Risk Factors, Diagnosis and a New Era of Treatment Options for Lung Cancer

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): And welcome to the show. I am Deborah Howell, and today we'll be talking about the risks for developing lung cancer along with diagnosis and treatment options available. Our guest today is Dr. Samer Kanaan, thoracic surgeon with Orange Coast Memorial Medical Center. Welcome, Dr. Kanaan.

Samer Kanaan, MD: Great, thank you for having me.

Deborah Howell (Host): You are very, very welcome. The American Cancer Society estimates that in the US about 225,000 new cases of lung cancer will be diagnosed, along with over 155,000 lung cancer deaths, occurring in 2017, making it the second most common cancer in both men and women. So doctor, what are the types of lung cancer, and what's the difference between them?

Samer Kanaan, MD: Yes, well, we divide lung cancer, there's many subtypes, but to simplify, there's non-small cell lung cancer, which is about 20% of patients, mainly treated with chemotherapy. And then 80% of patients have the non-small cell lung cancer. And the non-small cell, different than the small cell, can be divided into adenocarcinoma or squamous cell carcinoma. And if you can catch the non-small cell lung cancers early, you can hopefully do surgery to cure them, but chemotherapy and radiation are also used for people with advanced disease.

Deborah Howell (Host): I got it. You're actually using the word cure now.

Samer Kanaan, MD: Yes.

Deborah Howell (Host): That is fantastic news. Okay, what are some common risk factors for developing lung cancer?

Samer Kanaan, MD: Well, the most common risk factor, over 90 to 93% of patients, it's smoking. There are patients who can have other risk factors, second-hand smoke exposure is a known factor, radon from the environment, pollution, those are contributing factors, but the overwhelming risk factor is smoking. So anything we can do to get people to quit or prevention programs to get young high schoolers etc. to prevent them from ever starting smoking is really going to be the big difference for lung cancer prevention.

Deborah Howell (Host): Absolutely, it's a no-brainer. And then what are some symptoms one may experience if you have lung cancer?

Samer Kanaan, MD: Well, most patients if you can catch them early would be asymptomatic. And we can certainly talk about lung cancer screening for those patients. But patients that are symptomatic, many times it's a sign it could be more advanced disease. But I always tell physicians and patients, if you have a cough that doesn't go away, meaning months or weeks it just doesn't resolve itself, then that should be a sign to go seek medical attention. Anyone that coughs up blood should be a red flag, it shouldn't be ignored. It could represent a lung cancer, it could just be a bad infection, but you should seek medical attention. And then pleurisy or pain when you take a deep breath in, can also represent lung cancer. Many times it's just an infection, but those three symptoms are the ones that I recommend that you should seek medical attention to make sure it's nothing more serious.

Deborah Howell (Host): Absolutely. And how is lung cancer then diagnosed?

Samer Kanaan, MD: Many times we used a chest X-ray, but the gold standard now is a CAT scan. And many times it can be a CAT scan without contrast. That is the best test. If you see some abnormality in the lung, and then there are different ways. We can use a CT-guided biopsy, where a radiologist numbs the skin and puts a needle in to get a diagnosis. Sometimes it requires a surgical procedure to get a diagnosis, which we can talk about in a little bit. And then other ways, pulmonologists or lung doctors that are not surgeons, they'll put a scope on the inside of the lung and they can guide a needle in different ways to make a diagnosis that way.

Deborah Howell (Host): Okay, got it, plenty of ways to do that. We touched on this earlier, but what is the early lung cancer screening, and who should consider getting screened?

Samer Kanaan, MD: Yeah, that's a great question. So, for many years we didn't have a good answer. We used chest X-rays and sputum meaning coughing up into a cup, but those weren't very good. And the last several years, there was the National Lung Cancer Screening Trial that was published in the New England Journal of Medicine. And it was a landmark study looking at non-contrast low-dose radiation CAT scans. And it found that if you take patients between the age of 55 and 74 who had a significant smoking history, which we use the term a 30 pack-years, so that means maybe a pack a day for 30 years or two packs a day for 15 years, those patients, those high-risk patients, there was a significant survival advantage with screening every year with a lung cancer CAT scan. And so that's now been approved by Medicare and all the major insurance companies, and it clearly saves lives. And so if a patient is in that age group and they think they had a significant smoking history, they should talk to their doctor because they could qualify for a life-saving lung cancer screening CAT scan.

Deborah Howell (Host): Absolutely, that's covered by their insurance, amazing. Okay.

Samer Kanaan, MD: Yeah, it was not before, but the last year or two it has been and it's a major improvement for patients and their care.

Deborah Howell (Host): So no reason not to get one if that is your history. What are the various stages of lung cancer, doctor?

Samer Kanaan, MD: Well, lung cancer, we divide, as most cancers, into four stages. Stage 1 being the earliest, and then 2, 3, and 4. Stage 1 and 2, stage 1 means it's just confined to the lung, and stage 2 just to simplify means it's in the lung but there are some lymph nodes near it. Those are amenable to having a surgical procedure to get cure or the best chance for cure. Stage 3 means it's in lymph nodes that are far away from the lung, and again stage 4 would mean metastatic, whether it be to the brain or the liver. And stage 3 and 4, for the most part, are treated with chemotherapy and radiation.

Deborah Howell (Host): Okay. And what do we have, other alternative treatments for lung cancer other than the chemo and the radiation?

Samer Kanaan, MD: Well, surgery, radiation, and chemotherapy are the cornerstones. You touched upon the fact that 155,000 or more Americans will die from lung cancer in 2017. And I try to tell people that more people are going to die from lung cancer than from colon, prostate, or breast cancer combined in the United States. So it is the number one killer for both men and women. And so, if you can do lung cancer screening and catch a cancer early, then we can offer surgery. We used to do an open surgery, meaning we make a large incision and sometimes cut out a rib, and patients would have a lot of pain and a lot of complications. Now we do it video-assisted, and more recently, surgeons like myself are trained to do it robotically. So they're minimally invasive approaches, so you have the same good cancer operation, but tiny 8 to 10 millimeter incisions, so that you can remove the lung cancer, have less pain, faster recovery, less complications, and have people return to work or daily activities much sooner. If you can't do surgery because the patient doesn't have adequate lung function etc., then you can do chemotherapy, radiation, or a combination of them. And the newer things for chemotherapy, there's a lot of new drugs and I'm not a chemotherapy expert, but there's a lot of new drugs that have made the news, we call them targeted therapies. Some of them are recently approved, some of them are experimental, but there's a lot of advances in terms of the drugs that we're offered able to offer to patients in terms of treating them for lung cancer.

Deborah Howell (Host): Is chemo also available in an oral pill for lung cancer patients?

Samer Kanaan, MD: Yes. It's not the first line. Many patients' first line will get an IV, but there are now oral chemotherapy agents, those are the targeted therapies. So we take patients' lung cancers, we do genetic testing on it. And if they have certain mutations that specific drugs target, then those patients can actually have an excellent response. It might not cure them, but it would kind of stop the cancer. And then patients can live for months to years with the cancer kind of in a frozen or controlled state so it doesn't progress, and the oral chemotherapy keeps it in check. And there's been a lot of excitement, there's a lot of new drugs coming out that are specifically targeting different mutations and different areas. And it's very exciting. It's a very advanced and very exciting.

Deborah Howell (Host): It is an excellent new era to be a cancer patient these days.

Samer Kanaan, MD: Yeah, we're doing everything we can from surgery, from chemo to radiation to make strides to get patients cured, but get them cured in a way that's meaningful, so they have a meaningful post-treatment kind of quality of life and recovery.

Deborah Howell (Host): And what advancements do you think will be offered in the future for treating lung cancer?

Samer Kanaan, MD: Well, we touched upon the chemotherapy. I think the drugs are becoming better, less side effects, targeted, so they can take them by mouth instead of IV. Surgery, you know, I've always envisioned, you know, we're doing things now where we go on the inside of the trachea with a scope and we biopsy and diagnose. I wouldn't be surprised in 15 or 20 years if we start removing cancers from the inside so that people don't have scars. I think the technology and the thoughts are there, so why not try doing like that. So I'm excited. I think as we get more advancements with our technology and we apply them, I see some exciting futures of how we do surgery on patients and I think that's a possibility.

Deborah Howell (Host): Do you think we'll see a cure for lung cancer in our lifetimes?

Samer Kanaan, MD: I would hope so. I think the number one thing, as we've learned with all the other cancers, is if you do prevention. So if we can get the 20 million or so Americans to quit smoking, that would be a huge benefit in terms of getting people cured. And then those that did smoke or can't seem to quit, if we can screen them so we catch it early to cure them, I think that's where we need to invest our time because yes, I think it's possible if we do those two things very well, we can certainly find a cure for lung cancer in our lifetime. That would be my dream, that would be my hope.

Deborah Howell (Host): Certainly, certainly. Well, we want to thank you very, very much for your time this morning, Doctor, and we really appreciate you being on the show.

Samer Kanaan, MD: Well, thank you so much for having me. I really appreciate it. Have a wonderful day.

Deborah Howell (Host): You too. And for more information or to listen to a podcast of this show, please go to MemorialCare.org. That's all for this time. I'm Deborah Howell. Thank you for listening and have yourself a very good day.