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Lung Cancer Puzzle

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http://www.washingtonpost.com/wp-dyn/ar ... Apr11.html

By Gregory Mott

Washington Post Staff Writer

Tuesday, April 12, 2005; Page HE01

Though headlines more frequently focus on cancers of the breast, prostate or colon, last week's announcement that ABC News anchor Peter Jennings has lung cancer is a reminder that this form remains the most deadly of all malignancies.

According to the American Cancer Society (ACS), more than 172,000 Americans will be diagnosed with lung cancer in 2005. About 60 percent of those will be dead within a year of diagnosis; between 70 and 80 percent will be dead within two years. More people die of lung cancer than of colon, breast and prostate cancers combined, according to the ACS.

Most frustrating for cancer experts is that most lung cancer is rooted in a lifestyle choice that people freely make: the decision to smoke.

We spoke late last week with Peter Mazzone, co-director of the lung cancer program at the Cleveland Clinic, about the state of cancer research and treatment.

We often hear that lung cancer is difficult to detect in the early stages. Why is that?

When lung cancer is in its early stages, few patients have symptoms. . . . They're not coughing or having chest pains or shortness of breath. They often don't have any symptoms until the cancer has progressed to a later stage of the disease, so there'd be no reason for them to come to the attention of the medical system. . . .

What are the typical first indicators? There are two quite separate ways that someone might present with lung cancer. One is with symptoms that are pretty nonspecific. . . . Someone could have a cough because they had smoked, or they could have emphysema or they could have a cold that's taken a long time to go away.

The second way is that a lot of people get pictures of their lungs taken -- chest X-rays or CAT scans -- for entirely different reasons, and those scans or pictures might incidentally show an abnormality that later on turns out to have been a lung cancer.

Since nine out of 10 cases occur in smokers, should smokers have this sort of screening for cancer even when there are no symptoms?

There've been many, many studies through the years looking for ways to screen for lung cancer, just like mammography can screen for breast cancer and or a Pap smear can screen for cervical cancer. The methods used have been chest X-rays, examination of the sputum, now more recently CAT scans in people who are at risk for lung cancer -- right age group, having had a significant smoking history. To date there has been no screening test that has been proven to reduce lung-cancer-specific mortality and/or be cost-effective.

Now, the National Cancer Institute has the largest screening trial ongoing. It's a trial using CAT scan in one group at risk and chest X-ray in another group at risk. They are recruiting about 50,000 people, and results from this study should be available in around 2009. Maybe at that time we'll find out that we should be suggesting a screening test such as a CAT scan to our patients. But as of right now, there's no accepted screening test.

What is the life expectancy for people who are diagnosed with lung cancer in later stages?

The survival rate is very, very dependent on the stage of the cancer. Because most people present later in the course of their disease . . . the survival rate is only about 15 percent at five years. So five years after the diagnosis, only about one in eight patients diagnosed with lung cancer will be living. And the later the stage [at which the cancer is detected], the worse [the prognosis] is.

For disease that has already spread outside the chest, to the brain and bones and so on, we might have an average survival of 12 to 18 months, and maybe 1 or 2 percent of those individuals will be alive five years from their diagnosis.

What are some of the things that make treating lung cancer particularly challenging?

Most cancers of a solid organ, like a lung, a kidney, a colon or breast, are best treated if the tumor itself can be entirely removed from the body. Chemotherapy and radiation therapy are useful in some situations, but localized disease that can be entirely removed from the body is the best situation to try to cure someone of a cancer.

Lung cancer is particularly difficult to treat for two reasons: One is because most people present at a stage where the cancer has gone beyond a very local area -- where it's already spread to the lymph nodes or outside of the chest cavity; it's spread in a way that you cannot remove all the cancer cells with surgery alone.

The second reason is that even when you can remove the cancer from the lung, a lot of individuals who develop lung cancer have other lung diseases. They may have emphysema, because they've smoked throughout their life. And to remove a good portion of the lung to take out this cancer leaves somebody with less lung to breathe with. So you have to have a patient who's fit enough to tolerate removal of a good portion of a lung.

Are there developments on the horizon in terms of ways to prevent lung cancer?

There are things on the horizon for all of these areas -- prevent, diagnose, screen and treat -- none of which I'm so optimistic will be available in the next year or two, but certainly a lot of work's being done. Prevention, I think, is clear to everyone. Prevention is simply: Don't smoke. There's no other way to say that, or to advance it beyond helping people quit smoking. . . .

As far as diagnosis and possibly screening, there's a lot of work being done in a couple of arenas: One is looking at the gene patterns of people who have lung cancer, the protein patterns of people who have lung cancer, with hopes that there can be a constellation of proteins [that] may be detected on a blood test that might suggest very, very early cancer, early enough to treat with a curative intent. That's a ways away [but] both those are the kinds of things that are being looked at.

The other area, and where [the Cleveland Clinic] is involved in looking is analysis of the exhaled breath of patients . . . .We collect and analyze that breath to see if there are patterns of chemicals in the breath of lung cancer patients that are unique and therefore we can identify people with lung cancer just by collecting their breath. This would be a very nice diagnostic test, because it's noninvasive, breath is easy to get, there's no risks and if we can detect cancers early enough, it could perhaps be considered for studies of a screening test.

What about possible advances in therapy?

Advances in therapy are always being looked at. There are many different targeted therapies trying to use chemotherapy in a less-broad manner. Right now, the chemotherapies don't just go to the cancer cells and kill them, but they can affect any cells that are growing. The hope would be that targets could be identified that are specific to the cancer cells so that our chemotherapy agents could kill the cancer cells without damaging normal cells.

Other people are looking into delivery of chemotherapy agents directly to the cells with nanoparticles -- very, very tiny molecules that will hold chemotherapy agents and will attach themselves to the cancer cells and then release that chemotherapy agent locally within those cancer cells.

Those, again, are a sort of distant hope for major advancement in treatment of lung cancer, but a lot of work is being done in those areas.

And if there is a take-away message from all of this, given that lung cancer incidence is so dependent on smoking, is it that if you avoid that habit, this is very unlikely to happen to you?

Absolutely. Our technologies will advance, we'll get better at diagnosing and treating, there's no question whatsoever about that.

But the much, much simpler answer is that if you don't smoke, you are extremely unlikely to get lung cancer. The sooner you quit smoking if you've started, the less likely you are to develop lung cancer. And that really, really should be the take-home message. People can do that for themselves.•

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But the much, much simpler answer is that if you don't smoke, you are extremely unlikely to get lung cancer. The sooner you quit smoking if you've started, the less likely you are to develop lung cancer. And that really, really should be the take-home message. People can do that for themselves.•

Comments like that never cease to make we want to reach through the words and choke the "expert" who said it..... :evil:

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