What are the indications of lung cancer? How do we know that we might be suffering from this illness?
What we often see are people who actually do not have early stage disease. Some have a persistent cough that is not going away. Some of them have been treated for pneumonia repeatedly and the pneumonia is not clearing up. Some people are coughing up blood, have unusual sights of chest pain which is not resolving, experience weight loss, loss of appetite and in general a feeling of lethargy. These are some of the indications that a patient might have lung cancer.
We are always led to believe that because you are a smoker you are going to get lung cancer. Certainly I know it is a contributing factor but who is at risk for lung cancer? It is not only the smoker correct?
Smoking continues to be the single most important risk factor for lung cancer. From years of experience, we know that 85 to 87 percent of lung cancers are primarily related to smoking. First hand smoking continues to be the most important factor. However, we do know from past studies that second hand smoke, especially large quantities of exposure to second hand smoke, can also be an important risk factor. Radon exposure, which is an environmental agent, is also one of the risk factors for lung cancer. Finally, a likely less important factor for lung cancer, is a very strong family history of lung cancer. Also, 15 percent or so of individuals who tend to develop lung cancer have no prior issue of smoking first hand or significant second hand exposure to smoke. The people who develop this tend to be women who are older and do not really have any first hand history of lung cancer in their family. This is a rather unusual spectrum of people who get lung cancer; people who are smokers and those who have never had any exposure to smoking at all.
What are the treatment options?
The treatment options for lung cancer essentially depend upon the stage. When you look at lung cancer, you can broadly divide it into either early stage lung cancer, locally advanced lung cancer, which means that it has not spread to somewhere else in the body, and finally what we call advanced cancer which means that it has spread to a distant part of the body from the lungs. If patients have early stage lung cancer which is confined to the lungs, surgery remains the gold standard. By that standard, the goal is to remove the tumor entirely and to also remove several lymph nodes in that location because, as we know, lung cancer tends to spread to the lymph nodes. In patients who are not good candidates for surgery, either they are very high risk candidates for an operation or they have other major medical problems which basically preclude a safe operation, then we typically treat these patients with radiation therapy. In patients who have what is called locally advanced disease, these are tumors in the lungs as well as the lymph nodes and in the central part of the chest, often times the patients get initial chemotherapy and radiation therapy. Then they are finally considered for an operation to try and remove the tumor and the lymph nodes entirely. Unfortunately for people with advanced disease, the cancer has spread to a location outside of the chest, typically chemotherapy and in these current times more advanced forms of either immunotherapy or better tolerated chemotherapy, in the form of pills or oral agents are available to certain individuals. Often times, people with garishly advanced lung cancer undergo mutation testing where the tumor is tested to see if there are some genetic changes in the tumor which will allow us to use either specific forms of immunotherapy or the easier tolerated forms of chemotherapy.
How prevalent is lung cancer?
The prevalence of lung cancer is variable and it is different in different parts of the world. As a matter of fact, it is less prevalent in the developed world. However, the United States tends to have a high incidence of lung cancer when compared to many other parts of the developed world. Lung cancer is likely related to how many people smoke. Currently about 20 to 25 percent of the people in the country smoke. It is a number that has consistently gone down. However, when we look at the lung cancer that has occurred, it is related to prior smoking. Unfortunately even if every single person in the country today were to stop smoking, it would be ten to fifteen years later before we would see a substantial decline in the likelihood of lung cancer. Also, in the United States lung cancer, as a disease, used to be less prevalent in women. However, in the eighties and nineties, there was an uptick in the incidence of smoking in women so the smoking related lung cancer rates went up in women in 2000 to 2010 or so. Now in both men and women the rates are declining. So fortunately I think we are at the right part of the slope. We just haven’t completely realized the gains that we expect to see from the decrease in the incidence of smoking.
What about prevention? How preventable is lung cancer?
The disease is preventable essentially by limiting smoking and we do know that in parts of the world where smoking incidences are going down more rapidly than it has for us in the United States, the likelihood of lung cancer diminished. Also there have been many efforts at both the local level and in many communities to try and limit both first hand exposure to smoking through legislation and limit exposure to second hand smoking through legislation against smoking in public places. We have not really realized any long term gains from these decreases to smoking yet, but that remains to be seen whether we will have a significant decrease in the likelihood of lung cancers from these measures.
Very good. Dr. Puri I want to thank you for joining us and I want to remind your listeners that they can contact your office at Barnes-Jewish St. Peters Hospital at 314-362-4191. Thank you for taking time out to visit with us today. I appreciate it.
Thank you.