Written by Dahabreh Jubrail MD,PhD Thoracic Surgeon, Director of Thoracic Surgery Department, Athens Medical Center
The relationship of smoking to lung cancer, just as with other fatal diseases, is a serious social and economic problem.
It is estimated that 80% of deaths from lung cancer in women are due to smoking, while this percentage reaches 90% in men, and this relationship is linear with the number of smokable cigarettes and duration of smoking in years.
Besides smoking, the appearance of lung cancer may be attributed also to other factors such as radon, exposure to asbestos, uranium and coal, as well to contamination of the atmosphere.
Lung cancer is responsible for 28% of cancer deaths, and causes more deaths than the total of deaths caused by cancers of the colon, breast and pancreas.
The effects of lung cancer concern the patient, their family members, society, personal finances as well as the national economy. As regards the patient this is related to the duration of hospitalization, high cost of diagnostic tests, and treatments, which are often done at regular intervals.
Equally important is the social cost that is unbearable, as patients often suffer dramatic consequences in their personal as well as family and professional lives. Many times, patients are treated with compassion, others suffer rejection, lose professional development opportunities and all these create an additional intolerable psychic load.
It is important to implement programs for the prevention and early diagnosis and treatment for people with a family history, those at a high risk due to smoking, profession and those suffering from pulmonary emphysema and chronic obstructive pulmonary disease.
At the Athens Medical Center in Maroussi, the Thoracic Surgery Department operating since 2001 has treated a large number of patients suffering from lung cancer, many of whom underwent successful surgical treatment, with long-term survival. Patients undergo the required surgery after prior extensive clinical laboratory tests. The decision to carry out any treatment must be individualized and made once the perioperative risk is deemed acceptable, and in accordance with the guidelines of the European Society of Thoracic Surgeons (ESTS), European Society for Medical Oncology (ESMO), as well as the American Association for Thoracic Surgery (AATS) and American National Comprehensive Cancer network (NCCN).
It is worth mentioning that the decision to conduct the surgery is made after assessment of the whole of the patient by the responsible Thoracic Surgeon (Jubrail Dahabreh ), in collaboration with the Pulmonologist, Oncologist, Radiotherapist, Doctor of the CT and Cardiologist. Finally, the picture of the patient is also assessed by the Anesthesiologist, who has extensive experience in the administration of Anesthesia and in the treatment of postoperative pain. It must be noted that older age (80 and above), diabetes mellitus, renal failure, possible coronary heart disease, and prior Bypass surgery are not in themselves contraindications to perform the surgical treatment. An assessment of all these risk factors is done and based on the result, the final decision to perform or not the surgery is taken.
Patients with lung cancer comprise a specific group of thoracic surgery patients, that need proper evaluation by an experienced team of experts since surgical treatment is the treatment of choice offering long-term survival. It should be emphasized that major and specialized thoracic surgical procedures must only be performed by qualified, experienced Thoracic Surgeons and should be done in specialized Nursing Units. There are many patients who undergo successful surgical treatment after correct assessment by the specialized team of the Athens Medical Center in Maroussi, though initially they had been excluded from surgical treatment when the assessment was done at non-specialized centers. Patients with limited respiratory reserve can undergo surgical treatment with the performance of specialized surgical techniques, such as bronchoplasty, with or without angioplasty, that aim at maintaining as much functional pulmonary tissue as possible. Likewise patients with locally advanced cancer may be subjected to surgical treatment after successful preoperative chemotherapy or chemo-radiotherapy. Furthermore, patients with advanced lung cancer that has spread to adjacent anatomical structures, such as the ribs, diaphragm, pericardium, or the superior vena cava, but also those with monera metastasis in the brain, can be treated surgically with a very low post-operative risk. The execution of this type of surgery is very demanding and requires skill and extensive experience.
Surgery in the above groups of patients not only increases survival but also offers a better quality of life. Thanks to the significant advances in surgical techniques, the use of more modern technical support measures, the progress of anesthesia and also the support of Intensive Care Units, perioperative risk has been significantly reduced, even for the most complicated surgeries.
Until we reach the point where we have the perfect therapy with the desired results, young people must be properly informed on the risks of smoking and the provision of this information is more effective when done at schools. Finally, an important role in early diagnosis of lung cancer is played by a CT scan of the chest, with a low radiation dose, which should be done annually, in heavy smokers, aged over 55 years and in those who have first-degree relatives who had lung cancer, but also to those exposed to various risk factors, such as exposure to asbestos and contamination of the atmosphere.