Transcription:
Lung Cancer Treatment & Screening

Host: Joining us on the podcast today is Dr. Alex Herskovic, a radiation oncologist with the Riverside Cancer institute. Welcome, doctor.

Dr. Alex Herskovic: Thank you. Thanks for having me.

Host: Yeah. I appreciate you joining us. And today, we're going to be talking about lung cancer. That's something that I think people generally associate with smoking. There'll be other causes for it, but maybe you can talk a little bit in general terms to start with about who gets lung cancer? Who should we be concerned about maybe looking into their health, if they've been a smoker or had some other habits? Speak a little bit about generally who should we be concerned about possibly getting lung cancer.

Dr. Alex Herskovic: Yeah. So there are many possible causes of lung cancer. Of course, smoking is associated with a large number of the cases. In terms of specific screening guidelines for lung cancer, the US Preventative Services Task Force recommends lung cancer screening only for patients aged 55 to 80, who have a 30-pack-year smoking history and either currently smoke or haven't quit within the last 15 years. So those patients are the ones who would be eligible for screening.

Host: So when we say 30-pack-year, let's help folks and do a little math for them, including for me, because I want to make sure. So 30 pack years, if that was one pack a day for 30 years or two packs a day for 15 years, that would qualify somebody in that category.

Dr. Alex Herskovic: Correct.

Host: And the other age guidelines were 55...

Dr. Alex Herskovic: Fifty-five to eighty by the US Preventative Services Task Force.

Host: Let's start with a 40-year-old who's not even smoking, probably the first thing you'd say, "Quit smoking." That would make the most sense, right?

Dr. Alex Herskovic: As a doctor, I have to tell them to stop smoking.

Host: Yeah. And if they're having some issues, would their primary care doctor be the first one that they would talk to about some issue they might be having in their chest or a respiratory problem?

Dr. Alex Herskovic: Sure. If a patient has a respiratory issue, I think a primary care doctor for a non-urgent the emergency department for an urgent problem is appropriate. Just because you have a cough, it doesn't mean that you have lung cancer.

Host: And let's talk about those that might be diagnosed with a cancer. You know, what would the path be for an individual? I'm sure it would depend on the type and the size, location, those kinds of different things. But generally, what would the path be for somebody who was diagnosed with lung cancer?

Dr. Alex Herskovic: Yeah. So that question of course has a complex answer. I'll try to keep it on the brief side. When a diagnosis of lung cancer is either suspected or established, a patient will need certain tests such as blood tests, scans such as CT scans or MRIs, but also likely meet with multiple healthcare providers. That can be doctors of different specialties, nurse practitioners, nurses, dieticians, and others. All of those providers then work together to determine the best course of personalized treatment for a given patient.

Treatment may include one or more of the following. One is surgery. Two is chemotherapy. In general, chemotherapy is a medicine that goes throughout the body and could kill cancer wherever it might be hiding. Radiation, that's what I specialize in. In the very simplest terms and it's actually a lot more complicated than this, but in the very simplest terms, radiation therapy involves aiming painless x-rays at cancer that help us to kill that cancer.

And a new weapon in our arsenal against cancer is immunotherapy. That is a type of medication that boosts and recruits your own immune system to fight cancer.

Host: A lot there. And I know you mentioned you're a radiation oncologist, so that's really your area of expertise. But a little bit, maybe let's start with surgery. If someone has cancer in their lung, they'll remove that and perhaps remove part of the lung, but, I mean, allow the individual to still have a fairly normal life with just reduced lung capacity. That's kind of simplistic terms, but is that basically what happens?

Dr. Alex Herskovic: Yes. So again, if surgery is indicated or appropriate, depends upon the size and extent of spread of a given cancer. I've worked closely with the surgeons at Riverside who complete surgery for lung cancer. They are very careful to test a patient's lung function before proceeding with surgery, just to make sure that they can still breathe okay with a part of the lung missing after surgery is done.

Host: Sure. Yeah. And so let's talk a little more about your area of expertise in radiation therapies. You know, you mentioned it's really targeted using radiation in a targeted way to kill the cancer, for other very basic terms, but that's it.

One thing I know over the years, they've been able to develop that technology, that the good cells around that can be preserved to a degree. Is that the big consideration when giving radiation therapy, is killing the cancer, but trying to keep as much of the good cells and the healthy tissue and such alive and viable?

Dr. Alex Herskovic: Correct. Radiation oncology has changed rapidly over the past several decades. We have technology now to pinpoint the cancer very carefully and avoid the surrounding healthy tissue as much and as safely possible.

Host: And Riverside, it really is on the front edge of the technology that's able to do those things. Is that right?

Dr. Alex Herskovic: Right. So for more advanced lung cancers, a patient might need radiation once a day, Monday through Friday for a few weeks. That technology has been around for some time. What's new over the past 20 years or so is appropriate for early stage small lung cancers. And that's a high dose of radiation, usually given just over five days to a very precise location. It's called stereotactic radiation. And that gives us a good chance of killing the tumor in patients with small early stage lung cancers.

We do a lot of stereotactic radiation for lung cancer here, especially for a community hospital. I don't know anyone nearby who does as much as we do. We have a good staff here composed of technicians and physicists, who I work with to deliver that radiation safely and effectively.

Host: So by and large, those patients that are diagnosed with cancer and go through treatment generally have high success and productive life after that and go on to live a long life.

Dr. Alex Herskovic: You know, it really depends. So with lung cancer screening, we can catch lung cancers at an earlier stage. Obviously, if we catch cancer when it's smaller and it hasn't spread yet, chance of cure is higher. For patients with more advanced lung cancer, we still work hard with curative intent to give them the best outcome possible, balancing both survival and quality of life.

But again, you know lung cancer can be aggressive especially in its later stages. So the one thing to do is to stop smoking if you're hearing this. As many people have told you before, stop smoking. And another one again, if you are appropriate for lung cancer screening, that's something that we do through Riverside, or you can talk about with your primary care doctors. So if you do have a heavy smoking history, hopefully if you develop a lung cancer, we can catch it early.

Host: Yeah. And let's talk a little more about the lung cancer screening program at Riverside. You touched on some of the things before, but let's repeat, who would qualify and how would they get involved in that screening program?

Dr. Alex Herskovic: So the different organizations do have different criteria for who should get lung cancer screening. The criteria that I quoted age 55 to 80, a 30-pack-year smoking history who either currently smoke or quit within the past 15 years. That's from the US Preventative Services Task Force. And I double-checked today, they're actually about to update their guidelines soon. So that might be changing soon, but it probably won't be too different from that now.

We have a very active lung cancer screening program at Riverside. Actually, the Department of Radiology here, the American College of Radiology has actually designated them as Lung cancer Screening Center of Excellence. So again, for appropriate patients, I think this is something that we can do here effectively in order to improve outcomes for lung cancer patients..

Host: Yeah, that's great to hear. And you mentioned even if you quit within the past 15 years, which is quite a long period of time. So obviously if you've done it, smoking does damage. And even if it's been 15 years still, you want to get checked and see what probability may be of them having lung cancer. So somebody who thinks like, "I quit five years ago, I'm fine," That may not necessarily be the case.

Dr. Alex Herskovic: Correct.

Host: Yeah. That's interesting. Doctor, a lot of good information. In closing, what would you say to someone who has received a lung cancer diagnosis?

Dr. Alex Herskovic: So I would tell that person what I tell all of my patients, this could be very overwhelming. It could be very scary. My only advice is just to take it one day at a time. In oncology, we can't promise you a certain outcome. I know our team at Riverside, we will promise you one thing, that we will work very hard to do the best job we can taking care of you.

Host: Very good. Dr. Alex Herskovic, radiation oncologist with the Riverside Cancer institute. Thanks so much for being with us today.

Dr. Alex Herskovic: Thanks for having me.