Cáncer de Pulmón: Detección temprana

cáncer de pulmón | dr eli omar zavaleta

160.000 estadounidenses mueren cada año por cáncer de pulmón, que es sólo es superado por enfermedades del corazón como causa de la muerte. Esto se debe en gran parte a que el cáncer de pulmón usualmente se descubre sólo cuando ya se ha propagado. Sin embargo, ha habido un progreso remarcable en los últimos años en el diagnóstico y tratamiento del cáncer de pulmon.  Se ha visto que la Tomografía axial computarizada puede detectar el cáncer de pulmón cuando todavía es pequeño y localizado. Además, se han producido importantes avances en el tratamiento con radiación, con terapia de combinación de fármacos y con nuevos compuestos dirigidos a las “mutaciones controladoras”.

Aunque las curas son raras, los números siguencreciendo. Para aquellos con la enfermedad extendida, hay respuestas útiles a nuevas terapias que prolongan la supervivencia y mejoran la calidad de vida. Como resultado, ahora parece haber algo de luz al final de este largo túnel.

Algunas cifras sobre el cáncer

La incidencia del cáncer es mayor entre los hombres que entre las mujeres (76 y 53 por cada 100.000, respectivamente, ajustados por edad). Lo que probablemente esté relacionado al mayor uso en el pasado de tabaco entre los hombres.

El riesgo de por vida para los hombres y mujeres en conjunto es de casi 7%. Eso se traduce en que una de cada 14 personas desarrollará cáncer de pulmón en algún momento de sus vidas. Esta incidencia aumenta sustancialmente con la edad. Aproximadamente un tercio de los casos se desarrollan en personas menores a 65 años, un tercio entre los 65 y 75 y otro tercio por encima de los 75 años La edad media de aparición es de 70 años.

Ciertamente no es ninguna sorpresa que el tabaquismo es la principal causa de cáncer de pulmón; aproximadamente un 80 por ciento de las personas con cáncer  son fumadores (20%) o lo fueron (60%). Fumar aumenta de por vida el riesgo de una persona de desarrollar cáncer, en un factor de 20 veces.

Otras causas son el radón, el humo de segunda mano, amianto (especialmente cuando se combina con el tabaquismo), y una variedad de factores ambientales, incluyendo el arsénico, níquel y cromo. Sin embargo hay casos, especialmente de mujeres jóvenes, que están desarrollando cáncer de pulmón a pesar de no haber exposiciones conocidas a estas sustancias.

El cáncer de pulmón entre los hombres y las mujeres que nunca han fumado es la sexta causa de muertes por cáncer con alrededor de 28.000 muertes cada año, casi lo mismo que las muertes causadas por cáncer de próstata.

La incidencia de cáncer de pulmón se ha estancado o incluso disminuido ligeramente para los hombres, pero sigue en aumento para las mujeres. Esto refleja el hecho de que una estabilización del consumo de tabaco se produjo antes de los hombres que en las mujeres.

La mayoría de los cánceres de pulmón se diagnostican después de que ya se ha extendido más allá de los pulmones.Como resultado, la sola cirugía rara vez resulta en la cura; por desgracia, la mayoría de los pacientes no son candidatos para la cirugía debido a la diseminación local, regional o distante al momento del diagnóstico.

Sólo alrededor del 15 por ciento de los cánceres de pulmón son diagnosticados cuando todavía está localizado a su sitio pulmonar de origen; el resto ya se han propagado a nivel regional (22 por ciento) o distante (56 por ciento) con la incertidumbre de su etapa. Comparado con el cáncer de mama o cáncer de próstata donde cerca del 60% y 80%, respectivamente, son localizados al momento del diagnóstico. Lo que implica una gran diferencia en la capacidad de tratar con éxito la enfermedad.

La supervivencia es generalmente cortas con sólo el 15 por ciento de los sobrevivientes de cinco años (tasas de supervivencia a 5 años se usan comúnmente medidas de éxito de la terapia para el cáncer). Compárese esto con las tasas de curación para el cáncer de mama (90 por ciento), cáncer de próstata (casi el 100 por ciento), y cáncer de colon (65 por ciento). Dado que la larga fase de iniciación de fumar para el diagnóstico de cáncer es muchas décadas y dado que el 20 por ciento de los estadounidenses fuman regularmente actual, es razonable prever que en 2030 el número de casos se incrementará en un 50 por ciento para los hombres y las mujeres.

Categorías y detección temprana del cáncer

Los cánceres de pulmón se clasifican ya sea como:

  • Cáncer de pulmón de células pequeñas (SCLC)
  • Cáncer de pulmón de células no pequeñas (NSCLC) . Estas se definen tanto por su apariencia bajo el microscopio como escamosas, adenocarcinoma o células grandes y por el análisis genómico.

El cáncer de pulmón se puede detectar en su fase temprana con Tomografía axial computarizada de baja dosis. Esto significa que más individuos pueden ser potencialmente curados. La demostración de que la quimioterapia adyuvante para las personas con enfermedad microscópica distante aumenta la tasa de curación para el CPCNP, es un avance importante.

Sin embargo, por cada lesión del cáncer que se detecta a tiempo gracias a las tomografías computarizadas, 19 lesiones benignas se detectaron también; que por lo general no son fácilmente distinguibles de las cancerosas. Esto se traduce en un dilema para el paciente y el médico – tener un procedimiento invasivo para obtener una respuesta definitiva o tener regulares CT seguimiento para ver si la lesión progresa, se mantiene estable o retrocede. Claramente, los nuevos enfoques rápidos, eficaces pero menos invasivos para resolver este dilema son críticos.

Fuente: Medical News Today

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