Q: Reports of the surge in lung cancer in Sri Lanka have sounded a wake-up call among health officials who are currently working to reduce the incidence of cancer in the country in response to the challenges posed by the Covid 19 pandemic. Since many of our readers still don't know what lung cancer is, can you explain in plain language what it is?

Answer: Cancer is the uncontrolled growth of abnormal cells in the body. Lung cancer is a type of cancer that starts in the lungs. Lung cancer can grow rapidly and may invade the surrounding structures of the chest cavity. It may invade blood vessels and the patient may cough up blood. When the breathing tube is blocked and a large amount of lung tissue is affected, the patient will have difficulty breathing.

The spread of lung cancer to the chest cavity due to fluid accumulation in the pleural cavity is another cause of difficulty breathing. Cancer cells can spread through the bloodstream to distant places such as the brain and may begin to grow there. This is called transfer. Some cancers produce various chemicals, which may cause different symptoms, such as weight loss, confusion, and unstable gait.

Q: It is said that lung cancer is the most common cancer in many countries. In terms of gender, it is also considered to be the second most common male cancer in Sri Lanka. is this right? If so, why?

Answer: Lung cancer is the most common cancer in men worldwide. Lip cancer and oral cancer are the most common male cancers in Sri Lanka, and lung cancer ranks second. Both of these cancers are closely related to smoking. Chewing betel nut is another important cause of oral cancer. Lung cancer is less common among Sri Lankan women. In Sri Lanka, women rarely smoke.

Q: In 2014, according to data from the Cancer Registry, Sri Lanka reported 1,316 new lung cancer patients, of which 1,032 were male patients. Do you have an update of these figures? Or is it the same number today? When was the last national lung cancer survey?

Answer: Sri Lanka reported 2072 new lung cancer cases in 2020 (Global Cancer Observatory-March 2021.)

Question: Compared with ten years ago, what are the main risk factors for lung cancer in Lanka people today? Because cigarettes contain a lot of unnatural ingredients, smoking is the main reason. Is this correct? is this right? What is the main toxic element responsible for?

Answer: Smoking is the number one risk factor for lung cancer. The three main components of cigarette smoke are tar, nicotine and carbon monoxide. More than 4,000 compounds have been found in cigarette smoke, of which approximately 70 are known to cause cancer. These carcinogens are called carcinogens (PAH, N-nitrosamines, aromatic amines, 1,3-butadiene, benzene, aldehydes and ethylene oxide are some of them). Sri Lankan women rarely smoke, as does lung cancer.

Q: Foreign studies have found that the risk of lung cancer in smokers is many times higher than that of non-smokers, depending on the time and amount of smoking per day. do you agree?

Answer: As we all know, smoking increases the risk of lung cancer by 25 times. The risk increases with the number of sticks/bags and smoking time. If a patient diagnosed with lung cancer continues to smoke, the result will be poor and the survival rate will be reduced.

Question: What about cigar smokers and pipe smokers?

Answer: Smoking a cigar or pipe also increases the risk of lung cancer.

Q: Family history of lung cancer-how high is it on the risk list?

Answer: About 8% of lung cancers are caused by genetic (genetic) factors. Among relatives of people diagnosed with lung cancer, the risk has doubled.

Q: Second-hand smoke-what is it and how does it cause lung cancer?

Answer: Passive smoking, inhaling smoke from other people's smoking is a well-known cause of lung cancer.

Question: In addition to the lungs, does smoking affect other organs in our body? For example, will smoking a pregnant mother harm her fetus and her own reproductive organs?

Answer: A Smoking makes it more difficult for women to get pregnant (low fertility). Preterm birth (premature birth), stillbirth (the baby dies before delivery), and low birth weight are known complications of smoking. As we all know, sudden infant death syndrome, ectopic pregnancy and infant cleft lip are related to smoking during pregnancy. Smoking also affects male sperm and reduces fertility.

Smoking can cause cancer in most of the body's organs (bladder, kidney, liver, colon, oropharynx, stomach, pancreas, blood).

Smoking increases the risk of coronary heart disease and stroke by 2 to 4 times. It can reduce bone mass and make bones prone to osteoporosis and fractures. It can also increase the risk of cataracts (clouding of the lens of the eye). Smoking is a cause of type 2 diabetes and can make it more difficult to control. It will adversely affect the immune system and reduce the body's immunity.

Q: Will Covid 19 cause lung cancer?

Answer: The Covid 19 virus can cause pneumonia and lung scarring in some patients. Since it is a new disease, no one knows whether it will cause lung cancer. Many other viruses, such as HIV, hepatitis B and C, human papilloma virus, and Epstein-Barr virus, are known to cause cancer in humans.

Q: Any other factors, such as inhaling polluted air due to burning some wastes that release carcinogens outdoors, for example: burning polyethylene and plastics will release chemicals including dioxins into the environment and cause cancer, and exposure to the air Other carcinogens in may cause indoor or outdoor exhaust gas from diesel engines-will they increase the risk of lung cancer together?

Answer: As we all know, exposure to asbestos and other carcinogens such as arsenic, chromium and nickel can cause lung cancer. Exposure to radon from the natural decomposition of uranium in soil, rocks and water is also a known cause of lung cancer. Unsafe levels of radon can accumulate in any building, including homes. Previous radiation therapy to the chest is another cause of lung cancer. Outdoor air secretions also bring some risks of lung cancer.

Question: So what symptoms do we need to pay attention to?

Answer: Continuous coughing, coughing up blood even if it is very small, chest pain, difficulty breathing or changes in voice are common symptoms of lung cancer. Weight loss and loss of appetite are common in any cancer. If the cancer has spread to other organs, the patient may have other symptoms.

Q: Are there different stages of lung cancer? What symptoms and signs should be paid attention to in the late stage?

Answer: The staging of lung cancer will be based on the size of the cancer (Tumour-T), the degree of lymph node involvement (N) and distant metastasis (M). You may see it as a TNM stage in the biopsy report. Patients with advanced cancer may experience other symptoms, depending on the organ or distant part involved. If the cancer has spread to the brain, the patient may complain of headaches, weakness or cramps in the limbs; if it is in the spine, the patient may experience back pain, weakness and numbness in the lower limbs.

Q: When a patient comes to your clinic in Welisara with suspicious symptoms of lung cancer, what is the usual treatment procedure?

A: After detailed medical history and physical examination, basic examinations will be carried out, such as blood test for tuberculosis, sputum analysis and chest X-ray examination. The chest X-ray of most patients will be abnormal.

A CT scan of the chest will be arranged for further evaluation. Any patient with suspected cancer needs tissue confirmation (biopsy) before specific treatment.

After evaluating the chest X-ray and CT scan, it will be decided to scan guided biopsy, bronchoscopy, thoracoscopy and other procedures to obtain tissue samples (biopsy). Bronchoscopy is a process in which a thin tube with a camera is passed through the nose into the breathing tube under local anesthesia to obtain a sample. Thoracoscopy is performed under local or general anesthesia, in which a small camera is again introduced into the chest cavity to obtain a biopsy sample.

The treatment of lung cancer depends on its stage. After discussing with cancer specialists, thoracic surgeons, patients and guardians, further treatment of the patient will be decided. In the early stage when lung cancer is confined to the lungs, as long as the patient is suitable for surgery, surgery will be provided. Others will be referred to cancer specialists for chemotherapy or radiation therapy.

Q: If the patient is at an advanced stage, what is the chance of survival?

Answer: In advanced lung cancer, the chance of survival may be within weeks or months. The five-year survival rate for local (early stage) lung cancer is approximately 63%, and for advanced (stage 4) lung cancer is approximately 7%.

Q: For non-communicable diseases (NCD) such as cancer, prevention is considered a better option than treatment. For young and old people in this country who are prone to lung cancer, what gaps do you hope to fill urgently?

Answer: The most important thing is to educate people about the risks of smoking and how to keep our younger generation away from smoking.

Q Summarize some of the things that the public can do and should not do that can follow the guidelines of the Ministry of Health.

Answer: Quitting smoking will reduce the risk of lung cancer for you and your family. Look for non-smoking hotels, restaurants, and bars, and don't let visitors smoke in your home, workplace, or car. Ask your friends and family not to smoke around you and your children. Educate your children about second-hand smoke and how to avoid it.

Avoiding exposure to known carcinogens in the workplace and elsewhere may also help. A healthy diet that contains plenty of fruits and vegetables may also help reduce the risk of lung cancer.

Since 1928, "Sunday Observer" is Sri Lanka's oldest English weekly newspaper with the largest circulation.

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