Alexa Navarro

Project

Presentation

Progress Log

Capstone Essay

Alexa Navarro

Caballero

English 8

05 May 2020

Smoking and the Fatality of Lung Cancer

Lung cancer is the leading cause of cancer deaths worldwide, accounting for an estimated 23.5% of cancer deaths in 2019. Of these deaths, 80 to 90% were caused by some form of smoking (Cancer Stat Facts). Unfortunately, an estimated 1.1 billion people in the world smoke tobacco despite its negative effects on the human body (Aubrey). Sadly, I have grown up watching younger generations adopt harmful habits, mainly vaping, as access to tobacco-based products becomes less restricted. Since vaping became especially popular a few years ago, many people, even children my age, have developed vaping-related lung illnesses and immunocompromising diseases. Smokers, in particular, are facing even worse conditions. The majority of smokers develop lung cancer (Risk Factors), and in 2019 alone, over 100,000 people died from the fatal disease (Cancer Stat Facts). This is precisely why for my Capstone project, I will be creating an animated documentary on lung cancer to educate others on the fatal disease. In order to make this documentary, I need to explore significant topics in lung cancer so that I can present certain information in an accurate and interesting manner. By making this video, I aim to educate people of the fatality of lung cancer and thus the risk of smoking, which directly and indirectly kills millions of people every year.

There are two main types of lung cancer, with non-small cell lung cancer (NSCLC) as the most common type, making up roughly 80 to 85% of all cases. NSCLC has several subtypes. Adenocarcinoma is the most common and forms in the outer part of the lungs. In contrast, squamous cell carcinoma begins in the cells lining the respiratory tract and only makes up 30% of all NSCLC cases. Adenocarcinoma in situ (AIS) is a rare subset of adenocarcinoma that begins in the alveoli (Pietrangelo), small grape-like clusters of air sacs that allow oxygen and CO2 to pass into capillaries (Langwith). AIS develops much slower and does not require immediate treatment because of its location in the lung, and it is ultimately less aggressive than other NSCLC forms. Although each type of NSCLC is very different from each other, they can all be similarly categorized into one of four distinguishable stages that demonstrate the progress of the cancer. Stage I is when the cancer is found but has not spread outside the lung. In stage II, the cancer is already located in the lung and in nearby lymph nodes. During Stage III, the cancer has spread to lymph nodes in the middle of the chest. Furthermore, stage III has two sub-stages: stages IIIA and IIIB. Lung cancer is at stage IIIA when cancer is found in lymph nodes, but exclusively those on the same side of the chest where the cancer began to develop. Stage IIIB, however, is when cancer is found in lymph nodes on the opposite side of the chest or in lymph nodes above the collarbone. Finally, stage IV lung cancer is when the cancer has spread to both lungs, into the area around the lungs, or to other organs. At this point, there is only an estimated 6% five-year survival rate, compared to a 23% five-year survival rate for all stages (Pietrangelo).

While NSCLC is the more common type of lung cancer (80 to 85% of all cases), the other 15 to 20% of lung cancers are of the small-cell lung cancer (SCLC) type. SCLC grows and spreads faster than NSCLC and thus is usually treated with chemotherapy. At the same time, it is less likely to be cured. Unlike NSCLC, there are only two main stages of SCLC: limited and extensive. The limited stage represents all lung cancers that have been found in only one lung or in nearby lymph nodes. During the extensive stage, the cancer has spread throughout the lung, to the opposite lung, to bone marrow, to distant organs, to fluid around the lung, or to lymph nodes located on the opposite side of the chest (Pietrangelo). Because lung cancer is relatively difficult to diagnose and SCLC advances very quickly, two out of three people with SCLC are already in the extensive stage at the time of diagnosis (Britannica).

There are many methods of diagnosing lung cancer. However, lung cancer patients are usually not diagnosed until the cancer is at an advanced stage and symptoms or tumors begin to appear. Regardless, researchers have been working to find new ways to diagnose lung cancer more reliably and also to learn better ways to treat it. One common diagnosis approach involves imaging tests. Tumors and smaller lesions can be seen on X-ray, MRI, CT, and PET scans. If a patient produces phlegm, a sputum cytology can be taken. This is a microscopic examination that can tell if cancer cells are present in bodily fluids. Furthermore, tissue samples can be taken to determine whether or not tumor cells are cancerous; this is known as a biopsy. There are different methods to obtain tissue samples including bronchoscopies, mediastinoscopies, or simply using a needle inserted through the chest cavity into the lungs (Pietrangelo). Although there are many different diagnosis methods, lung cancer is still a difficult disease to detect, making it the most fatal type of cancer (Britannica). Yet, it is not particularly difficult to avoid lung cancer. As a result, it is important for people to take preventative measures and avoid risk factors before it is too late (Pietrangelo).

Smoking is, by far, the most common cause of lung cancer. Although it can occur in anyone, 90% of cases are caused by smoking cigarettes, cigars, and pipes. In fact, cigarette smokers are 15 to 30 times more likely to develop lung cancer than nonsmokers, and this likelihood increases the longer a person smokes. Tobacco products contain 7,000+ chemicals, at least 70 of which are known to cause cancer. Inhaling tobacco smoke immediately starts causing damage to the lungs (Risk Factors). Inhaled chemicals also may enter the bloodstream and can cause other types of cancer as they are carried throughout the body. Lung tissue is damaged as soon as smoke is inhaled. Although lungs are able to repair minimal damage, it becomes more difficult as they are continuously exposed to smoke. Cells in the lung begin to behave abnormally when damaged and they can eventually develop into cancerous cells. People who are heavy smokers have a much higher chance of developing lung cancer and not surviving. SCLC is the type of cancer typically associated with heavy smoking. Quitting smoking is important as over time, an individual’s chance of developing lung cancer is significantly lowered (Risk Factors). In fact, within 10 years of quitting, the risk of dying from lung cancer drops by half. Unfortunately, breathing in secondhand smoke is another risk factor. Every year, about 7,300 people in the U.S. who have never smoked die from lung cancer caused by secondhand smoke (Pietrangelo).

Many people fail to acknowledge that vaping can be nearly as harmful as smoking. However, increasingly frequent deaths in recent years due to vaping have raised awareness of the risks posed by electronic cigarettes. Since March 2019, there have been 52 confirmed deaths and nearly 2,400 hospitalizations as a result of vaping. The majority of deaths were of people aged 18 to 29 as vaping is especially popular among the younger generations. Many of these deaths have been associated with the use of black market THC products, although vaping nicotine has proved to be very harmful as well. In addition to nicotine, there are other vaping chemicals that harm the human body including propylene glycol, glycerin, and flavoring compounds. Researchers were able to track the use of smoking and vaping products among a group of people to learn how these products may affect the human body. Over three years, the risk of developing lung cancer among these people more than doubled. Researchers also discovered that people that only use e-cigarettes experienced a 30% increased risk of developing lung disease compared to non-nicotine product users. Specifically, they have a higher chance of developing chronic lung diseases such as COPD, chronic bronchitis, emphysema, or asthma. E-cigarettes are nearly as harmful as cigarettes. For people that use both e-cigarettes and cigarettes these two risks multiply. This is not surprising, as there is evidence that vaping leads to inflammation and can severely weaken immune defenses, as does smoking (Aubrey).

The second leading cause of lung cancer, particularly SCLC, is exposure to harmful gasses such as radon, a naturally occurring radioactive gas. It can easily enter buildings from small cracks in the foundation, so it is important that buildings are properly built. If exposed to radon gas, a smoker’s chance of developing lung cancer increases by a significant amount. According to the EPA, lung cancer from exposure to radon causes about 21,000 lung cancer deaths every year in the U.S. About 2,900 of these deaths are among people who never smoked. Other substances that can cause lung cancer include nickel, chromium, cadmium, arsenic, uranium, and some petroleum products (Britannica). In fact, exposure to radon and other harmful substances (mainly asbestos and diesel exhaust) is the leading cause of cancer in nonsmokers. Other risk factors include previous radiation therapy to the chest, as well as family history of lung cancer. This disease rarely occurs genetically, although inherited genetic mutations can increase an individual’s chance of developing lung cancer, especially if they smoke or are exposed to other carcinogens over a long period of time (Pietrangelo).

Lung cancer can be a very dangerous disease, fortunately, there are several promising new innovations on the horizon that will greatly improve patient outcomes, claims Dr. Paul Henry Schipper, a general thoracic surgeon at Oregon Health & Science University (OHSU). Immunotherapy and chemotherapy drugs are being developed to be more effective against advanced cases of cancer (Schipper). Still, any treatment for lung cancer varies from patient to patient, as it is based on a number of factors including type (NSCLC vs SCLC), stage, the patient’s health, and the patient’s preferences. Most often, one or more types of therapy are used to combat lung cancer. Some patients choose to not undergo treatment and are recommended other options to manage pain and symptoms. However, for the majority of patients, surgery is a common option. For all cases of lung cancer, patients and the healthcare team assess all the options and choose the optimal treatment plan together.

Surgery is the main treatment in patients with non-small cell lung cancer as it is usually the most effective approach in these cases. It can be used for non-small cell lung cancer patients with stage I, II, and some stage IIIA lung cancers. However, it is not used for stage IV as, by this time, the cancer is metastatic, meaning that it has already spread to other parts of the body. Only in rare cases is surgery used to treat SCLC as patients are usually diagnosed only after the cancer has spread. Chemotherapy and radiation therapy are often prescribed in addition to surgery in order to eliminate any cancer that was not removed. Lung cancer surgery is complex and usually performed by an experienced specialist such as a thoracic surgeon (“Treatment Options”).

Surgery is a treatment option only when the tumor has been found in an early stage, meaning that it can be removed safely and has not spread to other organs within or outside of the chest (“Treatment Options”). Doctors may take lung function tests before surgery to determine the best type of procedure to perform on a patient depending on their condition and whether or not they are healthy enough to undergo surgery. If surgery is the chosen treatment for a patient, it is important for them to follow the pre-operative instructions in order to allow a smooth recovery. It is also important that patients quit smoking to allow the lungs to recover properly after surgery is performed (“Lung Cancer Surgery”).

Lung cancer surgery can be very difficult, so it is important that surgeons have the right tools and assistance when performing surgery. During surgery, a patient will receive anesthesia, and to prevent infection, the area around the incision site will be cleaned. Surgical procedures either involve removing a diseased part of the lung or targeting (shrinking or removing) a tumor. In rare cases an entire lung is removed, however, thoracotomy and minimally invasive surgery are the procedures that are more commonly used for lung cancer. A thoracotomy is when surgery is performed through an incision between the ribs. During minimally invasive surgery, doctors use cameras and instruments to reach the lung through small incisions between the ribs. Any minimally invasive surgery procedure can be categorized into video-assisted thoracoscopic surgery (VATS) or robot-assisted surgery (RAS). VATS involves a small tube with a camera on the end being inserted through a small incision. RAS uses robots as extensions to the surgeon’s eyes and hands. The surgeon has complete control over this robotic surgical system which translates every hand movement the surgeon makes to precise movements the arms of the robot will make. Minimally invasive surgery is a common procedure that allows the surgeon a clear view of the lung with the help of cameras. Furthermore, the hospital stay for a patient who has been through this kind of surgery is usually shorter than that after a thoracotomy. Patients sometimes need the help of a respiratory therapist or a physical therapist after surgery to improve lung function; pulmonary rehabilitation is also common after surgery (“Lung Cancer Surgery”).

In many cases, surgery can be a very effective treatment against lung cancer, however, many patients require the help of other treatments that fight against the cancer on a cellular level. These include radiation therapy, also called radiotherapy, which is a treatment that uses high-powered energy beams (usually X-rays) to shrink tumors and directly kill cancer cells while causing minimal damage, if any, to surrounding healthy tissues. This type of therapy is used in different ways depending on the patient’s type and stage of cancer, health, and other significant factors. Radiation therapy may be used for both NSCLC and SCLC patients, and can be used in combination with other treatments or by itself. This treatment is effective in many cases and has been used to target cancer for over a century. Over time, this process has become significantly safer, precise, and effective. Unlike radiation therapy, targeted therapy is a treatment that uses drugs to attack cancer cells. After extensive research, scientists have been able to develop drugs that directly target some mutations caused by cancer. These drugs specifically target signals sent from proteins to cells that cause them to divide and grow uncontrollably (“Treatment Options”).

Angiogenesis inhibitors are one of several other drug-based treatments. These drugs are intended to work against a certain bodily process known as angiogenesis, the process by which the body makes new blood vessels. This is a normal process, however, when oxygen and nutrients are transported by new blood vessels to the cancer cells of a tumor, they help the tumor grow and spread. Drugs known as angiogenesis inhibitors help slow or even stop the growth and spread of tumors by stopping the formation of blood vessels. Lung cancer can be a very fatal disease, fortunately, many treatments are continuously being developed in order to find the most effective treatment against lung cancer (“Treatment Options”).

Some treatments, in particular, work especially well when combined with others to kill cancer and shrink tumors whether the cancer is localized or has spread to other places in the body. Immunotherapy is one of several non-invasive lung cancer treatments that is used to treat metastatic cancer. This type of drug works to enhance the body’s immune response to stop the lung cancer from evading the immune system (“Treatment Options”). This treatment has been successful against various kinds of cancer. There are four immunotherapy drugs in particular, known as checkpoint inhibitors, that have been approved for patient use. They activate a patient’s immune system against harmful cells that reproduce abnormally and uncontrollably. However, these drugs cost over $100,000 a year. They also only help a number of patients and have serious side effects on many others. When they do work though, they are extremely helpful, and so researchers are working to combine and improve these treatments. These researchers are making progress, but so far only benefitting 30 to 40 percent of patients, and so they continue to look for new approaches that may be more successful (Grady). Chemotherapy is another drug treatment that uses drugs to stop the growth and division of cancer cells. It can shrink lung cancer tumors, alleviate symptoms, and extend life. This specific type of therapy can be used at any stage of lung cancer and for both NSCLC and SCLC. It can be used as a single drug or in addition to other drugs or treatments. Chemotherapy has been used as a treatment against cancer for years and is known to be effective in many cases (“Treatment Options”). In fact, chemotherapy works well together with immunotherapy. There are several possible explanations for this, one being that tumor cells are like bags of proteins, that if exposed by the chemotherapy, they can be easy targets for the immune system that will also be able to find other cancer cells and attack them (Grady). Finally, clinical trials are an option for those who volunteer to test new treatments and be studied to help researchers find and develop new, effective treatments (“Treatment Options”).

If a patient chooses to not receive treatment or the cancer is far too advanced to be treated, there are several options that can improve quality of life before a patient dies. Palliative Care is given to a patient who has a serious or life-threatening disease. This treatment is used to anticipate, prevent, and treat the symptoms of a disease and the side effects of its treatment. It targets the symptoms of a disease rather than the disease itself, so as to help improve the patient’s quality of life. Palliative care may be provided at any time during a patient’s journey: the time of diagnosis, throughout treatment, and even at the end of life. Likewise, hospice care targets the symptoms of the cancer rather than the cancer itself. However, this treatment is generally for people who have a “life-limiting illness” or a life expectancy of under six months and have thus decided to refrain from taking curative treatment. Hospice care is intended to provide physical and spiritual comfort to the patient before they die (“Treatment Options”).

During the course of this research, I learned about the fatality of lung cancer and explored topics including the forms of lung cancer, risk factors, and treatments. It is unfortunate how many people are diagnosed with lung cancer every year, and it is especially disappointing because so many of these cases can easily be prevented by not smoking. In fact, tobacco smoking is one of the world's largest health problems (Aubrey), which is why it is particularly important for people to address the risk of smoking and the fatality of lung cancer. This is precisely my goal by creating an informative animated documentary on lung cancer; to inform the public on this deadly disease so as to dissuade them from adopting harmful habits, particularly smoking.

Works Cited

Aubrey, Allison. “Vaping Nicotine Linked To Increased Risk Of Chronic Lung Disease.” NPR, 16 Dec. 2019, https://www.npr.org/sections/health-shots/2019/12/16/788540191/vaping-nicotine-linked-to-increased-risk-of-chronic-lung-disease. Accessed 2 Apr. 2020.

“Cancer Stat Facts: Lung and Bronchus Cancer.” National Cancer Institute, SEER, https://seer.cancer.gov/statfacts/html/lungb.html. Accessed 10 Apr. 2020.

Grady, Denise. “Lung Cancer Patients Live Longer With Immune Therapy.” The New York Times, 16 Apr. 2018, https://www.nytimes.com/2018/04/16/health/lung-cancer-immunotherapy.html. Accessed 2 Apr. 2020.

Langwith, Jacqueline. Lung Cancer. Greenhaven Press, 2011. Accessed 8 Apr. 2020.

"Lung cancer." Britannica School, Encyclopædia Britannica, 12 Feb. 2019.

https://school.eb.com/levels/middle/article/lung-cancer/49376. Accessed 6 Apr. 2020.

“Lung Cancer Surgery.” American Lung Association, 18 Dec. 2017, https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/patients/treatment/types-of-treatment/lung-cancer-surgery.html. Accessed 6 Apr. 2020.

Pietrangelo, Ann. “Everything You Need to Know About Lung Cancer.” Healthline, 14 May 2019, https://www.healthline.com/health/lung-cancer. Accessed 2 Apr. 2020.

Schipper, Paul Henry. Personal Interview. 20 Mar. 2020.

“Treatment Options for Lung Cancer.” Lungevity, 2020, https://lungevity.org/for-patients-caregivers/lung-cancer-101/treatment-options-for-lung-cancer. Accessed 8 Apr. 2020.

“What Are the Risk Factors for Lung Cancer?” CDC, 18 Sept. 2019, https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm. Accessed 28 Apr. 2020.