HEALTH MATTERS: Screening, staging and appropriate treatment key to beating lung cancer

By John A. Heim, M.D.

If you have a history of smoking, it’s a fact that your risk for lung cancer increases exponentially.

In fact, people who smoke cigarettes are 15 to 30 times more likely to get lung cancer than people who do not smoke, according to the Centers for Disease Control and Prevention.

However, screening — along with accurate staging and appropriate treatment — can stop lung cancer from advancing and improve the chances of beating the disease.

Screen before symptoms occur

Lung cancer typically does not cause symptoms until it is in its advanced stages, when a cure is unlikely. When symptoms do develop, they most commonly include:

• A cough that does not go away or gets worse

• Coughing up blood

• Chest pain that is often worse with deep breathing, coughing or laughing

• Shortness of breath or wheezing

• Feeling tired or weak

• Recurring infections such as bronchitis or pneumonia

Screening using a low-dose CT scan in high-risk patients can detect lung cancer in its earliest stages before symptoms occur. People 55 and older who have a 30-pack-a-year smoking history are candidates for screening.

To help make lung cancer screenings more affordable and accessible, Penn Medicine Princeton Health makes them available at no cost to patients who meet the eligibility criteria.

Some lung cancers are also found early by accident through tests for other medical conditions. It is important to note that while smoking is linked to about 80 to 90 percent of lung cancers, people who have never smoked can still develop the disease. Research shows that most of these patients are women.

Staging key to effective treatment

If a lung nodule is detected and determined through a biopsy to be cancer, your doctor will order further tests to detect whether the cancer has spread, and if so, how far.

This staging process is key to identifying the most effective treatment approach. Several factors are considered when staging cancer, including:

• The size of the tumor and whether it has grown into nearby structures or organs

• Whether the cancer has spread to nearby lymph nodes

• Whether the cancer has spread to distant organs such as the brain, bones, liver, kidneys or other lung

Staging typically involves a range of imaging tests, including a CT scan, MRI and a PET/CT scan.

With CT and MRI, doctors are able to determine the size, shape and position of any lung tumors and are able to identify any enlarged lymph nodes that may contain cancer that has spread from the lungs.

A PET scan helps doctors further identify cancerous cells through the use of an injectable sugar solution containing a small amount of radioactive material that enables doctors to see areas where the sugar is being used. Because cancer cells use an abnormal amount of sugar, diseased areas will essentially light up when a patient undergoes the scan. This allows doctors to further pinpoint the location and behavior of the cancerous cells.

A combined PET/CT scan is designed to more accurately identify even small tumors and can help reveal whether they are benign or malignant. A biopsy, however, is the only sure way to determine whether a tumor is cancerous. A combined PET/CT scan is more precise than each test alone and allows for more accurate staging, which helps ensure effective treatment and reduces the risk for recurrence.

A team approach

Depending on the type, stage and other factors, treatment for lung cancer may include surgery to remove part of the lung that contains cancer (wedge resection) or the entire lobe that contains cancer (lobectomy). Surgery may also include the removal of nearby diseased lymph glands.

For patients who may not be candidates for surgery because of marginal lung function or other health complications, stereotactic body radiation therapy, which delivers targeted radiation to tumors using only a few treatments, may be an option.

Patients may also need radiation and/or chemotherapy.

Additionally, some patients may benefit from immunotherapy, a rapidly advancing form of treatment that uses the body’s own immune system to fight cancer.

At the Edward and Marie Matthews Center for Cancer Care at Penn Medicine Princeton Medical Center, weekly cancer conferences are held with a multidisciplinary team of physicians, including radiologists, surgeons and oncologists, who review National Comprehensive Cancer Network guidelines, along with the radiology, pathology and treatment plans for cancer patients. These weekly conferences are designed to ensure the most appropriate, personalized care is provided to all cancer patients.

To schedule an appointment with Princeton Medical Center’s Lung Cancer Screening Program, call 609-853-7070.

John A. Heim, M.D., is board certified in general and thoracic surgery and is the chairman of the Department of Surgery at Penn Medicine Princeton Medical Center.