Lung Cancer

Lung cancer is one of the most common cancers in Germany. Malignant cells of the lung tissue or bronchial tubes multiply uncontrollably and often affect other organs as well. Women and men are equally affected, but the tendency for women to develop lung cancer has been steadily increasing for years, while it is slightly decreasing for men. Onset before the age of 40 is very rare, and the mean age of onset is 69 years.

Causes and risk factors for the development of lung cancer

As with most cancers, a number of factors are responsible for the development of lung cancer. However, the most important cause of lung cancer is smoking, with harmful substances in tobacco smoke attacking lung tissue. The risk of contracting the disease increases the earlier people start smoking and the greater the number of cigarettes smoked per day. Another risk factor is passive smoking, i.e. inhaling tobacco smoke with the air we breathe. Again, the likelihood of developing cancer increases with the frequency and duration of passive smoking.

However, the damaged lung tissue can regenerate if smoking is stopped. The risk of developing lung cancer decreases significantly over the years; after 15-20 years, it is only slightly increased compared to non-smokers.

Other risk factors for lung cancer, often in combination with smoking, are:

• Breathing in pollutants in the workplace, e.g. asbestos, arsenic compounds, quartz or nickel dust - this mainly affects workplaces in metal processing, foundries, rubber production or coal gas and coke production
• Inhalation of pollutants with the air we breathe, e.g. diesel soot or particulate matter
• Contact with elevated radon concentrations, e.g. through work in uranium mines
• Family history, genetic factors: Women who smoke have a greater risk of falling ill than men who smoke
• Low vitamin diet, especially in smokers who eat few fruits and vegetables
• Late effects of diseases (tuberculosis) or operations
• Serious other lung diseases, e.g. COPD
• Infection with certain viruses, e.g. human papillomavirus (HPV) or Epstein-Bar (EBV) also seems to play a certain role

What symptoms does lung cancer cause?

Lung cancer causes almost no symptoms at the beginning, and often symptoms only appear at a later stage. These can be very non-specific and can also occur with other conditions. These include

• Chronic (smoker's) cough that suddenly changes
• Persistent bronchitis and pneumonia despite antibiotic administration
• Shortness of breath
• Coughing up blood
• Chest pain
• Episodes of fever
• Night sweats
• Weight loss and general weakness
• Swelling of the face and neck

How is lung cancer diagnosed?

There is no screening for lung cancer, as there is for bowel or breast cancer. If there is a suspicion of lung cancer, X-rays are first taken, which can provide initial indications. These are corroborated with a computed tomography (CT) scan of the thorax. However, we can only obtain definitive proof of the type of tumour by taking a biopsy of the lung tissue. This is done during a bronchoscopy or by means of fine needle aspiration. If these examinations do not provide definitive information, tissue is removed by surgery. In order to check whether other parts of the body are affected, we carry out a sonogram (ultrasound), scintigraphy and possibly a PET-CT in addition to CT and MRI if necessary. Lung cancers can come in different forms. We roughly distinguish between non-small cell carcinoma (NSCLC) and small cell carcinoma (SCLC). NSCLC tumours are also specified into further subtypes. The course of the disease and treatment differ significantly between the two forms. However, NSCLC forms make up the majority of lung cancers, accounting for about 75-80%. 

In order to be able to plan the best possible therapy, we record not only the type of tumour but also its spread and size. The classification is based on four stages, which are associated with different chances of cure. The following applies to all forms and subgroups: the earlier the disease is detected, the better the prospects for successful treatment.

How is lung cancer treated?

Depending on the type and stage of the disease, we compile the treatment individually. The attending physicians - lung specialists, radiologists, surgeons and, if necessary, other specialists - discuss each case in the multidisciplinary team meeting and work out the best possible treatment strategy. Surgery, chemotherapy and radiotherapy are the main pillars that are combined in many cases. The aim is to remove as much of the tumour tissue as possible during surgery and to minimise any remaining residue through radiation and chemotherapy. In some cases, radiation is also used prophylactically, e.g. to prevent brain metastases.

If surgery and radiation are not an option, we use newly developed tumour-specific drugs in addition to chemotherapy for certain subtypes of tumour. These antibody therapies act directly in the tumour cell by specifically delaying the progression of the tumour by blocking certain signalling pathways or inhibiting the growth factor. Immunotherapies work with active substances that reactivate the body's own immune response against cancer cells. Targeted drugs act on inactive immune cells and restore their ability to fight the cancer cells as foreign bodies. Often, antibody or immunotherapy is better tolerated by patients than conventional chemotherapy. In recent years, a number of these new targeted substances have been developed and approved as drugs. Further studies are ongoing. However, the use of these drugs is currently still subject to strict regulations, as they can lead to severe side effects, e.g. inflammation of healthy organs as well as problems in the gastrointestinal tract, skin and mucous membranes.

What are the advantages of integrative therapies?

During your inpatient stay at Havelhöhe, we combine conventional medical therapies with integrative treatments that help you to strengthen your self-healing powers, activate the immune system and mobilise your strengths. Also important and very helpful is respiratory therapy, which stabilises the lungs and bronchial tubes and supports you with symptoms such as shortness of breath or breathlessness.

Mistletoe is also available as an accompanying naturopathic medicine that strengthens the immune system and can also reduce the side effects of cancer therapy, e.g. symptoms of fatigue syndrome that may occur. Hyperthermia also helps to activate the immune system through a specifically induced fever reaction.

Further integrative therapies can additionally significantly reduce the side effects of cancer therapy. These include movement and body therapies, e.g. eurythmy therapy and rhythmical massage therapy, as well as painting and music therapy. Additional support is provided by our anthroposophic care therapies, which promote regeneration.

You also have the option of taking advantage of psycho-oncological counselling. You can discuss possible fears there as well as the effects of the disease on your family situation or perspectives for the time after treatment.

Our Lung Cancer HELP Havelhöhe gives you support to further strengthen your health in weekly courses. The service ranges from dietary changes to relaxation courses and lung sports to smoking cessation. After discharge from hospital, you can continue the courses on an outpatient basis.

Is lung cancer curable?

The prospects of a permanent cure depend in particular on the time of diagnosis. The earlier lung cancer is detected and treated, the greater the chances of success. Furthermore, the type and extension of the tumour tissue play a role.

If curative therapy, i.e. therapy aimed at a cure, is no longer possible, our mission is to support you in the best possible way with medication and with the help of complementary therapies and care measures. In many cases, it is possible to maintain a good quality of life for a prolonged period of time. To this end, we work closely with the experts in our supportive cancer care unit and in palliative medicine. 

What happens after the hospital stay?

Regular follow-up is important in order to be able to respond to changes at an early stage and to treat any recurrences that may occur in a targeted manner. In the first and second year after inpatient treatment, follow-up care is carried out at intervals of three months each. Later, the intervals increase to six to twelve months. However, if you notice any changes or symptoms during the intermediate phases, you should immediately make an appointment with your attending specialist.

During the follow-up examinations, your doctor will carefully check your general physical condition, perform laboratory tests and a lung X-ray. Further examinations depend on individual symptoms or the specific risk of recurrence. If necessary, the attending physicians also strive to further improve patients' quality of life by arranging psychological or complementary medical services. You can also find addresses at the Cancer Information Service (https://www.krebsinformationsdienst.de/wegweiser/adressen/psychoonkologen.php)

Before discharge from the Havelhöhe Community Hospital, you will receive an aftercare passport from our Aftercare and Study Outpatient Department, in which all therapies and check-ups can be clearly noted. Medical aftercare is provided on an outpatient basis by your attending specialist or general practitioner with whom we work closely.

We also ask you to report to our aftercare outpatient clinic at regular intervals so that we can document the progress of your treatment. As a oncology centre, we thus fulfil one of the quality criteria of the German Cancer Society.

Rehabilitation measures

Rehab usually follows the completed therapy - e.g. after radiotherapy. The teams of doctors, physiotherapists, psychologists and social services are at your disposal to facilitate your return to everyday life. In certain cases, the application for rehabilitation can already be made during the inpatient stay. The social services team at our facility will be happy to help you with this and will also discuss further options with you, e.g. applications for severe disability, aids, etc.

What is cancer-related fatigue?

Fatigue is a tiredness syndrome with physical weakness, listlessness and sadness. There are also often disturbances of the biological rhythms, for example problems falling asleep and sleeping through the night, a lack of regenerative capacity and increased stress levels. Besides the cancer itself, debilitating therapies seem to be a cause of fatigue. Taking a multi-modal approach, we at Havelhöhe integrate targeted activation through exercise programmes as well as integrative therapy tailored to the patient's symptoms. These not only bring about a return of strength, but also have a positive influence on their mood. In individual or group counselling sessions, you also have the opportunity to get information and background on fatigue and receive helpful tips for your everyday life. In addition, we give you tips on stress management and teach techniques for relaxation and regeneration. If necessary, we also treat fatigue syndrome with medication, for example with infusions or mistletoe therapy.

If you suspect that you are affected by fatigue syndrome, contact the doctor in charge of your treatment. Successful treatment of symptoms is a crucial prerequisite for returning to an active life after cancer.