The Ins and Outs of Lung Cancer - pt. 2

Posted by jonathan on 3/21/2017 to News

Can you live with one lung?


The answer to this question is an astounding yes, however, conditions in the healthy lung have to be perfect for an average to good life expectancy. The effected lung is removed by a process called pneumonectomy. It is a very complicated procedure because they have to re-route your entire respiratory system similar to a heart by pass . There is no difference in functionality between the right and left lung. They both operate the same. During this very complicated operation (Pneumonectomy), there is so much to consider such as:

1)When was your last chemo or radiation treatment?

2) Are you strong enough for such a procedure?

3) What condition is your immune system in?

4) Is the new primary lung in near perfect condition?

Now, if the healthier lung is compromised, then they might consider a lung transplant which in itself is a long process much like people waiting for kidney transplant’s. Sometimes, its a long wait and while you wait, they can still take the compromised lung and decide to keep you on treatments and oxygen on the better lung. The conditions that they would make their decision on is if you had:

1) Cystic fibrosis

2) Pulmonary hypertension

3) Fibrosis

Now, they can also decide to take out portions of an infected lung and this is called a Lobectomy. The factors on a lobectomy is:

1) Size of the tumor (or effected area)

2) Location of the effected tumor (or area)

3)Your general health as listed above. Remember, if your immune system is compromised, any transplants or removal of a lung demands a second though.

4) Your specialist (surgeon) must decide if the lung cancer is the primary, has it effected any other part of the body, so he or she might want to do a full body scan such a PET scan CAT scan. They probably will also recommend a bone scan, a brain scan and an abdomen scan(liver or stomach).

Once these tests are complete, your doctor must weigh the pro’s and con’s of which direction and which operation to do. Once he or she knows that not one single cell has escaped and effected any other area of the body. If the decision is to go forward with either a Lobectomy or a pneumonectomy, and they have made a determination on your immune system, they will decide to take you off anything your on that might effect a successful operation such as taking you off:

1)Any nsaids (non steroidal anti-inflammatory drug).

2) Drugs such as coumadin. (A blood thinner used for heart or circulatory problems and blood clots)

3) And of course, your anti-inflammatory drugs such an Advil

4) And the last, but almost most important, is that YOU MUST STOP SMOKING if your a smoker.


Pneumonectomy - The Procedure

In the operating room, you will be given a general to put you to sleep, and an endotracheal tube will be will be inserted down your throat so the machine can breath for you

{1}A long incision will be made along your side following the curve of your ribs. The surgeon will spread your ribs and may remove a portion of a rib to gain access to your lung.

When your lung is adequately exposed, they will collapse your effected lung. The major blood vessels (arteries and veins) traveling to your lung are tied off, and the bronchus leading to the lung will be tied off and sewn shut. This will prevent any cancer cells from escaping. After your lung is removed, the surgeon will carefully check to make sure all bleeding is controlled, and will then close the incisions. The space remaining where your lung had been will gradually fill in with fluid.



RECOVERY can be intense. In a lot of cases, after 3 days in ICU, you will still need a bronchial tube to help you breath. During this time, they will keep you sedated due to the fact that people panic and try to pull it out. Once the team feels they can remove the tube, a respiratory therapist will make your cough to mainly clear your throat of sputum. She will then start working with you on therapy such as breathing exercises with a spiromator to help get the remaining lung to accept full responsibility. You will feel weak but your team will make you get up and start walking short distances to both reduce the risk of blood clots. But one thing is for sure, is the harder you work to recover, the fasted your whole circulatory system and strength will come back so you can live a normal life. Some people actually return to work in 8-10 weeks which is amazing considering what your body just went through.

I don’t have to tell you, that the major downfall of having only one lung, is that you will never run a marathon, your always going to have to be careful of your activities and so forth. At the first sign of even the smallest cold or flu, you will always have to get into your PCP right away, because if it goes into pneumonia, you don’t want an infection in your one and only lung.

Although successful, there are many things you have to watch out for, such as heart and kidney problems and sometimes total failure, infections around the incision area, strokes, long term problems from the anesthesia (remember, anesthesia can stay in the system for up to 6 months.) and of course, there are your internal spaces such as..Did the new empty space where the lung was fill in with fluid correctly? The good news is, that your good lung, your remaining lung, is not likely to get cancer.

POPE FRANCIS , AT AGE 76, HAS ONLY HAD ONE LUNG SINCE HE WAS A TEENAGER. He lost a lung due to an infection.

Life expectancy with one lung

Most people can live a beautiful full life with only one lung, but the better question is, why did they lose the other lung and has it effected not only the healthier lung (as talked about above) or other parts of the body. Providing that the remaining lung is in perfect order, and the body is free of cancer, you can rest assure that you will live a full life. Now, this doesn’t mean, that you wont, on occasion, need oxygen , or be winded at times, but you will live normally. Now, here is the catch. What I just finished saying, is for stage 1 and stage 2 cancer. If you had stage 3 or 4 cancer, chances are, that the cells have spread to other parts of the body. The lung remains the primary site, but has affected other parts requiring treatments either long or short term. At this point, you hope and pray that the healthier lung stays healthy. If all conditions are optimal, one can live either a full normal life, or an average of 14-24 years without having to slow down , go on oxygen, etc. It also depends on whether your male or female, which brings me to our final subject of part two…. Estrogen.



Estrogen and lung cancer

Lung cancer continues to be the second most common cancer that women get (first is breast cancer) and with the obvious differences between male and female chemistry. Estrogen receptors have been detected in cancer cells, as female sex hormones play a huge roll in this increase. And there is new evidence that hormone replacement therapy may increase the incident of, and the mortality rate, of lung cancer. For example, lets take smokers. Percentage wise, more men are diagnosed with lung cancer from contributions due to smoking then females, at a rate of 85% men to 47% female. This trend shows that for women, it may be the presence of, or activity of, estrogen that leads to a higher increase of lung cancer. Another study that supports this, is the comparison of the mortality due to lung cancer of pre-menopause women and men aged in the same respect, to post-menopause women and men aged in the same respect. The study showed that the mortality rate was nearly the same between men and pre-menopause women of equal age, however post-menopause women had a significantly less mortality rate compared to men similarly in age. But aside from the variables of age and sex, there is evidence that estrogen, and hormone replacement therapy, does play a large roll in the increased rate of lung cancer due to estrogen receptors because they act as a controlled or genetic influence marker [1].

Now, most women who go through natural menopause have been known to lessen the chance of getting lung cancer. Out of all the studies AJ’s Wigs has gone through, this is what I'm summarizing. From natural pre menopausal to postmenopausal (again, we are summarizing very complicated controlled studies that we even had trouble understanding) as opposed to women who had estrogen replacement, the women who had estrogen replacement was found that more women died. Now, here was an interesting fact, that women younger then 45 had more of a chance in developing lung cancer then older women. Wow, we were shocked at this finding.

Now, lets take all of this above and put it all together in simple terms. Large studies have been done over a 6 year period with records of 38,000 women to see if there were links between estrogen therapy and lung cancer. Half the women were ages 50-76 and the other half were early menopause, menopause or post menopause, and 66% had a family history of cancer or were smokers, or had smoked in the past. Now, DURING the 6 years, a little less then 400 women developed lung cancer. To even further simplify this study, following the women after the study was done, 48% of women who used 10 years or more of hormone therapy, developed lung cancer, however, women who used hormone therapy for 9 years or fewer had only a 27% higher risk of lung cancer, still, even though the women who used HMT 9 years or fewer showed a significantly less chance of developing lung cancer, these women could be considered still at risk, but a lot less risk then those who used replacement therapy long term.

If your having trouble during menopause (sever hot flashes, mood changes, difficult sleeping, night sweats, vaginal discharges or dryness , low sex drive) and he/ she offers to put you on Hormone therapy, have an open conversation about Lung cancer. Menopause can be debilitating to a lot of women, and hormone therapy does help, but you have to weigh the benefits as opposed to the risk’s of increasing your chance at getting lung cancer.



Bibliography:



[1] Chakraborty, Subhankar, Apar Kishor Ganti, Alissa Marr, and Surinder K. Batra. “Lung cancer in women: role of estrogens.” The National Center for Biotechnology Information. U.S. National Library of Medicine, Aug. 2010. Web. 17 Mar. 2017. < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928145/>

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