Cheryl Martin (Host): Lung cancer does not discriminate. It's the leading cause of cancer deaths worldwide. Coming up, we dive into the complex world of lung cancer, breaking down its causes, misconceptions, and latest advancements in treatment. Here to give us a deep dive into lung cancer is Jen Chrysler. She's a certified adult gerontology nurse practitioner at Guthrie Sayre Pulmonology Department.

This is Medical Minds: Conversations with Guthrie Experts, a podcast from the Guthrie Clinic. I'm Cheryl Martin. Jen Chrysler, I know that you bring with you a wealth of knowledge and expertise in preventative medicine, including lung cancer and lung cancer screening. So first, let me start by asking, what is lung cancer and how does it develop in our bodies?

Jen Chrysler: Lung cancer is the uncongruent growth of cells in the lungs. It occurs through mutations during cell division. Some mutations are caught and the cells are destroyed by the body's defenses. In cancer, those stop mechanisms are disabled and the abnormal cells are cloaked from the body's immune system. And what that means is that these cells are allowed to double without anything stopping them. And that's what causes the masses. And once they are big enough and they are allowed a blood supply, they can move to other areas of the body.

Host: Now, there are often misconceptions and stereotypes about lung cancer and how only certain types of people can get it, like smokers. So, talk about that and who can actually get lung cancer.

Jen Chrysler: It's been long said that lung cancer is a smoker's disease. And it is true that there is a greater risk for patients who smoke, but it can occur in anyone. There are patients who are non-smokers who get lung cancers, and those are typically the patients who end up with what we call actionable mutations. These are genes that have been turned on in the body that cause the cancer in that individual. Most of the ones that are known are EGFR, MET or M-E-T, and ALK, A-L-K. When these are discovered, the patient can be treated with a pill. So, things like radon and diesel fuels can also increase the risk of somebody getting lung cancer.

Host: Jen, what are the symptoms? How would someone know that they could possibly have lung cancer?

Jen Chrysler: Symptoms of an advanced lung cancer are hemoptysis, or somebody bringing up blood when they cough, weight loss, loss of appetite, increased trouble breathing. Sometimes there can be fevers or chills from like an obstructive pneumonia. If the patient has a tumor that is blocking their airway, the backup can cause some infection there, and those are the main ones.

Host: You mentioned those are symptoms for advanced lung cancer. So, does that mean early on, you may not have symptoms?

Jen Chrysler: Correct. Early lung cancers typically do not have symptoms. That's why we try to encourage patients to quit smoking or if they are within the ages of 50 to 80 with over a 20-pack-year history, which is equivalent to one pack a day for 20 years, to get lung cancer screening because that is the best way to find cancer early when it's most treatable.

Host: Do you recommend that for people who are not smokers, lung cancer screening?

Jen Chrysler: Lung cancer screening is not recommended for patients who are not smokers or just have a family history, because the risk of the radiation is greater than the actual chance of finding a lung cancer in that lower risk population.

Host: So, break down for us the two main types of lung cancer, non-small cell lung cancer, NSCLC, and small cell lung cancer, SCLC.

Jen Chrysler: Non-small cell lung cancer is the most common, that's 80 to 85% of cancers, and that's broken down into two branches as well. Adenocarcinoma is the cancer that starts in the mucus-producing cells in the lung, and that is the one that's most common in nonsmokers. And they're more peripheral, meaning they're more toward the outside of the lungs. The squamous cell, the other type of non-small cell lung cancer, starts in the squamous cells, which are the flat cells in the airway, and these are found to be more central, and they are less common in non-smokers.

Small cell, on the other hand, is more rare. It's about 14% of the cancers. And it's smaller when seen under a microscope, hence the name small cell. This one is aggressive and my take on that is it's more like the Hulk. It's very aggressive, but it's very susceptible to chemotherapy and radiation therapy. Meaning once you start treating this, it's going to shrink very fast. So, you're going to see a relief of symptoms quite quickly when these are starting to be treated. Whereas the non-small cell type is reactive to radiation and chemotherapy, but you won't see the efforts as fast.

Host: So, what are some of the latest advancements in the treatment of lung cancer?

Jen Chrysler: The latest advancements that I've seen in my career, when I started, it was just chemotherapy alone and radiation, but we now have immunotherapy, which uses the body's own immune system to help fight cancer. And this is most effective if the patient has a high level of what we call PD-L1. And this is discovered through the genetic testing that we now have available for lung cancers, and it's also used in other cancers as well. This can be used in conjunction with chemotherapy, and sometimes it can be used alone if the patient has a 100% predictability of response.

There's also stereotactic radiation, which can be used on the smaller masses that are discovered to be cancer, if there's no other areas of the body that are affected. And this is different than the traditional radiation, which had been known to cause a lot of skin irritation, a lot of burns. Stereotactic is a little bit of a higher dose given over a shorter course of treatment. So, the patient would get five treatments, but every other day as opposed to the typical 30 treatments that they had been getting in the past.

One of the other really cool things that we have going on now is using cryotherapy and endobronchial treatments that we can do with the endobronchial scope. And that really is very good. And what we can do there is without doing any surgery or anything, the pulmonologist can go right down into the airway and actually freeze the tumor and take care of it. Similar to how the interventional radiology folks take care of liver cancers and they just cut off the blood supply to that one area, and it's able to be eradicated.

And the final one, I actually mentioned earlier, is our targeted agents and in the appropriate population, these oral drugs can be very helpful in controlling cancer for a number of years. And the patients can live a good quality life without coming into the cancer center for treatment.

Host: So, really, the prognosis is good if the cancer is caught early.

Jen Chrysler: Correct. The prognosis is much better when caught early. But now, we are finding that even patients that have the advanced cancers or they're discovered a little bit later in the staging, it's not just, okay, you have to go to hospice, you're done. There's a lot more hope for those patients as well. They can live a good quality of life and be good.

Host: That's great. So, what are the best ways to help prevent your risk of getting lung cancer? Because it's no way to prevent lung cancer, right?

Jen Chrysler: Right. You can't fully prevent lung cancer. You can't put yourself in a bubble and know that you won't get it. Because just by the cells dividing, that can happen. Because through a transcription error or through a splice mutation, a cancer can form no matter what you do. But to make your risk less, you can avoid smoking, minimize your exposure to things like diesel fumes, get your basement checked for radon and minimize any stone quarry dust exposure, because that silica can be very harmful as well. And those are the best ways, I would say, in my opinion.

Host: Jen Chrysler, thank you for giving us a deep dive into lung cancer. Great information.

Jen Chrysler: Thank you so much for having me.

Host: To learn more, go online to guthrie.org/services-treatments/lung-cancer-screening. Again, that's guthrie.org/services-treatments/lung-cancer-screening. And if you found this podcast helpful, please share it on your social media.

This is Medical Minds: Conversations with Guthrie Experts, a podcast from the Guthrie Clinic. Thanks for listening.