Early detection of lung cancer

The biggest problem with lung cancer is that early diagnosis is difficult

By: Luis D. Berrizbeitia, M.D.
   Lung cancer is second only to prostate cancer for men and breast cancer for women when it comes to new cancer cases in the United States. But it’s a different story when it comes to survival: Lung cancer is the leading cause of cancer deaths for both men and women, killing more than 160,000 people a year in this country.
   The deaths of ABC anchorman Peter Jennings, a former smoker, and Dana Reeve, a non-smoker, have drawn new attention to the prevention, diagnosis and treatment of this disease.
   The diagnosis and management of lung cancer, along with new research, have gained recent attention in the media and world medical community. The Cancer Program at University Medical Center at Princeton sees this as an opportunity to provide medical professionals with a comprehensive update on the current issues and controversies related to the diagnosis and management of lung cancer.
   On Friday, Dec.1, leading lung cancer specialists will gather in Princeton for a Lung Cancer Symposium that will examine these issues and look at the strategies that are most likely to impact survival.
   The biggest problem with lung cancer is that early diagnosis is difficult. Many people do not have any symptoms until the disease has already progressed to an advanced stage. In fact, only 15 percent of cases are discovered in the early stages when treatment is the most effective.
   By the time a patient complains about such symptoms as coughing, back pain, shortness of breath or fatigue and sees a doctor, a tumor in the lungs already may have grown to a significant size. The patient may experience symptoms completely unrelated to the lungs or respiratory system and not even think about the possibility of lung cancer. By that point the cancer may have spread from the lungs to other parts of the body.
   The major risk factor for lung cancer is exposure to tobacco. Someone may have stopped smoking 20 years ago, but if he smoked two packs a day for 10 years before that, he is at high risk for lung cancer. Second-hand smoke represents another huge risk.
   But there is no systematic way of diagnosing lung cancer on a prospective basis.
   For example, if a woman lost both her sister and her mother to breast cancer, the family history would be good reason for doctors to start testing her at an early age for risk factors and for the actual presence of breast cancer. Mammograms, which are usually recommended annually starting at the age of 40, would be started much earlier for patients who have such a family history.
   A study in the New England Journal of Medicine last month suggests that there is a diagnostic tool for screening and surveillance of lung cancer that could save millions of lives. The New York researchers, led by lead author Dr. Claudia Henschke of Weill Cornell Medical College, drew intense media scrutiny with the claim that annual spiral CT scans could prevent 80 percent of lung cancer deaths.
   Spiral computed tomography is a method of body imaging that uses computers and an X-ray beam to produce highly detailed cross-sectional images of the body. The three-dimensional images can detect a tumor and help determine its location, shape and size.
   The study looked at more than 31,000 people in seven countries, including smokers, former smokers and a small group of people in Japan who had never smoked. 482 cases of lung cancer were found — 412 of them at a very early stage.
   Some doctors say this study proves that spiral CT can be an effective diagnostic tool for lung cancer, while others say the results are rather sobering: Less than 2 percent of these 31,000 people had anything that suggested they had lung cancer.
   In fact, they say that even more important questions are raised: How many lung cancers were not detected? How many in the study would forgo any future spiral CT scans because they think they are safe and then end up being diagnosed with lung cancer? How many of them would die?
   While there are still many questions, spiral CT nonetheless remains an effective tool in the diagnosis of early stage lung cancer. This technology is available at UMCP.
   Diagnosis is still very tricky, but techniques for the treatment of early lung cancer have evolved significantly in recent years. Most surgical procedures today are done through a videocamera which allows limited incisions and less trauma. Recovery time is faster and the patient experiences less discomfort.
   Some surgeons still consider conventional large incisions as the best way to assure removal of the entire cancer, but the minimally invasive approach has proven very safe and effective.
   Treatment of advanced lung cancer has also improved with newer chemotherapeutic agents, drugs that are more effective in the management of lung cancer. There are also treatments based on radiation therapy.
   Physical techniques such as the Cyberknife and Radiofrequency Ablation also assist in the multidisciplinary management of advanced lung cancer.
   There are scientific developments in the molecular biology of lung cancer that can be applied to developing ways to diagnose it earlier and treat it more effectively.
   Research on DNA, RNA, and the protein synthesis apparatus of lung cancer cells may one day lead to something as simple as a blood test to determine the risk of developing lung cancer. This information could help patients make lifestyle changes that can help reduce that risk.
   The American Cancer Society says that the best thing current smokers can do to reduce their chances of contracting lung cancer and improving their overall health is to stop smoking. But kicking the habit is hard. While most smokers say they want to stop smoking, the average smoker tries to quit eight times before succeeding.
   If you’re trying to quit smoking, there are community resources that can offer help and moral support. One of them is New Jersey Quit Services, a free state program for New Jersey residents that includes phone and online counseling.There is no doubt that more needs to be done to diagnose, treat and develop a cure for lung cancer. The symposium will address these critical issues. The goal is to come up with answers and research that can help save lives from the deadliest cancer of all.
For more information regarding the Lung Cancer Symposium, contact University
Medical Center at Princeton Cancer Program, at (609) 497-4475 or visit www.lungcancer2006.org.
To find a Princeton HealthCare System physician, visit princetonhcs.org
or call (888) 742-7496.