Sitting is a basic action and resting position in which the body weight is supported primarily by the bony ischial tuberosities with the buttocks in contact with the ground or a horizontal surface such as a chair seat , instead of by the lower limbs as in standing , squatting or kneeling . When sitting, the torso is more or less upright, although sometimes it can lean against other objects for a more relaxed posture.
88-396: Sit commonly refers to sitting . Sit , SIT or Sitting may also refer to: Sitting Sitting for much of the day may pose significant health risks, with one study suggesting people who sit regularly for prolonged periods may have higher mortality rates than those who do not. The average person sits down for 4.7 hours per day, according to a global review representing 47% of
176-437: A biopsy of the suspected tissue be histologically examined for cancer cells. Given the location of lung cancer tumors, biopsies can often be obtained by minimally invasive techniques: a fiberoptic bronchoscope that can retrieve tissue (sometimes guided by endobronchial ultrasound ), fine needle aspiration , or other imaging-guided biopsy through the skin. Those who cannot undergo a typical biopsy procedure may instead have
264-566: A liquid biopsy taken (that is, a sample of some body fluid) which may contain circulating tumor DNA that can be detected. Imaging is also used to assess the extent of cancer spread. Positron emission tomography (PET) scanning or combined PET-CT scanning is often used to locate metastases in the body. Since PET scanning is less sensitive in the brain, the National Comprehensive Cancer Network recommends magnetic resonance imaging (MRI) – or CT where MRI
352-423: A cause for minor breathing disorders. Though still a large proportion of the clinical practitioners attribute absence of a neutral spine posture as one of the main causes of conditions like back pain and neck pain , the relationship is not thoroughly established. It is also thought that much of so-called " poor posture " is actually just postural stress and being stuck with bad ergonomics that could be causing
440-406: A chest radiograph or CT scan. In lung cancer screening studies as many as 30% of those screened have a lung nodule, the majority of which turn out to be benign. Besides lung cancer many other diseases can also give this appearance, including hamartomas , and infectious granulomas caused by tuberculosis , histoplasmosis , or coccidioidomycosis . At diagnosis, lung cancer is classified based on
528-433: A high-volume surgery clinic improve chances of survival. Those who are unable or unwilling to undergo surgery can instead receive radiation therapy. Stereotactic body radiation therapy is best practice, typically administered several times over 1–2 weeks. Chemotherapy has little effect in those with stage I NSCLC, and may worsen disease outcomes in those with the earliest disease. In those with stage II disease, chemotherapy
616-490: A large share of waking time by children and adolescents in a sedentary position is accumulated by media consumption in front of a screen. Lung cancer Lung cancer , also known as lung carcinoma , is a malignant tumor that begins in the lung . Lung cancer is caused by genetic damage to the DNA of cells in the airways, often caused by cigarette smoking or inhaling damaging chemicals. Damaged airway cells gain
704-439: A mass inside the lung. The X-ray may reveal an obvious mass, the widening of the mediastinum (suggestive of spread to lymph nodes there), atelectasis (lung collapse), consolidation ( pneumonia ), or pleural effusion ; however, some lung tumors are not visible by X-ray. Next, many undergo computed tomography (CT) scanning , which can reveal the sizes and locations of tumors. A definitive diagnosis of lung cancer requires
792-607: A new cough, or an increase in the frequency or strength of a pre-existing cough. Around one in four cough up blood , ranging from small streaks in the sputum to large amounts. Around half of those diagnosed with lung cancer experience shortness of breath, while 25–50% experience a dull, persistent chest pain that remains in the same location over time. In addition to respiratory symptoms, some experience systemic symptoms including loss of appetite , weight loss , general weakness, fever , and night sweats . Some less common symptoms suggest tumors in particular locations. Tumors in
880-516: A societal level, smoking cessation can be promoted by tobacco control policies that make tobacco products more difficult to obtain or use. Many such policies are mandated or recommended by the WHO Framework Convention on Tobacco Control , ratified by 182 countries, representing over 90% of the world's population. The WHO groups these policies into six intervention categories, each of which has been shown to be effective in reducing
968-495: A symptom tend to have worse outcomes. Tumor mutations in KRAS are associated with reduced survival. The uncertainty of lung cancer prognosis often causes stress, and makes future planning difficult, for those with lung cancer and their families. Those whose cancer goes into remission often experience fear of their cancer returning or progressing, associated with poor quality of life, negative mood, and functional impairment. This fear
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#17327723483231056-427: A tumor, and eventually spreading within and then beyond the lung. Rampant tumor growth and spread causes the symptoms of lung cancer. If unstopped, the spreading tumor will eventually cause the death of affected individuals. Tobacco smoking is by far the major contributor to lung cancer, causing 80% to 90% of cases. Lung cancer risk increases with quantity of cigarettes consumed. Tobacco smoking's carcinogenic effect
1144-520: A variety of other toxic chemicals – typically encountered in certain occupations – is associated with an increased risk of lung cancer. Occupational exposures to carcinogens cause 9–15% of lung cancer. A prominent example is asbestos , which causes lung cancer either directly or indirectly by inflaming the lung. Exposure to all commercially available forms of asbestos increases cancer risk, and cancer risk increases with time of exposure. Asbestos and cigarette smoking increase risk synergistically – that is,
1232-1202: Is hypercalcemia (high blood calcium) caused by over-production of parathyroid hormone-related protein or parathyroid hormone . Hypercalcemia can manifest as nausea, vomiting, abdominal pain, constipation, increased thirst , frequent urination , and altered mental status. Those with lung cancer also commonly experience hypokalemia (low potassium) due to inappropriate secretion of adrenocorticotropic hormone , as well as hyponatremia (low sodium) due to overproduction of antidiuretic hormone or atrial natriuretic peptide . About one of three people with lung cancer develop nail clubbing , while up to one in ten experience hypertrophic pulmonary osteoarthropathy (nail clubbing, joint soreness, and skin thickening). A variety of autoimmune disorders can arise as paraneoplastic syndromes in those with lung cancer, including Lambert–Eaton myasthenic syndrome (which causes muscle weakness), sensory neuropathies , muscle inflammation , brain swelling , and autoimmune deterioration of cerebellum , limbic system , or brainstem . Up to one in twelve people with lung cancer have paraneoplastic blood clotting, including migratory venous thrombophlebitis , clots in
1320-428: Is a magical act that connects the person who sits with other persons, states or places. The kneeling chair (often just referred to as " ergonomic chair") was designed to motivate better posture than the conventional chair. To sit in a kneeling chair, one rests one's buttocks on the upper sloping pad and rests the front of the lower legs atop the lower pad, i.e., the human position as both sitting and kneeling at
1408-648: Is also a risk of radiation-induced cancer . The United States Preventive Services Task Force recommends yearly screening using low-dose CT in people between 55 and 80 who have a smoking history of at least 30 pack-years . The European Commission recommends that cancer screening programs across the European Union be extended to include low-dose CT lung scans for current or previous smokers. Similarly, The Canadian Task Force for Preventative Health recommends that people who are current or former smokers (smoking history of more than 30 pack years) and who are between
1496-935: Is any waking behaviour, whether in sitting or reclining posture, by an energy expenditure less than or equal to 1.5 metabolic equivalents of task (METs). MET, beside the watt and kilojoules, is the unit for expressing the energy cost of physical activities. One MET is defined as resting metabolic rate – as energy used with a person at rest, sitting quietly in a chair or as the amount of oxygen (O 2 ) consumed with that person. MET for an adult weighing 70 kg equals 3.5 ml O 2 per kg body weight per min. Sedentary behaviour should be distinguished from being inactive – performing insufficient amounts of MVPA (moderate to vigorous physical activity). The World Health Organization recommends at least 60 min of daily MVPA for children and adolescents aged 5–17 years, and 150 min of weekly MVPA for adults. Sedentary behaviour can not be equated with screen time, although some researchers found out that
1584-567: Is associated with the development of the rare lung cancer lymphoepithelioma-like carcinoma in people from Asia, but not in people from Western nations . A role for several other infectious agents – namely human papillomaviruses , BK virus , JC virus , human cytomegalovirus , SV40 , measles virus , and Torque teno virus – in lung cancer development has been studied but remains inconclusive as of 2020. Particular gene combinations may make some people more susceptible to lung cancer. Close family members of those with lung cancer have around twice
1672-413: Is due to various chemicals in tobacco smoke that cause DNA mutations, increasing the chance of cells becoming cancerous. The International Agency for Research on Cancer identifies at least 50 chemicals in tobacco smoke as carcinogenic , and the most potent is tobacco-specific nitrosamines . Exposure to these chemicals causes several kinds of DNA damage: DNA adducts , oxidative stress , and breaks in
1760-528: Is exacerbated by frequent or prolonged surveillance imaging, and other reminders of cancer risks. Lung cancer is caused by genetic damage to the DNA of lung cells. These changes are sometimes random, but are typically induced by breathing in toxic substances such as cigarette smoke. Cancer-causing genetic changes affect the cell's normal functions , including cell proliferation , programmed cell death ( apoptosis ), and DNA repair . Eventually, cells gain enough genetic changes to grow uncontrollably, forming
1848-497: Is impractical are treated with combination chemotherapy and radiotherapy along with the immunotherapy durvalumab . Combined chemotherapy and radiation enhances survival compared to chemotherapy followed by radiation, though the combination therapy comes with harsher side effects. Those with stage IV disease are treated with combinations of pain medication, radiotherapy, immunotherapy, and chemotherapy. Many cases of advanced disease can be treated with targeted therapies depending on
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#17327723483231936-583: Is known in several European languages as tailor's posture , from the traditional working posture of tailors (compare: Tailor's bunion ) . It is also named after various plains-dwelling nomads : in American English Indian style , in many European languages "Turkish style", and in Japanese agura ( 胡座 , The sitting style of non-Han ethnics ) . In yoga it is known as sukhasana , meaning "easy pose." Various raised surfaces at
2024-521: Is moderate evidence to show that changes to chairs (adjusting the biomechanics of the chair or using different types of chairs) can effectively reduce musculoskeletal symptoms in workers who sit for most of their day. Public health programs typically focus on increasing physical activity rather than reducing sitting time. One major target for these public health programs is sitting in the workplace. For example, WHO Europe recommended in September 2015
2112-485: Is necessary due to the length of time it can take for lung cancer to develop following an exposure to carcinogens. The smoking of non-tobacco products is not known to be associated with lung cancer development. Marijuana smoking does not seem to independently cause lung cancer – despite the relatively high levels of tar and known carcinogens in marijuana smoke. The relationship between smoking cocaine and developing lung cancer has not been studied as of 2020. Exposure to
2200-510: Is not targetable by current molecular therapies instead can be treated with combination chemotherapy plus immune checkpoint inhibitors, which prevent cancer cells from inactivating immune T cells . The chemotherapeutic agent of choice depends on the NSCLC subtype: cisplatin plus gemcitabine for squamous cell carcinoma, cisplatin plus pemetrexed for non-squamous cell carcinoma. Immune checkpoint inhibitors are most effective against tumors that express
2288-407: Is present in many lung cancers, but absent from squamous cell carcinomas. Lung cancer staging is an assessment of the degree of spread of the cancer from its original source. It is one of the factors affecting both the prognosis and the treatment of lung cancer. SCLC is typically staged with a relatively simple system: limited stage or extensive stage. Around a third of people are diagnosed at
2376-402: Is stage IV. Each stage is further subdivided based on the combination of T, N, and M scores. Some countries recommend that people who are at a high risk of developing lung cancer be screened at different intervals using low-dose CT lung scans. Screening programs may result in early detection of lung tumors in people who are not yet experiencing symptoms of lung cancer, ideally, early enough that
2464-405: Is the most diagnosed and deadliest cancer worldwide, with 2.2 million cases in 2020 resulting in 1.8 million deaths. Lung cancer is rare in those younger than 40; the average age at diagnosis is 70 years, and the average age at death 72. Incidence and outcomes vary widely across the world, depending on patterns of tobacco use. Prior to the advent of cigarette smoking in the 20th century, lung cancer
2552-799: Is treated with radiation therapy and chemotherapy alongside drug treatments that target specific cancer subtypes. Even with treatment, only around 20% of people survive five years on from their diagnosis. Survival rates are higher in those diagnosed at an earlier stage, diagnosed at a younger age, and in women compared to men. Most lung cancer cases are caused by tobacco smoking . The remainder are caused by exposure to hazardous substances like asbestos and radon gas, or by genetic mutations that arise by chance. Consequently, lung cancer prevention efforts encourage people to avoid hazardous chemicals and quit smoking. Quitting smoking both reduces one's chance of developing lung cancer and improves treatment outcomes in those already diagnosed with lung cancer. Lung cancer
2640-442: Is typically treated with a combination of chemotherapy and radiotherapy. For chemotherapy, the National Comprehensive Cancer Network and American College of Chest Physicians guidelines recommend four to six cycles of a platinum-based chemotherapeutic – cisplatin or carboplatin – combined with either etoposide or irinotecan . This is typically combined with thoracic radiation therapy – 45 Gray (Gy) twice-daily – alongside
2728-420: Is unavailable – to scan the brain for metastases in those with NSCLC and large tumors, or tumors that have spread to the nearby lymph nodes. When imaging suggests the tumor has spread, the suspected metastasis is often biopsied to confirm that it is cancerous. Lung cancer most commonly metastasizes to the brain, bones, liver, and adrenal glands . Lung cancer can often appear as a solitary pulmonary nodule on
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2816-564: Is usually initiated six to twelve weeks after surgery, with up to four cycles of cisplatin – or carboplatin in those with kidney problems, neuropathy , or hearing impairment – combined with vinorelbine , pemetrexed , gemcitabine, or docetaxel . Treatment for those with stage III NSCLC depends on the nature of their disease. Those with more limited spread may undergo surgery to have the tumor and affected lymph nodes removed, followed by chemotherapy and potentially radiotherapy. Those with particularly large tumors (T4) and those for whom surgery
2904-958: Is well-established, but the risk of cancer mortality is unclear. Sedentary time is also associated with an increased risk of depression in children and adolescents. A correlation between occupational sitting specifically and higher body mass index has been demonstrated, but causality has not yet been established. There are several hypotheses explaining why sitting is a health risk. These include changes in cardiac output , vitamin D , inflammation , sex hormone activity, lipoprotein lipase activity, and GLUT4 activity due to long periods of muscular unloading, among others. Sitting may occupy up to half of an adult's workday in developed countries. Workplace programs to reduce sitting vary in method. They include sit-stand desks , counseling , workplace policy changes, walking or standing meetings, treadmill desks , breaks, therapy ball chairs, and stepping devices. Results of these programs are mixed, but there
2992-584: The cell division cycle , cellular stress responses , and chromatin remodeling . Some rare genetic disorders that increase the risk of various cancers also increase the risk of lung cancer, namely retinoblastoma and Li–Fraumeni syndrome . As with all cancers, lung cancer is triggered by mutations that allow tumor cells to endlessly multiply, stimulate blood vessel growth , avoid apoptosis (programmed cell death), generate pro-growth signalling molecules, ignore anti-growth signalling molecules, and eventually spread into surrounding tissue or metastasize throughout
3080-508: The spinal cord . Metastasis into the bone marrow can deplete blood cells and cause leukoerythroblastosis (immature cells in the blood). Liver metastases can cause liver enlargement , pain in the right upper quadrant of the abdomen , fever, and weight loss. Lung tumors often cause the release of body-altering hormones , which cause unusual symptoms, called paraneoplastic syndromes . Inappropriate hormone release can cause dramatic shifts in concentrations of blood minerals . Most common
3168-450: The thorax can cause breathing problems by obstructing the trachea or disrupting the nerve to the diaphragm ; difficulty swallowing by compressing the esophagus ; hoarseness by disrupting the nerves of the larynx ; and Horner's syndrome by disrupting the sympathetic nervous system . Horner's syndrome is also common in tumors at the top of the lung , known as Pancoast tumors , which also cause shoulder pain that radiates down
3256-472: The DNA strands. Being around tobacco smoke – called passive smoking – can also cause lung cancer. Living with a tobacco smoker increases one's risk of developing lung cancer by 24%. An estimated 17% of lung cancer cases in those who do not smoke are caused by high levels of environmental tobacco smoke. Vaping may be a risk factor for lung cancer, but less than that of cigarettes, and further research as of 2021
3344-627: The US, China, South Korea, Taiwan, Israel, Latvia, Iceland, Sweden, Austria, and Switzerland. SCLC is particularly aggressive. 10–15% of people survive five years after a SCLC diagnosis. As with other types of lung cancer, the extent of disease at diagnosis also influences prognosis. The average person diagnosed with limited-stage SCLC survives 12–20 months from diagnosis; with extensive-stage SCLC around 12 months. While SCLC often responds initially to treatment, most people eventually relapse with chemotherapy-resistant cancer, surviving an average 3–4 months from
3432-468: The ability to multiply unchecked, causing the growth of a tumor. Without treatment, tumors spread throughout the lung, damaging lung function. Eventually lung tumors metastasize , spreading to other parts of the body. Early lung cancer often has no symptoms and can only be detected by medical imaging . As the cancer progresses, most people experience nonspecific respiratory problems: coughing , shortness of breath , or chest pain . Other symptoms depend on
3520-426: The affected individual loses the ability to swallow. Coughing is also common, and can be managed with opioids or cough suppressants . Some experience terminal delirium – confused behavior, unexplained movements, or a reversal of the sleep-wake cycle – which can be managed by antipsychotic drugs, low-dose sedatives, and investigating other causes of discomfort such as low blood sugar , constipation , and sepsis . In
3608-593: The ages of 55–74 years be screened for lung cancer. Treatment for lung cancer depends on the cancer's specific cell type, how far it has spread , and the person's health. Common treatments for early stage cancer includes surgical removal of the tumor, chemotherapy , and radiation therapy . For later-stage cancer, chemotherapy and radiation therapy are combined with newer targeted molecular therapies and immune checkpoint inhibitors . All lung cancer treatment regimens are combined with lifestyle changes and palliative care to improve quality of life. Limited-stage SCLC
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3696-414: The appropriate height can be used as seats for humans, whether they are made for the purpose, such as chairs , stools and benches , or not. While the buttocks are nearly always rested on the raised surface, there are many differences in how one can hold one's legs and back. There are two major styles of sitting on a raised surface. The first has one or two of the legs in front of the sitting person; in
3784-515: The average person's lifespan by around 2 months. For stage I and stage II NSCLC the first line of treatment is often surgical removal of the affected lobe of the lung. For those not well enough to tolerate full lobe removal, a smaller chunk of lung tissue can be removed by wedge resection or segmentectomy surgery. Those with centrally located tumors and otherwise-healthy respiratory systems may have more extreme surgery to remove an entire lung ( pneumonectomy ). Experienced thoracic surgeons , and
3872-399: The blocking tissue by bronchoscopy, sometimes aided by thermal or laser ablation . Other causes of lung cancer-associated shortness of breath can be treated directly, such as antibiotics for a lung infection, diuretics for pulmonary edema , benzodiazepines for anxiety, and steroids for airway obstruction. Up to 92% of those with lung cancer report pain, either from tissue damage at
3960-753: The body. Different tumors can acquire these abilities through different mutations, though generally cancer-contributing mutations activate oncogenes and inactivate tumor suppressors . Some mutations – called "driver mutations" – are particularly common in adenocarcinomas, and contribute disproportionately to tumor development. These typically occur in the receptor tyrosine kinases EGFR, BRAF, MET, KRAS , and PIK3CA . Similarly, some adenocarcinomas are driven by chromosomal rearrangements that result in overexpression of tyrosine kinases ALK, ROS1, NTRK, and RET. A given tumor will typically have just one driver mutation. In contrast, SCLCs rarely have these driver mutations, and instead often have mutations that have inactivated
4048-739: The center of the lungs, in the major airways. Their cells appear small with ill-defined boundaries, not much cytoplasm , many mitochondria , and have distinctive nuclei with granular-looking chromatin and no visible nucleoli . NSCLCs comprise a group of three cancer types: adenocarcinoma , squamous-cell carcinoma , and large-cell carcinoma . Nearly 40% of lung cancers are adenocarcinomas. Their cells grow in three-dimensional clumps, resemble glandular cells, and may produce mucin . About 30% of lung cancers are squamous-cell carcinomas. They typically occur close to large airways. The tumors consist of sheets of cells, with layers of keratin . A hollow cavity and associated cell death are commonly found at
4136-438: The center of the tumor. Less than 10% of lung cancers are large-cell carcinomas, so named because the cells are large, with excess cytoplasm, large nuclei, and conspicuous nucleoli . Around 10% of lung cancers are rarer types. These include mixes of the above subtypes like adenosquamous carcinoma , and rare subtypes such as carcinoid tumors , and sarcomatoid carcinomas . Several lung cancer types are subclassified based on
4224-405: The extent of local spread: with the cancer metastasized to no lymph nodes (N0), pulmonary or hilar nodes (along the bronchi) on the same side as the tumor (N1), mediastinal or subcarinal lymph nodes (in the middle of the lungs, N2), or lymph nodes on the opposite side of the lung from the tumor (N3). Metastases are staged as no metastases (M0), nearby metastases (M1a; the space around the lung or
4312-549: The first two chemotherapy cycles. First-line therapy causes remission in up to 80% of those who receive it; however most people relapse with chemotherapy-resistant disease. Those who relapse are given second-line chemotherapies. Topotecan and lurbinectedin are approved by the US FDA for this purpose. Irinotecan, paclitaxel , docetaxel , vinorelbine , etoposide, and gemcitabine are also sometimes used, and are similarly efficacious. Prophylactic cranial irradiation can reduce
4400-691: The genetic makeup of the cancerous cells. Up to 30% of tumors have mutations in the EGFR gene that result in an overactive EGFR protein; these can be treated with EGFR inhibitors osimertinib , erlotinib , gefitinib , afatinib , or dacomitinib – with osimertinib known to be superior to erlotinib and gefitinib, and all superior to chemotherapy alone. Up to 7% of those with NSCLC harbor mutations that result in hyperactive ALK protein, which can be treated with ALK inhibitors crizotinib , or its successors alectinib , brigatinib , and ceritinib . Those treated with ALK inhibitors who relapse can then be treated with
4488-533: The global adult population. The form of kneeling where the buttocks sit back on the heels, for example as in the Seiza and Vajrasana postures, is also often interpreted as sitting. The British Chiropractic Association said in 2006 that 32% of the British population spent more than ten hours per day sitting down. The most common ways of sitting on the floor involve bending the knees. One can also sit with
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#17327723483234576-487: The growth characteristics of the cancer cells. Adenocarcinomas are classified as lepidic (growing along the surface of intact alveolar walls), acinar and papillary , or micropapillary and solid pattern. Lepidic adenocarcinomas tend to be least aggressive, while micropapillary and solid pattern adenocarcinomas are most aggressive. In addition to examining cell morphology, biopsies are often stained by immunohistochemistry to confirm lung cancer classification. SCLCs bear
4664-465: The heart , arrhythmia (irregular heartbeat), and heart failure . About one in three people diagnosed with lung cancer have symptoms caused by metastases in sites other than the lungs. Lung cancer can metastasize anywhere in the body, with different symptoms depending on the location. Brain metastases can cause headache , nausea , vomiting , seizures , and neurological deficits . Bone metastases can cause pain, bone fractures , and compression of
4752-409: The heart, and disseminated intravascular coagulation (clots throughout the body). Paraneoplastic syndromes involving the skin and kidneys are rare, each occurring in up to 1% of those with lung cancer. A person suspected of having lung cancer will have imaging tests done to evaluate the presence, extent, and location of tumors. First, many primary care providers perform a chest X-ray to look for
4840-423: The heart, or the opposite lung), a single distant metastasis (M1b), or multiple metastases (M1c). These T, N, and M scores are combined to designate a stage grouping for the cancer. Cancer limited to smaller tumors is designated stage I. Disease with larger tumors or spread to the nearest lymph nodes is stage II. Cancer with the largest tumors or extensive lymph node spread is stage III. Cancer that has metastasized
4928-473: The last few days of life, many develop terminal secretions – pooled fluid in the airways that can cause a rattling sound while breathing. This is thought not to cause respiratory problems, but can distress family members and caregivers. Terminal secretions can be reduced by anticholinergic medications . Even those who are non-communicative or have reduced consciousness may be able to experience cancer-related pain, so pain medications are typically continued until
5016-429: The legs unbent, using something solid as support for the back or leaning on one's arms. Sitting with bent legs can be done with the legs mostly parallel or by crossing them over each other. A common cross-legged position is with the lower part of both legs folded towards the body, crossing each other at the ankle or calf, with both ankles on the floor, sometimes with the feet tucked under the knees or thighs. The position
5104-510: The limited stage, meaning cancer is confined to one side of the chest, within the scope of a single radiotherapy field. The other two thirds are diagnosed at the "extensive stage", with cancer spread to both sides of the chest, or to other parts of the body. NSCLC – and sometimes SCLC – is typically staged with the American Joint Committee on Cancer 's Tumor, Node, Metastasis (TNM) staging system . The size and extent of
5192-403: The little-finger side of the arm as well as destruction of the topmost ribs . Swollen lymph nodes above the collarbone can indicate a tumor that has spread within the chest. Tumors obstructing bloodflow to the heart can cause superior vena cava syndrome (swelling of the upper body and shortness of breath), while tumors infiltrating the area around the heart can cause fluid buildup around
5280-494: The location and size of the tumor. Those suspected of having lung cancer typically undergo a series of imaging tests to determine the location and extent of any tumors. Definitive diagnosis of lung cancer requires a biopsy of the suspected tumor be examined by a pathologist under a microscope . In addition to recognizing cancerous cells, a pathologist can classify the tumor according to the type of cells it originates from. Around 15% of cases are small-cell lung cancer (SCLC), and
5368-828: The long term. In addition, a 2018 British Journal of Medicine systematic review concluded that interventions aimed at reducing sitting outside of work were only modestly effective. It is not clear how standing desks compare to other work-place interventions to reduce the length of time employees are sitting during the work day. Though most studies even until early 21st century relate human body postures to various musculoskeletal conditions , recent researches show no potential causal relationship between postures and these conditions like back pain ; other causes like sleep deprivation , stress and long-term physical inactivity or prolonged static unnatural postural stress could be significant confounders for various health conditions. However some research show that prolonged slouched position may be
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#17327723483235456-1057: The lower levels of radon that seep into residential spaces can increase occupants' risk of lung cancer. Like asbestos, cigarette smoking and radon exposure increase risk synergistically. Radon exposure is responsible for between 3% and 14% of lung cancer cases. Several other chemicals encountered in various occupations are also associated with increased lung cancer risk including arsenic used in wood preservation , pesticide application, and some ore smelting ; ionizing radiation encountered during uranium mining ; vinyl chloride in papermaking ; beryllium in jewelers , ceramics workers, missile technicians, and nuclear reactor workers; chromium in stainless steel production, welding , and hide tanning ; nickel in electroplaters , glass workers, metal workers, welders, and those who make batteries, ceramics, and jewelry; and diesel exhaust encountered by miners. Exposure to air pollution , especially particulate matter released by motor vehicle exhaust and fossil fuel -burning power plants, increases
5544-550: The lung increase one's risk of lung cancer. This association is strongest for chronic obstructive pulmonary disorder – the risk is highest in those with the most inflammation, and reduced in those whose inflammation is treated with inhaled corticosteroids . Other inflammatory lung and immune system diseases such as alpha-1 antitrypsin deficiency , interstitial fibrosis , scleroderma , Chlamydia pneumoniae infection, tuberculosis , and HIV infection are associated with increased risk of developing lung cancer. Epstein–Barr virus
5632-410: The markers of neuroendocrine cells , such as chromogranin , synaptophysin , and CD56 . Adenocarcinomas tend to express Napsin-A and TTF-1 ; squamous cell carcinomas lack Napsin-A and TTF-1 , but express p63 and its cancer-specific isoform p40. CK7 and CK20 are also commonly used to differentiate lung cancers. CK20 is found in several cancers, but typically absent from lung cancer. CK7
5720-516: The most-advanced stage, IVB, have a two-year survival of 10% and a five-year survival of 0%. Five-year survival is higher in women (22%) than men (16%). Women tend to be diagnosed with less-advanced disease, and have better outcomes than men diagnosed at the same stage. Average five-year survival also varies across the world, with particularly high five-year survival in Japan (33%), and five-year survival above 20% in 12 other countries: Mauritius, Canada,
5808-431: The nicotine replacement varenicline as first-line therapies to aid in smoking cessation. Clonidine and nortriptyline are recommended second-line therapies. The majority of those diagnosed with lung cancer attempt to quit smoking; around half succeed. Even after lung cancer diagnosis, smoking cessation improves treatment outcomes, reducing cancer treatment toxicity and failure rates, and lengthening survival time. At
5896-421: The pain, and not really a postural problem. iHunch is an example of postural stress which could cause upper back pain and neck pain, which is prevalent in younger generations and people whose occupation involves prolonged usage of computers. The concept of "good posture" has led to a common misconception that sitting in one good sitting position will allay the negative effects of sitting. Sedentary behaviour
5984-530: The protein PD-L1 , but are sometimes effective in those that do not. Treatment with pembrolizumab , atezolizumab , or combination nivolumab plus ipilimumab are all superior to chemotherapy alone against tumors expressing PD-L1. Those who relapse on the above are treated with second-line chemotherapeutics docetaxel and ramucirumab . Integrating palliative care (medical care focused on improving symptoms and lessening discomfort) into lung cancer treatment from
6072-446: The provision of adjustable desks in the workplace. In general, there is conflicting evidence regarding the precise risks of sitting for long periods. A 2018 Cochrane review found low-quality evidence that providing employees with a standing desk option may reduce the length of time some people sit at work in the first year. This reduction in sitting may decrease with time, and there is no evidence that standing desks are effective in
6160-459: The remaining 85% (the non-small-cell lung cancers or NSCLC) are adenocarcinomas , squamous-cell carcinomas , and large-cell carcinomas . After diagnosis, further imaging and biopsies are done to determine the cancer's stage based on how far it has spread. Treatment for early stage lung cancer includes surgery to remove the tumor, sometimes followed by radiation therapy and chemotherapy to kill any remaining cancer cells. Later stage cancer
6248-412: The risk of brain metastases and improve survival in those with limited-stage disease. Extensive-stage SCLC is treated first with etoposide along with either cisplatin or carboplatin. Radiotherapy is used only to shrink tumors that are causing particularly severe symptoms. Combining standard chemotherapy with an immune checkpoint inhibitor can improve survival for a minority of those affected, extending
6336-400: The risk of developing lung cancer as an average person, even after controlling for occupational exposure and smoking habits. Genome-wide association studies have identified many gene variants associated with lung cancer risk, each of which contributes a small risk increase. Many of these genes participate in pathways known to be involved in carcinogenesis, namely DNA repair , inflammation ,
6424-420: The risk of lung cancer. Indoor air pollution from burning wood , charcoal , or crop residue for cooking and heating has also been linked to an increased risk of developing lung cancer. The International Agency for Research on Cancer has classified emission from household burning of coal and biomass as "carcinogenic" and "probably carcinogenic" respectively. Several other diseases that cause inflammation of
6512-459: The risk of someone who smokes and has asbestos exposure dying from lung cancer is much higher than would be expected from adding the two risks together. Similarly, exposure to radon , a naturally occurring breakdown product of the Earth's radioactive elements , is associated with increased lung cancer risk. Radon levels vary with geography. Underground miners have the greatest exposure; however even
6600-413: The same lobe of the lung, or invade the chest wall , diaphragm (or the nerve that controls it ), or area around the heart. Tumors that are larger than 7 cm, have nodules spread in different lobes of a lung, or invade the mediastinum (center of the chest cavity), heart, largest blood vessels that supply the heart, trachea , esophagus , or spine are designated T4. Lymph node staging depends on
6688-603: The same time. In 1700, De Morbis Artificum Diatriba listed sitting in odd postures as a cause of diseases in "chair-workers". Current studies indicate there is a significantly higher mortality rate among people who regularly sit for prolonged periods, and the risk is not negated by regular exercise, though it is lowered. The causes of mortality and morbidity include heart disease , obesity , type 2 diabetes and cancer , specifically, breast , endometrial , colorectal , lung , and epithelial ovarian cancer . The link between heart disease and diabetes mortality and sitting
6776-602: The second, sitting astride something, the legs incline outwards on either side of the body. The feet can rest on the floor or on a footrest , which can keep them vertical, horizontal, or at an angle in between. They can also dangle if the seat is sufficiently high. Legs can be kept right to the front of the body, spread apart, or one crossed over the other. The upper body can be held upright, recline to either side or backward, or one can lean forward. There are many seated positions in various traditions and rituals. Four examples are: In various mythologies and folk magic, sitting
6864-681: The third-generation ALK inhibitor lorlatinib . Up to 5% with NSCLC have overactive MET , which can be inhibited with MET inhibitors capmatinib or tepotinib . Targeted therapies are also available for some cancers with rare mutations. Cancers with hyperactive BRAF (around 2% of NSCLC) can be treated by dabrafenib combined with the MEK inhibitor trametinib ; those with activated ROS1 (around 1% of NSCLC) can be inhibited by crizotinib, lorlatinib, or entrectinib ; overactive NTRK (<1% of NSCLC) by entrectinib or larotrectinib ; active RET (around 1% of NSCLC) by selpercatinib . People whose NSCLC
6952-442: The time of death. Around 19% of people diagnosed with lung cancer survive five years from diagnosis , though prognosis varies based on the stage of the disease at diagnosis and the type of lung cancer. Prognosis is better for people with lung cancer diagnosed at an earlier stage; those diagnosed at the earliest TNM stage, IA1 (small tumor, no spread), have a two-year survival of 97% and five-year survival of 92%. Those diagnosed at
7040-419: The time of diagnosis improves the survival time and quality of life of those with lung cancer. Particularly common symptoms of lung cancer are shortness of breath and pain. Supplemental oxygen, improved airflow, re-orienting an affected person in bed, and low-dose morphine can all improve shortness of breath. In around 20 to 30% of those with lung cancer – particularly those with late-stage disease – growth of
7128-443: The time of relapse. Those with limited stage SCLC that go into complete remission after chemotherapy and radiotherapy have a 50% chance of brain metastases developing within the next two years – a chance reduced by prophylactic cranial irradiation. Several other personal and disease factors are associated with improved outcomes. Those diagnosed at a younger age tend to have better outcomes. Those who smoke or experience weight loss as
7216-531: The tumor (T), spread to regional lymph nodes (N), and distant metastases (M) are scored individually, and combined to form stage groups. Relatively small tumors are designated T1, which are subdivided by size: tumors ≤ 1 centimeter (cm) across are T1a; 1–2 cm T1b; 2–3 cm T1c. Tumors up to 5 cm across, or those that have spread to the visceral pleura (tissue covering the lung) or main bronchi , are designated T2. T2a designates 3–4 cm tumors; T2b 4–5 cm tumors. T3 tumors are up to 7 cm across, have multiple nodules in
7304-502: The tumor can narrow or block the airway , causing coughing and difficulty breathing. Obstructing tumors can be surgically removed where possible, though typically those with airway obstruction are not well enough for surgery. In such cases the American College of Chest Physicians recommends opening the airway by inserting a stent , attempting to shrink the tumor with localized radiation ( brachytherapy ), or physically removing
7392-1312: The tumor site(s) or nerve damage. The World Health Organization (WHO) has developed a three-tiered system for managing cancer pain. For those with mild pain (tier one), the WHO recommends acetominophen or a nonsteroidal anti-inflammatory drug . Around a third of people experience moderate (tier two) or severe (tier three) pain, for which the WHO recommends opioid painkillers. Opioids are typically effective at easing nociceptive pain (pain caused by damage to various body tissues). Opioids are occasionally effective at easing neuropathic pain (pain caused by nerve damage). Neuropathic agents such as anticonvulsants , tricyclic antidepressants , and serotonin–norepinephrine reuptake inhibitors , are often used to ease neuropathic pain, either alone or in combination with opioids. In many cases, targeted radiotherapy can be used to shrink tumors, reducing pain and other symptoms caused by tumor growth. Individuals who have advanced disease and are approaching end-of-life can benefit from dedicated end-of-life care to manage symptoms and ease suffering. As in earlier disease, pain and difficulty breathing are common, and can be managed with opioid pain medications, transitioning from oral medication to injected medication if
7480-529: The tumor suppressors p53 and RB . A cluster of tumor suppressor genes on the short arm of chromosome 3 are often lost early in the development of all lung cancers. Those who smoke can reduce their lung cancer risk by quitting smoking – the risk reduction is greater the longer a person goes without smoking. Self-help programs tend to have little influence on success of smoking cessation, whereas combined counseling and pharmacotherapy improve cessation rates. The US FDA has approved antidepressant therapies and
7568-478: The tumors can be successfully treated and result in decreased mortality. There is evidence that regular low-dose CT scans in people at high risk of developing lung cancer reduces total lung cancer deaths by as much as 20%. Despite evidence of benefit in these populations, potential harms of screening include the potential for a person to have a 'false positive' screening result that may lead to unnecessary testing, invasive procedures, and distress. Although rare, there
7656-417: The type of cells the tumor is derived from; tumors derived from different cells progress and respond to treatment differently. There are two main types of lung cancer, categorized by the size and appearance of the malignant cells seen by a histopathologist under a microscope : small cell lung cancer (SCLC; 15% of cases) and non-small-cell lung cancer (NSCLC; 85% of cases). SCLC tumors are often found near
7744-453: Was a rare disease. In the 1950s and 1960s, increasing evidence linked lung cancer and tobacco use, culminating in declarations by most large national health bodies discouraging tobacco use. Early lung cancer often has no symptoms. When symptoms do arise they are often nonspecific respiratory problems – coughing , shortness of breath , or chest pain – that can differ from person to person. Those who experience coughing tend to report either
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