Lung Cancer

Lung cancer begins when cells in the lungs grow in an uncontrolled way and form a tumour. The two main types are Non-Small Cell Lung Cancer (NSCLC) — accounting for about 85% of cases — and Small Cell Lung Cancer (SCLC), which is less common but grows and spreads more rapidly. NSCLC includes adenocarcinoma (most common in non-smokers and women), squamous cell carcinoma, and large cell carcinoma. Lung cancer can spread to lymph nodes, the opposite lung, brain, bones, liver, and adrenal glands.

Major risk factors include tobacco smoking (the most important modifiable risk factor), exposure to secondhand smoke, indoor air pollution from biomass burning (wood, charcoal, dung), and occupational exposures (asbestos, radon, silica). Seek medical attention promptly for:

Chest X-ray is usually the first test and can detect a lung mass, though small tumours may be missed. CT scan of the chest provides detailed images and is the standard investigation. Bronchoscopy: a thin camera is passed through the airways to visualise and biopsy a central tumour. CT-guided needle biopsy: for tumours near the edge of the lung, a needle is guided by CT to take a tissue sample. PET scan detects metabolically active cancer anywhere in the body. Molecular testing of biopsy tissue (EGFR, ALK, ROS1, PD-L1) identifies mutations that guide targeted and immunotherapy.

NSCLC: Stage I — Small tumour in the lung only; Stage II — Tumour or nearby lymph nodes; Stage III — Tumour has spread to chest lymph nodes; Stage IIIA may still be curable; Stage IV — Spread to the other lung or distant organs. SCLC is classified as Limited stage (confined to one side of the chest — can be treated with radiation) or Extensive stage (spread beyond the chest — systemic chemotherapy is the main treatment). Most Ethiopian patients present with Stage III or IV disease.

NCCN Guidelines recommend treatment based on stage, histology, and molecular testing:

The single most effective prevention is not smoking — and quitting at any age reduces risk. Improve indoor air quality: use improved cookstoves that vent smoke outside, open windows while cooking. Avoid secondhand smoke. If you or a family member has a persistent cough, do not delay seeking care — early detection at Stage I or II greatly improves survival. During treatment, manage fatigue with gentle activity, eat high-protein foods to maintain weight, and keep follow-up appointments. Report any new neurological symptoms (headaches, confusion) promptly.