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Lung Scarring Symptoms And Causes
Scars on the lung tissue cause it to thicken and lose elasticity. Doctors call this pulmonary fibrosis and it can occur due to certain health conditions and exposure to hazardous materials.
Lung scars can result from illness or medical treatment, and they are permanent.
Small scars may not cause noticeable symptoms, but extensive scarring can make it hard for a person to breathe, as it can affect the transfer of oxygen into the bloodstream. As a result, the brain and other organs may not receive the oxygen that they need.
Idiopathic pulmonary fibrosis is a long-term condition in which lung scarring becomes gradually worse. It can be life threatening.
In this article, we look at why lung scarring happens and discuss some of the treatment options available.
Several conditions can cause scarring of the lungs.
Interstitial lung diseaseInterstitial lung disease involves inflammation of the air sacs or the web of tissue (interstitium) that surrounds them in the lungs. The inflammation can sometimes cause scar tissue to build up within the lungs, resulting in fibrosis.
Learn more here about interstitial lung disease.
Idiopathic pulmonary fibrosis is the most common type of interstitial lung disease. If doctors describe a condition as idiopathic, this means that they do not know exactly what causes it.
Idiopathic pulmonary fibrosis typically appears between the ages of 50 and 70 years. It affects 13–20 people in every 100,000 worldwide, according to the National Library of Medicine.
Other causes and risk factorsOther risk factors include:
In some cases, there may be a family history of the disease.
Some people experience exacerbations, during which symptoms suddenly worsen. These last for a while and then resolve. Exposure to triggers, such as tobacco smoke, may cause a flare.
What do the lungs do?
The scarring of lung tissue makes it thick and stiff. As the lung tissue thickens, it becomes increasingly difficult for the body to transfer oxygen from the lungs into the bloodstream. As a result, the brain and other organs may not receive enough oxygen.
The symptoms depend on the amount of scarring and how much of the lung it affects, but they may include:
shortness of breath, especially during or after physical activity
Scarring may also increase the risk of lung cancer.
Idiopathic pulmonary fibrosisThe symptoms of idiopathic pulmonary fibrosis may not be noticeable at first, but they tend to develop and worsen over time, making it increasingly difficult to breathe.
Eventually, pulmonary hypertension or respiratory failure can develop, both of which can be life threatening because they prevent oxygen from reaching the body's organs.
Many factors can lead to a cough or breathlessness, and many conditions can result in lung scarring.
Anyone who has concerns about breathing symptoms should seek medical help. A doctor will carry out a physical examination.
They will ask the person about:
After this, the doctor may carry out some tests, such as:
They may also carry out specific tests to rule out other conditions, such as TB.
As with scars on the skin, scars on the lung are permanent. It is not usually possible to remove them. The lungs are resilient, however, and small scars often do not cause any adverse effects.
Proper diagnosis and monitoring of the scars is key to treatment.
Scars that remain unchanged for 2 years or more are not usually a cause for concern. However, if they spread, they could indicate pulmonary fibrosis.
Idiopathic pulmonary fibrosisCurrently, a lung transplant is the only cure for idiopathic pulmonary fibrosis. However, a doctor can prescribe medications to help slow the progression of the disease and prevent flares. Pirfenidone (Esbriet) and nintedanib (Ofev) are two drugs that have proven effective.
As the disease progresses, the symptoms can become more severe. They can also worsen during a flare. In these cases, a person may need to spend time in the hospital. Treatment will include supplemental oxygen to support the person's breathing.
Occasionally, a doctor may recommend a transplant. This procedure can cure the condition, but the person will need to take medications for the rest of their life.
Lifestyle tips that may help prevent or relieve symptoms include:
It is important to talk to a doctor before making any significant lifestyle or dietary changes. A doctor can advise on a suitable exercise regimen, for example.
The outlook for pulmonary fibrosis varies among individuals and depends partly on a person's age and overall health. The person will need regular assessments.
In the past, only about 50% of people who received a diagnosis of idiopathic pulmonary fibrosis lived another 3 years, while close to 20% lived another 5 years.
However, new medications may slow the progression of the condition and reduce the risk of death in the first few years after diagnosis. Doctors hope that the outlook will continue to improve.
Stage 4 Neuroendocrine Small Cell Lung Cancer
Neuroendocrine small cell lung cancer (SCLC) occurs when neuroendocrine tumors develop as a result of overactive, cancerous neuroendocrine cells. Stage 4 is extensive stage SCLC.
Neuroendocrine cells are specialized cells found in many parts of the body, including the gastrointestinal (GI) tract, gallbladder, and lungs.
These cells receive signals from the brain to produce and release certain hormones that control many bodily functions.
Neuroendocrine tumors (NETs) develop when neuroendocrine cells become overactive and cancerous. NETs typically involve the GI tract and the lungs.
Small cell lung cancer (SCLC), also called oat cell cancer, accounts for 10–15% of all lung cancers. It is also the most prevalent type of neuroendocrine lung tumor.
Once a doctor makes a diagnosis, they determine how much the cancer has spread through staging.
Most doctors use a two-stage system for SCLC, dividing it into limited and extensive disease. Generally, extensive disease is the same as stage 4.
Stage 4 cancer means that cancer cells have spread from an original tumor to other parts of the body.
TNM stagingSome doctors may use the TNM staging system, though this is uncommon. TNM stands for tumor, node, and metastasis.
Stage 4, also called the advanced stage, means that cancer has spread. At stage 4, the tumor can be any size and may or may not have spread to nearby lymph nodes.
Neuroendocrine lung tumors are a family of tumors that arise from the cells that line the bronchi and other parts of the lung.
This disease group has distinct clinical and pathological characteristics. It varies in cell structure, features, appearance, presence of dead cells (necrosis), and the number of dividing cells (mitotic index).
Typical carcinoid (TC)TCs are low grade, slow-growing tumors that rarely spread (metastasize) outside the lungs. This type of tumor has a good outlook. Management and treatment typically involve surgery. Smoking is not associated with TCs.
Atypical carcinoid (AC)ACs are intermediate grade tumors that commonly affect people who smoke. They grow faster and tend to spread to the bones and liver.
SCLCSCLC is the most common NET of the lungs. It is also the most aggressive. In 70% of people with SCLC, the cancer has already spread to other areas by the time they receive a diagnosis. Smoking is the most significant risk factor for developing SCLC.
Large cell neuroendocrine carcinoma (LCNEC)Similar to SCLC, LCNEC is also a fast-growing tumor. However, it is not as common as SCLC. Smoking is also a major risk factor for developing LCNEC. LCNECs have cancerous cells that look similar to SCLC, though they are larger.
A 2021 article in the Annals of Oncology explains that people with carcinoids have a better outlook compared with those with SCLC and LCNEC. People who have carcinoids are also generally younger, and the disease is not strongly associated with smoking.
The 5-year relative survival rate for people with SCLC is 7%, compared with a 25% survival rate for those with non-small cell lung cancer.
Most people receive an SCLC diagnosis when their cancer has already spread extensively. A 2020 review notes that while SCLC tends to initially respond to chemotherapy, it is likely that people with it will go on to experience relapse or the disease will progress.
A person with SCLC may have symptoms related to a localized lesion (in the lung or lungs) or distant metastases (cancer that has spread to other parts of the body). Symptoms of localized lesions typically involve airway obstruction. This is because the cancer is in one or both lungs, meaning it will affect a person's airway.
Symptoms may include:
As the disease progresses and spreads, people may experience other symptoms, such as:
SCLC may also cause:
Endocrine involvement may include:
The majority of people with SCLC contact to their doctor because they experience symptoms of the disease. Before doctors ask people to undergo tests, they will first perform a thorough physical exam and take a medical history.
BiopsyIf results suggest the possibility of lung cancer, doctors may ask a person to undergo several tests. To make a diagnosis, specialists extract lung cell samples and examine them in a lab.
These tests include:
A pathologist will evaluate the samples and examine them under a microscope to check for the cell structure and appearance unique to SCLC.
Imaging techniquesDoctors can use several imaging techniques to help diagnose and monitor SCLC and other lung cancers. These include chest X-rays, CT scans, MRIs, bone scans, and PET scans.
The imaging techniques help identify suspicious masses or tumors that may be cancerous. They also help monitor cancer spread, its response to treatment, relapse, and whether it has returned.
Treatment for SCLC depends on the cancer's aggressiveness and a person's health status.
People with limited stage SCLC typically receive a combination of chemotherapy and chest radiation therapy. Surgery may also be an option for otherwise well individuals if the tumor is limited to one area. A person also receives chemotherapy after surgery.
Since brain metastasis is common, many people also receive radiation therapy to the head, called prophylactic cranial irradiation.
Surgery and radiation are not useful as initial treatments for extensive stage SCLC. The standard of care for this condition is radiation and a combination of the chemotherapy drugs etoposide and either cisplatin or carboplatin.
A 2020 review mentions that immunotherapy combined with chemotherapy is the new frontline treatment for SCLC. This combination may significantly improve the overall outlook for people with extensive stage SCLC.
Radiation therapy can also relieve symptoms caused by cancer growth in the lungs or when cancer has spread to other areas. People with additional health problems may benefit from low chemotherapy doses or supportive care to address complications and keep them as comfortable as possible.
Stage 4 neuroendocrine SCLC is the most common NET of the lung. Doctors often diagnose it when it has already spread.
Compared with other lung cancers, it has a poorer outlook. It is likely that a person will experience relapse even after their condition responds well to initial treatments.
Stages Of Crohn's Disease
The three stages of Crohn's disease include mild, moderate, and severe. Although Crohn's is a progressive disease, you may experience some periods of remission.
Crohn's disease is a type of inflammatory bowel disease (IBD). It's considered a chronic condition, which means that you'll have it for your entire life. The exact cause of Crohn's is unknown. It most often develops in your late teens or 20s.
Crohn's disease is marked by inflammation of the gastrointestinal (GI) tract. The inflammation can appear anywhere in the GI tract from the mouth to the anus.
People with the disease often experience ups and downs in symptoms. They may even experience periods of remission.
However, Crohn's is a progressive disease that starts with mild symptoms and gradually gets worse.
The stages of Crohn's range from mild to moderate to severe. The earlier you treat and manage Crohn's, the more likely you are to reduce your risk for developing severe symptoms.
With mild to moderate Crohn's, you may experience diarrhea or abdominal pain, but you won't experience other symptoms or complications.
You're able to move, eat, and drink as normal, and the disease has a minimal impact on your quality of life. In some cases, you won't even require treatment.
If you have moderate to severe Crohn's, you may experience diarrhea or abdominal pain as well as additional symptoms and complications. These may include fever or anemia. Treatments intended for people with mild to moderate disease, such as anti-diarrheals, won't provide symptom relief.
The severe stage of Crohn's is marked by symptoms that disrupt your daily life. You might be in constant pain and discomfort, and you may need to use the bathroom frequently. At this stage, inflammation occurs often, and your body tissues are at risk of permanent damage.
In Crohn's disease, healthy cells in the GI tract attack themselves, causing inflammation. As a result, you'll likely experience a range of symptoms.
Early signs of Crohn's disease include:
As the disease progresses, you may start feeling fatigued and even develop anemia. You may also experience nausea from constant irritation of the GI tract.
In addition, you may start experiencing symptoms outside of the GI tract. These symptoms include:
Early diagnosis is important to help prevent damage to the intestines.
If you experience these symptoms and have a family history of Crohn's, you should ask your doctor for testing.
Aside from a physical exam, your doctor may also order:
Medications can treat inflammation and stop your body from attacking its own cells. Treatment options come in the form of:
As your symptoms progress, your gastroenterologist may also recommend occasional bowel rest. However, not all doctors agree with this measure.
A bowel rest involves a strict diet of only liquids for a few days. The purpose is to let the GI tract heal from inflammation and essentially take a break. To prevent malnutrition, you may need an IV.
Talk to your doctor before switching to a liquid diet.
Diet and supplementsAlthough any stage of Crohn's disease can affect your nutritional intake, your risk for malnutrition is even more severe in the later stages.
At this point, your doctor may recommend supplements. Potential supplements include:
A low fiber diet may be recommended to prevent intestinal blockage. It may also help reduce the occurrence of frequent diarrhea.
Pain relieversIf you start experiencing symptoms outside of the GI tract, you might need additional medication to treat those symptoms.
You should avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), as these can make Crohn's worse. Instead, ask your doctor if you can safely take acetaminophen (Tylenol).
SurgeryDespite consistent treatment, you may need surgery if your symptoms become life threatening. Around 67 to 75 percent of all people with Crohn's will eventually need surgery, according to the Crohn's & Colitis Foundation.
Surgery can't cure the disease, but it may help repair severely damaged tissues and remove blockages.
Severe stages of Crohn's disease can put you at risk for colon cancer.
The constant inflammation and related tissue damage may also lead to other complications, such as:
You have an increased risk for developing Crohn's if you:
There's no cure for Crohn's disease, but medications and lifestyle changes can help manage the condition. This is why it's crucial to identify the disease in its earlier stages.
Untreated Crohn's can lead to further complications of the GI tract, some of which may become permanent.
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