LUNG CANCER
Lung Cancer kills more people than any other cancer in the world. It’s not only common, but deadly as well. The prognosis is grim with a 5-year survival rate of about 15%. Most cases (85%) are caused by smoking. There are hundreds of carcinogens in cigs, but the worst are probably the polycyclic aromatic hydrocarbons and arsenic. The second most common cause is Radon -- which is a radioactive byproduct of uranium decay. Fun fact - trace amounts of uranium are found in the soil. How much Radon is in your area is dependent on the geologic makeup of your local soil. Basements (which are surrounded by soil) are notorious for filling up with Radon, so be sure to put Radon detectors in your basement. Lung CA causes some B symptoms plus clubbing, a cough, breathlessness and occasionally hemoptysis. Screen old smokers for cancer with a yearly chest CT.
Lung Cancers are traditionally categorized as either “Small Cell” or “Non-Small Cell.” That’s because Small Cell Carcinoma is unique in two important ways. (1) It’s one of the deadliest cancers in existence, and (2) it has a lot of unusual paraneoplastic syndromes. Paraneoplastic syndromes are when a cancer secretes molecules that cause symptoms in other parts of the body.
Peripheral tumors (Adenocarcinoma, Large Cell) can press against the pleura. The irritated pleura will cause sharp chest pain when you breathe in.
Hypertrophic Osteoarthropathy is when an adult suddenly develops clubbing and arthritis. The most common cause is lung cancer.
Pancoast Tumor refers to any tumor at the top of the lung (aka the superior sulcus). That’s crowded real estate right there! A Pancoast Tumor can compress a lot of different structures. SVC → SVC Syndrome, which is bilateral venous stasis (ruddy edema) in the arms and face. SVC Syndrome is also caused by mediastinal masses and central line clots. Medical Emergency -- it can raise the ICP! Brachiocephalic Vein → unilateral venous stasis. Sympathetic Chain → Horner’s Syndrome (ptosis, miosis, anhidrosis). Recurrent Laryngeal N. → hoarseness. Phrenic N. → hemidiaphragmatic paralysis, where a high-riding diaphragm can be spotted on a chest x-ray. Brachial Plexus → arm weakness / numbness.
TOBACCO
Nicotiana tabacum
Smoking tobacco is perhaps the most preventable cause of death in the world. I think most people nowadays understand that. So I wanted to use this page to discuss some things that you may not know about tobacco. I’ll start off with the components inside of a cigarette. Nicotine is addictive, Carbon Monoxide fucks with oxygen, and there are dozens more carcinogenic, inflammatory, irritating or ciliacidal chemicals: Polycyclic Hydrocarbons, Tar, Phenol, Nitrosamine, Nitrogen Oxides and Formaldehyde. Nicotine itself is pretty safe - it doesn’t cause cancer. That’s why the Nicotine patch is safe. Nicotine is a neuro-active chemical with many, many effects on neurochemistry. The high it confers is both stimulating and calming. Smokeless Tobacco (eg, dip, chew) doesn’t cause COPD or lung cancer. Instead it causes mouth cancer (squamous cell cancer of the buccal mucosa and gums). Smoking Cessation is always advisable. The CV damage reverses after a few years. Unfortunately, the lung damage is more or less irreversible.
Here are some of the dangers of smoking, broken down by organ system.
Lungs - Lung cancer, COPD, Laryngeal cancer
CV - MI, atherosclerosis, PVD, Blood clots, HTN, Strokes
GI - Mouth cancer, Esophagus cancer, Stomach cancer, GERD, Peptic ulcers, Pancreatic cancer
Fetus - Low birth weight, growth retardation
GU - Cervical cancer, low T, low E (osteoporosis), Kidney cancer, Bladder cancer
Heme - AML, Immunosuppression due to ↓Neutrophil adhesion
Derm - Facial wrinkling, early aging, skin discoloration
Senses - Decreased sense of taste / smell, Macular degeneration, Cataracts
Secondhand Smoke is especially bad for children. It accounts for 50% of SIDS (Sudden Infant Death Syndrome), likely due to impaired CV reflexes and impaired arousal. It’s also tied to asthma, recurrent otitis media and cancer. Secondhand smoke is reportedly attributed to 3 - 5% of lung cancers, although consider me a bit skeptical of this fact, as it seems like a very difficult thing to study accurately.
Tobacco has a few (limited) benefits. For every 100 - 1,000 people killed by smoking, about 1 person’s life is saved by smoking. Still, smoking is dumb. Here are some of the beneficial effects:
Prevents / treats Ulcerative Colitis (though it worsens Crohn’s)
Prevents Parkinson’s (though it causes vascular dementia)
Prevents Endometrial Cancer
Prevents Preeclampsia (though it harms the fetus)
Improves Schizophrenia (90% of schizo’s smoke)
