If detected early, lung cancer is treatable, but there are rarely any early signs–except perhaps the presence of a cigarette between your lips.
Small cell lung cancer, nearly always associated with smoking, is aggressive, rapidly spreading and difficult to treat. Non-small-cell lung cancer (NSCLC), accounting for 80 percent of all cases, may develop gradually over many years.
The risk of either type of lung cancer increases with the number of cigarettes smoked and even more dramatically with duration of smoking. A tripling of the dose, for example, triples the risk while a tripling of the duration of smoking increases the risk 100-fold. By age 65 or later, when most lung cancers are diagnosed, a person who started smoking as an adolescent is likely to be at very high risk, both as a heavy and a long-term smoker.
‘Smoker’s Cough’ Not Normal
Brad and his co-workers who smoke several times a day in the parking lot outside their office frequently joke about lung cancer when one of them starts to cough. It’s no laughing matter; a “smoker’s cough” is never normal, particularly when it leads to coughing up a lot of sputum or bloody sputum.
Other symptoms of cancer include an achy chest pain, shortness of breath, fatigue, unexplained weight loss, frequent colds, wheezing or trouble breathing. By the time these symptoms appear, however, the cancer has usually spread, and the prognosis is poor. About 85 percent of patients with metastatic cancer die within five years–often much sooner.
Cancers that are detected before they spread–unfortunately comprising only 10 to 15 percent of the total–can usually be removed by surgery, with a survival rate of about 75 percent.
Location as well as size is important, however. A tumor often grows against a vital blood vessel, making it difficult to remove safely. Recently, doctors have been using chemotherapy before surgery to shrink the tumor in certain patients, and studies have found that this approach can greatly improve the outcome. Other studies have found that pre-operative chemotherapy, even with small tumors, can reduce the incidence of recurrence.
The more common approach is the use of chemotherapy immediately following surgical removal of the tumor. Known as adjuvant chemotherapy, this approach has been used effectively for some time with breast and colon cancer, and two large studies recently found it similarly effective for lung cancer.
When cancer has spread to other locations in the body, treatment typically involves chemotherapy or a combination of chemotherapy and radiation therapy.
Doctors have learned how to target radiation to increase its effectiveness and reduce complications. And new chemotherapy agents have improved the quality of life for many patients and may ultimately point the way toward more effective treatment.
The story is becoming familiar: new treatments are making life considerably better for patients with lung cancer by reducing the number of toxic side effects but they have made little dent in the overall survival rate. In 2005, more than 172,000 Americans will be diagnosed with lung cancer and about 163,000 will die. Even though less prevalent than breast or prostate cancer, lung cancer is far more deadly.
At this point, as always, the best strategy against lung cancer is simply to quit smoking...or never start.
Tana N Kaefer, PharmD
