What you should know about lung cancer

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Dr. Jyoti D. Patel is Professor of Medicine and Director of Thoracic Oncology at the University of Chicago and Associate Editor for Lung Cancer.

Lung cancer is responsible for more cancer deaths than any other cancer in men and women. In fact, it takes the lives of more than 150,000 Americans each year. Despite these staggering numbers, many people know very little about this disease. This is what everyone should know about lung cancer.

1. Anyone can get lung cancer. In fact, 1 in 16 people in the United States will be diagnosed with the disease in their lifetime; that’s a new diagnosis every 150 seconds! And while smoking is the most common cause of lung cancer, nearly two-thirds of all new diagnoses are in people who have never smoked or are former smokers. In fact, up to 30,000 Americans who have never smoked get lung cancer each year.

2. Symptoms of lung cancer may not be specific. Lung cancer may not produce noticeable symptoms in its early stages, and many people are not diagnosed with the disease until it is advanced. But people who develop any of the following problems should see a health care provider who can evaluate these symptoms and develop a diagnostic plan:

a new cough that does not go away;

changes in a chronic cough;

shortness of breath or getting out of breath more easily;

pain in the chest area;

persistent wheezing;

a raspy or hoarse voice;

unplanned weight loss;

Bone pain;

worsening of headaches.

3. Screening for lung cancer can save lives. As with many other types of cancer, the key to surviving lung cancer is to find it in its earliest stages, when it is most treatable. For patients with small, early-stage lung cancer, the cure rate can be as high as 80% to 90%. Cure rates decline dramatically as the tumor becomes more advanced and involves lymph nodes or other parts of the body. Screening with low-dose helical computed tomography (CT) scanning has been shown to reduce lung cancer deaths in people at high risk of lung cancer. In fact, the National Lung Screening Trial found a 20% reduction in lung cancer deaths among current and former heavy smokers who were screened with low-dose helical CT, compared with people examined with a chest X-ray. Because CT scans can also give “false-positive” results, mistaking scar tissue or noncancerous lumps for cancer, they’re recommended only for people at high risk. In these people, the benefits of early detection outweigh the risks of possible false positives. Lung cancer screening is recommended for people who meet these criteria:

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be between 55 and 80 years old;

have a smoking history of at least 30 pack years (1 pack year is the same as smoking 1 pack of cigarettes per day for an entire year);

be in good health and have no signs of lung cancer;

not have had a CT scan in the past year.

4. There are different types of lung cancer. About 80% to 85% of lung cancer diagnoses are non-small cell lung cancer (NSCLC), and there are 3 main subtypes:

adenocarcinoma. This is the most common subtype of cancer, but it is also much more common in people who have never smoked, younger patients, and women.

Squamous cell cancer. This is most commonly linked to a history of smoking. It develops in the airways of the lungs.

Large cell carcinoma. This is a rare type of lung cancer, accounting for less than 10% of cases.

Small cell lung cancer (SCLC) accounts for about 10% to 15% of all lung cancers and very rarely develops in someone who has not smoked .

5. Targeted therapies work. Up to a quarter of lung cancer tumors carry a genetic mutation, a genomic “glitch” that drives cancer growth, which can be treated with available drugs. This type of cancer treatment is called targeted therapy. Tumors from all patients with advanced adenocarcinoma should be tested for genetic mutations such as EGFR, ALK, ROS1, and BRAF. And, as research finds new and emerging targets, it makes sense to do more extensive testing to look for other mutations as well. Orally administered medications for patients with some of the mutations are highly effective; they can significantly shrink tumors, work for a long time, and give people with lung cancer a good quality of life.

6. Immunotherapy helps people with a wide variety of lung cancers live longer. Immunotherapy is a type of cancer treatment that works by stimulating or activating the immune system, causing it to recognize and destroy cancer cells. Researchers are investigating 4 main types of immunotherapies for lung cancer: checkpoint inhibitors, monoclonal antibodies, therapeutic vaccines, and adoptive cell therapy. Four immunotherapy drugs, all checkpoint inhibitors, have been approved to treat NSCLC. For patients who have tumors with high levels of a biomarker called PD-L1, pembrolizumab (Keytruda) works better than chemotherapy as first therapy. For tumors with low or no PD-L1 expression, drugs such as atezolizumab (Tecentriq) and nivolumab (Opdivo) may be effective as a second treatment. Sometimes the combination of immunotherapy and chemotherapy initially can also improve results. Recent research has also shown that giving the checkpoint inhibitor durvalumab (Imfinzi) after radiation therapy improved the time to cancer progression in people with locally advanced NSCLC. Several clinical trials are also investigating how immunotherapy can be combined with surgery for patients with early, curable lung cancer.

7. Early palliative care for people with advanced lung cancer improves outcomes. People with lung cancer who receive palliative or supportive care as part of their treatment are more satisfied with their treatment, have better symptom control, and live longer. Palliative care is a plan that prevents and treats suffering and addresses the physical, intellectual, emotional, social and spiritual needs that are unique to each patient. Palliative care puts patients in control of their care by giving them the opportunity to tell doctors and nurses what kind of treatment they want or do not want.

8. Lung cancer is tough, but we’re making progress thanks to discoveries from clinical trials. We have made tremendous advances in our understanding of the biology of cancer. These advances have a direct impact on people with cancer. Unfortunately, only 3% of Americans with cancer participate in clinical trials, so we often don’t have enough information to generalize what we learn from clinical trials to patients who are not as well represented in trials, such as adults older people and those with other medical problems. Read other blog posts about recent lung cancer research.

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9. You are not alone in this. The lung cancer community is growing. Many people have been affected by lung cancer. This disease affects more than 220,000 Americans each year. There are many active support groups for patients and family caregivers, so no one has to face a lung cancer diagnosis alone.

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