Pulmonology is a medical specialty dedicated to the study and investigation of the respiratory system, mainly the lower respiratory tract, which includes organs such as the larynx, trachea, bronchi, and pulmonary alveoli. Its specialist doctor is the pulmonologist, responsible for diagnosing, treating, and monitoring patients with pulmonary and respiratory pathologies such as asthma, tuberculosis, pneumonia, emphysema, or lung tumors.
Lung cancer is the most common type of cancer in the world since 1985 in incidence and mortality. The most recent estimate (2012) indicates an incidence of 1.8 million new cases worldwide in men and 583,000 in women, corresponding to about 13% of all new cancer cases. According to the National Cancer Institute (Inca), in Brazil, this is the second most common type of cancer in men and women, not counting non-melanoma skin cancer.
This incidence has been dropping since the mid-1980s, mainly due to smoking control policies, which, along with passive exposure to cigarette smoke, is considered the main risk factor for developing lung cancer. Exposure to air pollution, recurrent lung infections, chronic obstructive pulmonary disease, genetic factors and family history of lung cancer also favor the onset of the disease, which is more common in people aged 50 to 70 years.
Symptoms hardly appear when the disease is in an early stage, and when they do, it is usually a sign that the tumor is already advanced. The most common symptoms are persistent cough, bloody sputum, chest pain, and, in smokers, coughs with altered habitual rhythm and attacks at unusual times. It is essential that, when noticing these symptoms, the patient quickly seeks a pulmonologist to identify whether they have the illness as soon as possible.
Early detection can be done by investigating through clinical, laboratory, endoscopic, or radiological examinations, people with signs and symptoms suggesting the disease (early diagnosis), or people without signs or symptoms (screening), but belonging to groups at a higher risk of developing the illness.
The treatment involves, first and foremost, correct diagnosis and participation of a multidisciplinary team, formed, among others, by an oncologist, a thoracic surgeon, and a pulmonologist. This specialist will act not only in prevention and early detection, but also in pre-operative, to reduce risks of complications in case of surgical necessity, as well as in post-operative care, which includes intervening when there are complications such as asthma exacerbated by infections or neoplasms.
Pulmonology is key in prevention
The Brazilian Cancer Institute (Inca) warns that only 16% of cancers are diagnosed at an early stage (localized cancer), when the five-year survival rate is 56%. In this process, the pulmonologist has a fundamental role in prevention and early detection of tumors.
Considering, also, that smoking is the main risk factor for lung cancer development, this specialist is the most indicated to accompany those who wish to quit smoking. According to the Brazilian Society of Pneumology and Phthisiology (SBPT), most nicotine addicts need medical help to quit smoking.
According to Inca, the risk of lung cancer and death from it increases along with the intensity of exposure to smoking. Mortality from lung cancer is approximately 15 times higher than among people who have never smoked, while among former smokers it is about four times higher.
When the cancer is in a more advanced stage, the five-year relative survival rate for lung cancer is 18%, being 15% for men and 21% for women. In this scenario, pulmonology will also participate in palliative care, detecting early respiratory decompensations or promoting interventions to prevent and relieve symptoms. These aim, in addition to reducing symptoms caused by disease progression, to reduce emergency room visits and hospitalizations, as well as to promote end-of-life support. The effective implementation of palliative care in pulmonology ideally requires the participation of a multidisciplinary team (physicians, physical therapists, nurses, psychologists, and social workers) with appropriate knowledge and preparation.
Jornal de Pneumologia
Sociedade Brasileira de Pneumologia e Tisiologia https://sbpt.org.br/portal/espaco-saude-respiratoria-tabagismo/