Lung Cancer- A Basic Understanding
This interview was originally published in www.oncofocus.com on 19th November 2019
As November is marked for raising awareness about Lung Cancer and Pancreatic Cancer, this month we are bringing to our readers' observations/views of two of our highly experienced panel members. Below is the transcript of our interview with Dr. Bivas Biswas, Medical Oncologist from the Tata Medical Center, Kolkata.
He has 10+ years of experience in treating cancer patients and is actively involved in teaching/training medical students. He also is Section Editor inIndianJournalofMedical& Pediatric Oncology and is involved in reviewing journals like - Indian Journal of Pediatrics, BMC cancer, and Journal of Urology .
Dr. Bivas Biswas
DM [Medical Oncology, AIIMS] , MD [AIIMS], MBBS
Medical Oncologist, Tata Medical Center, Kolkata
Join Verifotheis, our in-house panel, to contribute to the evolution of the healthcare paradigm
We understand that most cancers are manageable if they are identified at an early stage. So, for someone with lung cancer to have an early diagnosis, what are the early signs and symptoms?
Dr. Bivas: In general, most lung cancer patients will have a persistent cough that is not improving, even with antibiotics and other supportive care. Other symptoms include-
Dry cough associated with occasional hemoptysis in the sputum
Unexplained weight loss
Hoarseness of voice
What are your suggestions to increase early diagnosis in lung cancer?
Dr. Bivas: Any person having the above said symptoms should consult a physician and get the appropriate evaluation done including a chest X-ray. If there is any discrepancy in the investigation, they should be further advised to go for a CT scan of the chest. A CT scan of the chest area can reveal small lesions in your lungs that might not be detected on an X-ray. The lesion may point towards malignancy which should be taken care by an Oncologist in presence of a Chest physician with further appropriate investigations including a biopsy or fine-needle aspiration.
Who are at risk of developing lung cancer?
Dr. Bivas: Anyone can be at risk of developing lung cancer, particularly those who are chronic smokers, are residing in a very polluted area, or are working in industries like coal mines & asbestos factories, wherein they may get exposed to asbestos and other carcinogens. Passive or second-hand smoking can also cause lung cancer.
From the moment you inhale smoke into your lungs, it starts damaging your lung tissue [cells]. The lungs can repair the damage, but continued exposure to smoke makes it increasingly difficult for the lungs to keep up the repair. Once cells are damaged, they begin to behave abnormally, increasing the likelihood of developing lung cancer in a complex way through millions of mutations in cells. Small-cell lung cancer is almost always associated with heavy smoking. When you stop smoking, you lower your risk of lung cancer over time.
If we treat Stage I lung cancer by surgery, more than 50% of cancer can be cured in the long run, by which I say, Yes! Lung cancer is curable.
What are the major types of Lung cancer?
Dr. Bivas: Lung cancer in medical terms is broadly classified into two major types:
Small cell lung cancers (SCLC)
Non-small cell lung cancers (NSCLC)
This classification is based upon the microscopic appearance of the tumor cells. NSCLC is the most common lung cancer, accounting for about 80% of all cases and SCLC comprises about 20% of lung cancers. Among the NSCLC there are two or three major types designated by the type of cells found in the tumor. The major variety is adenocarcinoma which accounts to 70% of lung cancer, followed by 20% to 25% of squamous carcinoma and 5% of large cell carcinomas.
What is the prognosis? What are the common treatment options?
Dr. Bivas: The prognosis of any cancer depends on the stage of cancer, and the same applies to lung cancer. With the aid of multidisciplinary management, lung cancer patient with Stage I to Stage III disease is potentially curable
The response to the treatment varies from person to person. If we treat Stage I lung cancer by surgery, more than 50% of cancer can be cured in the long run, by which I say, Yes! Lung cancer is curable. When it comes to Stage II and Stage III lung cancer, the chances of survival are 30-40% % and 20%, respectively. The odds are more when it comes to Stage IV cancer, where cancer has now infested the other organs so by theoretical means and all practical means it is currently incurable. The treatment options in stage IV cancers include:
Nowadays, there are immunotherapy options available for lung cancer patients, which can be combined with chemotherapy. There are lots of permutations and combinations, and if patients who are in the last stage undergo treatment, they could survive for two to three years. There are 10 to 15% of patients who may even survive beyond five to six years with these immunotherapies. The patients with molecular mutations (like- EGFR/ALK/ROS1, etc) can survive beyond 5-6 years with available oral targeted therapies [termed as tyrosine kinase inhibitors]
Concerning India, although new treatments are available, there are inequalities in terms of access to these treatments. Consequently, consideration is needed in the commissioning of resources to tackle inequality-related issues.
Do you foresee any interesting trends in terms of lung cancer space?
Dr. Bivas: Many molecular diagnostics and pharmacological [therapeutic] developments have happened in the diagnosis prognostication and treatment of lung cancer over the past decade. As mentioned earlier, there has been a tremendous advancement in targeted therapies and immunotherapies. FDA is very much active in having something ground-breaking for the early development of a drug, which can potentially give long-term control and even maybe a cure in advanced lung cancer.
Concerning India, although new treatments are available, there are inequalities in terms of access to these treatments. Consequently, consideration is needed in the commissioning of resources to tackle inequality-related issues. Approximately, seventy thousand new lung cancer cases are reported yearly in India, and it’s increasing. We are predicting the lung cancer epidemic in the coming future including a flurry of cases in non-smokers too. So, we must be very much active in terms of awareness, prevention, treatment, and research and development.
It was an insightful discussion. Thank you for your time!
Dr. Bivas: Thank you!