Will cigarettes be out of date at some point?

Lung cancer: "If you have symptoms, it is usually too late for you."

Lung cancer is one of the most common types of cancer in Germany. In men, it is the second most common cancer and in women, malignant tumors in the lungs are in third place in the statistics. t-online.de asked a lung specialist from the professional association of pulmonologists what warning signals for lung cancer are and how you can reduce your risk.

Dr. Michael Barczok is a resident pulmonologist in Ulm and spokesman for the professional association of pulmonologists.

Dr. Barczok, the emigrant and popular pop singer Jens Büchner died of lung cancer surprisingly to the public. How is it possible that he was singing on stage just a few weeks ago?

Dr. Michael Barczok: He's had lung cancer for a long time and knew it at some point. But the efficiency of the lungs is not necessarily hindered by a tumor. You can sing with it. In lung cancer, a foreign body grows, but the tissue around it is still functional.

How is lung cancer announced?

Unfortunately, the disease is not so clearly announced. First, it takes a long time for a tumor to be so pronounced in the lungs that it actually causes discomfort, and when it does, it triggers a cough. And of course that's a symptom that many don't take seriously, especially if they smoke. Lung cancer also causes mucus and, depending on where it is located, shortness of breath. And then what comes next is the body deteriorates, you lose weight, your facial features change. It becomes physically visible that something is no longer working.

Is the cough comparable to the cough that is familiar from cold infections or is familiar to smokers anyway because it occurs every now and then?

Lung cancer is caused by smoking in almost all people. The pollutants hinder waste collection from the lungs. If you smoke a cigarette, the garbage disposal stops for about eight hours. We have cilia in the bronchi that bring mucus and dirt and everything we breathe up. It works like a conveyor belt. The lungs have to ensure that the dirt is continuously removed from the lungs. And she does that with a cough.

Does that mean the body's own cleaning mechanisms of the lungs are overwhelmed in smokers?

Exactly. This no longer works properly for smokers because they switch off the garbage disposal for eight hours with every cigarette. This is why many smokers cough up phlegm in the morning. The last cigarette has been behind long enough for the cilia to recover. And then they often cough up the phlegm. Smoking paralyzes the cilia and destroys them over time. The dirt remains at some point. Coughs, especially in the morning, have been known to smokers for many years and then no longer take it seriously. And the symptoms of lung cancer are very similar to the usual smoker's cough.

When should you go to the doctor in any case?

If someone who doesn't otherwise have a cough suddenly gets one that won't go away or gets worse, that's definitely a good reason to see a doctor. As a resident doctor, relatives of smokers are an important target group for me. If they say to their smoking family members, "You keep coughing," they shouldn't be fobbed off with answers like, "Yes, I smoke too." Instead, they should try to convince them to get an X-ray to help them see if something isn't there after all.

How Long Can Lung Cancer Go Undetected?

Years can pass between the development of a single lung cancer cell and the first appearance, for example in an X-ray, or the first symptoms. Lung cancer doesn't develop within a few weeks. First a cancer cell develops, it has to double, then two cells live for a few weeks, then they double again and so on. That is, the lung cancer we see today may have developed many months or even years ago and is slowly growing. The time between the onset and detection of the disease can therefore be years.

Is there any indirect evidence of lung cancer?

Unfortunately not. At least not when it comes to lung cancer. But in smokers, lung cancer is often associated with what is known as COPD, also popularly referred to as smoker's lung. You can understand this when measuring lung function. A tumor two or three centimeters in the lungs does not cause any problems. The lung function is not impaired by this. Lung cancer cannot therefore be detected by measuring lung function. You can only see the tumor on the X-ray. This is the only examination method that makes a cancerous tumor visible in the lungs.

At what stage is lung cancer usually discovered in practice?

If the symptoms of lung cancer cause you to see a doctor, then the doctor is usually at an advanced stage. Sometimes, however, patients come because of a persistent cough or pneumonia or because they have a regular check-up or because they already have COPD and an X-ray is therefore done. Then lung cancer is sometimes discovered by accident even before it has caused any symptoms. These patients then got lucky. But if the tumor itself is the reason to see a doctor, then it is usually too late.

Then what is the prognosis of such a patient?

Often, unfortunately, bad.

How does that look in numbers?

There are different types of lung tumors. It is therefore very important to clarify which species it is. There are tumors that grow very quickly and also quickly metastasize to other organs, the brain or bones. You can then try to slow down tumor growth through measures such as chemotherapy or radiation, but you cannot cure the tumor. There are bronchial carcinomas which, if they have not yet exceeded a certain size, can be operated on. However, the vast majority of lung cancer patients, 90 to 95 percent, die within five years of being diagnosed.

Does a smoker's lungs recover when he quits, or is that a myth?

There are certain things that get better by quitting. For example, the oxygen supply in the blood, the carbon monoxide that is inhaled when smoking, can no longer burden the body. The risk of a heart attack decreases again, especially if you also do sports. However, the risk of cancer does not actually decrease. Those who quit smoking and have not had lung cancer five years later can hope that they will not get one from smoking earlier. Because the cells that could have been created by smoking should have become so large that you can see them.

And what happened to the lung tissue?

The damage to the organ caused by the smoke, which can lead to the smoker's lung (COPD), is not reduced by stopping smoking. Cells die and alveoli break. This damage remains. Unfortunately, people who stop smoking too late will benefit little in terms of quality of life and life expectancy. You should therefore quit smoking early as long as there is no irreversible damage. Once the lung function is damaged by smoking, it no longer recovers. It just doesn't get worse as quickly as it would have if you kept smoking.

What can you do preventively, besides quitting smoking?

Little. We don't have a good screening for lung cancer. It is not simply X-rayed out of suspicion, because the X-rays themselves are harmful. We can say that if you are a non-smoker, you have a very low risk of developing lung cancer. And when you smoke, you have a very high one.

Stop smoking

Various institutions support those who want to quit smoking. The Federal Association of Pulmonologists, for example, offers a non-smoking program. The Federal Center for Health Education (BZgA) also has an exit program for smokers. Your health insurance usually finances a weaning course as well.

What is the risk of passive smokers?

With passive smoking you get less dirt, but there are still enough pollutants in the air. Passive smokers therefore have an approximately 30 percent higher risk of developing lung cancer than non-smokers.

What is the gradation of lung cancer risk between casual smokers and "real" smokers?

Unfortunately, there is no safety threshold. There are no studies that say, for example, that less than five cigarettes are zero risk of lung cancer. At the top, however, you can definitely say that the more poison you bring into the lungs, the greater the risk of disease. It will make a difference whether you smoke a few cigarettes a day or two packs. With COPD, we know that as a woman you have to deal with a box every day for a period of 20 years and with men you have to deal with a box every day for a period of 30 years. You get a smoker's lung. If you smoke three boxes a day, it will not take 20 but only six years before the chronic lung disease COPD occurs. We don't know for sure whether this also applies to lung cancer. One can only say one thing: as long as you smoke to an extent that does not completely paralyze the garbage disposal of the lungs for days and the normal disposal mechanisms still work, the risk of lung cancer is probably manageable.

Thank you very much for the conversation.

Important NOTE: The information is in no way a substitute for professional advice or treatment by trained and recognized doctors. The contents of t-online cannot and must not be used to independently make diagnoses or start treatments.

more on the subject

  • Subjects:
  • Health,
  • Diseases,
  • Symptoms,
  • Lung cancer
  • Cancer risk,
  • COPD,
  • Smoke,
  • Lung,
  • Cigarettes,
  • To cough,
  • Jens Büchner,
  • Chemotherapy,
  • Life expectancy,
  • Passive smoking,
  • Shortness of breath,
  • tumor