LUNG CANCER IS A DISEASE THAT IS MORE EASILY PREVENTED THAN CURED. Ninety percent of patients with lung cancer are smokers. Secondhand smoke (inhaling the air contaminated by someone else's smoking) is almost as dangerous as smoking itself. The toxic smoke fumes which firemen inhale as part of their job increases their risk of lung cancer, even if they don't smoke. Radon, a natural gas produced by radioactive elements in the earth, can result in lung cancer in houses that have a higher than normal contamination in their foundation. This is particularly dangerous for smokers. Although lung cancer is not the most frequent cancer in either men or women, it is the leading cause of cancer death in women, exceeding breast cancer, and remains the leading cause of cancer death in men. Ninety percent of patients with lung cancer will die of their disease.

For the most part, early lung cancer is discovered only by accident. There are no “early” symptoms. Most smokers have some cough but only as the cough becomes more irritating or blood-streaked will patients call it to their doctors' attention. An x-ray establishes the diagnosis. Routine chest x-rays are no longer part of regular checkups; therefore, most lung cancers go undetected until they are in a later stage.

To determine the type of lung cancer and to establish the extent of disease, a procedure called “bronchoscopy” may be performed where a flexible fiber optic tube is passed through the throat into the diseased area of the lung and a biopsy is taken. Another test is called “mediastinoscopy.” This procedure, done under anesthesia, examines the lymph nodes in the chest around the lung to determine if the cancer has spread to these nodes. Other tests are done such as CT scans and blood tests. After these assessments the stage (extent) of the disease will be established.

The two major forms of lung cancer are small cell and non-small cell. Approximately 25% of lung cancers are small cell; the remainder are non-small cell, including squamous carcinoma and adenocarcinoma. A small number of broncho-alveolar carcinomas also occur. Mesothelioma is a cancer of the lining of the lung and the chest wall (frequently associated with exposure to asbestos) and falls into a different category.

After determining the type of lung cancer that has occurred and before embarking on a course of treatment for small cell carcinoma, it is necessary to be certain that the disease is still confined to the chest since it may spread to other organs early on. Non-small cell carcinoma can do so also but not as frequently in the earliest stages. For disease which is apparently still localized in the chest, small cell carcinoma of the lung is treated by multiple agent chemotherapy and radiotherapy may also be given. If the tumor as seen on x-ray and CT scans responds completely to these treatments, prophylactic radiation to the brain is frequently advised because the chemotherapy which was effective for the tumor in the chest will not penetrate into the brain, leaving untreated cells which may have lodged there early in the course of the disease.

Many early stage non-small cell carcinomas of the lung may be operable. Others that are still localized to the chest can be made operable by combined chemotherapy and radiation, followed by a surgical procedure. Post-operative radiation combined with chemotherapy is also frequently an important component of attempts to cure the disease.

The problem with lung cancer is that for the most part they are discovered in advanced state, making the prospect of cure less likely. Research into the use of newer chemotherapeutic agents and aggressive radiation are being studied in clinical trials available to patients in Rhode Island. Check the Rhode Island Cancer Council website (www.ricancercouncil.org) for more information on clinical trials.

With the development of advanced technology CAT scans, small, non-symptomatic lung nodules can be found which may be malignant. These may prove to be early cancers that may be at a curable stage. A large clinical trial is now under way to test this hypothesis. It will be at least 5 years to have any answers. Previous studies with older types of x-ray equipment done at Memorial Sloan-Kettering in New York and the Mayo Clinic in Minnesota both failed to improve survival of the people in whom cancer was detected.

At the present time the most prudent course is to avoid tobacco smoke and other noxious fumes. Smokers can seek assistance in the many cessations programs in Rhode Island. These are listed on the Rhode Island Cancer Council website (www.ricancercouncil.org/resources/smoking.php) or call the American Lung Association in Providence for help. This is one cancer where prevention is far better than any treatments available and it's never too late to stop smoking.

For more information and answers to specific questions contact the Rhode Island Cancer Council at info@ricancercouncil.org or call us at (401) 728-4800 or toll free 866-879-4100.

IT IS EASIER TO PREVENT CANCER THAN TO TREAT IT.

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