World Lung Cancer Day - August 1st, 2018

by Jane Ashley

August 1, 2018, is World Lung Cancer Day. Lung cancer is one of the most frequently diagnosed cancers worldwide. Sadly, lung cancer accounts for more deaths than breast, colon and prostate cancers combined. Approximately 1.2 million people die worldwide from lung cancer.

World Lung Cancer Day

Statistics in the United States

About 14 percent of cancers diagnosed in the U.S. are lung cancer. That’s almost 235,000 people in 2018 with slightly more men diagnosed than women (almost 122,000 men and over 112,000 women). Lung cancer accounts for more deaths in the U.S. by far – over 155,000 people die annually from lung cancer. Sadly, lung cancer kills more women than breast cancer. 

There are two types of lung cancer: Small cell and non-small cell. Dana-Farber explains that it’s the difference in how the cells look under the microscope. Non-small cell accounts for about 87 percent of lung cancers in the U.S. Treatments differ according to which type someone has.
Lung cancer is predominantly diagnosed in people who are over 65 – the average age at diagnosis is 70.

Age At Diagnosis

Risk Factors

Smoking is a major risk factor. About 80 percent of the lung cancer deaths are attributed to smoking. Smokers who are exposed to radon or asbestos are at particular risk.

Not every person diagnosed with lung cancer is a smoker. Some were exposed to second-hand smoke, radon, asbestos, diesel fumes or air pollution. Non-smokers who develop lung cancer are younger and may have genetic changes. Certain other gene changes may develop because of exposure to environmental exposure. These include the TP53 or p16 tumor suppressor genes and the K-RAS or ALK oncogenes. More research will help cancer researchers learn more about genetic factors, whether inherited or acquired.

In some areas of the world (primarily Southeast Asia and South America), arsenic is found in the water. People living in these areas are at higher risk of developing lung cancer.

Two large studies have shown that smokers who took beta-carotene supplements have a higher risk of lung cancer. It is recommended that smokers not take beta-carotene.

Prior exposure to chest radiation (for treatment of Hodgkin lymphoma or radiation after a mastectomy) puts you at higher risk for lung cancer. Women who had radiation therapy after a lumpectomy are not at increased risk. 

A family history of lung cancer may also be a risk factor. It’s not known whether it’s genetics or shared living quarters.

Symptoms of Lung Cancer

Symptoms of lung cancer range from obvious ones to less obvious ones.
• Chest pain when one is deep coughing
• Cough that doesn’t go away
• Coughing up blood
• Fatigue
• Hoarseness
• Lung infections like bronchitis and pneumonia that recur
• Shortness of breath
• Weight loss/loss of appetite
• Wheezing

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While these symptoms don’t always mean that a person has lung cancer, it’s best to consult your primary care physician.

How is lung cancer treated?

Lung cancer can be treated in a number of ways, depending on the stage of your cancer and which type it. Treatments include surgery, radiation, chemotherapy and/or targeted therapy.

Surgery. There are four surgical options:

• Lobectomy. Our lungs have 5 lobes – 3 on the right side and 2 on the left side. This is often the surgery of choice for Non-Small Cell Lung Cancer (NSCLC).
• Pneumonectomy. This surgery removes the entire lung and might be the surgery of choice is the tumor is near the center of the chest.
• Sleeve resection. If a tumor is located in a large airway, the section of the airway containing the tumor can be removed, thus preserving lung function.
• Wedge resection. Sometimes only a portion of a lobe is removed if a patient doesn’t have sufficient lung function to allow removal of the whole lobe.

A newer technology for earlier stage lung cancer is called video-assisted thoracic surgery (VATS), where smaller incisions are utilized with the help of a tiny camera to allow the surgeon to view the chest on a TV monitor. This is less invasive resulting in less pain and a shorter stay in the hospital.

Radiation 

Radiation may be used for several reasons:

• If the tumor can’t be surgically removed (due to size or location)
• If a person is too weak to have surgery
• To shrink the tumor before surgery
• To treat a single tumor if the cancer has spread to the brain, adrenal gland or other organs
• For symptom relief, such as when a large tumor presses on an airway

Most radiation is performed with an external beam of radiation. The radiation is focused on the tumor from an external machine. Patients may have treatments five days a week for 5-7 weeks.

A specialized type of higher-dose radiation called SBRT allows early stage cancers to be effectively treated with 1-5 treatments.

A third option is the Gamma Knife, where over 200 beams from different angles are focused on a lung cancer tumor that has spread to the patient’s brain.

Chemotherapy

There are at least 11 different chemotherapy drugs. They can be used before surgery, combined with radiation, after surgery or as the principal treatment.

Targeted Therapy 

These are specialized drugs given by IV to help prevent the formation of new blood vessels that would feed an existing tumor or help a new tumor gain a foothold. They are Bevacizumab (Avastin) and Ramucirumab (Cyramza). 

Immunotherapy

This new class of cancer treatment includes Keytruda (given to President Jimmy Carter), Opdivo and Tecentriq. If your tumor tests positive for PD1 or PD-L1, then one of these might be used if your cancer has spread to distant organs.

WhatNext?

Patients are living longer and more productive lives after a diagnosis of lung cancer. The American Lung Association offers inspiration and encouragement to patients and caregivers. Many patients remain active by making adjustments in their routines. LUNGEVITY offers these 10 practical steps to survive lung cancer. Advice #10 is classic, “Choose to live.”

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