Lung Cancer Awareness: Facts, Advances in Treatment and How to Lower Your Risk
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Lung cancer remains a significant health challenge, affecting millions worldwide. In this blog, we speak to Nathaniel Moulton, M.D., a board-certified interventional pulmonologist at INTEGRIS Health Medical Group Baptist Pulmonary Medicine, to learn more.
“Recent advances in screening, diagnosis, treatment and research are providing new avenues of hope and improved outcomes for patients,” Moulton says. “Understanding the risk factors is key, and we’ll explore effective strategies to reduce those risks, including lifestyle modifications and preventive measures.”
The basics
At a glance: Lung cancer begins in the lungs, which are two spongy organs in the chest responsible for taking in oxygen and releasing carbon dioxide. It occurs when cells in the lungs grow uncontrollably, forming tumors that can interfere with the lungs’ ability to function normally.
Lung cancer begins when cells genetically mutate and grow uncontrollably.
- As cancer cells multiply, they form a tumor.
- Tumors can interfere with the normal functioning of the lungs, affecting breathing and oxygen exchange.
- Symptoms include a persistent cough, chest pain, shortness of breath, wheezing, coughing up blood and recurrent respiratory infections such as pneumonia or bronchitis.
“Lung cancer may not present with symptoms until it’s in late stages,” Moulton adds, “making it important to pursue screening when it’s more easily treated.”
Two types of lung cancer exist: non-small cell and small cell.
- Non-small cell lung cancer (NSCLC) is the most common type, accounting for about 80 to 85 percent of all lung cancer cases.
- Small cell lung cancer (SCLC), which grows fast, accounts for about 10 to 15 percent of lung cancers and is usually associated with smoking.
Non-small cell lung cancer falls under three subtypes.
- Adenocarcinoma is the most common type of NSCLC and is usually found in the outer part of the lung in non-smokers and women.
- Squamous cell carcinoma typically starts in the central part of the lungs in the bronchi and is linked to smoking.
- Large cell carcinoma can develop in any part of the lung and tends to grow and spread quickly.
Small cell lung cancer is more aggressive and is more likely to spread to distant parts of the body.
- Small cell carcinoma (oat cell cancer) is the most common type and tends to grow rapidly and form large tumors.
- Combined small cell carcinoma is a mixture of small cell carcinoma and non-small cell components, such as adenocarcinoma or squamous cell carcinoma.
The facts
Why it matters: Lung cancer is the leading cause of cancer-related deaths, with smoking being the primary risk factor, contributing to approximately 85 percent of cases. Despite advancements in treatment, the overall five-year survival rate remains low at 26.6 percent. Lung cancer is more common in older adults, with the majority of cases occurring in individuals aged 65 and older. Men historically have had higher incidence rates.
Lung cancer kills about 357 people per day, according to the American Lung Association.
- Each year, lung cancer is diagnosed in about 234,580 people, according to the American Cancer Society, with 116,310 cases in men and 118,270 in women.
- Tragically, it leads to about 125,070 deaths, affecting 65,790 men and 59,280 women.
- As the leading cause of cancer death in the United States, lung cancer accounts for about 20 percent of all cancer-related fatalities. It claims more lives each year than colon, breast and prostate cancers combined.
Older adults are primarily affected by lung cancer, with the majority of diagnoses occurring in people aged 65 and older (70 is the average age of diagnosis).
- Over time, older adults are exposed to more risk factors such as smoking, secondhand smoke, air pollution and occupational hazards like asbestos and radon.
- Additionally, cells undergo more divisions as people age, increasing the likelihood of genetic mutations and cancer development.
- Older people also suffer from weakened immune systems, which makes it harder to detect and destroy cancerous cells.
The five-year survival rate for lung cancer is 26.6 percent, which is up from 22 percent, according to figures from the American Lung Association.
- The use of low-dose CT scans for high-risk populations has led to earlier detection of lung cancer, which is crucial for improving survival rates.
- There have also been significant advancements in lung cancer treatments, including targeted therapies and immunotherapies.
Men have a higher rate of developing lung cancer compared to women.
- More men smoke, and smoking is the leading cause of lung cancer.
- More men also work in industries with higher exposure to lung carcinogens, such as asbestos, radon and certain chemicals.
Lung cancer screening
Lung cancer screening began in 2015. Thanks to lung cancer screening, early detection rates are increasing each year. Screening can reduce the lung cancer death rate by 20 percent by detecting tumors at early stages when cancer is more likely to be curable. The United States Preventative Task Force recommends annual lung cancer screening with a low-dose CT scan for patients who meet the following criteria:
- Age between 50-80.
- Have a smoking history of at least 20 pack-years.
- Currently smoke or have quit smoking within the past 15 years.
Patients should talk with their doctor to see if screening is right for them.
Diagnosis
Lung nodules are typically identified after a CT scan of the lungs, either for screening or incidentally found when the CT is performed for other reasons. Some nodules are benign, while others are more concerning for cancer. A pulmonologist will help determine if a biopsy is needed.
Traditionally, biopsy is performed using a flexible bronchoscope. This is a tool used by the pulmonologist to reach into the lungs to take a small sample of the lung nodule.
Recent advances in pulmonary medicine have seen the use of robotics to assist pulmonologists in lung biopsy. The robotic bronchoscopy platform allows for the use of computer-assisted navigation, a smaller catheter, more flexibility and increased stability to help the pulmonologist reach smaller and more distant nodules deep in the lung. This helps to catch and diagnose lung cancer at earlier stages, when it is more easily curable.
Advancements in lung cancer treatment
Key points: Traditionally, lung cancer treatment relied heavily on surgery, chemotherapy and radiation therapy. While beneficial, these options often came with significant side effects and varying success rates, especially in advanced stages. The landscape of lung cancer treatment has seen significant advancements, offering new hope and options for patients at both early and advanced stages. These innovations are continuously reshaping how lung cancer is managed, focusing on personalized approaches and leveraging cutting-edge therapies.
Early-stage treatment
Surgery remains the main treatment option for early-stage non-small cell lung cancer.
- However, recent developments have shown that less invasive surgical techniques can be as effective as traditional methods.
- A notable clinical trial determined that removing only part of the affected lobe can be as beneficial as removing the entire lobe.
Targeted therapies block the growth and spread of cancer by interfering with specific molecules, often proteins, that are involved in tumor progression.
- One significant advancement is the approval of osimertinib by the FDA in 2021.
- This targeted therapy is used as an adjuvant treatment following surgery for patients whose tumors have specific EGFR mutations.
Immunotherapy has grown as an important treatment option for lung cancer by harnessing the body's own immune system to combat cancer cells.
- Atezolizumab and pembrolizumab have been approved for use after surgery and chemotherapy in patients with early-stage disease.
- Nivolumab, in combination with chemotherapy, is approved for use before surgery (neoadjuvant therapy) and showed improved survival rates.
Advanced-stage treatment
Advanced-stage lung cancer treatment has been revolutionized by the introduction and refinement of immunotherapies and targeted therapies. Immunotherapy options have been refined over the years and now include several approved options such as pembrolizumab, atezolizumab and nivolumab.
- Researchers continue to explore predictive markers such as PD-L1 levels and tumor mutational burden (TMB) to determine which patients can benefit the most.
Targeted therapies have grown thanks to various drugs that target specific genetic mutations within tumors.
- ALK inhibitors (alectinib and ceritinib) target ALK gene rearrangements in NSCLC patients – alectinib also treats brain metastases associated with ALK-positive cancers.
- EGFR inhibitors (osimertinib) are the most common treatment for EGFR-mutated non-small cell lung cancer, with other inhibitors (afatinib and gefitinib) providing alternative options.
- ROS1 inhibitors (crizotinib and entrectinib) and BRAF inhibitors (combination of dabrafenib and trametinib) target two rare gene rearrangements that can cause non-small cell lung cancer.
- Other NSCLC targeted drugs inhibit other genetic mutations, such as NRTK inhibitors (larotrectinib), MET inhibitors (tepotinib or capmatinib) and RET inhibitors (selpercatinib and pralsetinib).
Reducing the risk
The bottom line: To lower the risk of lung cancer, avoid smoking and secondhand smoke, as tobacco exposure is the leading cause of this disease. Minimize contact with known carcinogens such as radon and asbestos. Live a healthy lifestyle by exercising regularly and eating a balanced diet.
Avoid smoking or quit if you currently smoke.
- Well-known carcinogens such as benzene, formaldehyde and polycyclic aromatic hydrocarbons found in tobacco smoke damage the DNA in lung cells.
Avoid secondhand smoke by ensuring your home and workplace are smoke-free environments.
- In the U.S., exposure to secondhand smoke causes more than 7,000 lung cancer deaths a year, according to the American Lung Association.
Test for radon, a naturally occurring gas that can accumulate in homes.
- Radon particles emit radiation that damages lung tissue, potentially leading to cellular mutations.
Use protective equipment if you work in an industry with exposure to carcinogens.
- Respirators, masks and ventilation systems are all ways to protect against contaminants.
Maintain a healthy diet by eating fruit, vegetables, whole grains and lean meats.
- Antioxidants and other nutrients in fruits and vegetables support overall health.
Exercise regularly to help improve lung function.
- More efficient lungs enhance the body's ability to filter out harmful substances and reduce the likelihood of cellular damage.
