LUNG CANCER'S BOTTOM LINE: DON'T SMOKE

Treatment is initiated after the identification of the cellular cancer type – either Small Cell Lung Cancer (SCLC) or Non-Small Cell Lung Cancer (NSCLC) – and once an accurate evaluation of the tumour expansion or “staging” has been made. Conventional lung cancer treatment modalities include surgery, chemotherapy, radiotherapy and targeted therapies. Herbal treatments and immune treatments with vaccine are currently being evaluated in clinical trials.

For SCLC surgery is rarely performed because the diagnosis often reveals a tumour that has already spread. In most cases, the treatment of choice is radiation therapy associated with one or two chemotherapeutic medicines.

In NSCLC a surgical resection may be carried out in stages 0 to IIB. For Stage 0 the total removal of the growth means the cancer is gone for good and radiation or chemotherapy is not needed. This highlights that early diagnosis can greatly reduce the lung cancer mortality rate. 

When NSCLC cancer reaches stages I and II, surgery remains the treatment of choice but chemotherapy and/or radiation therapy need to be added either before and/or after the surgery. In more advanced stages, treatment may involve a combination of chemo-radiation therapy, targeted therapy and possibly palliative surgery. Targeted therapy includes special medicines that “target” specific proteins, which are indispensable for the cancer growth. 

At the beginning of the 20th century, lung cancer was a reasonably rare disease. It is now reaching pandemic magnitude and fast expanding in countries where tobacco marketing remains unabated and the awareness of smoking danger is still low. 

Despite recent advances, the curative treatment for lung cancer remains far from satisfactory. However, lung cancer is one of the most preventable illnesses. 

Since smoking is responsible for about 87 per cent of lung cancer deaths, according to the American Cancer Society, avoiding smoking altogether or at least discontinuing smoking would obviously have a huge positive impact on the death rate. 

In fact, the deleterious effects of tobacco on health are enormous. Tobacco use is responsible for nearly 20 per cent of all premature deaths in the US, or about 443,000 premature deaths annually. Worldwide, smoking causes about 6 million deaths. 

Smoking is not only linked to lung and respiratory tract (throat, larynx) cancers. Tobacco intoxication also markedly increases the risk of digestive cancers (mouth, tongue, stomach, pancreas, colon, rectum), uro-genital cancers (bladder, ovary, cervix, uterus) as well as leukaemia. It is also a major risk for cardiovascular diseases, namely heart attacks and strokes. In short, smoking reduces life expectancy by 14 years. Such continuous high prevalence of tobacco-related diseases is not merely a fatality, it is the result of the unthinkable passivity of health policy decision-makers.

There is fortunately some good news with regards to lung cancer screening. The past methods using chest X-ray and sputum analysis are no longer recommended because these were not found to save lives due to poor sensitivity of these tests. 

The only proven detection test is the Low-Dose Helical Computed Tomography, which was found in October 2010 to reduce lung cancer mortality by 20 per cent. This CT scan is recommended for people aged 55 to 74 years and who have long history of smoking addiction. 

In addition, a new technique used in leading centres called autofluorescence bronchoscopy offers a promising way for the early diagnosis of lung cancer. The fluorescent light at the tip of the bronchoscope allows for easier visualisation of the cancer because cancerous cells appear in different colours than normal ones. 

Such screening tests need to be proposed to heavy smokers. Smoking cessation is highly rewarding because the risk of dying from lung cancer falls by 50 per cent after 5 years and becomes similar to that of non-smokers after 10 years. 

But despite these and future innovations, as doctors, we only have one message and it is short: Don’t smoke please.

 

Professor Sawang Saenghirunvattana, is Emeritus Professor of Medicine and Chief of Pulmonary Diseases Centre at Bangkok hospital. He can be contacted at [email protected].

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].