Lung cancer: symptoms, cigarettes, can we cure?

[Mise à jour le 31 janvier 2022 à 09h29] Le cancer du poumon est le 3^e cancer tous sexes confondus en France. C'est le 2^e plus fréquent chez l'homme et le 3e chez la femme. Le 25 janvier, le chanteur Florent Pagny (60 ans)) a annoncé sur les réseaux qu'il en était atteint : "Je dois annuler l'ensemble de mes concerts suite à un problème de santé. On vient de me diagnostiquer une tumeur au(x)) poumon(s)), une tumeur cancéreuse qui ne peut pas s'opérer donc je dois rentrer dans un protocole de 6 mois de chimiothérapie et de rayons X" a-t-il expliqué sur son compte Instagram. En novembre 2021, c'était l'ex-présentateur du JT de TF1 Jean-Pierre Pernaut qui annonçait sur Twitter se battre contre cette même maladie. Le tabac constitue de loin la première cause de cancer du poumon avec plus de 8 cancers du poumon sur 10 qui y sont liés : "Pendant toute ma vie, j'ai fumé entre un et deux paquets par jour, pendant 50 ans, a raconté Jean-Pierre Pernaut sur RTL le 29 novembre. (...)) Mon frère, qui est médecin m'a dit d'arrêter de fumer, comme tous les membres de mon entourage. Le 'ça n'arrive qu'aux autres', je suis tombé dans le piège et je n'ai pas arrêté de fumer. (...)) Si mon histoire peut inciter des personnes à arrêter de fumer, je suis content d'en parler." Le cancer du poumon est dit "de mauvais pronostic". C'est la première cause de décès par cancer en France. L'incidence du cancer du poumon est plus élevé chez l'homme que chez la femme mais "l'écart se resserre au détriment de ces dernières" rapporte l'Institut national du cancer.

What is the definition of lung cancer?

Lung cancer, also called "bronchial cancer" or "bronchopulmonary cancer", is a malignant tumor developed from the coating cells of bronchi, bronchioles or pulmonary alveoli.There are two main types of lung cancer as a function of the origin and appearance of cancer cells under the microscope: bronchial cancers not with small cells and bronchial cancers with small cells: ► Lung cancer non -small cells: they represent almost 85% of lung cancers.In this family, we find adenocarcinoma (which originates rather on the outskirts of the lungs)), epidermoid carcinoma (rather in the large bronchi in the center of the lungs)) and large cell carcinoma.Currently, non-small cell bronchial cancers are also categorized as to the expression of certain markers: expression or not of PD-L1 and presence or not of mutations which will guide the choices of treatments.► Small cell lung cancers: they constitute the remaining 15%.If they are fewer, they are however more aggressive because of a rapid proliferation of cancer cells.

What is the age of occurrence of lung cancer?

According to the latest statistics from the National Cancer Institute which dates from2018 the median age to the diagnosis of lung cancer is 67 years in men and 65 years in women.

What are the stages?

The stages make it possible to classify lung cancer according to the size of the tumor, the extent of cancer in the chest, and remotely in other parts of the.There are 5 stages from 0 to 4 stages.

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What are the symptoms ?

If respiratory symptoms that may seem trivial, persist (chronic bronchitis cough, difficulty breathing...)), especially in smokers or former smokers, you must consult a doctor.Lung cancer can sometimes be discovered by chance on a medical imaging assessment made to search for another pathology.

What are the causes of lung cancer?

Predominant risk factors in lung cancer are: active (80%)) and passive smoking, professional exhibitions to toxic substances, environmental pollution and personal and family history of lung cancer or other unrelated cancersat the cigarette shop.

What is the share of cancers attributable to tobacco?

Tobacco is responsible for 8 lung cancers out of 10.All forms of tobacco are affected (cigarettes, cigars, cigarillos, hookah, cannabis, etc..)).Cannabis smoke contains four times more tar than that of tobacco and more carcinogenic substances.Almost 92 % of deaths from cancer of lungs in humans result from tobacco consumption.The risk increases according to the daily dose of tobacco and the duration of smoking ...

The duration during which we smoke seems greater than the quantity of smoked cigarettes.Young people smoking earlier and earlier, the age of occurrence of the disease rejuvenates and it sometimes manifests itself from the age of 40.Because of smoking, lung cancer has multiplied by 7 in the past 30 years and has almost doubled between 2000 and 2012 (INCa)).This increase concerns much more women than humans in recent years.Passive smoking increases the risk of lung cancer by 30% compared to a person who evolves in a non -smoking entourage.

What causes among non-smokers?

In non-smokers, other external factors can be involved in the occurrence of lung cancer. C'est le cas, notamment, d'une exposition prolongée à des substances comme l'amiante, certains hydrocarbures polycycliques aromatiques (gaz d'échappement des moteurs diesels…)), les radiations ionisantes (dont rayons X, rayons gamma issus de l'imagerie médicale)), le radon, l'arsenic, le nickel, le chrome, la silice, le cadmium… On peut également citer les maladies inflammatoires chroniques des bronches ou encore la pollution atmosphérique.There are rare cases of family cancer characterized by their occurrence in younger people.

How do you know if you have lung cancer?

Lung cancers are often diagnosed at an advanced stage (stages III or IV)).The chest x -ray has been replaced by the thorax scanner without injection of contrast product at the slightest alert sign in particular in a smoking person.A biopsy then confirms whether it is cancer or not. Elle peut s'effectuer par une fibroscopie bronchique, une ponction trans-pariétale sous scanner (à travers la paroi du thorax)), ou au cours d'une intervention chirurgicale.If cancer is confirmed, onco-pneumologist proposes to make an extension assessment to specify the extent of the disease and classify it in stage. Ce bilan comprend en général un scanner thoracique et abdominal avec une injection de produit de contraste iodé, une IRM ou un scanner cérébral et une tomographie par émission de positon (TEP))/scintigraphie couplée à un scanner.There is no blood test that allows you to diagnose lung cancer.Other examinations can be carried out according to the results of the previous ones.

What are the treatments to treat lung cancer?

Treatments are multiple today: surgery, radiotherapy, chemotherapy, immunotherapy or targeted therapeutic, without forgetting support treatments for pain, weight loss, anxiety or depression.Treatment depends on the histological type and the extent of cancer.Small cell cancer is almost never treated by surgery.For non -small cell cancers, surgery is the preferred treatment for stages located for so -called "operable" patients who can therefore bear the operation.It can also be considered in locally advanced stages if it is possible to remove the tumor.Surgery and radiotherapy are very often supplemented by chemotherapy or even immunotherapy.In extensive diseases, the choice of treatments will depend on the results of molecular research carried out on biopsies at the time of diagnosis.

Life expectancy: can we cure lung cancer?

"Yes today we can cure from lung cancer," replied Prof. Jacques Cadranel, head of the pneumology service and thoracic oncology at Tenon Hospital (Paris))."Life expectancy depends enormously on the type of cancer and the stage of diagnosis, but today thanks to combined treatment and in particular the advent of immunotherapy and targeted therapies, the prognosis of lung cancer has beenconsiderably improved for some patients."Even in the case of an extended disease.If lung cancer remains the deadliest in France, its mortality rate between 1990 and2018 decreased by 1.6% in humans on average.On the other hand, it increased by 3% in women.According to figures published by Public Health France in 2020: The prognosis of survival at 5 years for people diagnosed between 2010 and 2015 was estimated at 20 % all sexes combined (respectively 24 % for women and 18 % for men)).These figures also confirm an improvement in net standardized survival at 5 years of 11 percentage points in 25 years and an improvement in survival at 10 years between 1990 and 2010 regardless of age.

How to prevent lung cancer?

Knowing that in the majority of cases, patients with lung cancer are smokers, the first prevention is stopping smoking.Stop smoking or not starting to smoke decrease the risk of lung cancer.But this risk continues after stopping and remains greater than that of non-smokers."80 % of lung cancers are tobacco, recalls Professor Cadranel.You have to reduce your consumption.Substitutive treatments are free in France.Thanks to these treatments and electronic cigarettes, we can stop smoking.And whatever age, as soon as you stop smoking, you reduce your risk of lung cancer and therefore die."Passive smoking must also be avoided.As for "organized" screening, on date, the High Authority for Health has not authorized it for lung cancer as well as its reimbursement "but programs will be put in place" informs our interlocutor.On the other hand, screening does not do everything.Negative screening is not a "" pass "to continue smoking then".And isolated, it is not enough. Dès lors qu'on commence à se faire dépister (comme dans le cadre du cancer du sein)), il faut le faire de façon régulière selon les préconisations des autorités de santé.

Thank you to Professor Jacques Cadranel, head of the Pneumology and Thoracic Oncology Service at the Tenon Public Assistance Hospital Hospitals in Paris (Paris)).Sources:

Panorama of cancers in France 2021 - National Cancer Institute.

Possible symptoms of lung cancer.National Cancer Institute.2018

Survival of people with cancer in mainland France 1989-2018 - Lung - Public Health France.Updated on December 16, 2020