Don’t ignore mild and latent symptoms of lung cancer, say experts

Dr Rudrappa
Dr Rudrappa
Don’t ignore mild and latent symptoms of lung cancer, say experts
Faruque Ahamed
Is lung cancer, most prevalent deadly disease in India, changing its area of prevalence from urban to rural life? Are initial signs of the fatal disease becoming elusive making doctors confused?
Experts in pulmonology as well chest medicine feel that now rural people who are not usually exposed to urban pollutions and smoking are also getting vulnerable to lung cancer because of biomass fuel like coal. Sometimes, the early manifestations of the suspects become confusing if they are not advised for investigations like chest CT scan.
Concerned with the trend of biomass fuel leading to cancer the state health department led by the chief minister Miss Mamata Banerjee has also decided to sensitize health administrations in districts to create awareness among rural people. 
“We are aware of the issue and asking people living to use kerosene or LPG for cooking instead of using solid fuel like coal, wood, dry leaves etc that emit smoke. We have also plans to create awareness in some districts where use of biomass fuel is rampant,” said Dr Ajoy Chakraborty, director of health services (DHS) in the state. 
“It’s a common thing that people living in cities as well industrial belts with regular 
habits of smoking are vulnerable to get lung cancer because of environment pollutions aggravated by construction industries also. The rampant and unrestricted use of polluting fire crackers during the Kali puja this year in Kolkata and districts had increased the pollution level in an alarming manner,” said Dr Alok Gopal Ghosal, pulmonologist and former head of chest medicine of state-run N R S Medical College and hospital. 
“But the lung cancer is also slowly changing its area of prevalence from cities to villages. Villagers who are regularly exposed to smoke of biomass fuel may also get the deadly disease. Villagers suffering from chronic obstructive pulmonary disease (COPD) are at the high risk zone of getting lung cancer if they are exposed to the solid fuel regularly. In addition to this, manifestations of symptoms of lung cancer suspects become sometimes confusing to us. We advise for low dose CT scan of chest to detect solitary 
pulmonary nodule (SPN) in the lungs. This issue is being discussed in different seminars on pulmonary diseases,” he added.
Bengal is one of the most high risk zone states of cancer with fresh cases of more than 80,000 patients of this disease every year, said a senior professor in radiation oncology associated with government medical college in the city. 
“Lung cancer cases are being reported among village people. It’s also changing its areas like dengue, a mosquito-borne urban disease is spreading its bites in rural Bengal,” he said requesting anonymity. 
The initial signs of lung cancer are highly elusive. The only noticeable thing may be a slight cough that exists over an extended period of time. It may or may not be accompanied by breathing difficulty and weight loss. It may or may not produce blood in the spit or phlegm. There may only be mild fatigue,” Dr Mohan Rudrappa , who advises not to 
ignore these mild symptoms, told
In a seminal study published in Chest, Dr. Rudrappa, a US-based NRI research scholar associated with Mercy Hospital in Joplin, has demonstrated that there may be early tell-tale signs of lung cancer.
Some excerpts of an interview with Dr Rudrappa are given below:
Faruque Ahamed: Could you just brief about what is lung nodule and what is the potential risk in lung cancer?
Mohan Rudrappa: Small growth in lung is called a lung nodule. It can be carcinogenic or non-carcinogenic. Nodules are very common and can be found one in every third person 
following a chest CT scan. Only 5% nodules end up with a lung cancer. Noncancerous lung nodules develop due to infections in lungs, non-cancer growth such as fibroma or could be scar from old infections. Any nodule that grows with time is considered cancer unless 
proven otherwise. So, when nodules are found on CT scans, same investigations are advised again to detect the growth of these nodules and to treat timely. 
FA: What is SPN?
MR: A solitary pulmonary nodule (SPN) of approximate 3 cm round spot is detected on the CT scan. They are usually single and hence called solitary and should have normal lungs all around. As they are very small they do not cause any harm to patients. As most nodules are not cancerous, it is very important to detect the one which can turn carcinogenic.
FA: Risk factors for the nodules to be cancerous?
MR: It depends on multiple aspects. Bigger nodule can cause higher risk. Any nodule that is above 3mm is considered as masses and have more tendency of being malignant. Bigger nodules and nodules among chain smokers turn malignant more often. Also, new nodules, which develop in short span of time may also turn malignant more often. The risks of nodules becoming cancer is around 5% in health people and can be as high as 42% in heavy smoker with other medical problems.
FA: What are the methods for screening lung cancer?
MR: CT scan is the sole and primary method to diagnose lung cancer in a patient. If nodule is seen in the investigation but is smaller than one cm, then one more CT scan so that doctors can get it confirmed that the patient complains of lung cancer. The interval 
depends can be from 3 months to 12 months and bigger nodules get in short interval. This step is vital and is crucial, if we wait too long to get repeat CT scan, the disease can spread to other organs.
Lung cancer can be detected at veryearly stage and can be effectively treated so that patients live long and live better. Preliminary findings of my work have been published in Chest. I serve as the Director of Lung Nodules Surveillance Program at Overton Brooks VA Medical Center from 2013-2018. It was a great opportunity for me to serve the veterans, many of whom are at increased risk for lung cancer due to their environmental 
exposure. From a pioneering view point I introduced the electromagnetic navigation bronchoscopy system to detect lung cancer at an early stage.