Learning about Lung Cancer
- A recently published case report illustrates the scary reality that lung cancer can widely spread before a patient starts feeling any symptoms.
- Diagnosis and treatment of the lung cancer can be tricky since symptoms often don’t appear until the cancer has spread.
- Lung cancer, the second most common type of cancer, is the leading cause of cancer deaths for men and women in the United States. But early detection via screening techniques like the low-dose computed tomography (CT) scan can save lives.
- Talk to your doctor about getting a low-dose CT scan (LDCT) or chest x-ray if you are at high risk or if you experience a cough that doesn’t go away, a cough that produces bloody mucus or if you experience chest pain or trouble swallowing or breathing. The U.S. Preventive Services Task Force recommends that adults ages 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should be screened.
A recently published case report in Cureus, unfortunately, demonstrated how an advanced metastatic lung cancer might not be diagnosed until something as “seemingly benign” as shoulder pain shows up.Read More
After first trying an urgent care, the woman eventually ended up at the emergency room where she was properly diagnosed with adenocarcinoma in the bottom of her left lung, which had spread to her spine, ribs and adrenal gland. The cancer did not seem to have spread to her shoulder joint’s, so her pain was likely the result of her lung cancer’s extension into her thecal sac (a fluid filled sac that the spinal cord “floats” within).
Devastatingly, the woman’s cancer was not caught in time and she was put into hospice care less than a month later.
“This case depicts an unusually isolated and mild chief complaint in the context of widely metastatic lung adenocarcinoma,” the case report reads. “A strictly clinical outpatient evaluation without advanced, high-resolution imaging would have been grossly insufficient to diagnose our patient’s underlying cancer.
“Highly atypical cases of malignancies may present insidiously, despite recent advances in medicine. Unfortunately, as in the case of our patient, it may elude even seasoned physicians until the prognosis becomes extremely poor.”
Understanding Lung Cancer
Lung cancer, the second most common type of cancer, is the leading cause of cancer deaths for men and women in the United States. Diagnosis and treatment of the disease can be tough since symptoms often don’t appear until the cancer has spread. An initial symptom, for example, could be as serious as a seizure if the lung cancer has already spread to the brain. But other symptoms can include increased coughing, chest pain, unexplained weight loss, shortness of breath, wheezing, losing your voice or persistent infections like bronchitis or pneumonia.
The two main types of lung cancer are non-small cell, which makes up 85 percent of cases, and small-cell. These types act differently and, accordingly, require different types of treatment. Dr. Patrick Forde, a thoracic oncologist at Johns Hopkins Medicine, previously told SurvivorNet about how distinguishing between the two types – and their subtypes – is beneficial.
“Within that non-small cell category, there’s a subtype called non-squamous adenocarcinoma, and that’s the group of patients for whom genetic testing is very important on the tumor,” he explains. “Genetic testing is looking for mutations in the DNA, in the tumor, which are not present in your normal DNA.”
Lung Cancer Screening
More men and women die of lung cancer than of colon, breast and prostate cancers combined, but how can screenings make a difference? Lung cancer usually affects people above the age of 65, but a small number of people are diagnosed younger than 45 years old.
Many lung cancers are found accidentally, but screening can help doctors diagnose lung cancers at earlier stages of the disease when successful treatment is more likely. Early-stage lung cancers that are removed with surgery may even be curable. But more often than not, lung cancer diagnoses come after the disease has already spread to other parts of the body making it more difficult to treat.
“In about 70 to 80 percent of patients who are diagnosed with lung cancer, unfortunately the cancer has spread outside of the lung and is not suitable for surgery,” Dr. Forde tells SurvivorNet.
But screening methods such as the low-dose computed tomography (CT) scan can save lives – if those who are at risk participate. This test uses a very small amount of radiation to create highly detailed pictures of your lungs to reveal cancer long before initial symptoms. The State of Lung Cancer 2020 report from the American Lung Association found that screening every currently eligible person would save close to 48,000 lives, but only about 6 percent of Americans who are at high risk are actually getting screened.
“The concern is perhaps patients who are on Medicaid or don’t have insurance will not be referred for appropriate screening,” Dr. Forde says. “I think it behooves us all to try and increase the uptake of CT screening in particular, given that it’s been shown to reduce lung cancer mortality.”
So, Who Should Get Screened
You should talk to your doctor about getting a low-dose CT scan (LDCT) or chest x-ray if you are at high risk or if you experience a cough that doesn’t go away, a cough that produces bloody mucus or if you experience chest pain or trouble swallowing or breathing.
Nearly 20 percent of people who die from lung cancer in the United States each year have never smoked or used any other form of tobacco, but smoking is a huge risk factor for the disease since the tobacco in cigarettes is a carcinogen that causes mutations in lung cells and enables the growth of cancer. If you quit smoking, you can significantly reduce your risk of developing the disease, but you don’t go all the way down to the level of a non-smoker.
In March 2021, the U.S. Preventive Services Task Force (USPST) introduced new guidelines which dropped the age of eligibility for lung cancer screening and the number of “pack years,” or number of years a person smoked an average of one pack of cigarettes a day.
The new guidelines specify that adults ages 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should be screened. So if someone smoked one pack of cigarettes per day for 20 years, their “pack history” would be 20 years, and they should be screened. But if someone smoked two packs a day for 10 years, they would also have a 20 year “pack history.”
The USPSTF says that expanding screening eligibility will be “especially helpful” to Black people and women and will increase screening access. Data shows that both groups tend to smoke fewer cigarettes than white men. Data also shows that Black people have a higher risk of lung cancer than white people.