Although some lung cancer cases are noticed in young people, primary lung cancer in teens is rare. Smoking is the major risk factor for lung cancer, and the risk may vary depending on the duration of smoking and the number of cigarettes. Some teens may develop metastatic or secondary lung cancers followed by other childhood cancers. Lung cancer is the leading cause of cancer deaths worldwide (1). Therefore, it is recommended to seek medical care to identify the cause of persistent respiratory symptoms and cease smoking habits. Read on to know the causes, types, symptoms, tests, prevention, and management of lung cancer in teens.
Symptoms Of Lung Cancer In Teenagers
Early stages of cancer can be asymptomatic. The following signs and symptoms can be seen in lung cancers, especially in the advanced stage (2). These symptoms can also be seen in other respiratory or lung diseases. Make an appointment with your teen’s doctor if you notice any concerning signs and symptoms. Delayed interventions could increase the risk of complications such as pleural effusion (fluid in the pleural cavity) and metastasis to other parts of the body.
Causes Of Lung Cancer In Teenagers
Cigarette smoking is the cause of lung cancer in 80% to 90% of cases (3). Cigarette smoke contains carcinogens (cancer-causing substances) and results in immediate changes in the lung tissue. Teen smokers have the potential risk of developing lung tumors and cancers, even at a later age. The following are some of the other possible causes of lung cancer in teens.
Children who are exposed to secondhand smoke (passive smoking) may have an increased risk of lung cancer.
Marijuana (cannabis) smoke and menthol cigarettes can also cause lung cancer (4).
Exposure to radon gas and air pollution, asbestos exposure can also play a role. Asbestos is known to cause cancer of lung pleura known as mesothelioma (3).
Exposure to certain products of coal combustion and rubber or certain metal products may increase the risk of lung cancers, especially in teens who work in such industries or reside in industrial areas.
Inherited genetic changes rarely cause lung cancer. Positive family history of lung cancers, especially in non-smokers, could indicate an inherited cause (5).
The primary cause of cancer growth is lung damage from smoking or other irritants.
Types Of Lung Cancer
Lung cancer can be divided into two groups based on the type of cancer cells (6).
Small cell lung cancer (SCLC): It is also known as oat cell carcinoma. These are rapidly growing aggressive cancers of the lung and account for nearly 15% of total lung cancers (7). Oat cell cancers are common in heavy smokers. The cancer is often widely spread by the time of diagnosis.
Non-small cell lung cancer (NSCLC): It is the most common type of lung cancer and accounts for about 85% of all lung cancer cases (8). The sub types of NSCLC are squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
Primary lung adenocarcinomas are rare in teenagers. If your child had any history of acute leukemia or other pediatric malignancies, then they may have a higher risk of secondary cancers, including lung cancer.
Diagnosis Of Lung Cancer In Children
After the assessment of symptoms and physical examination, the doctor may order some of the following tests to confirm the diagnosis (9).
Imaging tests: Chest X-ray and CT scan are ordered to look for any abnormal nodule or growth (mass) in the lung. CT scan or MRI scan is useful to identify smaller lesions that may not be visible through X-ray imaging.
Sputum cytology: Laboratory microscopic analysis of sputum may help identify cancer cells.
Bronchoscopy: This is a visualization of airways and lungs using a thin tube called a bronchoscope, which contains a special camera. Bronchoscopy can help identify lesions and collect tissue samples for biopsy.
Mediastinoscopy: It visualizes mediastinum, which is the space behind the breast bone, through a small incision at the base of the neck. Biopsy samples are collected during this procedure.
Image-guided needle biopsy: This is a method of obtaining tissue samples using needles, with the guidance of X-ray or computed tomography (CT) images.
These tests help confirm the diagnosis and identify the type and stage of lung cancer. MRI or PET scans are often done to look for metastatic tumors. Lung cancer has stage 0 to stage IV, where the lowest stages are confined to the lung, and metastasis happens in the advanced stage. The extent of cancer spread (stage) is an essential factor in determining treatment and outcome (10).
Treatment Of Lung Cancer In Teenagers
The treatment options for lung cancer may vary based on stage and type of cancer. Doctors may prescribe some medications for relieving symptoms, such as pain or breathing problems, until the cancer treatment is done. Immediate treatment is recommended to prevent further growth, especially in rapidly growing small cell lung cancers (SCLC). The following are included in lung cancer treatment (11) (12).
1. Lung cancer surgery
Surgical removal of cancerous tissue with healthy margins is beneficial in the treatment of lung cancer. Depending on the size and local spread of cancer, any of the following types of surgeries may be done.
Wedge resection: Surgical removal of a small part of the lung containing the cancerous growth. It is useful in small-size cancers.
Segmental resection: Removal of a large portion of the lung, which contains cancer.
Lobectomy: Removal of an entire lobe of the lung that has cancer. The right lung consists of three lobes, and the left lung has two lobes.
Pneumonectomy: The complete removal of the lung, that is, the right or left lung containing the cancer.
Thoracic surgeons may also remove nearby lymph nodes in the chest to prevent the spread. Lung cancer surgery can be done as initial treatment if the cancer is limited to the lungs.
2. Radiation therapy
High-energy beams from X-ray or proton sources are used to destroy cancer cells. Radiation oncologists often perform radiotherapy before surgery in cases of advanced cancer. The therapy can be combined with systemic chemotherapy, and can also be done to reduce symptoms in late-stage cancers.
3. Chemotherapy
Systemic chemotherapy uses intravenous or oral drugs to kill cancer cells. It can be given along with radiotherapy. Chemotherapy helps reduce tumor size before surgery. It can be performed after surgery to destroy remaining cancer cells, which may cause secondary cancers. Chemotherapy can also be used for palliation purposes, that is, to relieve symptoms in late stages.
4. Stereotactic body radiotherapy
This radiosurgery uses intense radiation from different directions to destroy cancer growth. It is useful to treat small cell lung cancer if surgery is contraindicated.
5. Targeted drug therapy
The treatment uses drugs that block genetic material or proteins of cancer cells, thus leading to the death of cells. This is the method of treatment for recurrent and advanced lung cancers. A few targeted therapy techniques only work for specific types of cancer cells, and these are decided based on the cytology analysis of biopsy samples.
6. Immunotherapy
Drugs are used to boost the immune system to fight against cancer. Cancer cells escape immune attack by specific proteins. Certain medicines can interrupt these processes, and the immune system can identify and destroy harmful cancer cells. Immunotherapy is commonly used in locally advanced lung cancers and metastatic cases. Palliative care or support care aims to support cancer patients before, during, and after treatment to reduce symptoms. Your teen’s oncologist may involve palliative care specialists with the cancer expert team. Complementary and alternative therapies may not cure cancer. However, palliation may include some methods of alternative and complementary therapies such as massage, acupuncture, hypnosis, yoga, and meditation. You may seek the oncologists’ advice on this.
Prevention Of Lung Cancer In Teen
There is no way to prevent the occurrence of lung cancer in teens (13). However, you may reduce the risk by reducing exposure to carcinogens. Preventive steps may include (14):
If your teen has a habit of smoking cigarettes or cannabis and is unable to stop, then you may seek medical care to help them. Counseling, cessation strategies, and medications or nicotine replacement products can be prescribed by the doctor if required.
Avoid exposure to secondhand smoke.
Check for the radon gas levels in your home if your residential area is known to have this issue.
Avoid exposure to asbestos and other carcinogens.
Screening may help detect lung cancers early. However, it is most often recommended for people older than 55 years. You may discuss with your teen’s doctor if there are any known risk factors that warrant a screening. You may encourage your child to participate in lung health programs and other events that sensitize children to the risks of tobacco and cannabis use. It may help your kid have an idea about the causes of cancer, and play a significant role in reducing the instance of teen marijuana use and cigarette smoking.
Lung Cancer Survival Rate
Survival rates in lung cancer patients may vary depending on the stage of cancer and the type of cancer. A doctor may share a five-year survival rate. According to National Cancer Institute, the five-year survival rate is defined as the percentage of people in a study or treatment group who are alive five years after they were diagnosed with or started treatment for a disease, such as cancer (15). Do note during this period, the disease may or may not have come back. The five-year survival rate is 56% for the early stages of lung cancer, where the cancer is confined to the lungs. The rate decreases to 16% in advanced stages of lung cancer (16). You may discuss with your teen’s oncologist for the exact survival rates based on the stages and type of cancer.
17.8 cases of cancer are diagnosed per 100,000 children under 15 years 77.4 cases of cancer are diagnosed per 100,000 adolescents and young adults between 15 and 39 years
Ages 0-14 years: Leukemias, brain tumor, and nervous system tumors Ages 15-19 years: Brain and nervous system tumors and lymphomas
