Basic Cancer Info

Over the lasat decade, PET scans have become commonplace in the staging of NSCLC. There's an older post that reviews the concept of PET scans in providing metabolic imaging, as well as a podcast that provides a more complete discussion of PET scanning in oncology, with a focus on lung cancer.

“Locally-advanced NSCLC” is a term generally applied to lung cancers with tumors that have either grown into major structures (such as vertebrae or spine bones, the central airways, or involve the main blood vessels supplying the lung or central chest) or those cancers that have spread to lymph nodes in the central chest (the mediastinum). In the case of many of these cancers, removing them with surgery is not possible, but treatment with the combination of chemotherapy and radiation given at the same time may be used with the goal of curing the cancer.

There is nothing more disheartening to the patient, and quite frankly for the treating oncologist, than have to hear (or say) the words “I’m afraid the treatment isn’t working”. The scientific term is “disease progression”, but the reality is that the cancer is growing despite the treatment and it doesn’t take an expert to know that isn’t good news.

The role of hormones in the development and progression of lung cancer in women has generated much interest. Unfortunately, a lot of the data to date has been observational, which doesn't establish a "cause and effect" relationship. The Nurses Health Study (more on this below) is a good example: a large cohort of women was observed over time. The women completed questionaires on all sorts of exposures (diet, hormone replacement therapy, tobacco, etc), and they were followed over time.

In 2007 there was much excitement about the publication of a study by the researchers behind the landmark IALT adjuvant chemotherapy trial, which suggested that patients with early stage NSCLC could be divided into those who benefited greatly from cisplatin-based adjuvant chemotherapy and those who did not.

Over the last 5 years, it’s become standard to consider and often recommend post-operative chemotherapy to patients with higher risk, early stage lung cancer in order to reduce the risk of it recurring and increase the cure rate. In that time, we’ve also seen that there are subgroups of patients who may be harmed by chemo. This may be because their risk of recurrence is not high enough to justify the potentially detrimental effects of adjuvant chemotherapy, or because they are relatively resistant to chemo, or a combination of these issues.

Please Note: New Treatments Have Emerged Since this Original Post

Among the many challenges in clinical oncology is the fact that a very significant proportion of our patients are quite a bit more debilitated than the vast majority of patients in clinical trials that test our anti-cancer therapies. Approximately a third of the patients with advanced NSCLC have what would be considered a poor performance status (PS) of 2 or 3 (0 to 5 scale, 0 being asymptomatic, and 5 being dead), but they are extremely under-represented on our clinical trials.

Here's a video presentation on never-smokers with lung cancer, a population that has been a subject of great interest to me for the past several years. Ten years ago, we really didn't focus on smoking status as a relevant issue and didn't break out never-smokers as a group within our lung cancer trials.

Last Friday I saw a patient in clinic who was referred to me after presenting to the emergency room with shortness of breath. He has a large pleural effusion, and eventually needed a thoracoscopic surgery to drain the effusion and pleurodese the lung (this eliminates the space around the lung so no fluid can collect there).