What to know about lung cancer screening, treatment and research

Lung cancer is the leading cause of cancer deaths, but new advances in prevention, lung cancer screening and research are helping to save more lives. And, here at MD Anderson, we're leading the fight against lung cancer by focusing on prevention, lung cancer screening and personalized lung cancer treatment through our Moon Shots Program, an ambitious program to reduce cancer deaths for several cancers and ultimately find cures for these and other cancers.

We spoke with Ara Vaporciyan, M.D., and Mara Antonoff, M.D., to find out what you need to know about lung cancer. Here's what they had to say about lung cancer screening and early detection, as well as the latest in lung cancer treatment and research.

Who is more likely to develop lung cancer?
Cigarette smoking is estimated to directly cause about 85% of all lung cancers. Smoking cigars or pipes, as well as secondhand smoke exposure, also put you at increased risk of developing lung cancer. 

So does exposure to certain environmental carcinogens, such as asbestos, radon, arsenic, tar, chromium and nickel.

Lung cancer also can run in families, but we have yet to identify exactly the genetic basis for this.

Lung cancer also is becoming more common in women.

Why are more women being diagnosed with lung cancer?
We're not entirely sure. Many attribute it to women's late adoption of smoking compared to men. Women didn't really start smoking until a couple of decades after men, so there may be a lag in lung cancer showing up in women.

In addition, lung cancer screening is improving, which may be causing us to diagnose more lung cancer cases in both men and women, and more women may be undergoing lung cancer screening.

What are common lung cancer symptoms?
Many lung cancer patients don't show any symptoms, and instead discover lung cancer during an X-ray taken for another reason. However, some individuals may experience coughing, shortness of breath or recurrent lung infections.
 
Lung cancer symptoms sound similar to those of other conditions, such as bronchitis, pneumonia and asthma. At what point should a patient ask seek further testing?
If symptoms don't get better with treatment, become worse, or return repeatedly, see a doctor for further testing. Also see your doctor if you're at higher risk for lung cancer.

Ask for a chest X-ray, and, if something shows up, ask to repeat the test, even if your symptoms improve with treatment. That'll help confirm that what they saw went away with treatment.

What can people do to boost their chances of finding lung cancer early, when it's most treatable?
In 2013, the US Preventive Services Task Force issued recommendations that for annual lung cancer screening with a low-dose spiral CT scan for those who:

• Are 55 to 80 years old
• Have a 30-pack-year history of smoking (which translates to 1 pack of cigarettes a day for 30 years, 2 packs a day for 15 years, etc.)
• Smoke or have quit smoking within the past 15 years

If you fit this description and are interested in screening, talk to your doctor about your options. You may decide to undergo screening at MD Anderson's Lung Cancer Screening Clinic.

What are the most common lung cancer treatment options?
We determine the best course of lung cancer treatment on a case-by-case basis, depending on the disease stage, tumor size, location, and involvement of other structures, as well as the patient's age and overall health. Surgery is the standard of care for early-staged lung cancer, but most lung cancer cases require surgery in addition to chemotherapy, radiation and/or other targeted therapies.

Even though some patients have tumors that are small enough to be removed surgically, significant lung damage from smoking may prevent us from safely removing any amount of lung.  For these patients, new radiation options, such as proton radiation therapy are available. 

What are the most promising areas of lung research happening at MD Anderson?
We're studying the role that genetics play in lung cancer and looking at specific mutations in the cancers, so that we can better treat them through targeted therapies. These targeted therapies hold great promise. In the future, we may no longer stage the cancer with X-rays and instead simply get a biopsy, test for genetic abnormalities, and start the targeted therapy that treats that specific tumor. 

Radiation therapy also has improved. Better targeting with stereotactic body radiotherapy (SBRT), for instance, allows small tumors to be treated with less damage to the surrounding lung.  And, new energy sources such as proton therapy allow us to target the tumor without damaging the surrounding tissue.

Finally, we're using minimally invasive techniques and robotic surgery. This allows us to perform surgery without affecting the ribs. We also can better control patients' pain with new analgesics, which has improved recovery and results after surgery.

What's your advice for those who've been newly diagnosed with lung cancer?
Focus on getting the best possible care instead of rushing to undergo surgery. Hurrying to get surgery without working with a team that really understands your tumor can hurt you much more than a two-week delay waiting for test results.

So, seek lung cancer treatment at a cancer center that focuses on lung cancer staging, like we do here at MD Anderson. Be patient while all the information is assembled. Every treatment decision we make is based on the stage of the cancer, so it's crucial to have this information before surgery or other treatments.

Cancer treatment is a team sport. As with any team, we are only as strong as our weakest link. Getting evaluated and treated at a center with extensive lung cancer experience is the best way to ensure you have the best team. 
 
Lung cancer is one of the cancers MD Anderson is focusing on as part of our Moon Shots Program to dramatically reduce cancer deaths. Learn more about our Lung Cancer Moon Shot.