Lung cancer prevention starts with screening for early detection, particularly for those with risk factors.
Gaurav Signh, Medical Director of Cancer Institute and Chief of Radiation Oncology at Dignity Health, discusses lung cancer symptoms, treatment, and the importance of getting screened.
Selected Podcast
Lung Cancer - Risk Factors, Screening and Treatment
Featured Speaker:
Learn more about Gaurav Singh, MD
Gaurav Singh, MD
Gaurav Singh, MD graduated from the University of Vermont College of Medicine in 2005. Singh works in Stockton, CA and specializes in Radiation Oncology.Learn more about Gaurav Singh, MD
Transcription:
Lung Cancer - Risk Factors, Screening and Treatment
Bill Klaproth (Host): Lung cancer is the most common cause of cancer-related death for men and women outnumbering colon, breast and prostate cancers combined. Here to talk with us about lung cancer, risk factors, screening, and treatment is Dr. Gaurav Singh, Medical Director of the Cancer Institute and Chief of Radiation Oncology at Dignity Health and St. Joseph’s Medical Center in Stockton. Dr. Singh thank you for your time. So, who is most at risk for lung cancer?
Gaurav Singh, MD (Guest): Hi Bill. Thanks for having me. Well in general, 90% of our lung cancer cases that we see are related to people who smoke or have significant exposure to second-hand smoking. We do see a fair amount of patients that have exposure to asbestos which can also cause cancer.
Bill: So, that secondhand smoke, that really is problematic as well.
Dr. Singh: Absolutely. We know that not only does direct smoking but those that have family members in the household that heavy smoke can also create a higher risk of developing lung cancer in that population as well.
Bill: So, is it true that if you were or are a heavy smoker, you could possibly be living with lung cancer and be unaware of it?
Dr. Singh: Yes. Most times lung cancer starts off as a small cancer in the lung which does not cause any symptoms and patients may be unaware of that. It is usually when the symptoms arise is when the cancer is detected, however, at that point, patients who have symptoms from lung cancer usually present with advanced stage III or IV disease.
Bill: So, what are the signs and symptoms of lung cancer?
Dr. Singh: Generally, we see patients that have lung cancer, they develop a cough early on, possibly some shortness of breath. They are at risk of having a pneumonia related to the cancer. They could also be coughing up blood or have unexplained weight loss over the past few months.
Bill: So, if someone is experiencing these symptoms, when is it time to see the doctor?
Dr. Singh: Certainly, when the symptoms arise patients should seek medical care immediately. But I would say more importantly if you are a smoker, patients should visit the doctor regularly and to determine whether they are a candidates for lung cancer screening in an effort to detect the lung cancer prior to developing symptomatic lung cancer.
Bill: So, let’s talk about screening. You just mentioned that. How important is the screening and how and when should someone get screened?
Dr. Singh: Sure. We believe lung cancer screening is very important as it will help us detect lung cancer at an earlier stage where we feel we have a better chance of cure. Studies have shown that lung cancer screening reduces the risk of dying from lung cancer by approximately 15% which is significant in our oncology world. Patients can ask their primary care doctor about lung cancer screening programs to determine if they qualify. And if they do qualify, then the patients can be enrolled in a lung cancer screening program that typically offers a yearly low dose CT scan of the chest to detect early signs of lung cancer. We do have a program here at St. Joseph’s Cancer Center in Stockton and most cancer centers in other geographical areas will have a program or at least have access to one in which the patients can inquire.
Bill: So, like we undergo a colonoscopy for colon cancer; for a smoker, should these types of screenings be mandatory or guidelines like when you hit a certain age, make sure you go in for your lung cancer screening?
Dr. Singh: Absolutely. We do have data that supports screening patients as early as age 50 who have a significant past smoking history or are current smokers. A significant smoking history generally implies a 20-pack-year smoking history or more.
Bill: Wow. Okay, that’s very interesting. And then when it comes time for diagnosis; how do you diagnose lung cancer generally?
Dr. Singh: There’s many ways we can diagnose lung cancer, but usually the course of events in diagnosing lung cancer starts off with a CT scan related to possibly some symptoms that the patient is complaining about. The CT scan typically will demonstrate an abnormality in the lung which can be biopsied with a needle. Once the biopsy is performed, we then have the pathologic diagnosis of lung cancer which then we take that information and then go on to staging of the disease. And staging is important obviously, because that will dictate how the patient will do prognostically and also what would be the best treatment options for the patient. Typically, for staging, we conduct a whole-body PET scan and or a mediastinoscopy which is a surgical procedure which samples the lymph nodes in the center of the chest to determine whether the lung cancer has spread to the lymph nodes as part of the staging process.
Bill: So, through that staging, you come up with treatment options. So, then what are the general treatment options for someone who has lung cancer?
Dr. Singh: Good question. It’s highly variable dependent on the stage. For example, stage I disease, when its early stage, the mainstay is surgical resection or surgical removal of the tumor. However, there are some patients that have had a heavy smoking history that have poor lung function and may not be eligible for surgery. There are alternatives that are non-invasive such as stereotactic ablative body radiotherapy which is a form of radiation therapy that’s precisely applied to the lung tumor with a high dose of radiation and as short as three to five treatments which offers equivalent results as surgery. That’s solely for stage I and maybes some early stage II disease. However, for stage II and going forward, higher stage II and early stage III, surgery is still the main option, however, radiation may be employed along with chemotherapy prior to surgery in an effort to shrink the tumor down, making it more amendable to surgical resection. When we get to higher stage III or even IV, then really chemo/radiation is the main option. Surgery plays less of a role, unless it’s for palliation and stage IV typically where there is widespread metastases beyond the area of origination; chemotherapy is the first line option. So, it really is important to not only gauge the performance status of the patient, how healthy they are outside of the cancer, but also to properly stage them prior to making the treatment recommendation. As you can see, there are many treatment options available that would be determined to be appropriate for each stage of disease.
Bill: So, with advances in medicine; has the overall prognosis improved for someone with lung cancer?
Dr. Singh: I think overall unfortunately, we still 70% of the patients that we diagnose with lung cancer have advanced stage III or IV disease and we are still looking at overall survival rates or cure rates in the 30-40% range which really hasn’t changed dramatically over the last ten to fifteen years. However, now with the data showing that lung cancer screening can be quite effective at detecting cancer at an earlier stage; we are optimistic that if we detect patients at these earlier stages that we can increase the cure rate overall for lung cancer where we have more treatment options and better treatment options for early stage disease compared to advanced stage disease. The field of lung cancer treatment and oncology is advancing. We are making strides with advances in our research and we are hopeful that we can better help advance staged disease as well in the future.
Bill: So, it sounds like early detection is key and if you could wrap it up for us Dr. Singh. Can you tell us how we can keep our lungs healthy and why we shouldn’t be smoking?
Dr. Singh: Sure. Well I would say keeping lung healthy one way to do it would be exercising regularly and eating a healthy diet as would keep all your organs healthy for that matter and smoking we know from studies that were done in the 50s, 1950s and 60s onward that carries an increased risk of developing lung cancer and it’s something that we can prevent by abstaining from smoking and as a community to encourage others to quit smoking because the risk is so high of developing lung cancer in that population.
Bill: Really good message and good information and don’t smoke. You just said it. The best preventative medicine for lung cancer, don’t smoke. It makes sense. So, if you are a smoker, please get into a program and quit smoking. Dr. Singh, thank you so much for your time and for more information please visit www.stjosephscares.org/lungscreening, that’s www.stjosephscares.org/lungscreening. This is Hello Healthy, a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.
Lung Cancer - Risk Factors, Screening and Treatment
Bill Klaproth (Host): Lung cancer is the most common cause of cancer-related death for men and women outnumbering colon, breast and prostate cancers combined. Here to talk with us about lung cancer, risk factors, screening, and treatment is Dr. Gaurav Singh, Medical Director of the Cancer Institute and Chief of Radiation Oncology at Dignity Health and St. Joseph’s Medical Center in Stockton. Dr. Singh thank you for your time. So, who is most at risk for lung cancer?
Gaurav Singh, MD (Guest): Hi Bill. Thanks for having me. Well in general, 90% of our lung cancer cases that we see are related to people who smoke or have significant exposure to second-hand smoking. We do see a fair amount of patients that have exposure to asbestos which can also cause cancer.
Bill: So, that secondhand smoke, that really is problematic as well.
Dr. Singh: Absolutely. We know that not only does direct smoking but those that have family members in the household that heavy smoke can also create a higher risk of developing lung cancer in that population as well.
Bill: So, is it true that if you were or are a heavy smoker, you could possibly be living with lung cancer and be unaware of it?
Dr. Singh: Yes. Most times lung cancer starts off as a small cancer in the lung which does not cause any symptoms and patients may be unaware of that. It is usually when the symptoms arise is when the cancer is detected, however, at that point, patients who have symptoms from lung cancer usually present with advanced stage III or IV disease.
Bill: So, what are the signs and symptoms of lung cancer?
Dr. Singh: Generally, we see patients that have lung cancer, they develop a cough early on, possibly some shortness of breath. They are at risk of having a pneumonia related to the cancer. They could also be coughing up blood or have unexplained weight loss over the past few months.
Bill: So, if someone is experiencing these symptoms, when is it time to see the doctor?
Dr. Singh: Certainly, when the symptoms arise patients should seek medical care immediately. But I would say more importantly if you are a smoker, patients should visit the doctor regularly and to determine whether they are a candidates for lung cancer screening in an effort to detect the lung cancer prior to developing symptomatic lung cancer.
Bill: So, let’s talk about screening. You just mentioned that. How important is the screening and how and when should someone get screened?
Dr. Singh: Sure. We believe lung cancer screening is very important as it will help us detect lung cancer at an earlier stage where we feel we have a better chance of cure. Studies have shown that lung cancer screening reduces the risk of dying from lung cancer by approximately 15% which is significant in our oncology world. Patients can ask their primary care doctor about lung cancer screening programs to determine if they qualify. And if they do qualify, then the patients can be enrolled in a lung cancer screening program that typically offers a yearly low dose CT scan of the chest to detect early signs of lung cancer. We do have a program here at St. Joseph’s Cancer Center in Stockton and most cancer centers in other geographical areas will have a program or at least have access to one in which the patients can inquire.
Bill: So, like we undergo a colonoscopy for colon cancer; for a smoker, should these types of screenings be mandatory or guidelines like when you hit a certain age, make sure you go in for your lung cancer screening?
Dr. Singh: Absolutely. We do have data that supports screening patients as early as age 50 who have a significant past smoking history or are current smokers. A significant smoking history generally implies a 20-pack-year smoking history or more.
Bill: Wow. Okay, that’s very interesting. And then when it comes time for diagnosis; how do you diagnose lung cancer generally?
Dr. Singh: There’s many ways we can diagnose lung cancer, but usually the course of events in diagnosing lung cancer starts off with a CT scan related to possibly some symptoms that the patient is complaining about. The CT scan typically will demonstrate an abnormality in the lung which can be biopsied with a needle. Once the biopsy is performed, we then have the pathologic diagnosis of lung cancer which then we take that information and then go on to staging of the disease. And staging is important obviously, because that will dictate how the patient will do prognostically and also what would be the best treatment options for the patient. Typically, for staging, we conduct a whole-body PET scan and or a mediastinoscopy which is a surgical procedure which samples the lymph nodes in the center of the chest to determine whether the lung cancer has spread to the lymph nodes as part of the staging process.
Bill: So, through that staging, you come up with treatment options. So, then what are the general treatment options for someone who has lung cancer?
Dr. Singh: Good question. It’s highly variable dependent on the stage. For example, stage I disease, when its early stage, the mainstay is surgical resection or surgical removal of the tumor. However, there are some patients that have had a heavy smoking history that have poor lung function and may not be eligible for surgery. There are alternatives that are non-invasive such as stereotactic ablative body radiotherapy which is a form of radiation therapy that’s precisely applied to the lung tumor with a high dose of radiation and as short as three to five treatments which offers equivalent results as surgery. That’s solely for stage I and maybes some early stage II disease. However, for stage II and going forward, higher stage II and early stage III, surgery is still the main option, however, radiation may be employed along with chemotherapy prior to surgery in an effort to shrink the tumor down, making it more amendable to surgical resection. When we get to higher stage III or even IV, then really chemo/radiation is the main option. Surgery plays less of a role, unless it’s for palliation and stage IV typically where there is widespread metastases beyond the area of origination; chemotherapy is the first line option. So, it really is important to not only gauge the performance status of the patient, how healthy they are outside of the cancer, but also to properly stage them prior to making the treatment recommendation. As you can see, there are many treatment options available that would be determined to be appropriate for each stage of disease.
Bill: So, with advances in medicine; has the overall prognosis improved for someone with lung cancer?
Dr. Singh: I think overall unfortunately, we still 70% of the patients that we diagnose with lung cancer have advanced stage III or IV disease and we are still looking at overall survival rates or cure rates in the 30-40% range which really hasn’t changed dramatically over the last ten to fifteen years. However, now with the data showing that lung cancer screening can be quite effective at detecting cancer at an earlier stage; we are optimistic that if we detect patients at these earlier stages that we can increase the cure rate overall for lung cancer where we have more treatment options and better treatment options for early stage disease compared to advanced stage disease. The field of lung cancer treatment and oncology is advancing. We are making strides with advances in our research and we are hopeful that we can better help advance staged disease as well in the future.
Bill: So, it sounds like early detection is key and if you could wrap it up for us Dr. Singh. Can you tell us how we can keep our lungs healthy and why we shouldn’t be smoking?
Dr. Singh: Sure. Well I would say keeping lung healthy one way to do it would be exercising regularly and eating a healthy diet as would keep all your organs healthy for that matter and smoking we know from studies that were done in the 50s, 1950s and 60s onward that carries an increased risk of developing lung cancer and it’s something that we can prevent by abstaining from smoking and as a community to encourage others to quit smoking because the risk is so high of developing lung cancer in that population.
Bill: Really good message and good information and don’t smoke. You just said it. The best preventative medicine for lung cancer, don’t smoke. It makes sense. So, if you are a smoker, please get into a program and quit smoking. Dr. Singh, thank you so much for your time and for more information please visit www.stjosephscares.org/lungscreening, that’s www.stjosephscares.org/lungscreening. This is Hello Healthy, a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.