Symptoms and Management of Lung Cancer
1 in 16 people in the US will be diagnosed with lung cancer in their lifetime. Dr. Marc Rappaport explores symptoms of lung cancer and ways that it can be managed.
Featured Speaker:
Marc Rappaport, DO
Marc Rappaport, DO is a Board Certified Oncologist at Crystal Run Healthcare. He earned his Medical Degree from Western University of Health Sciences, College of Osteopathic Medicine of the Pacific in Pomona, CA. He completed his Residency in Internal Medicine at Albert Einstein College of Medicine, Jacobi Medical Center in Bronx, NY and Fellowship-training in Oncology & Hematology at Fox Chase Cancer Center in Philadelphia, PA. He is Board Certified in Medical Oncology and Internal Medicine and is seeing patients in Newburgh. Transcription:
Symptoms and Management of Lung Cancer
Caitlin Whyte: One in 16 people in the US will be diagnosed with lung cancer in their lifetime with a new diagnosis happening every 2.2 minutes. In this episode, we will be discussing the symptoms and management of lung cancer with Dr. Marc Rappaport, a medical oncologist at Montefiore St. Luke's Cornwall.
This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. So doctor, we're talking about the symptoms and management of lung cancer. Let us start with the first part of that topic. What are some symptoms that could warn us of lung cancer?
Marc Rappaport, DO: Some common symptoms that we see in the office are cough, which doesn't go away. Of course, any sign of blood tinged in any sputum associated with the cough is definitely a red flag and needs to be addressed. Unexplained weight loss, any chest discomfort, new shortness of breath or dyspnea, which is like tiredness walking up the stairs or just going on a regular walk. Any new symptoms like that should be addressed with their doctor.
Caitlin Whyte: Okay. And if I'm experiencing these symptoms, what does screening look like for lung cancer? And then how has it diagnosed?
Marc Rappaport, DO: Well, so screening is independent of these symptoms. So screening would be somebody who meets the criteria, which is X number of years smoker or a recent smoker or somebody who's actively smoking. So there are certain parameters and guidelines we use for who's a candidate for screening, and those patients are sent for what's called a low dose CAT scan, which is read by a radiologist, which we'll read out as negative, positive or repeat in six to twelve months. So that's the screening part of it.
If somebody has symptoms, then they would go right to see their primary or a lung specialist and have, you know, immediate workup done with a CAT scan or other imaging.
Caitlin Whyte: And once diagnosed, what are some of our treatment options?
Marc Rappaport, DO: So based upon the stage I, II, III, IV, if it's early stage I, II, normally it's right to surgery. If they're not a surgical candidate, we can utilize sometimes radiation for a small lesion if it's a stage I. For stage II, normally like I mentioned, surgery. If not a candidate for surgery, it could be radiation plus chemo or just radiation alone. Stage III, we normally do chemo and radiation followed by surgery or we do surgery first followed by chemotherapy. And of course, stage IV is more just a palliative approach with either chemotherapy or different targeted therapies.
We have come a tremendous long way over the last five years in developing new targeted medications and testing. So what we do now is any new stage IV cancer patient or, in some centers, they do all stages, they send the tumor out for what's called genomic testing. And right now, we're testing maybe 11 to 14 different proteins for different mutations. And if one has those, they are eligible for a pill, which is pretty remarkable. And the chance of having a mutation is low. We're talking less than 1% to 2% of the population but, you know, they're out there. I mean, we certainly have a lot of them in the office and, you know, they do have a dramatic response because in general, those mutations are what caused this person's specific lung cancer, at least one pathway. And so they tend to have a pretty robust response for a certain amount of time.
Caitlin Whyte: And when it comes to life after lung cancer, life with lung cancer, how can patients manage their illness and continue to lead the lifestyles that they've had before? Or with that same note, what has to change?
Marc Rappaport, DO: It is pretty traumatic. If somebody does have surgery and they have to take a lobe, they're very symptomatic, more shortness of breath. They have to modify their activities. They may be dependent upon oxygen. For those patients that received radiation, especially if they were heavy smokers, they already have compromised lungs, so they could have more inflammation, more shortness of breath. So, yeah, it's a very big change in quality of life.
Caitlin Whyte: What would you like patients to know when they hear that diagnosis, lung cancer? You know, like you said, it is so traumatic hearing anything with cancer. What should patients know going into , starting their journey.
Marc Rappaport, DO: Well, I think that they should know that lung cancer is not a death sentence anymore. It is still one of those cancers that we tend to find, you know, more of an advanced stage than an early stage. But with our screening CAT scans, we are picking up cancers earlier, but we do have a lot of new treatments, including immunotherapies now. And patients are living a lot longer than what they were three, four or five years ago.
Caitlin Whyte: Well, thank you so much for joining us today. That was Dr. Marc Rappaport, a medical oncologist at Montefiore St. Luke's Cornwall. Visit montefiore.slc.org for more information. And if you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.
Symptoms and Management of Lung Cancer
Caitlin Whyte: One in 16 people in the US will be diagnosed with lung cancer in their lifetime with a new diagnosis happening every 2.2 minutes. In this episode, we will be discussing the symptoms and management of lung cancer with Dr. Marc Rappaport, a medical oncologist at Montefiore St. Luke's Cornwall.
This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. So doctor, we're talking about the symptoms and management of lung cancer. Let us start with the first part of that topic. What are some symptoms that could warn us of lung cancer?
Marc Rappaport, DO: Some common symptoms that we see in the office are cough, which doesn't go away. Of course, any sign of blood tinged in any sputum associated with the cough is definitely a red flag and needs to be addressed. Unexplained weight loss, any chest discomfort, new shortness of breath or dyspnea, which is like tiredness walking up the stairs or just going on a regular walk. Any new symptoms like that should be addressed with their doctor.
Caitlin Whyte: Okay. And if I'm experiencing these symptoms, what does screening look like for lung cancer? And then how has it diagnosed?
Marc Rappaport, DO: Well, so screening is independent of these symptoms. So screening would be somebody who meets the criteria, which is X number of years smoker or a recent smoker or somebody who's actively smoking. So there are certain parameters and guidelines we use for who's a candidate for screening, and those patients are sent for what's called a low dose CAT scan, which is read by a radiologist, which we'll read out as negative, positive or repeat in six to twelve months. So that's the screening part of it.
If somebody has symptoms, then they would go right to see their primary or a lung specialist and have, you know, immediate workup done with a CAT scan or other imaging.
Caitlin Whyte: And once diagnosed, what are some of our treatment options?
Marc Rappaport, DO: So based upon the stage I, II, III, IV, if it's early stage I, II, normally it's right to surgery. If they're not a surgical candidate, we can utilize sometimes radiation for a small lesion if it's a stage I. For stage II, normally like I mentioned, surgery. If not a candidate for surgery, it could be radiation plus chemo or just radiation alone. Stage III, we normally do chemo and radiation followed by surgery or we do surgery first followed by chemotherapy. And of course, stage IV is more just a palliative approach with either chemotherapy or different targeted therapies.
We have come a tremendous long way over the last five years in developing new targeted medications and testing. So what we do now is any new stage IV cancer patient or, in some centers, they do all stages, they send the tumor out for what's called genomic testing. And right now, we're testing maybe 11 to 14 different proteins for different mutations. And if one has those, they are eligible for a pill, which is pretty remarkable. And the chance of having a mutation is low. We're talking less than 1% to 2% of the population but, you know, they're out there. I mean, we certainly have a lot of them in the office and, you know, they do have a dramatic response because in general, those mutations are what caused this person's specific lung cancer, at least one pathway. And so they tend to have a pretty robust response for a certain amount of time.
Caitlin Whyte: And when it comes to life after lung cancer, life with lung cancer, how can patients manage their illness and continue to lead the lifestyles that they've had before? Or with that same note, what has to change?
Marc Rappaport, DO: It is pretty traumatic. If somebody does have surgery and they have to take a lobe, they're very symptomatic, more shortness of breath. They have to modify their activities. They may be dependent upon oxygen. For those patients that received radiation, especially if they were heavy smokers, they already have compromised lungs, so they could have more inflammation, more shortness of breath. So, yeah, it's a very big change in quality of life.
Caitlin Whyte: What would you like patients to know when they hear that diagnosis, lung cancer? You know, like you said, it is so traumatic hearing anything with cancer. What should patients know going into , starting their journey.
Marc Rappaport, DO: Well, I think that they should know that lung cancer is not a death sentence anymore. It is still one of those cancers that we tend to find, you know, more of an advanced stage than an early stage. But with our screening CAT scans, we are picking up cancers earlier, but we do have a lot of new treatments, including immunotherapies now. And patients are living a lot longer than what they were three, four or five years ago.
Caitlin Whyte: Well, thank you so much for joining us today. That was Dr. Marc Rappaport, a medical oncologist at Montefiore St. Luke's Cornwall. Visit montefiore.slc.org for more information. And if you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.