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Lung Cancer Questions:

One of the characters in my series develops lung cancer. He lives in a place where treatment for this (chemo, radiation, etc.) is unavailable. I have a few questions relating to this:
  • About how long would one's expected life span be after that point? After a while, would it be completely unbearable, or could one live quite comfortable on painkillers until they pass?
  • What are usual symptoms? Is it likely for the cancer to spread to other body parts after a while?
If anyone could give me any tips or links for helping write this I would really appreciate it.

edited 13th Feb '13 5:24:16 AM by TheMuse

1. It would depend on the precise type and stage of the cancer. But generally speaking the 5-year survival rate (i.e. the chance you live 5 years past the point of diagnosis) is around 10% or less.

2. The symptoms are mostly non-specific and would depend on the stage of the disease; particularly if it has spread (as it is very prone to do) and if so, where. For the most part, the most noticeable symptoms early on are going to be minor respiratory problems like persistent coughs, chest pain and difficulty breathing; alongside unexplained weight loss and tiredness (the latter two being bad signs indicating the cancer has spread). After that, things tend to only get worse; with hormonal imbalances (if the cancer produces hormones), bone pains, and neurological problems (when the cancer metastasises to the brain).

Overall, the disease course is extremely difficult and requires significant monitoring and close support from others in order to maximise comfort.
 
 3 d Roy, Wed, 13th Feb '13 11:12:05 AM Relationship Status: Getting away with murder
You might find this thread useful.
"Allah may guide their bullets, but Jesus helps those who aim down the sights."
Thanks, I'll have to definitely check that out :)

edited 13th Feb '13 5:16:34 PM by TheMuse

I heard once, from a fairly reliable source, that cancer grows quicker in young people. Cancer is much more common in old people, though. There it grows more slowly, and presumably also spreads more slowly.

So take those "5 year survival" stats with a grain of salt. They're based on averages, including the average at which people get that particular kind of cancer. If someone gets it much earlier, 15-25 years earlier, being alive 5 years later is much less likely (unless quicker growth leads to earlier diagnosis of course, if earlier diagnosis means treatment).

The spreading, called "metastasizing" or something like that, is often what causes the real problem; the first tumour, the original one, might quite likely be in a fairly harmless place, just an annoying lump, maybe eventually pressing a bit on some nerves or something. But if single cancer cells, or small bunches of cancer cells, get torn lose (which happens frequently with some forms of cancer, not so often with others) and spreads to other parts of the body, and manages to grow there (i.e. gett enough nutrient-rich blood), then chances are one of those dozens of colonies will sit somewhere important. Squeeze on something that dislikes being squeezed, or maybe close off blood supply, or render a nerve nonfuctional.

Also think about what kinds of pain killers is the character on, and what side effects they tend to have. If your setting is technologically primitive, maybe they only have primitive stuff like morphine (which, by the way, can easily be used as assisted suicide, if the patient is given extra-high doses).

The character's around 19-24 years old so the 'cancer spreading more quickly' would apply. But if they were to have a common kind of lung cancer, like squamous cell cancer, is there a decent estimate you could give me for when the cancer would start metastasizing? And are there any particuarly common places lung cancer often spreads to?
  • Also, would somewhere in the 8 month ballpark be a reasonable estimate for how long the cancer would start tonoticably mestastasize?

We don't know when the cancer will metastasize; we're not even sure if it will. You'd have to do histologic studies and such. Furthermore, up to 75% of people with non-small cell lung cancer (of which squamous cell cancers are part of) don't get diagnosed until their disease hits the later stages.

Basically, it's hard to tell.

Lung cancers commonly spread to the skeletal syndrome, hence the prevalence of bone/back pain.

I'm not sure about those eight months, but it's very likely that metastatic activity will go undiagnosed, until things get really bad, at least. Bad as in exhibiting neurological deficits.

So in this low tech setting, obviously it would take a while for one to actaully be diagnosed. They probably wouldn't notice anything until they started coughing excessively or having joint pain and such. From the information I've seen on this, one would definitely need to be in a later stage for these severe symptoms to appear. What would the average life expectancy be after the 3 or 4 th stage of lung cancer?

edited 14th Feb '13 1:46:35 PM by TheMuse

[up] As I originally stated, the vast majority (about 90%) of people diagnosed with lung cancer will die within 5 years of diagnosis.

A point of clarification about the term '5-year survival'. It is a common and standardised term in medical science to measure survival and to describe prognosis. It's - simply put - obtained by identifying a sample population (of people just diagnosed with lung cancer) and following up on them 5 years later to see if they are still alive. The percentage described (in this case, around 8% in Europe and most of the developing world) is the percentage of those followed up who are still alive. Just as an indication of its importance and widespread acceptance, it is one of the ways how doctors and scientists frequently measure and evaluate how effective a new treatment is (i.e. does it raise the 5-year survival rate?).

Also, @Peter 34: I would advise you to carefully consider the source of information; especially if it is by a so called "expert" who gives his opinion without backing it up with literature (or you can't find studies that come to a similar conclusion; always independently double check your facts, even mine). "Expert opinion" is generally considered the weakest form in terms of the hierarchy of evidence. If there was such a binomial distribution regarding survival rates in terms of age, it should come up in the literature. And while there are certain cancers that are indeed more aggressive when found in individuals of certain ages, this is by no means the norm let alone exclusively skewed towards younger patients as having a worse prognosis. As far as I'm aware, age is not a major prognostic factor for lung cancer.

edited 14th Feb '13 3:57:22 PM by peasant

 
[up] That would be correct. The major prognostic factors for lung cancer are the stage of the cancer itself and systemic symptoms such as weight loss. Also smoking: those who quit last longer.

@ The Muse The estimated five year survival rates are as follows:

  • Stage 3A = 10 - 35%
  • Stage 3B = <5%
  • Stage 4 = <5%

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