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Scott Webb: Lung cancer is the leading cause of cancer death. And yearly, more people die from lung cancer than colon, breast and prostate cancer combined. But medicine is advancing. And when found in its earliest stages, lung cancer may be curable. Tests and technology are tools on our side and Franciscan Health offers a comprehensive lung cancer program to take you from diagnosis to treatment to survivorship.

And my guest today is Dr. Corey Hogue. He's a radiation oncologist with the Franciscan Health Cancer Center. This is the Franciscan Health Doc pod. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about lung cancer signs, symptoms, treatment options, and so on. So as we get rolling here, what is lung cancer? And can you explain the two types of lung cancer, both small cell and non-small cell?

Dr. Cory Hogue: So lung cancer is one of the most common cancers that we see every day, and it comes in a couple different varieties. There's two main types. They're called small cell and non-small cell lung cancer. So the vast majority, about 80%, fall into the non-small cell category, and about 20% fall into the small cell category.

Scott Webb: And when we think about the differences between the two, right? What does that mean, I guess? I like sort of pictured in my head, small cell, non-small cell, so maybe one's smaller than the other, but what does that mean exactly?

Dr. Cory Hogue: Cancer is an overgrowth of cells, and there's different types of cells within our body. So the lung would have a couple of different types of cells. So, depending on which cell has overgrown, our pathology doctors, when they look at it under the microscope, they give it a classification. So what cell of origin did it come from? And there's two types that happen to be called small cell and non-small cell. But for patients, it matters because the treatments between the two types are very different. So whenever doctors come together and decide the best treatment option, we have to consider the cell of origin because they respond to different treatments and it can impact the recommendations that a patient would get.

Scott Webb: Got it. I see what you mean. The cell of origin sort of dictates and drives everything. So from our perspective as, of course, nobody wants to have lung cancer, but we do need to be aware, especially if we have the risk factors, what are some of the signs and symptoms of lung cancer?

Dr. Cory Hogue: Yeah, that's a great question. Unfortunately, the most common symptom of lung cancer is really no symptoms at all. It takes a certain volume or size of tumor before it would cause any symptoms. So that's why, and we'll talk about this later, that's why screening for people that are high risk can be important. But for some people that present with symptoms, certainly if you had a cough that doesn't get better, if you're coughing up blood, if you're losing weight, if you're short of breath, these are all reasons to go to your primary care doctor and do some additional investigation.

Scott Webb: So you mentioned screening, so let's talk about that, especially since it's a sort of, for most people, asymptomatic maybe until the advanced stages, what are some of the tests that are available?

Dr. Cory Hogue: So we learned in about the mid-2000s that a low-dose CAT scan can be very helpful for those at high risk for lung cancer. And the risk categories, they're changing all the time, and it's different based on which guidelines you look at. But in general, if you take the number of years that you've smoked and how many packs per day you smoke, you can come up with a number and we can stratify you based on that into risk categories. So if you are someone that would be eligible, a low-dose lung screen can be very helpful. And the benefit of screening across all cancer types is to find cancer at the earliest stages. So we know that whenever you find cancer early, the treatments are much more effective.

Scott Webb: And I know at Franciscan, I found this hard to believe, I had to do a double take, but there's a $49 lung scan. Maybe you can tell us about that.

Dr. Cory Hogue: Yeah, this is a great service that Franciscan provides for many people. You might find that working with your primary care doctor, the screening test can be approved through insurance if you meet the criteria. But for patients who maybe don't have a primary care doctor or they want to self-refer because they know that they're at high risk, Franciscan does offer a $49 lung scan and that is completely outside of insurance and it's self-referral, so very, very affordable. As we know, everything in medicine is incredibly expensive. So for less than the price of a nice dinner, you can get a lung scan read by a trained radiologist, and then it will give you the peace of mind or tell you that you need to do some additional testing.

Scott Webb: Yeah, that's amazing. As you say, everything is expensive in medicine. But for less than $50, probably money well spent, especially if you are at a higher risk, let's say if you are a smoker. So let's assume, doctor, that someone has come back with a scan and there was a finding. What would be the next steps?

Dr. Cory Hogue: What we know about CAT scans of the lung is we find we can find a lot of stuff. Most of it doesn't matter at all, especially as we age. We can see things within the lung that are very normal, especially for people that live in the Midwest. We can have mucus plugs. We can have little nodules that are completely benign, but that we need to keep an eye on.

For a small percentage of people, they will have a finding that needs to be investigated further. And our radiologists are very helpful because they can categorize things that they see and give it some kind of risk category, and that helps us determine what the next steps would be. So in some cases, a biopsy would be recommended. And a biopsy is where a doctor goes in and gets a sample of the tissue, sends it to a pathology doctor, they look at it under the microscope after they've chopped it up, and they tell us exactly what it is. And that's the best way to find out what's going on.

And there's several ways we can do a biopsy. One is through a needle going through the chest wall from the outside, working its way in. Another is through the airways, through a robotic bronchoscopy. And Franciscan Health has a couple of different systems that are very, very precise and can get to the smallest of airways and obtain tissue from the inside. So it's non-invasive, robotic, and we can get to some of the smallest airways and get tissue from some of the smallest nodules. So, a couple of different ways, but Franciscan Health has a state-of-the-art robotic bronchoscopy that we have found to be very helpful.

Scott Webb: And then, of course, if cancer would be found, we might be talking about surgery, which could also be robotic surgery, chemotherapy, radiation, and so on. Maybe you can take us through that a bit.

Dr. Cory Hogue: Sure. So for the small percentage of people where we do unfortunately find cancer, we do have many, many treatment options available. In general, they fall into three big categories. Number one, as you mentioned, is surgery, which used to be quite invasive and require opening up the chest. But now, at many facilities including Franciscan Health, we have robotic surgery options as well.

The next category is kind of in general, something called systemic therapy or treatment that goes all throughout the body, so that would be chemotherapy, immunotherapy these days, other targeted therapies that are very specific for different types of lung cancer, so it kind of minimizes the side effects if they're very targeted to a patient's individual tumor type.

And then, we also have radiation therapy, which I do, and that has advanced significantly over the years where we can precisely give high dose of radiation to the tumor alone and we can spare all the healthy, normal tissues nearby. So Franciscan Health has the whole complement of treatments for every new diagnosis. We discuss it in a multidisciplinary tumor board, so that would include thoracic surgeons, that would include medical oncologists, radiation oncologists, pathologists, radiologists, everybody together puts their head together and comes up with a treatment plan. So, it's not one doctor coming up with something on their own. It's, you know, five, six, seven, eight doctors together. Even if you don't ever even see that doctor, they're providing their input and expertise.

Scott Webb: I want to talk a little bit about, as we get close to the end here, just talk about smoking cessation. You know, it's easy to say, "Well, if you smoke, stop smoking and that would be good for you." Yes, of course. But when we think about how to help folks quit smoking, smoking cessation, what are your recommendations?

Dr. Cory Hogue: The number one way to decrease your risk of lung cancer is to stop smoking. And we know that even once you have been diagnosed with lung cancer, we know that patients that quit smoking live longer than patients that continue to smoke. With all that being said, we do have sympathy to smokers and we understand how difficult it is. Tobacco is designed to be addictive and some would say it's the most addictive substance out there. But, fortunately, you're not alone whenever you decide to quit smoking. Franciscan has many resources available called the ASPIRE Tobacco Cessation Program.

If you want to learn more, you can go to franciscanhealth.org/aspire, A-S-P-I-R-E, and that gives you access to resources that we have available, which could include individual counseling, group counseling, and then medication management as appropriate. So, the best way is a combination of medication, either a pill, a patch, or nicotine gum. We know that these are very effective and can be more effective than just trying to do it on your own, which is fine if you want to, but the combination of treatments together can be or is shown to be the most effective way to quit smoking.

Scott Webb: Yeah. I love that. That's such a great way to put that. As we wrap up here, what else would you like to share with listeners? What are your final thoughts and takeaways when it comes to lung cancer and the importance maybe of early diagnosis?

Dr. Cory Hogue: Yeah, this was a great discussion. Thanks for having me. I do want to emphasize that early diagnosis is the key for lung cancer. When lung cancer is caught at earlier stages, the outcomes are significantly better. So the ways to detect it early are the CAT scan screening, which we have available here at Franciscan Health. The $49 lung scan has always maintained a close relationship with your primary care physician as well. Stop smoking. We have many resources available. We don't judge people because they smoke. We're just here to help and we have all the resources available that can help anyone. So, in summary, I think Franciscan Health is kind of at the leading edge of lung cancer and we're here to help in any way possible.

Scott Webb: Yeah, that's perfect. Well, doctor, thanks so much for your time, your expertise today. Really amazing to hear, you know, a $49 lung scan. As you say, for the price of a decent meal, you can have this lung scan. Find out if, you know, more testing, more investigation is necessary. So thanks so much. You stay well.

Dr. Cory Hogue: Thank you so much for having me.

Scott Webb: And for more information on lung cancer and the $49 lung scan, visit franciscanhealth.org/lungcancercare. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.