Lung cancer | Diagnosis, treatment & prevention in Turkey

Forms of lung cancer

There isn't just one form of lung cancer. The exact type is identified by examining tumor cells under a microscope (pathology),a crucial step for choosing the right treatment.

Non-small cell lung cancer (NSCLC)

This is the most common type, accounting for about 80–85% of lung cancers (American Cancer Society). It includes several subtypes:

• Adenocarcinoma (the most common subtype, including in people who have never smoked)
• Squamous cell carcinoma, strongly linked to smoking
• Large cell carcinoma, less common

NSCLC tends to grow more slowly than small cell cancer. Depending on the stage, it can be treated with surgery, radiotherapy, chemotherapy, targeted therapy or immunotherapy.

Small cell lung cancer (SCLC)

Less common (about 10–15% of lung cancers) but more aggressive, this type grows rapidly and spreads early. It is strongly linked to smoking and is often diagnosed at an advanced stage. Chemotherapy, with radiotherapy and immunotherapy depending on the stage, is the standard treatment. It often responds well at first but frequently recurs, which requires close monitoring.

Related conditions that are not lung cancer

• Malignant pleural mesothelioma is a rare cancer of the pleura (the membrane surrounding the lungs),linked to asbestos exposure. Symptoms (shortness of breath, chest pain) usually appear late, and treatment differs from lung cancer.
• Pulmonary metastases are secondary tumors from another organ (breast, kidney, colon…). Their management depends on the primary cancer.

Lung cancer: Causes & risk factors

Lung cancer is strongly linked to inhaled substances. The lungs are directly exposed to the air we breathe, including tobacco smoke and carcinogenic agents present in some workplaces and homes.

Tobacco: the main risk factor

Smoking is the leading cause of lung cancer: about 80 to 90% of lung cancers are linked to tobacco. Regular exposure to secondhand smoke also increases the risk in people who have never smoked.

Other inhaled exposures

• Asbestos: inhaled fibers significantly raise the risk, especially in occupational settings.
• Radon: a naturally occurring radioactive gas, invisible and odorless, that can accumulate in poorly ventilated buildings.
• Air pollution: fine particles are associated with a higher number of lung cancer cases.
• Occupational exposure to certain substances (for example arsenic or silica).
• Smoked cannabis: smoke contains carcinogenic substances similar to those in tobacco smoke, but evidence of a direct link to lung cancer is still limited.

Other risk factors

• Family or personal history of lung cancer.
• Previous radiotherapy to the chest.
• Chronic lung disease such as COPD.
• Beta-carotene supplements in smokers, which are associated with an increased risk.

Diagnosis of lung cancer

The diagnosis of lung cancer is confirmed by a biopsy: a tissue sample examined by a pathologist. Imaging (chest CT, PET-CT) suggests the diagnosis and the stage, but cannot confirm it alone. The sample is taken by bronchoscopy, CT-guided needle biopsy or surgery, depending on where the tumor is. The analysis allows:

• Identifying the type of cancer (small cell or non-small cell).
• Testing for genetic alterations such as EGFR, ALK or ROS1, and for PD-L1, in non-small cell cancer.
• Choosing treatment according to the tumor profile and stage.

Persistent symptoms (cough lasting more than 3 weeks, shortness of breath, coughing up blood, unexplained weight loss) require a medical evaluation.

If you have your treatment in Turkey, ask for the pathology and molecular reports so that your own oncologist can review them.

Lung cancer treatment options in Turkey

Treatment depends on the type of cancer (small cell or non-small cell),its stage, molecular findings and the patient's overall health. It is defined by a multidisciplinary team.

Non-small cell lung cancer (NSCLC)

• Surgery: the preferred treatment for early-stage disease (stage I–II and some stage III) when the patient is fit enough. Lobectomy (removal of one lobe) is the standard operation, with lymph node removal or sampling; pneumonectomy (removal of the whole lung) is reserved for tumors that cannot be removed with less lung tissue. Minimally invasive (video-assisted thoracoscopic) surgery is used when appropriate.
• Stereotactic radiotherapy (SBRT): an alternative for early-stage tumors in patients who cannot have surgery.
• Chemotherapy (platinum-based drugs such as cisplatin or carboplatin, usually in cycles every 3 to 4 weeks),with or without radiotherapy.
• Targeted therapies: for tumors with specific alterations (EGFR, ALK, ROS1…) found by molecular testing.
• Immunotherapy: immune checkpoint inhibitors, alone or with chemotherapy, depending on the stage and tumor markers such as PD-L1.

Small cell lung cancer (SCLC)

• Limited stage: chemotherapy combined with thoracic radiotherapy; surgery only for very small, localized tumors.
• Extensive stage: chemotherapy combined with immunotherapy; radiotherapy may be added for symptoms or selected cases.

Sources: National Comprehensive Cancer Network (NCCN) guidelines for NSCLC and SCLC; American Cancer Society treatment pages.

How to prevent lung cancer?

Lung cancer has several risk factors, and the most important one can be changed: tobacco.

Quitting smoking is the most effective measure, at any age; the earlier, the greater the benefit. Avoiding secondhand smoke also reduces risk.

Other inhaled substances increase the risk: asbestos, radon and air pollution. Testing and ventilating the home for radon and following workplace safety rules help reduce exposure.

Screening with annual low-dose CT is recommended only for people at high risk. For example, the US Preventive Services Task Force recommends it for adults aged 50 to 80 with a smoking history of at least 20 pack-years who currently smoke or quit within the past 15 years. Talk to your doctor to find out whether you qualify. A healthy diet and physical activity are good for overall health, but they do not replace quitting smoking.

Complete Support in Turkey

If you consider treatment in Turkey, the medical decisions remain with the team that examines you. Turquie Santé organizes your trip once you have decided to go ahead, and the hospital gives you its price after reviewing your file.

Whatever you decide, a second opinion from a thoracic oncologist is reasonable before starting treatment, and your own oncologist should receive all reports, scans and treatment records.