No to Smoking” campaign not only is a sound public health measure but also will reduce the future burden of lung cancer. Reducing the attraction of children to smoking is the most efficient means of reducing tobacco addiction in adults. By addressing environmental and behavioral issues shown to affect lung cancer incidence, health officials, private and public businesses, and communities can make large-scale, long-term changes in the future burden of lung cancer.