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Many years have passed since the first description of lung cancer and the beginning of the attempt to cure it. However, this pathology remains a very serious threat to the lives of millions of people.

The highest incidence of lung cancer (or, otherwise, Bronchogenic Cancer) concerns men aged 65 and over. Unfortunately, in recent years the problem has been increasingly observed at younger ages. There has also been an increase in the incidence of women, as in recent years the consequence of the increase in women who have adopted the destructive habit of smoking is reflected.

In Greece, younger ages (<45 years) are more frequently affected, compared to the rest of Europe (4 people per 100,000, in Greece, compared to 2.5 per 100,000 in the rest of Europe). The main cause of the development of bronchogenic cancer is smoking. The association of smoking with the occurrence and development of lung cancer has been known since 1939, from the research work of Ochner and Debakey. The probability of a smoker developing lung cancer is directly related to the years of smoking, the daily number of cigarettes consumed and the quality of the tobacco. Young people who smoke and whose parents were smokers with cancer have a higher risk of developing cancer, compared to other people of the same age who are not smokers.

Of course, no one should forget that smoking is a serious cause of chronic obstructive pulmonary disease and pulmonary emphysema, which in turn are fertile ground for the development of bronchogenic cancer.

The risk of developing lung cancer in smokers is 35 times higher than that of non-smokers. Also, the harmful effect of passive smoking, which may be small, but certainly exists, should not be ignored. Non-smokers, life partners of smokers, have a 20-30% higher chance of developing bronchogenic cancer, compared to those with a non-smoking partner.

Lung cancer has various symptoms, which, unfortunately, often coincide with the symptoms of other pathological conditions. These symptoms usually appear when the cancer is in an advanced stage. Such symptoms are cough and sputum, which often “companion” smokers and, for this reason, are not evaluated correctly by the patient and, sometimes, not even by the attending physician.

There are two main histological types of lung cancer:

Small Cell Carcinoma, and Non-Small Cell Carcinoma. The latter type includes two main subcategories: Adenocarcinoma, and Squamous or Epidermoid Carcinoma.

The treatment of lung cancer depends on the histological type, the stage of the disease, the general condition of the patient, their cardiorespiratory reserve and the presence or absence of other serious systemic diseases. Patients with Small Cell Carcinoma are treated with conservative treatment, including chemotherapy, radiotherapy and, more recently, immunotherapy, while, extremely rarely (<5%), they may also undergo surgical treatment, but never as a monotherapy, and only when the cancer is in the first stage. Patients with Non-Small Cell Lung Cancer, in Stage I & II, are treated - mainly - surgically, if their general condition and cardiorespiratory reserve allow it. Surgical treatment continues to be the most effective, offering long-term survival, at least in the early stages. Some of the patients who undergo successful surgery may need to undergo additional chemotherapy or immunotherapy or radiotherapy. Patients with advanced stage cancer are usually treated conservatively and this treatment includes chemotherapy, immunotherapy, targeted therapy, radiotherapy and, of course, combinations of these treatments. Patients who show significant improvement are re-evaluated clinically and laboratory, and some of them may undergo the necessary surgical treatment. The determination of the appropriate treatment in each case is made by the Pulmonologist, the Thoracic Surgeon and the Oncologist, who are the main members of an oncology board, assisted by the CT radiologist and the cardiologist. Obviously, in the case of surgical treatment, there must also be an anesthesiologist, with experience in the anesthesia of thoracic surgery patients and the appropriate equipment, both in the operating room and in the Intensive Care Unit. The advice of the doctors in the Intensive Care Unit and the physiotherapy department is of great importance in the final outcome of the operation. The ability of the Medical Council to work as a team is important, in order to ensure excellent intra-team cooperation, for the benefit of the patient.

What the patient with lung cancer should know is that the treating physician now has many weapons at his disposal. With the progress of science, technology and early diagnosis, patients have significant chances of cure or, at least, longer survival, with a better quality of life, compared to the past. Thanks to research, new targeted therapies are added every day. In the future, perhaps each patient will have their own completely personalized treatment.

Until the time comes when we can say that we have defeated lung cancer, the advice is to stop smoking or, better yet, to completely avoid smoking, which is the appropriate action for any reasonable person.Life is beautiful and offers many ways to enjoy it, much better (and much cheaper!) than smoking.

My second piece of advice is the annual preventive check-up with a low-dose chest CT scan (Low Dose Chest CT Scan).

Such a preventive lung cancer screening program is provided at the Athens Medical Center, Maroussi and the Inter-Balkan Medical Center of Thessaloniki. The evaluation of the CT scan results-findings is done by a team of specialized experienced doctors, which includes the Director of the CT Unit, the Director of the Thoracic Surgery Clinic, the Director of Pulmonology, and the Director of Oncology. This program is aimed at smokers aged 54 and over, people with emphysema or Chronic Obstructive Pulmonary Disease, and people who have a first-degree relative with a history of lung cancer.