Understanding the Significance of Early Detection
Lung cancer poses a significant threat to health, being the leading cause of cancer-related deaths in the UK. However, amidst this challenge lies a beacon of hope: early detection. As an experienced oncologist, I am deeply committed to lung health, I am driven by the mission to improve outcomes and enhance survival rates through early detection initiatives. Join me in exploring the pivotal role early detection plays in combating non-small cell lung cancer.
You should be mindful of the symptoms of lung cancer or attend a lung cancer screening appointment if you are at high risk of lung cancer. There are many benefits of discovering a lung cancer in its early stages, including:
- Improved Treatment Options: Detecting lung cancer in its early stages provides patients with a wider array of treatment options. Early-stage lung cancer is more likely to be operable, meaning surgical removal of the tumour may be possible. Additionally, early detection allows for less aggressive treatments, potentially reducing side effects and improving quality of life.
- Increased Survival Rates: The survival rates for lung cancer are significantly higher when the disease is diagnosed at an early stage. Patients diagnosed with localised lung cancer have a much better prognosis compared to those with advanced-stage disease. Early detection enables timely intervention, leading to better chances of successful treatment and long-term survival.
- Reduced Disease Progression: Lung cancer that is diagnosed at an advanced stage is more likely to have spread to other parts of the body, making treatment more challenging and less effective. Early detection allows for interventions to prevent or delay the spread of cancer, potentially stopping the disease in its tracks and improving overall prognosis.
- Enhanced Quality of Life: Early detection not only improves survival rates but also enhances the quality of life for lung cancer patients. By identifying the disease before it causes significant symptoms or complications, patients can undergo less aggressive treatments, experience fewer side effects, and maintain better physical and emotional well-being.
- Empowerment Through Screening Programs: Screening programs, such as low-dose computed tomography (LDCT) scans for high-risk individuals, play a crucial role in detecting lung cancer at its earliest stages. These programs empower individuals at risk, such as current or former smokers, to undergo regular screenings, facilitating early detection and intervention when needed.
- Cost-Effectiveness: From a healthcare perspective, early detection of lung cancer can lead to cost savings by reducing the need for extensive treatments and hospitalisations associated with advanced-stage disease. Detecting lung cancer early not only saves lives but also reduces healthcare costs and resource use. It would mean that after treatment, you are much more likely to be well enough to return to work than if the cancer had spread to other parts of the body at diagnosis.
Who might benefit from a private lung health check?
Lung cancer screening, also known as a lung health check, is a valuable tool in detecting lung cancer at its earliest stages, when treatment is most effective. However, not everyone is eligible for screening. Here’s an overview of who may benefit from lung cancer screening:
- Age and Smoking History: The primary eligibility criteria for lung cancer screening typically include age and smoking history. In most cases, individuals aged over 55 who have a significant smoking history are considered eligible. This includes current smokers or those who have quit smoking within the past 15 years.
- Smoking History Criteria: Eligibility based on smoking history is often defined by the number of pack-years smoked. A pack-year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years smoked.
- High-Risk Groups: While smoking is the primary risk factor for lung cancer, other factors may also increase an individual’s risk, making them eligible for screening. These factors may include exposure to environmental pollutants, occupational hazards such as asbestos or radon, a family history of lung cancer, or a personal history of certain lung conditions such as chronic obstructive pulmonary disease (COPD).
How to get the most of a lung health check
It’s important that if you enter into a screening programme, you choose one that prioritises, and uses:
- Shared Decision-Making: It’s essential to engage in shared decision-making with your doctor to determine if lung cancer screening is appropriate for you. This involves discussing the potential benefits and risks of screening, as well as considering individual preferences and values.
- Screening Guidelines: Eligibility criteria for lung cancer screening may vary slightly depending on the specific guidelines followed by healthcare providers or organizations. At our first consultation, we will set out to understand the screening guidelines that apply to you and whether you meet the criteria for screening.
- Regular Screening Interval: For individuals who meet the eligibility criteria for lung cancer screening, regular screening intervals are typically recommended. This may involve low-dose computed tomography (LDCT) scans to monitor for any signs of lung cancer.
What are the symptoms of lung cancer?
Lung cancer can often go unnoticed in its early stages, as symptoms may be subtle or easily mistaken for other respiratory conditions. Being aware of potential symptoms can aid in early detection and treatment. Here are some common signs and symptoms associated with lung cancer:
- Persistent Cough: A persistent cough that worsens over time or doesn’t go away can be a sign of lung cancer. You should see a doctor if you have a new cough for 3 weeks or more, or if a cough you have had for a long time changes in any way.
- Coughing up blood: Your sputum may contain blood or change colour (rust coloured)
- Shortness of Breath: Lung cancer can cause shortness of breath, even with minor exertion. This symptom may worsen as the disease progresses.
- Chest Pain: Chest pain that is constant and worsens with deep breathing, coughing, or laughing may indicate lung cancer. The pain may be dull, sharp, or stabbing in nature.
- Hoarseness: A hoarse voice or changes in voice quality that persist for an extended period may be a symptom of lung cancer, especially when accompanied by other respiratory issues.
- Wheezing or noisy breathing: similar to asthma or chronic obstructive pulmonary disease (COPD), noisy breathing can occur with lung cancer due to airway obstruction.
- Unexplained Weight Loss: Sudden and unexplained weight loss, especially if significant, can be a warning sign of various cancers, including lung cancer.
- Fatigue: Persistent fatigue or weakness that doesn’t improve with rest can be a symptom of advanced lung cancer.
- Loss of Appetite: A significant decrease in appetite, along with unexplained weight loss, may indicate underlying health issues such as lung cancer.
- Bone Pain: Lung cancer that has spread to the bones may cause bone pain, particularly in the back, hips, or chest.
- Headaches: Lung cancer that has spread to the brain may cause headaches, seizures, or other neurological symptoms.
It’s important to note that these symptoms can be caused by conditions other than lung cancer. However, if you experience any of these symptoms, especially if they persist or worsen over time, it’s essential to consult a doctor for proper evaluation and diagnosis.
Early detection of lung cancer can significantly improve treatment outcomes and overall prognosis. If you have a history of smoking or exposure to other risk factors for lung cancer, such as environmental toxins or a family history of the disease, it’s crucial to remain vigilant and report any concerning symptoms to your doctor promptly.
Encouraging Action for Your Well-Being
It’s vital to be proactive in safeguarding your lung health. Whether you’re experiencing symptoms or fall within high-risk categories, I urge you to take the first step towards early detection. By recognising the symptoms, understanding screening eligibility criteria, and embracing shared decision-making, you empower yourself on the path to early detection and improved outcomes. Together, let’s embark on a journey towards better lung health. Schedule an appointment today and take control of your well-being. If you appreciate the importance of early detection and are ready to prioritise your lung health, I invite you to contact me on +44 (0)20 7993 6716. Let us partner in your health journey, providing compassionate care, personalised guidance, and empowering solutions tailored to your needs.
Embarking on lung radiotherapy can be a challenging journey, but with the right dietary approach, you can support your body through the process. In this article, written by award-winning dietitian, Jo Cunningham, of Green Light Nutrition: Cancer & Gut Dietitian Clinic we’ll discuss what to eat before treatment, offer advice for managing radiation-induced oesophagitis, and provide general tips for maintaining your health during follow-up.
What to Eat Before Treatment:
Before starting radiotherapy, focus on nourishing your body with a balanced diet rich in nutrients. This Mediterranean style diet, which is well evidenced to be the best type of diet for those living both with and without cancer. Here are some key tips to consider:
High-Protein Foods:
Incorporate lean proteins such as chicken, fish, tofu, and beans into your meals to support muscle strength and repair. Red meat can be included in moderation.
Whole Grains:
Opt for whole grains like brown rice, quinoa, and whole wheat bread to provide sustained energy throughout the day. These also nourish the gut microbiota to support reducing inflammation in the body.
Fruits and Vegetables:
Load up on colourful fruits and vegetables, which are packed with vitamins, minerals, and antioxidants to support your immune system. Variety is what we’re aiming for to provide a balance of nutrients and fibre. It’s better to have a mouthful of 5 different veggies at meal compared to 5 mouthfuls of one vegetable!
Hydration:
Stay well-hydrated by drinking plenty of water and herbal teas. Proper hydration is essential for supporting your body’s natural detoxification processes. As a rough guide, aim for 2 litres of fluid per day.
Managing Radiation-Induced Oesophagitis:
Radiation-induced oesophagitis is inflammation in the oesophagus (food pipe) which can occur after radiation therapy, and often for lung, breast and other thoracic cancers. It can cause discomfort and difficulty swallowing, and reduced oral intake as a result.
Here are some dietary strategies to help alleviate symptoms:
Soft and Moist Foods:
Choose soft, moist foods that are easier to swallow and less likely to irritate your oesophagus. Examples include mashed potatoes, yoghurt, smoothies, and soups. Don’t forget make these nutrient dense by adding extra plant foods. For example, mash in broccoli and carrot to mashed potatoes, add ground nuts or nut butters to yoghurts, and blend in beans, lentils, and other vegetables into soups and casseroles. Soft and moist doesn’t have to be totally bland!
Avoid Trigger Foods:
Some foods may irritate the lining of the food pipe, so notice whether alcohol, spicy foods, acidic fruits and juices (e.g. citrus fruits), and carbonated beverages trigger for you, and temporarily look to avoid these. Melons, apples, pears and bananas are less acidic and less likely to trigger symptoms. Note that not all of these trigger for everyone, so only exclude what you need to.
Avoid Temperature Extremes:
Very hot or very cold foods may aggravate symptoms, so aim to have foods at room temperature whilst your symptoms are settling.
Small, Frequent Meals:
Divide your meals into smaller, more frequent portions to reduce the strain on your oesophagus. This eating pattern can help you maintain adequate nutrition without discomfort. If you’re struggling to maintain your weight then speaking with a dietitian will provide you with personalised advice.
Nutritional Supplements:
Oral nutritional supplement drinks can be prescribed to help you meet your nutritional requirements if you’re struggling. A dietitian can provide you with samples to help you work out which products are right for you, and then liaise with your GP to arrange a prescription. The dietitian will explain how these products can be used within your day – they aren’t usually to replace your existing meals, but to supplement the diet to support you during this acute phase. In some cases hospital admission for nutrition support may be needed and your dietitian will discuss this with you and your oncologist if appropriate.
Other Supplements:
Caution when it comes to taking supplements (herbal, nutritional & other) whilst on cancer treatment as herb-drug interactions are common. One supplement which has been associated with reduced rates of oesophagitis and mucositis is glutamine, which is an amino acid (building block of protein) found within high protein foods such as meats, fish, eggs, nuts, beans and milk. As the supplement market is saturated and often confusing, we recommend talking to your oncology dietitian before commencing any supplement.
What to Eat After Treatment:
As you progress through your treatment and beyond, that Mediterranean style diet is what we want to be aiming for to support our gut health and overall health.
Here’s some general principle of the Mediterranean diet to keep in mind:
Include oily fish & other omega-3 sources
Rich in anti-inflammatory omega-3 fats, include fish like salmon, mackerel, anchovies and trout. Plant sources of omega-3s include flaxseed, chia seeds and walnuts.
Include plenty of plants
Wholegrains, vegetables, fruits, nuts, seeds and legumes are all plant foods which are known to have a range of health benefits. As a guide, aim for 30 different types of plants in our diet each week to support gut health and the immune system.
Include extra virgin olive oil
This oil is a wonderful source of polyphenols (plant chemicals) which have gut-loving and anti-inflammatory properties. Aim for 1-4 tablespoons per day.
Avoid processed meats
There’s strong evidence that foods such as ham, bacon and sausages are a cause of cancer and the World Cancer Research Fund and American Institute for Cancer Research recommends we avoid these where possible.
Avoid alcohol
Alcohol is a known cause of many types of cancer and so we recommend avoiding it or keeping intake to a minimum.
Conclusion
Navigating lung radiotherapy involves more than just medical treatments; it requires a holistic approach that includes dietary considerations. By understanding what to eat before, during, and after treatment, you can actively support your body’s healing process and overall health.
Before, during and after treatment, focus on a Mediterranean-style diet rich in lean proteins, whole grains, colourful fruits and vegetables, nuts, seeds and legumes. These foods support gut health and overall well-being.
If you’re experiencing radiation-induced oesophagitis, soft and moist foods can help alleviate discomfort, while avoiding trigger foods and extremes in temperature can further ease symptoms. If swallowing becomes difficult, nutritional supplements prescribed by your healthcare team can provide additional support.
Remember, your oncology dietitian is here to guide you every step of the way. Together, we can create a personalised nutrition plan that empowers you to nourish your body and thrive throughout your lung radiotherapy journey. With the right dietary approach and ongoing support, you can face this challenge with strength and resilience.
By combining state-of-the-art radiotherapy techniques with first-class supportive care, we aim to optimise the chance of success of your treatment by reducing side effects and maintaining your quality of life before during and after treatment for lung cancer.
Radiotherapy is a potentially curative treatment for lung cancer. However, like all medical treatments, it comes with potential side effects, some of which may persist long after the therapy has concluded. As the effectiveness of radiotherapy for lung cancer increases, and drug treatments improve the likelihood of long-term survival for patients with lung cancer, the need to minimise side effects side effects that occur after treatment become even more important. This post explores the long-term side effects of radiotherapy for lung cancer, offering insights into management strategies and the latest advancements in treatment techniques that I offer to minimise these effects and maintain your quality of life.
What are Long-Term Side Effects?
Long-term side effects of radiotherapy are those that either continue for months after treatment or develop years later. They can vary widely among patients depending on the specific area treated, the radiation dose, and the individual’s overall health. Common long-term side effects for lung cancer patients may include:
– Lung Changes: Fibrosis (scarring of the lung tissue) is a common issue and can lead to a persistent cough or shortness of breath.
– Cardiac Effects: In some cases, radiation can affect heart health, especially if the heart was within the radiation field. This is particularly true for people who have pre-existing heart problems or risk factors.
– Oesophageal Changes: Difficulty swallowing, known as dysphagia, can occur if the oesophagus was exposed to radiation.
– Secondary Cancers: A very small increased risk of developing a second cancer in the areas treated with radiation exists. As this risk is many years after treatment, it is only now that that chance of cure is improving that this is increasing in importance. The risk is very low (3 in 1000 at 10 years, 5 in 1000 at 15 years after treatment).
It’s important to remember that not everyone experiences side effects. The benefits of eradicating cancer far outweigh the potential risks.
Management of Long-Term Effects
Managing long-term side effects involves regular monitoring and early intervention. Here are some ways to handle these persistent effects:
Pulmonary Rehabilitation
Pulmonary rehabilitation programs can help improve lung function after radiotherapy. These programs typically include exercise training, education, and support, aimed at enhancing quality of life.
Cardiac Care
For patients with potential heart issues post-radiotherapy, regular cardiovascular check-ups and monitoring might be recommended. This may include echocardiograms, ECGs and stress tests to monitor heart health and function.
Nutritional Support or oesophageal intervention
Patients experiencing oesophageal changes may benefit from dietary adjustments. If needed, a dietitian can recommend meals that are more comfortable to swallow, ensuring that nutrition does not suffer. Very rarely, we may need to perform an endoscopy to relieve any narrowing of the oesophagus to restore a normal swallow.
Prevention of long-term side effects is better than cure!
Advancements in radiotherapy techniques have dramatically improved the precision with which radiation is delivered, significantly reducing the risk of long-term side effects. At all my clinics, I utilise the latest technology and treatment protocols to ensure the highest standards of care:
Intensity-Modulated Radiotherapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT)
IMRT and VMAT allow for the radiation dose to be shaped precisely around the tumour, minimising exposure to healthy tissues and reducing the risk of side effects.
Image-Guided Radiotherapy (IGRT)
IGRT helps to significantly reduce the risk of long-term side effects associated with traditional radiotherapy methods. IGRT involves frequent imaging during treatment, ensuring that radiation is accurately targeted, which is crucial for tumours that move, like those in the lung. This greatly enhances the precision and effectiveness of radiotherapy, but also ensures important, critical structures are spared from high doses of radiation.
Advanced motion management techniques
These techniques are designed to precisely target tumours while protecting healthy tissues, even as patients breathe and their internal organs naturally move. I personalise the use of these techniques to each individual patient with the aim of reducing the amount of normal tissue that receives any radiation dose and therefore reduce side effects.
– Breath-Hold Techniques
Breath-hold technologies, such as Active Breathing Control (ABC), allow doctors to deliver radiation while the lungs are in a consistent position. By instructing the patient to hold their breath at a specific point in their breathing cycle, the movement of the lung and heart is minimised. This stability enables more accurate targeting of the tumour, significantly reducing radiation exposure to healthy tissues and thus lowering the risk of heart and lung damage.
– CyberKnife Tumour Tracking
The CyberKnife system represents a revolutionary approach in radiotherapy. It features real-time tumour tracking technology, which tracks the tumour’s position during each breath and adjusts the radiation beam accordingly. This dynamic synchronisation means that even tumours that move with each breath can be targeted with extreme precision, sparing surrounding healthy tissues from unnecessary radiation and reducing side effects.
– Abdominal Compression
Abdominal compression is another effective technique used to reduce the movement of tumours in the chest and abdomen during radiation treatment. By gently compressing the abdomen, this method restricts the range of tumour motion due to breathing, which enhances the accuracy of radiation delivery. This not only improves the effectiveness of the treatment but also minimises the exposure of healthy organs to radiation.
These advanced motion management techniques represent a significant step forward in the treatment of lung cancer. By improving the precision of radiation delivery, they reduce the risk of damaging critical organs and tissues, thereby offering patients a better quality of life both during and after treatment.
Proton Therapy (PBT) for lung cancer
Proton beam therapy is a cutting-edge form of radiotherapy that is gaining traction in the treatment of lung cancer due to its precision and potential to reduce long-term side effects. Unlike traditional radiotherapy that uses X-rays, proton therapy uses protons — positively charged particles — which have a unique advantage. They can be programmed to deliver their energy directly to the tumour site with remarkable precision, minimising exposure to surrounding healthy tissues.
Proton beam therapy offers a type of radiation that stops at the tumour, significantly reducing the dose delivered to the surrounding normal tissues and thereby lowering the risk of long-term damages. In selected patients, those most at risk of long-term or serious side effects, I can treat patients with proton beam therapy at Proton International London (https://www.protonintlondon.com/consultants/dr-james-wilson/)
The ability of proton beam therapy to precisely target tumours means that higher doses of radiation can be used to kill cancer cells while sparing healthy tissues and organs. This can lower the incidence of side effects that patients might experience both during and after treatment.
Another potential benefit of proton therapy is its potential to reduce the likelihood of secondary cancers. Secondary cancers are a serious concern for long-term survivors of lung cancer, often triggered by exposure of healthy tissues to radiation. By limiting this exposure, proton therapy helps to minimise the risk of developing new cancers later on.
For patients undergoing lung cancer treatment, proton beam therapy offers a hopeful path with fewer long-term health concerns. This technique embodies the advancements in medical technology aimed at not just treating cancer more effectively, but also enhancing the quality of life for survivors by minimising adverse effects.
Coping with Long-Term Side Effects
Coping with long-term side effects can be challenging, but with the right strategies and support, many patients manage their symptoms effectively. All the patients that I treat are given access to all the necessary support to both prevent side effects from developing, but also minimise their impact should they occur. All patients will have access to support groups, counselling/talking therapies, and rehabilitation programs if so desired or needed. Dieticians, physiotherapists and occupational therapists will be consulted during treatment. These can be invaluable resources for patients and their families.
Conclusion
While the prospect of long-term side effects from radiotherapy can be daunting, it’s important to balance these concerns with the benefits of treating lung cancer effectively. With ongoing advancements in radiotherapy technology and techniques, the risk of severe side effects continues to decrease. We are committed to providing the safest and most effective treatment options, ensuring that you receive the best possible care tailored to your individual needs.
Regular follow-ups, a focus on symptom management, and the use of cutting-edge technology help us minimise side effects and support you through your recovery journey and help you return to your normal life after treatment. If you have any concerns about radiotherapy or its potential long-term effects, please don’t hesitate to reach out. We are here to help every step of the way.
Remember, every patient’s journey is unique, and we are dedicated to ensuring yours is as smooth and comfortable as possible. We will offer you the right treatment, at the right time in a way that is personalised to your individual needs.
Contact us on +44 (0)20 7993 6716 to discuss how I can help you receive the best treatment for lung cancer – to eradicate the tumour, while minimising long-term side effects.
I received a couple of questions about one of my slides on a previous post.
This is an early result from some work I’ve been doing with University College London Hospitals NHS Foundation Trust looking at how we can improve cure rates following radiotherapy for #lungcancer
Here we’ve tried two different ways or reducing the radiation dose received by the heart. You’ll see that #protontherapy can significantly reduce the radiation dose received by the heart. If we put the amount that the dose can be reduced on to a risk prediction method from Robert Dess at the University of Michigan, you’ll see that the risk of a major cardiac event could be reduced to less than half in selected patients if they received proton beam therapy.
This is a treatment I can offer to private patients at Proton International London. We have some way to go before we can offer this treatment routinely to NHS England patients, but we’ll keep seeking out the evidence required to make this potentially life-saving treatment available to everyone.
Stereotactic Ablative Radiotherapy (SABR) is a cutting-edge treatment for lung cancer that delivers highly precise radiation therapy to tumours in the lungs. Unlike traditional radiation therapy, which may require numerous sessions, SABR delivers a concentrated dose of radiation in just a few sessions, often as few as one to five.
During SABR, advanced imaging techniques are used to precisely locate the tumour in the lung. The radiation beams are then carefully directed at the tumour from multiple angles, ensuring that the cancer cells receive a high dose of radiation while minimising exposure to surrounding healthy tissue.
SABR is an excellent option for patients with early-stage lung cancer who may not be candidates for surgery due to other medical issues. It offers a non-invasive alternative that can effectively destroy cancer cells while preserving lung function.
Overall, SABR is a targeted and efficient treatment option for lung cancer, offering patients hope for better outcomes with minimal impact on their daily lives.
How is SABR for lung cancer given?
SABR for lung cancer is typically administered using cutting-edge treatment machines like linear accelerators (Linacs) or CyberKnife systems. These advanced devices offer precise targeting capabilities, minimising radiation exposure to healthy tissues while effectively treating the tumour. LINACs, widely used for SABR, employ high-energy X-ray beams shaped to match the tumour’s contours from various angles. The CyberKnife systems utilise robotic technology to deliver radiation beams with exceptional accuracy from multiple directions. Both LINACs and CyberKnife systems can deliver the high radiation doses necessary for SABR while prioritising patient safety and comfort.
CyberKnife and Linacs can be used for SABR
How are central lung tumours different?
Central lung tumours pose unique challenges due to their proximity to critical structures like the trachea and main bronchi. However, recent advancements in radiotherapy techniques have paved the way for more precise and targeted treatments, minimising, but not eliminating, the risk of collateral damage to healthy tissue.
Conclusion
As the landscape of cancer care continues to evolve, SABR remains a cornerstone of modern oncology, offering new hope and possibilities for patients facing lung cancer treatment.
Any questions?
Call me on 020 7993 6716 or email Carol to set up on appointment at info@drjameswilson.co.uk
Essential reading:
Tekatli H, Giraud N, van Eekelen R, Lagerwaard FJ, Senan S. Ten years outcomes after SABR in central and ultracentral primary lung tumors. Radiotherapy and Oncology. 2023;188:109848.