Lung Cancer – Prevention is the Best Treatment

with Rula Al-Saghir, M.D., pulmonary specialist with Advanced Healthcare

Last Updated: Aug. 1, 2003

A lot of different diseases have been termed “the silent killer” but among cancers, lung cancer holds that title. There are no screenings for lung cancer. By the time symptoms appear the cancer has often spread and the prognosis becomes poor. Fortunately, it is almost always preventable, by not smoking or by quitting the habit.

Though very rare, lung cancer can appear in non-smokers. Other risk factors include exposure to secondhand smoke, asbestos, soot, tar, radiation and other occupational carcinogens. Lung scarring secondary to tuberculosis, lung fibrosis and chronic obstructive lung disease also increase the risk of lung cancer.

Rula Al-Saghir, M.D., Pulmonary Specialist with Advanced Healthcare "It’s tough to tell people they have lung cancer so I try to prepare them even before the biopsy by telling them it doesn’t look good, they are a smoker, that it might be a tumor."

Screening – a vital issue
According to Dr. Rula Al-Saghir, a pulmonary specialist with Advanced Healthcare, there are no good screenings methods for lung cancer. Most lung cancer is caught by routine chest X-rays but is usually far advanced by the time it can be seen on an X-ray.

Recent studies revealed that “low dose CT scan” of the chest to be a promising screening method for lung cancer. However more studies are needed before it is considered standard of care. “There is currently a National Institute of Health study of this scan going on at the Marshfield Clinic. One of my patients did choose to go and did test positive for lung cancer and I just sent her to a surgeon,” the doctor said.

Symptoms
Symptoms of lung cancer include an increase in chronic “smoker’s cough,” recurring bronchitis or lung infection, shortness of breath, hemoptysis “coughing up blood,” chest pain, hoarseness, weight loss, persistent low fever, and pain and weakness in shoulder, arm or hand.

“Patients are most lucky if the cancer grows toward the airway and causes recurrent infection and pneumonia which will make a physician suspect lung cancer,” said Dr. Al-Saghir.

Lung cancer also causes symptoms elsewhere in the body. High levels of calcium and other electrolytes abnormalities in the blood might be caught by lab work during a physical. A little-known outward symptom is clubbing of the fingertips. “The ends of the fingers become round and puffy. In all the patients I’ve seen with this change, not one noticed it,” Dr. Al-Saghir said.

Tests and treatment
Biopsies for lung cancer depend on its location. If the cancer is near the main airways, the likely procedure will be a bronchoscopy. In this procedure, a thin and flexible tube is passed down the airway. The doctor can examine the airways and take samples of suspicious areas.

For cancers located closer to the chest wall, physicians take a tissue sample through the chest wall using a CT scan guided needle. Both of these are done on an outpatient basis. “I do my own bronchoscopies. A radiologist will do the needle biopsies,” Dr. Al-Saghir said.

Once cancer is diagnosed, the next step is to determine if it has spread. For this, physicians are beginning to use full-body PET scans, a relatively new type of scanning. “It’s fairly sensitive and specific at seeing lung cancer,” the doctor said.

If the cancer has not spread, the most effective treatment is surgical removal of the cancer. Usually an entire lobe in the lung will be taken to ensure that all the cancer cells are caught.

Once cancer is diagnosed, the next step is to determine if it has spread.

Not everyone is a good candidate for surgery. A patient who also suffers from emphysema might not have enough lung capacity after surgery. For these patients, the treatment becomes radiation and chemotherapy.

“I usually send them to an oncologist who will tell them their options and may suggest a clinical trial if they qualify. They will likely also meet with a radiation oncologist concerning that treatment,” the doctor said.

Treatment can be taxing, particularly on those who are older or not otherwise in good health. “In some patients the treatment can be worse than the cure. I tell these patients that it is OK to do nothing. I say that we can control the pain, which is something people often fear the most,” the doctor said.

Breaking the news
“It’s tough to tell people they have lung cancer so I try to prepare them even before the biopsy by telling them it doesn’t look good, they are a smoker, that it might be a tumor. If it is cancer, I follow up personally and always want a family member to come in with the patient. That helps emotionally. Also when you discuss options, the patient may not comprehend everything you say because they are in a state of shock. Family members can help them deal with the options,” the doctor said.

Beating the odds
“I know far more sad stories than good stories but people should have hope,” Dr.
Al-Saghir admitted and shared these stories of people who beat the odds.

“In 1992 I saw a patient who had significant emphysema so only the tumor could be removed. She is still alive and well with no evidence of cancer. Another patient with emphysema could have only radiation and chemotherapy. He did so well his cancer was cured. However, he continued to smoke, thinking it was too late to quit! Eleven years after his first cancer was diagnosed, he had it again.”

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