Basic Cancer Info

This week I happened to see a man in my clinic who I had first met at the time of his diagnosis with metastatic lung cancer more than five years ago. He's from another part of Washington state, and this was his first time back with me to revisit treatment options.

When I joined GRACE earlier this month, a question was posed by a reader regarding whether there is an increasing frequency of the diagnosis of lung cancer in women who have never smoked. This is a very interesting question that those of us who specialize in lung cancer frequently wonder about.

Admit it. You have probably wondered why you or your loved one was unlucky enough to get lung cancer while that obnoxious neighbor or coworker has smoked 2 packs a day for 50 years and doesn’t even have a cough. In fact, only about 15% of male smokers and 10% of female smokers eventually develop lung cancer. The field at large has been searching for why some smokers get lung cancer and others don’t for many years, and while progress has been made the answer has been elusive.

We all know now that lung cancer, and in particular NSCLC, sits atop the list of cancer killers in the United States and western world. We also have been having extensive discussions on this site about all these great new treatment modalities: better staging (i.e. PET), better surgeries (i.e. VATS), radiosurgery (i.e. gamma knife), better radiation (i.e. IMRT), and better chemotherapy or targeted agents.

Have you ever wondered how exactly your oncologist knew what kind of cancer you had when he/she told you or a loved one about your diagnosis, whether it was non-small cell lung cancer (such as squamous cell or adenocarcinoma), breast cancer, or colon cancer?

Erlotinib (Tarceva) was approved for treatment of progressive non-small cell lung cancer (NSCLC) after the BR21 study that showed that tarceva not only improved survival but also improved lung cancer symptoms and quality of life. This study and others have also taught us that the benefit of tarceva is much better in those who had never smoked and less effective in current smokers.

One of the most common questions I am asked by newly diagnosed lung cancer patients is “What can I, personally, do to help fight my cancer?” The two most common topics are diet and exercise. While the influence of diet on cancer outcomes is a good topic for discussion, today I wanted to focus on the question of exercise in cancer patients, and whether exercise may help people with lung cancer either live longer or at least have a better quality of life.

Lung cancer screening is one of my least favorite topics to discuss because it's probably one of the biggest areas where there is a gulf between the medical establishment's party line and the expectations of many patients and advocates. I tackled a discussion of screening a few years ago that included the anticipated benefits as well as the challenges with LC screening (nowadays really focusing on low dose, spiral CT).

The average age at which lung cancer is diagnosed in the US is 71. Would it be fair to say that at least half of those who are diagnosed with lung cancer are elderly? How do we define “old”? How does age impact the effect of chemotherapy?

Several weeks ago, I described the results of a survey I sent out to several colleagues who are lung cancer experts around the country, asking how they would manage a case of a newly diagnosed Caucasian never-smoking patient with advanced NSCLC, adenocarcinoma, and asymptomatic subcentimeter brain metastases, treated with whole brain RT before starting systemic therapy.