In Fort Bend County, home to most Katy News readers, 217 residents will be diagnosed with lung and bronchus cancer this year, according to the Texas Cancer Registry. Lung cancer is the deadliest cancer in Texas. For oncologists like me, this is especially troubling because most lung cancer is smoking-related and therefore, preventable.
Indeed smoking is the largest preventable cause of death of cancer and other diseases, and contributes to 80 percent of lung cancer deaths, according to the American Cancer Society. Still, 40 million adult cigarette smokers remain in the U.S., according to a new study published in JAMA Internal Medicine.
The study reports that cancer deaths attributable to cigarette smoking vary substantially across states, but the rates are highest in the South, where approximately 40 percent of cancer deaths in men are linked to smoking.
Each year, more people die from lung cancer than colon, breast, and prostate cancers combined. In 2016, an estimated 13,645 new lung cancer diagnoses and 9,438 deaths are expected from the disease in Texas.
Lung cancer is the uncontrolled growth of abnormal cells in the lungs. Most lung cancers start in the bronchial tubes, which let air in and out of your lungs so you can breathe. The most common type, non-small cell lung cancer, accounts for approximately 80 to 85 percent of lung cancers. The other main type is small cell lung cancer, sometimes call oat cell cancer.
Risk Factors and Prevention
Smoking is the leading cause of lung cancer. In fact, at least 30 percent of all cancer deaths are caused by smoking, according to the American Cancer Society. Men and women who smoke are 23 times and 13 times, respectively, more likely to develop lung cancer. Smoking can shorten life expectancy by 10 years.
Not everyone who smokes develops lung cancer, and sometimes people who do not smoke still get lung cancer. Second-hand smoke, air pollution, and workplace exposures to asbestos, arsenic, radioactive gas, and diesel exhaust can sometimes cause lung cancer. Although rare, some lung cancers are caused from exposure to a gas called radon — a colorless, odorless, radioactive gas sometimes found in indoor air and in water from underground sources like wells.
The genes we inherit from our parents also play a factor in lung cancer. Genes essentially contain instructions for controlling when cells grow, divide to make new cells, and die. Some people inherit a weak ability to rid certain types of cancer-causing chemicals in the body, such as those found in tobacco smoke. That may put them at a higher risk for lung cancer. People with a parent or sibling with lung cancer also face an increased risk of lung cancer.
Prevention measures help guard against lung cancer. Doctors recommend not smoking; avoiding secondhand smoke; and taking precautions at work against harmful fumes, dust, and chemicals. A universal screening test is not yet available, but people ages 55-74 with a history of heavy smoking, who smoke now, or who quit within the past 15 years should consider a yearly low-dose CT to screen for lung cancer, which could reduce risk of dying from lung cancer. Radon detection kits, as well as EPA-suggested companies, can be used to test your home for radon.
Symptoms
There are a few detectable symptoms, which can vary from person to person. They may include coughing up blood or a cough that does not go away or worsens; chest pain that is often worse with deep breathing; hoarseness; loss of appetite; fatigue or weakness; wheezing; unexplained weight loss; shortness of breath; or infections such as bronchitis and pneumonia that don’t go away, or keep coming back.
If lung cancer spreads to distant organs, it may cause bone pain; nervous system changes such as headache, weakness or numbness of an arm or leg; or yellowing of the skin and eyes, from cancer spread to the liver.
Diagnosis and Treatment
To diagnose lung cancer, physicians may use a variety of tests. If cancer is confirmed, doctors conduct additional tests to learn cancer’s severity and if it has spread to other parts of the body, which may include a computed topography scan (CT scan) or positron emission tomography (PET ). The results help physicians determine the best treatment options.
After a doctor has found the cancer and its stage, patients may be treated by a team of specialists, including pulmonologists, thoracic surgeons, medical oncologists, radiation oncologists, and palliative physicians. Treatment options vary depending on the stage and type of the cancer, the patient’s symptoms and overall health, and a variety of other factors. Treatment for lung cancer is determined by the stage at presentation and may consist of a combination of surgery, radiation, or chemotherapy.
Targeted therapies may be beneficial in lung cancers with certain gene mutations, which can be identified by molecular testing. Immunotherapy and proton therapy are other treatment options. Clinical trials evaluating new therapies for lung cancer may be available to patients.
Patients treated with immunotherapy are given drugs that enhance the immune system. The growth of cancer cells is slowed or stopped entirely and the cancer cannot spread as a result. Two new immunotherapy drugs, nivolumab and pembrolizumab, were approved in October 2015 to boost the body’s ability to fight against lung cancer cells.
For some lung cancer patients, highly precise proton beam radiation therapy may be the optimal treatment option. The new Texas Center for Proton Therapy in the Dallas/Fort Worth area has the most advanced proton therapy technology in the state, which destroys cancer cells while minimizing side effects and damage to healthy tissue.
Lung cancer is a deadly disease. But it is preventable through avoiding smoking, and it is treatable. Working with your doctor for the best treatment options, hope is within reach.
Branden Hsu, M.D. is a medical oncologist at Texas Oncology–Katy, 1331 West Grand Parkway North, Suite 340 in Katy, Texas and at Texas Oncology–Houston Memorial City, 925 Gessner Road, Suite 550, in Houston, Texas.