Risk Factors 

A number of factors may increase the risk of lung cancer. Some risk factors can be controlled, for instance, by quitting smoking. Other factors can't be controlled, such as your family history.

Risk factors for lung cancer may include the following: 

• Smoking cigarettes, pipes, or cigars, now or in the past Your risk of lung cancer increases with the number of cigarettes you smoke each day. Your risk also increases with the number of years you have smoked. Quitting at any age can significantly lower your risk of developing lung cancer.
• Being exposed to secondhand smoke Breathing the smoke in the air from other people who are smoking is called secondhand smoke.
• Being treated with radiation therapy to the breast or chest 
• Being exposed to asbestos, radon, chromium, nickel, arsenic, soot, or tar 
• Living where there is air pollution 
• Family history of lung cancer 

Symptoms:

Lung cancer symptoms vary from person to person. Some people with lung cancer don't have any symptoms. Often, symptoms are easily confused with common respiratory illnesses such as bronchitis or pneumonia, delaying an accurate diagnosis.

The most common symptoms of lung cancer include:

• Cough that does not go away and gets worse over time.
• Chest pain that is constant and often made worse by deep breathing, coughing or laughing.
• Coughing up blood ranging from small streaks in the sputum to large amounts.
• Shortness of breath.
• Hoarseness of voice.
• Infections like pneumonia or bronchitis that do not go away or come back often.
• Loss of appetite and/or weight loss.
• Feeling weak or tired.

Diagnosis:

Those suspected of having lung cancer typically undergo a series of imaging tests to determine the location and extent of any tumors. Definitive diagnosis of lung cancer requires a biopsy of the suspected tumor be examined by a pathologist under a microscope.

Once your healthcare team diagnoses your lung cancer, you may have other tests to figure out the extent of the cancer. This is called the cancer's stage.

Tests and procedures used to stage lung cancer may include:

• Blood tests, such as a tumor marker, complete blood count and tests to show how well the kidneys and liver are working.
• Bone scan.
• CT scan.
• MRI.
• Positron emission tomography scan, also called a PET scan.

Not everyone needs all of these tests. Your healthcare team picks the right tests based on your specific situation.

Treatment:

The cancer treatment options for lung cancer that are often used together in order to improve outcomes are surgery, radiotherapy, chemotherapy, and other specific targeted treatments.

Treatment for early stage lung cancer includes surgery to remove the tumor, sometimes followed by radiation therapy and chemotherapy to kill any remaining cancer cells.

Later stage cancer is treated with radiation therapy and chemotherapy alongside drug treatments that target specific cancer subtypes.

Your healthcare team considers many factors when creating a treatment plan. These factors may include your overall health, the type and stage of your cancer, and your preferences.

Surgery

During surgery, your surgeon works to remove the lung cancer and some healthy tissue around it. Procedures to remove lung cancer include:

• Wedge resection to remove a small section of lung that contains the cancer along with a margin of healthy tissue.
• Segmental resection to remove a larger portion of lung, but not an entire lobe.
• Lobectomy to remove the entire lobe of one lung.
• Pneumonectomy to remove an entire lung on one side.

If you have surgery, your surgeon also may remove lymph nodes from your chest to test them for cancer.

lung cancer surgery

Surgery may be an option if your cancer is only in the lungs. If you have a larger lung cancer, chemotherapy or radiation therapy may be used before surgery to shrink the cancer. Chemotherapy or radiation therapy also may be used after surgery if there's a risk that cancer cells were left behind or that your cancer may come back.

Radiation therapy:

Radiation therapy uses focused, high-energy photon beams to destroy lung cancer cells.

During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

For lung cancer that has spread within the chest, radiation may be used before surgery or after surgery. It's often combined with chemotherapy treatments. If surgery isn't an option, combined chemotherapy and radiation therapy may be your first treatment.

For lung cancers that have spread to other areas of the body, radiation therapy may help relieve symptoms.

Shefa-El Orman uses leading-edge radiation therapy techniques, such as:

• 3D Conformal Radiation Therapy. 
• Intensity modulated radiation therapy (IMRT) and image-guided radiation therapy
• Stereotactic body radiation

Chemotherapy:

Chemotherapy uses cancer drugs to interfere with cancer cells’ ability to grow and divide. Different drug combinations work in different ways to fight cancer cells.

The subtype of lung cancer determines the choice of chemotherapy medications and dosages, as well as the duration of their administration.

Chemotherapy is often used after surgery to kill any cancer cells that may remain. It can be used alone or combined with radiation therapy. Chemotherapy also may be used before surgery to shrink cancers and make them easier to remove.

In people with lung cancer that has spread, chemotherapy can be used to relieve pain and other symptoms.

Targeted therapy:

Cancer cells use specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules.

Compared to conventional chemotherapy drugs, medications that target specific mutations often have better response rates. In many cases, targeted therapies are also less toxic to healthy cells, which can mean fewer side effects. 

Some targeted therapies only work in people whose cancer cells have certain DNA changes. Your cancer cells may be tested in a lab to see if these medicines might help you.

Immunotherapy:

One way that cancer cells grow out of control is by “tricking” the immune system into not attacking them. Immunotherapy works by helping the body’s immune system recognize and destroy cancer cells. 

Immunotherapy drugs have been approved for treating some types of lung cancer, and in some cases these treatments work better than conventional chemotherapy.

The current standard of care for non-small cell lung cancer includes the use of checkpoint inhibitor immunotherapies, which take the natural “brakes” off the immune system, allowing it to attack cancer cells. This treatment can lead to durable responses and has revolutionized care for lung cancer patients.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team's goal is to improve quality of life for you and your family.

Palliative care specialists work with you, your family and your care team. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as you're getting strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

The use of palliative care with other proper treatments can help people with cancer feel better and live longer.

Lung cancer care at Shefa-El Orman Hospital:

Shefa-Orman lung cancer experts offer comprehensive and compassionate care to people with lung cancer.

Your care team is composed of experts in different fields who work together to determine your lung cancer treatment options.

Your lung cancer care team works together to find the most targeted, least invasive treatment for you, with the goal of preserving your lung function and quality of life. Your care is coordinated by a multidisciplinary team, which may include oncologists, radiation oncologist, thoracic oncologist surgeon, pathologists, nurses, radiologists, all working together to determine the best treatment options for you.

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1.    diagnostic:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• review of medical records
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical blood analysis
  • tumor markers
  • indicators of inflammation
  • indicators of blood coagulation
• CT/ MRI / ultrasound/ X-ray examination (if indicated clinically):
• bronchoscopy with biopsy or CT guided biopsy from bronchi and lung masses.
• Video assisted thoracoscopy (if indicated clinically),
• histological study with essential immunohistochemistry / cytological examination.
• nursing services
• consultation of related specialists
• consultation of the chief physician and all leading experts
• development of individual treatment plan

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: outpatient

Expected duration of the program: 4 days

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2.    surgery:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • inflammation indicators (CRP, ESR)
  • indicators blood coagulation
  • tumor markers (CEA)
• ultrasound examination: pelvis, abdomen (if indicated clinically)
• MRI/CT scan for staging (if indicated clinically)
• PET CT (if indicated clinically)
• preoperative care
• operations:
  • extended pneumonectomy
  • lobectomy
  • segmental resection
• histologically examination of the excised tissue (if clinically indicated) with immunohistochemistry testing.
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results

Price from: on request

Type of program: Inpatient

Expected duration of the program: 14 days

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3.    Radiotherapy or chemo- radiotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • tumor markers (CEA)
  • indicators of inflammation (CRP, ESR)
  • indicators of blood coagulation
• CT simulation and planning of radiation therapy
• Physics calculation
• full course of radiation therapy with different modalities (3D, IMRT, VMAT) according to your treatment plan.
• PET CT for fusion for radiotherapy if indicated.
• individual plan of the chemotherapy, the cost of medicines is included
• symptomatic treatment (for side effects of chemo and radiotherapy that may developed).
• cost of essential medicines and materials
• nursing services
• control examinations
• consultations of related specialists
• explanation of future recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will elaborate the chemotherapy regimen, conduct radiotherapy CT or MRI SIMULATION then planning, make the permanent tattoo marks on the skin to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy and radiation therapy are carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded linear accelerator radiation therapy room.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

Chemotherapy may be through oral or intravenous route according to your treatment plan, during the chemotherapy session, after the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

During radiotherapy, you are under close follow-up daily from doctors and nurses.

After the completion of the chemotherapy and radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days

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4.    Chemotherapy, targeted therapy or immunotherapy:

• Initial presentation in the clinic
• clinical history taking
• analysis of medical records
• physical examination
• laboratory tests:

• • complete blood count
  • biochemical analysis of blood
  • tumor markers
  • inflammation indicators
  • indicators of blood coagulation
• Ultrasound scan of the abdomen (if indicated).
• CT / MRI scan of the abdomen (if indicated).
• 1 course of chemotherapy
• consultations of related specialists
• symptomatic and specific treatment
• the cost of essential medicines and materials
• nursing services
• control examinations
• full hospital accommodation
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the inpatient procedure or outpatient according to chemotherapy protocol type. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course and control examinations you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan, PET CT (not older than 3 months)
• Biopsy results.
• Any recent laboratory results.

Price from: On request (regarding chemotherapy protocol)

Type of program: Inpatient or outpatient (regarding chemotherapy protocol)

Expected duration of the program: from 1 to 5 days per cycle (regarding chemotherapy protocol)

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