Wednesday, January 17, 2018
Health

Mayo Clinic Q&A: Causes of lung cancer; why the big cast for the broken finger?

LUNG CANCER HAS MANY CAUSES

My brother-in-law has never smoked, but was diagnosed with late-stage lung cancer at the age of 45. He was told there is no way to determine what caused it, even though he had a biopsy. What are some of the things that cause lung cancer?

It's true that pinpointing a specific cause of lung cancer based on biopsy results — or any other lab test, for that matter — isn't possible. A likely cause often can be assumed, though, based on a person's lifestyle, medical history and environmental factors. Smoking is by far the most common cause of lung cancer, but it certainly isn't the only one.

As it has been for many years, lung cancer remains the leading cause of cancer deaths in the United States for both men and women. Smoking causes the majority of lung cancers. People who smoke are nine times more likely to get the disease than those who do not. That's because when cigarette smoke enters the lungs, it almost immediately begins to damage cells that line the lungs. At first, the body can repair that damage. But, as exposure to the toxins in cigarette smoke continues, the damage increases. Over time, that can trigger abnormal changes in the lung cells that can lead to lung cancer.

But, lung cancer is not just a smoker's problem. People who live or work around smokers or who otherwise have sustained exposure to cigarette smoke over time also are at an increased risk for lung cancer. Secondhand smoke includes breathing smoke that a smoker exhales, as well as inhaling smoke that comes from a burning tobacco product. The smoke contains a wide range of chemicals known to cause cancer, including ammonia, butane, carbon monoxide, cyanide and lead.

Although the research is not definitive at this time, other forms of smoking also appear to raise the risk of lung cancer, including smoking marijuana and using electronic cigarettes. Basically, anytime you inhale toxins, you raise your risk for lung cancer.

Another factor that has been associated with lung cancer is long-term exposure to radon gas. Radon is created by the natural breakdown of uranium in soil, rock and water. Over time, it becomes part of the air you breathe. In areas prone to radon, the gas can build up within homes and other buildings. If you live in an area where radon is known to be a problem, it's a good idea to have your home tested for it. If the level of radon is high, there are ways to bring it down to a safer range.

Working or living around other substances known to cause cancer can increase the risk of developing lung cancer, too. Examples of these kinds of substances include asbestos, arsenic, chromium and nickel.

Finally, in some cases, a family history of lung cancer may raise an individual's risk for the disease. In particular, the risk seems to go up most in people who have a parent, sibling or child with lung cancer.

Anyone who is concerned about the possibility of developing lung cancer should talk to his or her doctor. He or she can assess an individual's overall risk. In people who are at high risk, tests such as CT scans may be appropriate to look for signs of lung cancer before symptoms appear.

Eric Edell, M.D., Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn.

FINGER BROKEN, WHY A BIG CAST?

My son injured his index finger, but didn't complain much and even played in a basketball game the next day. After four days, the swelling didn't go down, and we took him to the doctor and found out it was broken. They put a cast on his entire hand, all the way up to his elbow. Why is such a huge cast necessary? Did we make it worse by waiting?

It's unlikely that waiting a few days to see a doctor changed the outcome of treatment. Broken fingers are a frequent childhood injury, and, most of the time, they heal without any long-term problems. A cast up to the elbow is typical for a broken finger, because it is the most effective way to promote healing.

Children are at a higher risk for breaking bones than adults, simply because children tend to be more active. Of the bones children often fracture, fingers are some of the most common. Broken fingers are frequently the result of a fall onto an outstretched hand or a collision during a sports activity.

The most obvious symptoms of a broken finger are deformity of the finger or being unable to move it. However, as in your son's situation, the symptoms can be more subtle, and swelling may be the main complaint. Pain, tenderness, bruising, stiffness or numbness also can signal a broken finger.

A long delay between the time of the injury and the start of treatment for a broken finger could lead to poor healing, decreased range of motion or decreased grip strength. But, waiting just a few days usually isn't a problem.

For a bone to heal properly, it needs to be fixed in place so it can't move. The best way to do that is with a cast. It's difficult to immobilize only one finger or just the hand with a cast. Casts that go up to the elbow often are used for broken fingers because they keep the finger and hand from moving.

For finger fractures that don't require surgery, a cast usually is only needed for about three or four weeks. When a child is in a cast for that short period of time, it shouldn't cause any problems with the wrist or forearm.

Medication to reduce pain may be helpful for your son as his finger heals. Over-the-counter pain relievers, such as acetaminophen, ibuprofen or naproxen, may be all he needs. If your son has severe pain, talk to his doctor. He may benefit from a prescription pain reliever, such as codeine.

After the cast is removed, your son's doctor may recommend exercises, occupational therapy or another type of rehabilitation to ease stiffness in the finger, as well as to restore a full range of motion to the finger, hand and wrist.

There are some issues that can make healing a broken finger more complicated. They include a break that involves a finger joint, damage to ligaments around the broken bone, a break that's the result of a crushing accident, loose bone fragments that could enter a joint, or an unstable or displaced fracture. In these situations, treatment could include surgery, and healing may take much longer.

If the fracture is a simple one, it's quite likely your son will be able to return to the basketball court and his other activities without any problems. If you have questions about his treatment or the healing process, be sure to talk with his doctor.

Shelley Noland, M.D., Plastic and Hand Surgery, Mayo Clinic, Phoenix

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ[email protected] For more information, visit mayoclinic.org. © 2016 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.

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