Lung cancer smoking
The new millennium has shown a change in disease trends. Communicable diseases that were the main cause of mortality in the last century have been replaced by non-communicable diseases (NCD) as the leading cause of morbidity and mortality in the world’s population. According to a recent WHO report, the four leading causes of death are cardiac diseases, cancers, chronic lung diseases and diabetes, which victimise three out of five people. The report shows that heart diseases were responsible for the largest proportion of NCD deaths under the age of 70 (39 percent), followed by cancers (27 percent). Chronic respiratory diseases, digestive diseases and other NCDs were together responsible for approximately 30 percent of deaths, and diabetes was responsible for 4 percent. No wonder doctors today are diagnosing heart diseases and cancers more and more.
One of the most commonly detected cancers among patients at present is lung cancer. It was alarming to see that half the patients in my respiratory unit at a time were lung cancer victims. Seeing this, I tried to gather some statistics from the WHO report on NCDs in Nepal, but unfortunately there was no comprehensive data on the incidence and prevalence of cancers. So I have decided to focus on my own cases to emphasise on the problem of lung cancer and to highlight its association with smoking.
Case 1: A 65-year-old lady from Palpa presented with 15 days history of fever and chest pain, which was managed locally as pneumonia for 10 days. But since her chest pain did not subside and she became more and more breathless, she was referred to me. On examination and investigation she was found to have pneumonia and fluid effusion in her chest cavity. A chest tube drainage was put and biopsy sent. The biopsy report came as adenocarcinoma of lung. This lady was a smoker in the past. She had smoked around eight cigarettes per day for almost 20 years.
Case 2: 60-year-old gentleman from Nawalparasi presented with history of chest pain and shortness of breath. He was diagnosed with tuberculosis and had already started taking an anti-TB drug. Since he was not improving, he had been referred to me. On examination of the chest he was found to have a collapsed lung with fluid in the pleural cavity. In spite of being on anti-TB medication for one month, his lung was still collapsed and the fluid had not been absorbed, making the diagnosis of TB doubtful. A CT scan of the chest showed a tumor in his right bronchus and the fluid showed squamous cell carcinoma, another type of lung cancer. Again this man had smoked like a chimney for almost 40 years.
Case 3: A 57 year old gentleman was admitted with history of coughing up of small amount of blood in his sputum. His chest X-ray showed collapse of the right lower lung. A bronchoscopy (pipe inserted through the airway) was done and it showed a growth in the right lower lobe bronchus, which was biopsied and confirmed as small cell type of lung cancer. He had been an occasional smoker of bidis.
Case 4: An elderly lady was transferred to my unit from the orthopedic unit, complaining of difficulty in breathing. She was taken to the bone doctors as she had fallen down and broken her arm. She had also continuously complained of back pain and the orthopedics had diagnosed a fracture of her vertebra in the upper back. We took her and investigated and she was found to have lung cancer, which had also spread to her bones. She was still smoking.
Case 5: A 70-year-old gentleman was brought to my clinic with a history of prolonged fever. He had visited all possible private clinics in Kathmandu where he was prescribed different antibiotics, finally settling on anti-TB antibiotics. We reevaluated him and his sputum showed malignant cells and a CT also confirmed a widespread lung cancer. He succumbed to his disease eventually. He had smoked 30 sticks per day since the age of 14.
Case 6: An elderly gentleman who had been my patient for the last one year presented with history of coughing up of significant amount of blood in his sputum for a month. Otherwise an active man, he had been diagnosed with coronary heart disease and aortic aneurysm (dilated artery) about a year back. He smoked almost 20 cigarettes per day and continued to do so in spite of our counseling. Unfortunately he was found to have lung cancer in a recent CT scan and was rushed to TATA memorial.
These records were collected in a two-month period. One could argue that the reason for the large number of lung cancer cases is because my specialty is respiratory medicine, but let me assure you, there has been a definite increase in numbers compared to a few years ago. People are continuing to smoke and lung cancer is on the rise, despite the unavailability of official data. But considering the huge social and monetary impact it is going to have, we need to start monitoring these cases as we do in tuberculosis.
What is depressing is that most of these patients cannot afford the huge cost of treatment. After diagnosis, the choice we generally give is between starting treatment, or going to one of the three government hospitals—Bir hospital, Bhaktapur hospital or the Bharatpur cancer hospital. Unfortunately, most of them choose to go home and wait for the disease to take its natural course. Only the few who can afford private hospitals go to oncologists to decide their fate.
The lesson here is that prevention is indelibly better than cure. We need to have healthier lifestyles; consume more fruits and vegetables, less meat, and incorporate exercise into our routines. Alcohol and smoking need desperately to be regulated, maybe even banned. The question is, can we?
Dr Neopane is a Senior Consultant Physician and Associate Professor of Medicine at the Kathmandu Medical College in Sinamangal
Posted on: 2012-02-06 09:59
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