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What Is Lung Cancer?

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Published on April 21, 2015

Many of us know that it is a disease that can greatly affect our lives and even put our lives in danger, but what is it? How is it developed, detected and treated? Lung cancer experts, Dr. David Carbone and Dr. Scott Antonia, define lung cancer for an audience full of caregivers and patients living with lung cancer at our "HOPE Summit Live: Living Well with Lung Cancer Today" town meeting. Hear what is systematically taking place when lung cancer begins to develop.



Moffitt Cancer Center LUNGevity Foundation

Transcript | What Is Lung Cancer?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you

Andrew Schorr:

So, doctors, people want to understand lung cancer. What is it? And I remember somebody saying once, “Well, cancer is not an infection.”  You didn’t catch it. One person with cancer is not going to give cancer to someone else. So let’s just start with you, David.  What is cancer, and what’s lung cancer? What’s happening to your cells?

Dr. Carbone:       

So every cell in your body is a finely tuned machine where it has to know when to grow and know when to stop growing, know when it’s in the right place, know when it’s doing the right functions.

And there are complicated signals that tell it to do all of those things.  Sometimes, those signals get damaged by things such as gene mutations. And it’s like putting a brick on your gas pedal on your car. It just goes out of control and divides when it’s not supposed to and results in what we call cancer. 

Andrew Schorr:                  

All right. And in lung cancer, what are the symptoms? I mean, some people had their lung cancer discovered late. They maybe didn’t even know they had it. They had a cough. They thought they had just a chronic cough or bronchitis.  What are the symptoms?

Dr. Carbone:       

So too often, lung cancer is diagnosed because of symptoms from a metastasis.  Your lungs are big.  You think about a couple of gallon milk jugs.  There’s a lot of space in there.

So a tumor can get grapefruit sized in your lungs, and you would have no idea that it’s there.  But, unfortunately, lung cancer tends to spread to other places and result in bone pain or seizures. And that’s often how you first find out about it when it’s already stage IV.

Andrew Schorr:                  

Okay. And obviously, we’d like to be able to discover it early. Some people are fortunate. Sometimes, they go in for a lung X-ray for just another reason in a physical or something, and they spot something.

Dr. Carbone:       

But right now, it just recently has been approved by CMS, the CT screening for high-risk patients, where people who have smoked and are over 50 years old are now paid—their screening CTs are paid for in order to detect their cancers early. And I think that’s a great advance. The big study that approved that was effective showed 20 percent reduction in the risk of death from lung cancer. And that’s huge.

Andrew Schorr:                  

Well, the fact is though you’re here because you or your loved one has that diagnosis. So let’s go on, Dr. Antonia. So somebody had suspected, or it has been diagnosed. So now, what are you trying to figure out in this world of genomics? Because we’ve talked about people who have had different drug therapies. We’ll talk a lot about surgery and radiation.  So we’re in kind of the age of personalized care.                        

So what do you do here, for example, to understand what are you dealing with with that patient situation?

Dr. Antonia:        

It depends on lots of things. So there are lots of different subtypes of lung cancers. And we manage those all differently in terms of thinking about genomic testing. And there are different stages. And so lung cancer is still a curable disease when it’s early staged.  It’s I, II or III, and standard treatments don’t incorporate genomic testing.

It’s still an operation. It’s still radiation. It’s still chemotherapy that produces those cures. So really, it’s important to do this genomic testing with patients who have advanced stage disease. And it doesn’t help everyone. And actually, it helps a relatively small number of people right now.  So this genomic testing, what is the purpose of it?  The purpose of it is to pick up what we call actionable mutations in driver genes.

So just, as David said, lung cancer is what? It’s uncontrolled growth of cells.  And sometimes, that uncontrolled growth is because there’s one mutation and one gene that’s driving that uncontrolled growth. And we have drugs now that can hit those proteins, those mutant proteins that are on all the time.  And it’s about 10 or 15 percent of all lung cancer patients so not insignificant.

And people who do have those changes benefit greatly from these drugs. So everyone certainly with adenocarcinoma of the lungs should get genomic testing at least for those two genes, EGFR and ALK. We here at Moffitt do many more. And David does many more at his place. And that is because there are now the ever increasing recognition of more and more of these driver genes and these driver mutations and drugs that hit each of those.

So right now, out in the community, there are two drugs and two mutations that need to be tested on everybody who has non-small cell lung cancer, in particular, adenocarcinoma.  But we think, of course, it’s important to test for those many more, because we have drugs available on clinical trials to hit those. So very important.  For a relatively small number of people right now, benefit from that genomic testing.

But everyone should get it because there’s no other way to predict whether or not someone has that mutation or not. So we need to do it in everyone.

Andrew Schorr:                  

Let me back up for a minute. So there are different subtypes of lung cancer, but there are two big groups. So maybe you could raise your hands if you know. So if you have small cell lung cancer, will you just raise your hand? And then non-small cell, which is more common, as you can see. So two different groups.

So are they treated differently, Scott?

Dr. Antonia:        

Yes, they are distinct diseases. And there are distinct diseases within the non-small cell category. But first, let’s just stick with your question of small cell versus non-small cell.  They’re staged differently. Small cell lung cancer we stage as either being in the chest or outside of the chest.  Non-small cell lung cancer, in the chest or involved in the lymph nodes or outside of the chest. So stage I, II, III and IV.  Small cell is limited stage.

It’s in the chest, or it’s outside of the chest at its extensive stage. So it’s staged differently.  Most people, the vast majority of people with small cell lung cancer, it’s already spread at least to the lymph nodes in the center of the chest.  It’s rare that we get it that it’s just in the lungs.  So a little bit more rapidly progressive cancer, small cell lung cancer but more responsive to first-line treatments as well. First-line treatments with conventional chemotherapy work very well in that disease and have a significant impact on making people feel better, significant impact on making people live longer.

We can still cure the early stage of that, the limited stage small cell lung cancer.  But the unfortunate thing with small cell lung cancer is we’re using the same drugs today that we did 25 years ago.  We’ve not made much progress there until recently. And immunotherapy is going to have a very important role in this disease is my prediction as well.

So similar.  They’re similar in that, when the diseases spread, you still need to give something in the vein that will go throughout the body, systemic treatment.  And the mainstay of treatment is chemotherapy for both of those diseases, sometimes different types of chemotherapy and many additional options for non-small cell lung cancer in terms of different modalities so not just chemotherapy, but there’s also anti-blood vessel therapy. 

And there’s also molecularly targeted therapy that we were just talking about.  And there’s immunotherapy. And small cell lung cancer really is still just chemotherapy, except for I think that’s going to change very soon. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you

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