Brain metastases from systemic cancer are the most common type of intracranial neoplasm in adults, being almost 10 times more common than primary malignant brain tumors, which cause a significant burden on the management of patients with advanced cancer (1). The lungs represent one of the most frequent sources of metastases to the brain, with a probability of (36 64%) (3). Symptoms suffered by the patients include headaches, epilepsy, focal weakness, numbness or changes in mental status. The prognosis of patients with brain metastases is not optimistic and the median survival time is  1 2 months if left untreated. The 1-year survival rate has been recorded as 10.4% (4,5). The treatment of metastatic brain tumors is complex; not only due to being able to provide local control and improve neurological function, but also due to factors such as age, performance and systemic disease status and the size, volume, location and number of metastases at presentation

CyberKnife is a robotic radiosurgery system with a linear particle accelerator (linac), which is coupled with real-time imaging to track and compensate for the patient s or target s motion. As a relatively non-invasive treatment modality, CyberKnife demonstrates certain benefits, including a more accurate target localization and improved dose delivery for the management of metastatic brain tumors that allows higher biologically effective dose delivery without increased incidence of toxicity.

In the present case, the results for the treatment of multiple brain metastases after CyberKnife surgery with a 7 8 Gy marginal dose was promising. CyberKnife for metastatic brain tumors is an effective and safe method for reducing the marginal dose prescribed for multiple brain metastases and for minimizing the radiation-related neurotoxicities. In conclusion, CyberKnife, a focused, highly-targeted radiosurgery and fractionated radiotherapy is particularly useful for multiple brain metastases. CyberKnife provides the advantage of the management of local recurrence and a tolerable complication rate. Although the treatment of brain metastases has been performed with CyberKnife, the clinical significance and optimal dose fractionation scheme require further investigation.

In case you have a concern or query you can always consult an expert & get answers to your questions!

CyberKnife Therapy Of 24 Multiple Brain Metastases From Lung Cancer!

The sound of the word cancer can be really traumatic and the fact the one may most of the time be unaware of this condition can be hard to handle. The same is the situation in the case of lung cancer as it does not produce any remarkable signs and symptoms in its early stages. However, there are ways in which you can be aware of this life-threatening ailment. Here are some tell-tale signs of an early stage of lung cancer:

A stubborn cough:
Beware when a cough is lingering on for long with no sign of relief. When a cough is related to cold and respiratory infection, it will subside within a week or so. But in case the cough is persistent, it can be a symptom of lung cancer. You should never dismiss a stubborn cough regardless of whether it is dry or producing mucus. You should talk to a doctor right away as he can check the lungs and may order for other tests to determine whether you have cancer.

Breathing problems:
Becoming easily winded or shortness of breath is considered the most prominent symptoms of lung cancers. This may occur when cancer blocks or inhibit the airway or when the fluid from the tumor starts building up in the chest. If you find that it is becoming difficult for you to breathe in doing tasks that you found easy before, you should not ignore it.



Wheezing:
When the airways become inflamed, blocked or constricted, then the lungs would produce a wheezing and whistling sound while breathing. It can be associated with a host of other causes that are easily treatable but could also be due to lung cancer.

Headache:
Even though headaches are considered one of the most common health problems, if there is a persistent headache, then it could be a sign that lung cancer has spread to the brain. It is important to understand that all headaches are not associated with the brain metastases. There are times when the lung cancer creates pressure on the superior vena cava which is in charge of supplying blood to the upper part of the brain. This pressure can also lead to headaches.

Pain in the bone:
If the lung cancer has spread to the other parts of the body, then it may produce mild pain in the back and other parts of the body. It tends to become worse during the night when you are resting on your back. But it can be difficult for a commoner to differentiate between muscle and bone pain. In case you are suffering from bone pain, you will see that it is becoming worse with movement. Moreover, lung cancer is also associated with pain in the shoulder, neck, and arm even though it is very rare. You should be very attentive to the pain and aches in the body and consult with an expert at the earliest.

You can easily combat lung cancer if diagnosed and treatment is started in its early stages. In case you have a concern or query you can always consult an expert & get answers to your questions!

Five Signs That You Might Be Suffering From Early Stage Lung Cancer!

Pulmonary diseases are some of the most commonly experienced health conditions all over the world. Millions of people suffer due to various causes including genetics, smoking, pollutants and infection. Now lungs are one of the most important and complex organs of the body. They are the apparatus through which oxygen enters and carbon dioxide gets expelled. 

Lungs expand and contract on a constant basis to ensure that we can breathe properly. Let us find out more about lung or pulmonary diseases.

Asthma: This is one of the most common and potentially fatal conditions that affect children and adults. It grips the airways formed by the bronchi which branch off into smaller tubes from the main trachea that holds them. This condition causes inflammation, and even spasms, which can lead to wheezing and breathlessness. The main triggers of asthma attacks include allergies, infections and pollutants that may escape into the airways.
COPD: This is also known as Chronic Obstructive Pulmonary Disorder. It is an umbrella term used for various lung conditions that cause breathing difficulties due to an obstruction of the airways. Chronic bronchitis is one of the conditions that falls under COPD, and is usually characterised by persistent, hacking coughs.
Cystic Fibrosis: This is another condition that affects the airways by causing poor passage of mucus from the bronchial tubes. This condition is a genetic one where the mucus that gathers eventually becomes a lung infection.
Pneumonia: This is a condition that causes an infection in the alveoli, which are the tiny tubes that the airways branch into. These are air sacs that can catch myriad infections like pneumonia.
Tuberculosis: This is also a kind of pneumonia, which is caused by bacteria called Mycobacterium Tuberculosis. This condition usually attacks the air sacs of the lungs and can be a potentially fatal disease if it is not treated on time. The patient will require immediate hospitalisation.
Pulmonary Edema: This condition is caused by fluid leaks from the tiny blood vessels into the surrounding air sacs within the lungs. It can also be caused due to heart failure as well as back pressure which falls on the lungs. Direct injury to the lungs can also lead to this condition.
Lung Cancer: This is a fatal disease which can be found in any part of the lungs. It has many forms and the type as well as the location usually determines the kind of treatment option that will be followed.
Acute Respiratory Distress Syndrome: When the lungs suffer a sudden injury which is usually caused by a bout of serious illness, it is called ARDS. Treatment involves the use of life support ventilation.

All About Pulmonary Diseases

Lung cancer is the cancer killer of both men and women in the world. When you think of risk factors for lung cancer, what comes to mind? Most of us think about the risk associated with smoking cigarettes, but did you know that air pollution can also cause lung cancer? Overwhelming evidence shows that particle pollution in the outdoor air we breathe like that coming from vehicle exhaust, coal-fired power plants and other industrial sources - can cause lung cancer. Particle pollution increases the risk of dying early, heart disease and asthma attacks, and it can also interfere with the growth and function of the lungs. 

What is Particle Pollution?

Particle pollution is a mix of tiny solid and liquid particles in the air and can be made up of a number of components, such as acids, organic chemicals, metals, soil and dust particles. It can be emitted directly from wood stoves, forest fires, vehicles and other sources, and it can also form from other types of pollution that come from sources like power plants. 

Why does particle pollution harm our bodies?

While breathing in larger sizes of particle pollution can be harmful to our health, smaller particles are more dangerous. Bigger particles can irritate your eyes, nose and throat, but our natural defenses help us to cough or sneeze them out of our bodies. Unfortunately, those defenses don't keep out smaller particles, which get trapped deep in the lungs and can even get into the bloodstream, causing damage to our health.



Who is most at risk?

As for who is at risk for health problems from breathing in particle pollution. Those who live where particle pollution levels are high is at risk. Some people face higher risk, including children, the elderly, people with lung and heart disease and diabetes, people with low incomes, and people who work or exercise outdoors.

How do we protect ourselves from particle pollution?

Check the air quality index forecast for the day and limit your activity if pollution levels are high. Avoid exercising along heavily traveled highways regardless of the overall forecast.

As individuals, we can play our part in reducing air pollution levels by trying to avoid creating more of it. Choosing  active travel  options where possible, like walking and cycling, can help reduce pollution levels from transport and is also a great way to be more active, which is linked to a reduced risk of cancer and other diseases. In case you have a concern or query you can always consult an expert & get answers to your questions!

The Connection Between Lung Cancer & Outdoor Air Pollution!

Cancer like most other diseases has the best rates of recovery with early detection and intervention. As there are no regular health screenings for blood cancer, only the awareness about the early warning signs can save your life. November is designated as the Lung Cancer Awareness Month, to ensure every individual is equipped to fight against lung cancer right from the start. Here are 4 vital facts you must know to win your fight against blood cancer.
Lung cancer is also known as pulmonary carcinoma or cancer of the lung. It occurs when DNA mutations develop in the cells/ tissues of the lungs leading up to uncontrolled growth in the tissues of the lung. By far, it is known to be the most common cancer in Asia.

1. Type: lung cancers can present as one of the following types: 

Non-Small Cell Lung Cancer (NSCLC): Most common type of lung cancer and constitutes nearly 85% of all lung cancers. The sub-types of NSCLC are as follows:
Large cell carcinoma
Squamous cell carcinoma (SqCC) (Epidermoid)
Adenocarcinoma   accounts for majority of the NSCLC.
Small Cell Lung Cancer (SCLC): It is also known as oat meal cancer and tends to spread (metastasize) quickly. This constitutes about 15% of the lung cancers.
Mesothelioma: It is a rare cancer that develops in the mesothelial cells of the pleural or peritoneal surfaces. It usually arises in the pleural membrane lining the lungs, known as pleural mesothelioma. One that arises from the peritoneum is called the peritoneal mesothelioma and the one that arises from the pericardium is known as pericardial mesothelioma. Lastly, it can also arise from the tunica vaginalis known as testicular mesothelioma. People working with or prior exposure to asbestos are mostly at risk of developing mesothelioma. The latency period between time of exposure and development of mesothelioma can be somewhere between 20 to 40 years. Maximum of the patients who develop mesothelioma are men.
2. Gender: It affects the male populace predominantly. It is more common in men than in women and in those of lower economic status. However, the incidence of lung cancer, in women too, is on the rise of late.

3. Etiology: Cigarette/ Tobacco smoking remains the most important cause of lung cancer accounting for 85   90% of the cases. Incidence/ risk is proportionate to the number of cigarettes smoked irrespective of the age. Also, environmental toxins including smoke from burning black tar, exhaust gases from automobiles etc. too contribute actively to various lung diseases including cancer. People working in asbestos manufacturing factories who are exposed to asbestos dust are also likely to get lung cancer. Tuberculosis too is an additive risk factor. Again, people who have received ionizing radiation especially to treat Hodgkin Lymphoma or other malignancies also run the risk of developing lung cancer. Above-mentioned causes apart, genetic factors may also play a role.

4. Features: Lung cancer clinically presents in the following ways mainly. Signs & symptoms of malignant mesothelioma are as enumerated below

Difficult/ labored breathing (Dyspnea)
Chest pain
Palpable chest wall mass
Discordant chest wall expansion
Weight loss (Cachexia)
Loss of appetite (Anorexia)
Night sweats
Signs & symptoms of non-small cell lung cancer (NSCLC) are as enumerated below. Majority of patients are symptomatic at diagnosis

Chronic cough
Difficult/ labored breathing (Dyspnea)
Chest pain
Blood stained sputum (Hemoptysis)
Hoarseness
Weight loss (Cachexia)
Loss of appetite (Anorexia)
Weakness
Bone pain
Pleural or pericardial effusion
Superior vena cava syndrome
Brachial plexopathy
Neurologic pain
Hypercalcemia of malignancy
Signs & symptoms of small cell lung cancer (SCLC) are as enumerated below

Symptoms as per the points 8   18 depicted above for NSCLC are applicable for SCLC as well. Additionally, patients suffering from SCLC may have:

Fever associated with chest infections like bronchitis/ pneumonia that refuse to go away or keep coming back
Horner syndrome
Paraneoplastic syndromes including encephalitis/ sub-acute sensory neuropathy, hyponatremia, acromegaly, cancer associated retinopathy, ectopic corticotropic syndrome etc all.
5. Screening: is generally recommended for asymptomatic/ symptomatic populations as surveillance for high-risk individuals   who are either current or former smokers (quit smoking within the last 15 years) have at least a 30 pack-year smoking history and those who do not have any prior history of lung cancer. The goal of screening, as usual, is to be able to detect & diagnose lung cancer at an early stage which is potentially curable. It is mostly radiologic with a low dose helical computed tomography (CT) scan being more effective in detecting early-stage lung cancer than a chest radiograph can.

6. Diagnosis: Abnormal blood test results may be indicative of malignancy, but a follow-up imaging/ biopsy is always the gold standard for an accurate diagnosis. Following are the diagnostics employed mainly:

Blood: Hb may be low, TLC, ESR and polymorphs increased. Adenocarcinomas are likely to express thyroid transcription factor 1 (TTF-1) or carcinoembryonic antigen (CEA). On the other hand, mesotheliomas are likely to express Wilms Tumor -1 (WT-1) protein and Calretinin.
Imaging: Thoracoscopy, Bronchoscopy, X-Ray, CT Scan etc all. Positron Emission Tomography (PET) / CT scan and Magnetic Resonance Imaging (MRI) scan help detect metastasis if any.
Biopsy: It clinches the histologic diagnosis and the nature of the disease.
7. Treatment: Conventional treatment includes surgery, chemotherapy and radiotherapy as contextually appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.

8. Prognosis: Preventive measures, earlier diagnosis and right early treatment are key for effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for early-stage lung cancer are more. The cure/ recovery chances are influenced by the grade, stage of cancer, recurrence and the patient s general health & vitality etc all. The primary determinant of prognosis in NSCLC is the stage at which the cancer is diagnosed. For non-metastatic cancers, however, it is the nodal status that determines the stage and hence the prognosis.

9. Prevention: Rightly said, prevention is always a better choice. Cigarette smoking is to be avoided by all means as it is the single major cause of lung cancer. Even exposure to cigarette smoke (passive or secondhand) is also an established cause of lung cancer and is known to increase the risk of lung cancer in non-smokers as well. Preventing exposure to secondhand smoke can be helpful in decreasing the incidence and mortality of primary lung cancers. Above-mentioned apart, other important risk factors such as exposure to ionizing radiation, environmental carcinogens like smoke from burning black tar, exhaust gases from automobiles, outdoor air pollution, and occupational exposure to asbestos, arsenic, beryllium, nickel, cadmium, chromium etc all too are known to increase the risk for lung cancer and mortality thereof. In fact, cigarette smoking is known to potentiate the effect and hence the lung cancer risk of many of the above-mentioned carcinogens, multi-fold, in smokers. Thus, either eliminating or reducing the exposure to the above-mentioned carcinogens can lead to a decrease in the risk of lung cancer and incidences thereof. Furthermore, randomized clinical trials indicate that high-intensity smokers (only) who take supplementation of beta-carotene have an increased risk/ incidence of lung cancer. Vitamin E supplementation, on the other hand, does not affect the risk of lung cancer as indicated by the trials. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Lung Cancer Awareness Month - Lung Cancer In Nutshell!

As much as you want to avoid, there are things you have no control over. Lung cancer (Bronchogenic Carcinomas) is one such nemesis that can throw life in shambles. The malignant tumor that originates in the lungs slowly spreads onto the other distinct and vital organs as well. Thought to be mostly affecting men who are chain smokers and into severe tobacco consumption, incidences of lung cancer in women are rising at an alarming rate over the past few years. Non-smokers may also be susceptible (to a lesser extent though) to lung cancer.

Lung cancer can be either

Non-small cell lung cancers: The NSCLC, accounting for ~85% of the lung cancer is one of the most common types of lung cancer affecting people, NSCLC may further be divided into
Adenocarcinoma: This type of NSCLC originates mostly in the peripheral regions of the lungs and may affect (spread) the lymph nodes. Non-smokers and women are mostly at the receiving end (other than the chain smokers).
Squamous Cell Carcinoma: Also known as Epidermoid Carcinoma, often affects men, epidermoid carcinoma may originate in the tissues that line the bronchial tubes. The lymph nodes are often affected by Epidermoid Carcinoma.
Large-cell Undifferentiated Carcinoma: The point of origin of large-cell undifferentiated carcinoma is the surface of the lungs. They have a higher probability of spreading to the lymph nodes.
Bronchioalveolar Carcinoma: Though rare, bronchioalveolar carcinoma originates close to the air sacs.
Small Cell Lung Cancer (SCLC, accounting for ~25% of the lung cancer): As the name suggests, SCLC is marked by the rapid proliferation of small cells into large malignant tumors. SCLC can move throughout the body (affecting vital organs).
Radiotherapy to treat Lung cancer:
Radiotherapy plays a pivotal role in the treatment of lung cancer. The radiation therapy is mainly of two types

External beam radiation therapy (EBRT)
Internal radiation therapy (Brachytherapy)
In external beam radiation therapy, high-energy rays are focused on the cancer cells (thereby resulting in the apoptosis of the cancer cells) externally, from outside the body. EBRT is particularly helpful in case of Non-small cell lung cancers.

The EBRT may be of the following types

3D-CRT (Three-dimensional conformal radiation therapy): An advanced radiation therapy, 3D-CRT accurately marks the position of the cancer cells (using advanced computers). The treatment ensures minimum damage to the other healthy cells and tissues (energy rays are directed at the affected cells from different positions).
SBRT (Stereotactic body radiation therapy): This is a radiation therapy used in the treatment of NSCLC, when it is at a nascent stage.
IMRT (Intensity modulated radiation therapy): As the name suggests, in IMRT, the intensity of the radiation reaching the normal tissues and cells can be modulated. Like 3D-CRT, the radiation in IMRT is directed from different angles (for maximum results).
Internal radiation therapy (Brachytherapy): This type of radiation therapy is generally used to deal with lung cancers that tend to block the airways. In this therapy, the radiation process is carried out through a narrow tube, thereby, shrinking and collapsing the tumor.
The effect, dosage, and duration of radiation therapy depend on the stage and severity of the condition. In some cases, radiation therapy may be given together with chemotherapy.

Radiotherapy - Is It Beneficial For Lung Cancer?

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