November is Lung Cancer Awareness Month

By Gigi Chen, MD

Lung cancer accounts for about 14% of all cancer diagnosis, however, it is responsible for almost 29% of all cancer deaths. Lung cancer is the leading cause of cancer death for both men and women in U.S. In 2012, an estimated 226,200 new cases of lung cancer will be diagnosed. The incidence and death have been decreasing for men, but had been rising for women until around the year 2000 when they began to level off. The major cause of lung cancer is smoking, which is responsible for 85% to 90% of lung cancer. Other risk factors include environmental and occupational exposures such as asbestos, radon, air pollution, radiation and second hand tobacco.

More than 95% of lung cancer consists of one of the four major types: squamous, adenocarcinoma, large cell, or small cell cancer. Squamous, adenocarcinoma and large cell are together called non-small cell lung cancer. Adenocarcinoma comprises of 50% of lung cancer in US. The most common symptoms patients experience are decreased appetite, fatigue, weakness and cough.

Currently, most patients with lung cancer are diagnosed at an advanced stage. There has been recent promising data in the area of lung cancer screening. The National Lung Cancer Screening trial enrolled 53,000 current or former heavy smokers and showed that screening high risk patients with low dose CT decreased mortality from lung cancer by 20% compared to chest X ray. High risk patients are either current or former smokers with 30 pack year smoking history, aged 55 to 74 years. The International Early Lung Cancer Action Program (I-ELCAP) assessed whether annual screening with low dose CT can increase early detection in patients at risk for lung cancer. They found that if lung cancer is detected in stage I and promptly removed, the 10 year survival is 92%. These trials suggest that early screening can decrease the risk of death from lung cancer in high risk patients.

Treatment of lung cancer requires a collaborative effort between patients and their medical oncologist, thoracic surgeons and radiation oncologist. Treatment strategies for non-small cell lung cancer can include surgery, chemotherapy or radiation or a combination of these methods. Whereas treatment for small cell lung cancer typically involves chemotherapy or combined chemotherapy and radiation.

There have a number of new and exciting drugs in lung cancer that can target cancer at a molecular level. Erlotinib is an oral drug that works effectively in patients with EGFR mutation, which can be found in up to 50% of Asian patients and about 10% Caucasian patients. Another example is Crizotinib, which is effective in patients with tumor express EML4-ALK rearrangement, which occurs in about 10,000 patients in US. Bevacizumab and Cetuximab which are monoclonal antibodies can be used in conjunction with chemotherapy in newly diagnosed non-small cell lung cancer. Understanding lung cancer genomics and biology will enable development of medicines that are more effective and have fewer side effects. 

Dr. Chen is board certified in medical oncology and hematology and practices with Diablo Valley Oncology, located at the California Cancer and Research Institute in Pleasant Hill. She treats all forms of cancer and blood disorders and has a special interest in lung and gynecologic cancer.  

November is National Lung Cancer Awareness Month and the California Cancer and Research Institute has arranged to offer complimentary consultants for screening during the week of November 12-16.

To learn more about this lung cancer awareness program, please call 925-826-1900.