For project in science

1. Group 4
Presentation
Topic: Colds, Flu , and Lung
Cancer

2. Common Cold
The common cold also
known as nasopharyngitis,
rhinopharyngitis, acute
coryza, head cold, or simply
a cold) is a contagious
infection of the upper
respiratory tract .

3. Symptoms of a common cold
 Infection with a cold virus affects the mucous membranes of the nose and
throat, causing such symptoms as nasal congestion and discharge, sore
throat, and coughing. These symptoms are typical also of respiratory
infections caused by bacteria, and of allergic conditions such as hay fever
and asthma; therefore, the common cold is difficult to diagnose with
certainty.
 Normally a cold runs a mild course, without fever, and goes away on its
own in about seven days. If the symptoms do not go away after two
weeks, they may result from an allergy. The medical significance of a cold
lies in the possible complications that may follow. Various diseases, such
as bronchitis, pneumonia, and sinus or middle-ear infections, may arise
from the cold. A cold accompanied by high fever, by a cough that brings
up mucus, or by severe sinus pain may call for attention from a physician.

4. Causes and transmission of a
cold
 The great majority of colds are caused by viruses, and the rhinoviruses cause about
half of all colds. Research indicates that there are several strains of each type of cold
virus with varying degrees of virulence. Infection with one strain of cold virus provides
only a brief immunity to reinfection by the same strain, and gives no immunity against
the other viral strains.
 The common cold was once thought to result from exposure to cold weather, a belief
probably traceable to the fact that people tend to crowd together indoors at this time,
causing a more efficient transmission of virus from person to person. Chilling was
also believed to cause a cold, but there is no scientific evidence for the belief that
chills or exposure to cold play a role in causing colds. Research does suggest,
however, that stress may weaken the body’s immune response and thereby make it
easier to become infected.
 Cold viruses are transmitted from person to person through droplets of mucus in the
air. The droplets containing cold viruses enter the air when an infected person
sneezes. The viruses can also be spread by hand—for example, by touching the
hand of an infected person, or by touching a telephone, piece of paper, or other
contaminated surface, and then touching the eyes or nose

5. Prevention
 The only possibly useful ways to reduce the spread of cold viruses
are physical measures such as hand washing and face masks; in
the healthcare environment, gowns and disposable gloves are also
used. Isolation, e.g. quarantine, is not possible as the disease is so
widespread and symptoms are non-specific. Vaccination has proved
difficult as there are so many viruses involved and they mutate
rapidly. Creation of a broadly effective vaccine is thus highly
improbable.
 Regular hand washing appears to be effective in reducing the
transmission of cold viruses, especially among children.[46] Whether
the addition of antivirals or anti bacterials to normal hand washing
provides greater benefit is unknown. Wearing face masks when
around people who are infected may be beneficial; however, there is
insufficient evidence for maintaining a greater social distance. Zinc
supplements may help to reduce the prevalence of colds. Routine
vitamin C supplements do not reduce the risk or severity of the
common cold, though they may reduce its duration.

6.  No medications or herbal remedies have been conclusively demonstrated to shorten the
duration of infection.[49] Treatment thus comprises symptomatic relief.[50] Getting plenty
of rest, drinking fluids to maintain hydration, and gargling with warm salt water, are
reasonable conservative measures.[21] Much of the benefit from treatment is however
attributed to the placebo effect.[51]
 Symptomatic
 Treatments that help alleviate symptoms include simple analgesics and antipyretics such
as ibuprofen[52] and acetaminophen/paracetamol.[53] Evidence does not show that
cough medicines are any more effective than simple analgesics[54] and they are not
recommended for use in children due to a lack of evidence supporting effectiveness and
the potential for harm.[55][56] In 2009, Canada restricted the use of over-the-counter
cough and cold medication in children six years and under due to concerns regarding
risks and unproven benefits.[55] In adults there is insufficient evidence to support the use
of cough medications.[57] The misuse of dextromethorphan (an over-the-counter cough
medicine) has led to its ban in a number of countries.[58]
 In adults the symptoms of a runny nose can be reduced by first-generation antihistamines;
however, these sometimes have adverse effects such as drowsiness.[50] Other
decongestants such as pseudoephedrine are also effective in adults.[59] Ipratropium
nasal spray may reduce the symptoms of a runny nose but has little effect on
stuffiness.[60] Second-generation antihistamines however do not appear to be
effective.[61]
 Due to lack of studies, it is not known whether increased fluid intake improves symptoms
or shortens respiratory illness[62] and a similar lack of data exists for the use of heated
humidified air.[63] One study has found chest vapor rub to provide some relief of nocturnal
cough, congestion, and sleep difficulty.[64]

7.  Antibiotics and antivirals
 Antibiotics have no effect against viral infections and thus have no effect against the
viruses that cause the common cold.[65] Due to their side effects, antibiotics cause overall
harm, but are still frequently prescribed.[65][66] Some of the reasons that antibiotics are
so commonly prescribed include people's expectations for them, physicians' desire to
help, and the difficulty in excluding complications that may be amenable to antibiotics.[67]
There are no effective antiviral drugs for the common cold even though some preliminary
research has shown benefits.[50][68]
 Alternative medicine
 While there are many alternative treatments used for the common cold, there is insufficient
scientific evidence to support the use of most.[50] As of 2010 there is insufficient evidence
to recommend for or against either honey or nasal irrigation.[69][70] Zinc has been used to
treat symptoms, with studies suggesting that zinc, if taken within 24 hours of the onset of
symptoms, reduces the duration and severity of the common cold in otherwise healthy
people.[47] Due to wide differences between the studies, further research may be needed
to determine how and when zinc may be effective.[71] Whereas the zinc lozenges may
produce side effects, there is only a weak rationale for physicians to recommend zinc for
the treatment of the common cold.[72] Vitamin C's effect on the common cold, while
extensively researched, is disappointing, except in limited circumstances, specifically,
individuals exercising vigorously in cold environments.[48][73] There is no firm evidence
that Echinacea products provide any meaningful benefit in treating or preventing colds.[74]
It is unknown if garlic is effective.[75] A single trial of vitamin D did not find benefit.[76]

8. INFLUENZA
DEFINITION
CAUSE
SYMPTOMS

9. Influenza
 Influenza, also known as flu, contagious infection
primarily of the respiratory tract. Influenza is
sometimes referred to as grippe. Influenza is
caused by a virus transmitted from one person to
another in droplets coughed or sneezed into the
air.

10. Types of Influenza
 Influenzavirus A
 This genus has one species, influenza A virus. Wild aquatic birds are the natural hosts for a large
variety of influenza A. Occasionally, viruses are transmitted to other species and may then cause
devastating outbreaks in domestic poultry or give rise to human influenza pandemics.[37] The type A
viruses are the most virulent human pathogens among the three influenza types and cause the most
severe disease. The influenza A virus can be subdivided into different serotypes based on the
antibody response to these viruses.[38] The serotypes that have been confirmed in humans, ordered
by the number of known human pandemic deaths, are:
 H1N1, which caused Spanish Flu in 1918, and Swine Flu in 2009
 H2N2, which caused Asian Flu in 1957
 H3N2, which caused Hong Kong Flu in 1968
 H5N1, which caused Bird Flu in 2004
 H7N7, which has unusual zoonotic potential[39]
 H1N2, endemic in humans, pigs and birds
 H9N2
 H7N2
 H7N3
 H10N7
 H7N9

11. Influenzavirus B
Influenza virus nomenclature (for a Fujian flu virus)
This genus has one species, influenza B virus. Influenza B almost exclusively
infects humans[38] and is less common than influenza A. The only other
animals known to be susceptible to influenza B infection are the seal[40] and
the ferret.[41] This type of influenza mutates at a rate 2–3 times slower than
type A[42] and consequently is less genetically diverse, with only one influenza
B serotype.[38] As a result of this lack of antigenic diversity, a degree of
immunity to influenza B is usually acquired at an early age. However, influenza
B mutates enough that lasting immunity is not possible.[43] This reduced rate
of antigenic change, combined with its limited host range (inhibiting cross
species antigenic shift), ensures that pandemics of influenza B do not
occur.[44]
Influenzavirus C
This genus has one species, influenza C virus, which infects humans, dogs
and pigs, sometimes causing both severe illness and local epidemics.[45][46]
However, influenza C is less common than the other types and usually only
causes mild disease in children

12. Cause
 The word influenza is derived from the Latin word influentia. Italians in the early 16th century
first applied the word influenza to outbreaks of any epidemic disease because they blamed such
outbreaks on the influence of heavenly bodies. The first known use of the name specifically for
the flu occurred in 1743 when an epidemic swept through Rome and its environs.
 Today scientists know that members of the family Orthomyxoviridae, a group of viruses that
infect vertebrate animals, cause influenza. The virus consists of an inner core of the genetic
material ribonucleic acid (RNA) surrounded by a protein coat and an outer lipid (fatty) envelope.
From this envelope, spikes of proteins called hemagglutinin and neuraminidase stick out.
Hemagglutinin enables the virus to bind to and invade cells, and neuraminidase allows the virus
to move among cells. But these proteins also act as antigens—that is, they are recognized as
foreign matter by the human or other host organism, and this recognition triggers an immune
response in the host.

13. Transmission
 Influenza viruses pass from person to person mainly in droplets expelled during sneezes and
coughs. When a person breathes in virus-laden droplets, the hemagglutinin on the surface of the
virus binds to enzymes in the mucous membranes that line the respiratory tract. The enzymes,
known as proteases, cut the hemagglutinin in two, which enables the virus to gain entry into cells
and begin to multiply. These proteases are common in the respiratory and digestive tracts but not
elsewhere, which is why the flu causes primarily a respiratory illness with occasional
gastrointestinal symptoms. In the 1990s scientists discovered that some flu strains also can use
the enzyme plasmin to cut hemagglutinin. Plasmin is common throughout the body, enabling the
flu strains to infect a variety of tissues.
 Although an influenza epidemic can occur at any time of year, flu season in temperate regions
typically begins with the approach of winter—November in the Northern Hemisphere, April in the
Southern Hemisphere. Flu viruses spread more easily during cold weather. An influenza epidemic
may be restricted to a town or city or may quickly spread geographically as infected people travel.
 Scientists long thought that the flu season occurred in winter because that is when people tend to
spend more time crowded together in homes and schools, as well as in buses, subways, and
other places with poor ventilation. A study on guinea pigs, reported in 2007, found that
transmission of the virus depends upon temperature and humidity. Transmission among the
guinea pigs declined as the temperature rose above 5°C (41°F) and stopped completely at 30°C
(86°F). Low humidity favors transmission of the virus. The scientists who conducted the study
believe the flu virus is most stable at low temperatures and in dry air, conditions prevalent in
winter.
 .

14. Symptoms and diagnosis
 Influenza is an acute disease with a rapid onset and pronounced symptoms. After
the influenza virus invades a person’s body, an incubation period of one to two days
passes before symptoms appear. Classic symptoms include sore throat, dry cough,
stuffed or runny nose, chills, fever with temperatures as high as 39ºC (103ºF),
aching muscles and joints, headache, loss of appetite, occasional nausea and
vomiting, and fatigue. For most people flu symptoms begin to subside after two to
three days and disappear in seven to ten days. However, coughing and fatigue may
persist for two or more weeks.
 Death from influenza itself is rare. But influenza can aggravate underlying medical
conditions, such as heart or lung disease. Invading influenza viruses produce
inflammation in the lining of the respiratory tract, damage that increases the risk
that secondary infections will develop. Common complications include bronchitis,
sinusitis, and bacterial pneumonia, occurring most frequently in older people,
people on chemotherapy, and people with acquired immunodeficiency syndrome
(AIDS) or other diseases that compromise the immune system. If properly treated,
these complications seldom are fatal.
 Because influenza is so common and exhibits standard symptoms, doctors often
diagnose the illness based on the season and whether flu cases have recently been
reported in the area. To prove a diagnosis of influenza in a patient, the virus must
be isolated from the person’s nasal or cough secretions or blood and identified
under a microscope.

15. TREATMENT AND
PREVENTION
 There is no specific cure for influenza.
Recommended treatment usually consists of
bed rest and increased intake of non alcoholic
fluids until fever and other symptoms lessen
in severity. Certain drugs have been found
effective in lessening flu symptoms, but
medical efforts against the disease focus
chiefly on prevention by means of vaccines
that create immunity.

16. Drugs that ease symptoms
 No drugs can cure influenza, but certain antiviral
medicines can relieve flu symptoms. Available by
prescription, these drugs provide modest relief, but only
if taken on the first or second day of symptoms. The
drugs amantadine (sold under the brand name
Symmetrel) and rimantadine (Flumadine), both in pill
form, work against hemagglutinin and are effective in
treating type A influenza. Two other drugs inhibit
neuraminidase and are effective against both type A
and type B strains: oseltamivir (Tamiflu) is in pill form
and zanamivir (Relenza) is an inhalant.

17. Vaccines
 A flu vaccine consists of greatly weakened or killed flu viruses, or fragments of dead viruses.
Antigens in the vaccine stimulate a person’s immune system to produce antibodies against the
viruses. If the flu viruses invade a vaccinated person at a later time, the sensitized immune system
recognizes the antigens and quickly responds to help destroy the viruses.
 About 5 to 10 percent of people who receive a flu vaccine experience mild, temporary side effects,
typically soreness at the injection site. Young children who have not previously been exposed to
the influenza virus are most likely to have side effects.
 Flu viruses constantly change so different virus strains must be incorporated in vaccines from one
year to the next. Scientists try to provide a good match between the vaccine and the most serious
virus strains circulating at the time. But because it takes months to manufacture and distribute
vaccines, decisions on their composition must be made well before the start of each flu season.
Each February experts at the World Health Organization (WHO) recommend the composition of the
vaccine for the forthcoming winter in the Northern Hemisphere; a second recommendation is made
in September for vaccines to be used in the Southern Hemisphere. Typically vaccines contain
antigens from three virus strains, usually two type A and one type B.
 According to the CDC, the success of flu vaccines varies from one person to another. In healthy
young adults, the vaccines are 70 to 90 percent effective in preventing the disease. In the elderly
and people with certain chronic medical conditions, the vaccines are less effective in preventing
illness but help reduce the severity of an infection and the risk of major complications or death.
Studies show that flu vaccines reduce hospitalization by about 70 percent and death by about 85
percent among elderly people.

18. Recommendations
for flu shots
 The CDC recommends annual flu shots for people who are at high risk for developing serious
complications as a result of an influenza infection. This group includes all people age 65 and
older; people in nursing homes and other facilities that house people with chronic medical
conditions; people with chronic heart, lung or kidney disease, diabetes, an impaired immune
system, or severe forms of anemia; children and adolescents with conditions treated for long
periods of time with aspirin (which makes them vulnerable to Reye’s syndrome); and women who
will be in the second or third trimester of pregnancy during the influenza season.
 To help stop the disease’s spread, the CDC also recommends vaccination for health-care
workers, employees of nursing homes and chronic-care facilities, and household members of
people in high-risk groups. Doctors encourage individuals who travel to areas of the world where
influenza viruses circulate to receive the most current vaccine, particularly if they are at higher
risk of complications.
 It takes the human immune system one to two weeks after vaccination to develop antibodies to
the flu antigens. According to the CDC, the best time to get flu shots in the United States is
between October 1 and mid-November—sufficiently in advance of the peak of influenza activity,
which in the United States generally lasts from late December until early March.
Flu shots must be given annually for two reasons. First, antibody protection provided by the vaccine
decreases during the year following vaccination. Second, vaccines created for pre-existing viral
strains may not work against new strains; nor does an infection with one flu strain confer immunity to
infection by another strain.

19. LUNG
CANCER

20. Lung Cancer
 Lung cancer, also known as carcinoma of the lung or pulmonary carcinoma, is a malignant lung tumor
characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread
beyond the lung by process of metastasis into nearby tissue or other parts of the body. Most cancers that
start in the lung, known as primary lung cancers, are carcinomas that derive from epithelial cells. The main
primary types are small-cell lung cancer (SCLC), and non-small-cell lung cancer (NSCLC). The most
common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest
pains.[1]
 The most common cause is long-term exposure to tobacco smoke,[2] which causes 80–90% of lung
cancers.[1] Non smokers account for 10–15% of lung cancer cases,[3] and these cases are often attributed
to a combination of genetic factors,[4] and exposure to; radon gas,[4] asbestos,[5] and air pollution[4]
including second-hand smoke.[6][7] Lung cancer may be seen on chest radiographs and computed
tomography (CT) scans. The diagnosis is confirmed by biopsy[8] which is usually performed by
bronchoscopy or CT-guidance.
 Treatment and long-term outcomes depend on the type of cancer, the stage (degree of spread), and the
person's overall health, measured by performance status. Common treatments include surgery,
chemotherapy, and radiotherapy. NSCLC is sometimes treated with surgery, whereas SCLC usually
responds better to chemotherapy and radiotherapy.[9] Overall, 17% of people in the United States
diagnosed with lung cancer survive five years after the diagnosis,[10] while outcomes on average are worse
in the developing world. Worldwide, lung cancer is the most common cause of cancer-related death in men
and women, and was responsible for 1.56 million deaths annually, as of 2012.[11]

21. Signs and symptoms
 respiratory symptoms: coughing, coughing up blood, wheezing or shortness of breath
 systemic symptoms: weight loss, fever, clubbing of the fingernails, or fatigue
 symptoms due to local compress: chest pain, bone pain, superior vena cava obstruction, difficulty
swallowing
 If the cancer grows in the airways, it may obstruct airflow, causing breathing difficulties. The
obstruction can lead to accumulation of secretions behind the blockage, and predispose to
pneumonia.[1]
 Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to
the disease.[12] In lung cancer, these phenomena may include Lambert–Eaton myasthenic
syndrome (muscle weakness due to autoantibodies), hypercalcemia, or syndrome of inappropriate
antidiuretic hormone (SIADH). Tumors in the top of the lung, known as Pancoast tumors, may invade
the local part of the sympathetic nervous system, leading to Horner's syndrome (dropping of the
eyelid and a small pupil on that side), as well as damage to the brachial plexus.[1]
 Many of the symptoms of lung cancer (poor appetite, weight loss, fever, fatigue) are not specific.[8] In
many people, the cancer has already spread beyond the original site by the time they have
symptoms and seek medical attention. Common sites of spread include the brain, bone, adrenal
glands, opposite lung, liver, pericardium, and kidneys.[13] About 10% of people with lung cancer do
not have symptoms at diagnosis; these cancers are incidentally found on routine chest
radiography.[14]

22. Causes
 Smoking, particularly of cigarettes, is by far the main contributor to lung cancer.
Cigarette smoke contains at least 73 known carcinogens,[including benzopyrene,radioisotopes
from the radon decay sequence, and nitrosamine. Additionally, nicotine appears to depress the
immune response to cancerous growths in exposed tissue.Across the developed world, 90% of
lung cancer deaths in men during the year 2000 were attributed to smoking (70% for women.
Smoking accounts for 80–90% of lung cancer cases.
 Passive smoking—the inhalation of smoke from another's smoking—is a cause of lung
cancer in non smokers. A passive smoker can be defined as someone living or working with a
smoker. Studies from the US, Europe and the UK have consistently shown a significantly
increased risk among those exposed to passive smoke. Those who live with someone who
smokes have a 20–30% increase in risk while those who work in an environment with second
hand smoke have a 16–19% increase in risk. Investigations of side stream smoke suggest it is
more dangerous than direct smoke.[Passive smoking causes about 3,400 deaths from lung
cancer each year in the USA.
 The tar from marijuana smoke contains many of the same carcinogens of that of tobacco
smoke.[

23. Picture of a healthy lungs and a
lung with cancer cause by
smoking

24.  Radon gas
 Radon is a colorless and odorless gas generated by the breakdown of radioactive radium, which
in turn is the decay product of uranium, found in the Earth's crust. The radiation decay products
ionize genetic material, causing mutations that sometimes turn cancerous. Radon is the second-
most common cause of lung cancer in the USA, after smoking.[23] The risk increases 8–16% for
every 100 Bq/m³ increase in the radon concentration.[30] Radon gas levels vary by locality and
the composition of the underlying soil and rocks. For example, in areas such as Cornwall in the
UK (which has granite as substrata), radon gas is a major problem, and buildings have to be
force-ventilated with fans to lower radon gas concentrations. The United States Environmental
Protection Agency (EPA) estimates one in 15 homes in the US has radon levels above the
recommended guideline of 4 picocuries per liter (pCi/l) (148 Bq/m³).[31]
 Asbestos
 Asbestos can cause a variety of lung diseases, including lung cancer. Tobacco smoking and
asbestos have a synergistic effect on the formation of lung cancer.In smokers who work with
asbestos, the risk of lung cancer is increased 45-fold compared to the general
population.Asbestos can also cause cancer of the pleura, called mesothelioma (which is different
from lung cancer).
 Air pollution
 Outdoor air pollution has a small effect on increasing the risk of lung cancer.[4] Fine particulates
(PM2.5) and sulfate aerosols, which may be released in traffic exhaust fumes, are associated
with slightly increased risk.For nitrogen dioxide, an incremental increase of 10 parts per billion
increases the risk of lung cancer by 14%.Outdoor air pollution is estimated to account for 1–2% of
lung cancers.

25.  Genetics
 It is estimated that 8 to 14% of lung cancer is due to inherited factors.In relatives of
people with lung cancer, the risk is increased 2.4 times. This is likely due to a
combination of genes. Polymorphisms on chromosomes 5, 6 and 15 are known to
affect the risk of lung cancer.
 Other causes[edit]
 Numerous other substances, occupations, and environmental exposures have been
linked to lung cancer. The International Agency for Research on Cancer (IARC) states
there is "sufficient evidence" to show the following are carcinogenic in the lungs:
 Some metals (aluminum production, cadmium and cadmium compounds,
chromium(VI) compounds, beryllium and beryllium compounds, iron and steel
founding, nickel compounds, arsenic and inorganic arsenic compounds, underground
hematite mining)
 Some products of combustion (incomplete combustion, coal (indoor emissions from
household coal burning), coal gasification, coal-tar pitch, coke production, soot, diesel
engine exhaust)
 Ionizing radiation (X-radiation, radon-222 and its decay products, gamma radiation,
plutonium)
 Some toxic gases (methyl ether (technical grade), Bis-(chloromethyl) ether, sulfur
mustard, MOPP (vincristine-prednisone-nitrogen mustard-procarbazine mixture),
fumes from painting)
 Rubber production and crystalline silica dust

26. Staging
 Staging
 Lung cancer staging is an assessment of the degree of spread of the cancer
from its original source. It is one of the factors affecting the prognosis and
potential treatment of lung cancer.
 The initial evaluation of non-small-cell lung cancer (NSCLC) staging uses the
TNM classification. This is based on the size of the primary tumor, lymph node
involvement, and distant metastasis. After this, using the TNM descriptors, a
group is assigned, ranging from occult cancer, through stages 0, IA (one-A), IB,
IIA, IIB, IIIA, IIIB and IV (four). This stage group assists with the choice of
treatment and estimation of prognosis. Small-cell lung carcinoma (SCLC) has
traditionally been classified as 'limited stage' (confined to one half of the chest
and within the scope of a single tolerable radiotherapy field) or 'extensive stage'
(more widespread disease).[1] However, the TNM classification and grouping
are useful in estimating prognosis.
 For both NSCLC and SCLC, the two general types of staging evaluations are
clinical staging and surgical staging. Clinical staging is performed prior to
definitive surgery. It is based on the results of imaging studies (such as CT
scans and PET scans) and biopsy results. Surgical staging is evaluated either
during or after the operation, and is based on the combined results of surgical
and clinical findings, including surgical sampling of thoracic lymph nodes.

27. prevention
 Prevention is the most cost-effective means of decreasing lung cancer development. While in
most countries industrial and domestic carcinogens have been identified and banned, tobacco
smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of
lung cancer, and smoking cessation is an important preventive tool in this process.
 Policy interventions to decrease passive smoking in public areas such as restaurants and
workplaces have become more common in many Western countries. Bhutan has had a complete
smoking ban since 2005while India introduced a ban on smoking in public in October 2008.[The
World Health Organization has called for governments to institute a total ban on tobacco
advertising to prevent young people from taking up smoking. They assess that such bans have
reduced tobacco consumption by 16% where instituted.[
 The long-term use of supplemental vitamin A,[vitamin C, vitamin D or vitamin E does not reduce
the risk of lung cancer. Some studies suggest that people who eat diets with a higher proportion of
vegetables and fruit tend to have a lower risk, but this may be due to confounding—with the lower
risk actually due to the association of a high fruit/vegetables diet with less smoking. More rigorous
studies have not demonstrated a clear association between diet and lung cancer risk.
 Screening
 Screening refers to the use of medical tests to detect disease in asymptomatic people. Possible screening tests for
lung cancer include sputum cytology, chest radiograph (CXR), and computed tomography (CT). Screening
programs using CXR or cytology have not demonstrated benefit. Screening those at high risk (i.e. age 55 to 79
who have smoked more than 30 pack years or those who have had previous lung cancer) annually with low-dose
CT scans may reduce the chance of death from lung cancer by an absolute amount of 0.3% (relative amount of
20%).There is, however, a high rate of falsely positive scans which may result in unneeded invasive procedures as
well as substantial financial cost. For each true positive scan there are more than 19 false positives. Radiation
exposure is another potential harm from screening.

28. Management
 SURGERY
 If investigations confirm NSCLC, the stage is assessed to determine whether the disease
is localized and amenable to surgery or if it has spread to the point where it cannot be
cured surgically. CT scan and positron emission tomography are used for this
determination.[1] If mediastinal lymph node involvement is suspected, mediastinoscopy
may be used to sample the nodes and assist staging.[76] Blood tests and pulmonary
function testing are used to assess whether a person is well enough for surgery.[14] If
pulmonary function tests reveal poor respiratory reserve, surgery may not be a
possibility.[1]
 In most cases of early-stage NSCLC, removal of a lobe of lung (lobectomy) is the surgical
treatment of choice. In people who are unfit for a full lobectomy, a smaller sublobar
excision (wedge resection) may be performed. However, wedge resection has a higher
risk of recurrence than lobectomy.[77] Radioactive iodine brachytherapy at the margins of
wedge excision may reduce the risk of recurrence.[78] Rarely, removal of a whole lung
(pneumonectomy) is performed.[77] Video-assisted thoracoscopic surgery (VATS) and
VATS lobectomy use a minimally invasive approach to lung cancer surgery.[79] VATS
lobectomy is equally effective compared to conventional open lobectomy, with less
postoperative illness.[80]
 In SCLC, chemotherapy and/or radiotherapy is typically used.[81] However the role of
surgery in SCLC is being reconsidered. Surgery might improve outcomes when added to
chemotherapy and radiation in early stage SCLC.[82]

29.  Radiotherapy
 Radiotherapy is often given together with chemotherapy, and may be used with curative intent in
people with NSCLC who are not eligible for surgery. This form of high-intensity radiotherapy is
called radical radiotherapy.[83] A refinement of this technique is continuous hyperfractionated
accelerated radiotherapy (CHART), in which a high dose of radiotherapy is given in a short time
period.[84] Postoperative thoracic radiotherapy generally should not be used after curative intent
surgery for NSCLC.[85] Some people with mediastinal N2 lymph node involvement might benefit
from post-operative radiotherapy.[86]
 For potentially curable SCLC cases, chest radiotherapy is often recommended in addition to
chemotherapy.[8]
 If cancer growth blocks a short section of bronchus, brachytherapy (localized radiotherapy) may
be given directly inside the airway to open the passage.[87] Compared to external beam
radiotherapy, brachytherapy allows a reduction in treatment time and reduced radiation exposure
to healthcare staff.[88]
 Prophylactic cranial irradiation (PCI) is a type of radiotherapy to the brain, used to reduce the risk
of metastasis. PCI is most useful in SCLC. In limited-stage disease, PCI increases three-year
survival from 15% to 20%; in extensive disease, one-year survival increases from 13% to
27%.[89]
 Recent improvements in targeting and imaging have led to the development of stereotactic
radiation in the treatment of early-stage lung cancer. In this form of radiotherapy, high doses are
delivered in a small number of sessions using stereotactic targeting techniques. Its use is primarily
in patients who are not surgical candidates due to medical comorbidities.[90]
 For both NSCLC and SCLC patients, smaller doses of radiation to the chest may be used for
symptom control (palliative radiotherapy).[91]

30. Chemotherapy[edit]
The chemotherapy regimen depends on the tumor type.[8] Small-cell lung carcinoma (SCLC), even
relatively early stage disease, is treated primarily with chemotherapy and radiation.[92] In SCLC, cisplatin
and etoposide are most commonly used.[93] Combinations with carboplatin, gemcitabine, paclitaxel,
vinorelbine, topotecan, and irinotecan are also used.[94][95] In advanced non-small cell lung carcinoma
(NSCLC), chemotherapy improves survival and is used as first-line treatment, provided the person is well
enough for the treatment.[96] Typically, two drugs are used, of which one is often platinum-based (either
cisplatin or carboplatin). Other commonly used drugs are gemcitabine, paclitaxel, docetaxel,[97][98]
pemetrexed,[99] etoposide or vinorelbine.[98]
Adjuvant chemotherapy refers to the use of chemotherapy after apparently curative surgery to improve the
outcome. In NSCLC, samples are taken of nearby lymph nodes during surgery to assist staging. If stage II
or III disease is confirmed, adjuvant chemotherapy improves survival by 5% at five years.[100][101] The
combination of vinorelbine and cisplatin is more effective than older regimens.[101] Adjuvant chemotherapy
for people with stage IB cancer is controversial, as clinical trials have not clearly demonstrated a survival
benefit.[102][103] Trials of preoperative chemotherapy (neoadjuvant chemotherapy) in resectable NSCLC
have been inconclusive.[104]
Chemotherapy may be combined with palliative care in the treatment of the NSCLC. In advanced cases,
appropriate chemotherapy improves average survival over supportive care alone, as well as improving
quality of life.[105] With adequate physical fitness maintaining chemotherapy during lung cancer palliation
offers 1.5 to 3 months of prolongation of survival, symptomatic relief, and an improvement in quality of life,
with better results seen with modern agents.[106][107] The NSCLC Meta-Analyses Collaborative Group
recommends if the recipient wants and can tolerate treatment, then chemotherapy should be considered in
advanced NSCLC.[96][108]

31. Palliative care
Palliative care when added to usual cancer care
benefits people even when they are still receiving
chemotherapy.[109] These approaches allow
additional discussion of treatment options and provide
opportunities to arrive at well-considered
decisions.[110][111] Palliative care may avoid
unhelpful but expensive care at the end of life.[111]
For individuals who have more advanced disease,
hospice care may also be appropriate.[14]