Lung cancer is cancer that usually starts in the lining of the bronchi (the main airways of the lungs), but can also begin in other areas of the lungs, including the bronchioles, or alveoli.
It is the leading cause of cancer death in both men and women.
Nearly all lung cancers are carcinomas, a cancer that begins in the lining or covering tissues of an organ.
The tumor cells of each type of lung cancer grow and spread differently, and each type requires different treatment.
Listen in as Swapnil Rajurkar, MD talks about lung cancer and explains your options if you or someone close to you has been diagnosed with lung cancer.
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What You Need to Know About Lung Cancer
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Learn more about Swapnil Rajurkar, MD
Swapnil Rajurkar, MD
An active member in the American Society of Clinical Oncology and the American Society of Hematology, Swapnil Rajurkar, M.D. has published in the Journal of Clinical Oncology and presented at several major clinical conferences. As an oncologist, Rajurkur is especially interested in lung, prostate and ynecological cancers. His goal is to provide compassionate and individualized treatment for his patient’s through the use of evidence based medicine, access to the best technology and enrollment in clinical trials.Learn more about Swapnil Rajurkar, MD
Transcription:
What You Need to Know About Lung Cancer
Melanie Cole (Host): If you have been recently diagnosed with lung cancer or are looking for a second opinion, you and your family may be facing a lot of difficult questions. City of Hope’s lung cancer specialists can walk you through the treatment process, address your concerns and create a personalized plan designed to give you the best possible results. My guest today is Dr. Swapnil Rajurkar. He’s a thoracic oncologist at City of Hope. Tell us about lung cancer and the world today. Are you seeing more lung cancer than you used to? Or less?
Dr. Swapnil Rajurkar (Guest): First of all, Melanie, thank you for having me on your show and, yes, you’re absolutely right. We are seeing lung cancer. It happens more frequently and I am seeing a lot of new cancer patients, especially women, who never even smoked. So, there is clearly something going on that we do not understand at this time.
Melanie: Okay. So, if somebody has been a smoker or if they are somebody whose family--is there a genetic component doctor?
Dr. Rajurkar: At this time the genetics are really not important for lung cancer. There could be some new information coming out soon but, at this time, there really isn’t a genetic test that can help us guide and see if any person is at a higher risk for getting lung cancer.
Melanie: Okay. So, then, back to the question I was going to ask you. If somebody is a smoker, and we’ve heard lately about lung cancer screening, who can get this screening and is it helping you docs to detect lung cancer earlier?
Dr. Rajurkar: Absolutely. There are very specific criteria as to who should get lung cancer screening. First of all, this is a low dose CT scan and these CT scans should be ordered in people between the ages of 55-74 who have smoked at least 30 pack years and, if they are a former smoker, have quit within the last 15 years.
Melanie: What does 30 pack years mean? People hear those terms and they’re not sure what that even means.
Dr. Rajurkar: If a person smokes one pack a day of cigarettes for about 30 years, that would be called a 30-pack year smoking history.
Melanie: If someone has been that, then this is the criteria and is this something they ask their doctor if they can have this screening and at what age?
Dr. Rajurkar: This is approved to be done between the ages of 55 and 74 years, first of all. Secondly, whenever we see a new patient, we get this history in their initial paperwork and if a person thinks he’s at a high risk of getting lung cancer because of the high risk of smoking, they should bring this up with their primary care physician so that this scan can be ordered for them.
Melanie: So, you do the screening. What are the symptoms of lung cancer doctor that people might, if they haven’t been screened, or if they’ve been a smoker or they just feel something’s not right, what are some red flags for lung cancer?
Dr. Rajurkar: Sure. So, shortness of breath, chest pain, cough, coughing up blood, losing weight significantly without trying to lose weight. These are all possible symptoms of lung cancer.
Melanie: You mentioned coughing up blood, does every lung cancer patient cough or sometimes it cannot have a cough accompanying it?
Dr. Rajurkar: That’s correct. Not every lung cancer patient has a cough or even has shortness of breath. Sometimes, lung cancers are diagnosed incidentally. Say, for example, a patient is going to have a surgical procedure and the surgeon orders a pre-operative chest x-ray. That, incidentally, picks up a mass in the lung. A lot of patients who have lung cancer don’t even have any symptoms. That’s the scary part.
Melanie: Wow. That’s the scary part. Now, if somebody hears that diagnosis--and what a scary diagnosis it would be--but it’s not always the death sentence that it used to be 50 years ago. Tell us what’s going on in the world of lung cancer treatment now.
Dr. Rajurkar: Sure. Say a person has a CT scan which shows a mass in the lung. The first step is to get a biopsy of that mass. It’s usually done by putting a needle in the mass from outside or through a bronchoscopy where a camera is passed in the airway. One of these ways we get a biopsy and confirm if it is lung cancer or not. Once it is confirmed to be lung cancer, we get a full body scan called a PET scan and we also get a MRI of the brain to make sure the cancer has not spread anywhere else in their body. Once we have these results, we know the exact stage of the lung cancer. There are four stages. Stage I, II, III, IV and the treatment of the cancer depends on the stage of the cancer. Also, it is important to know that there are two major types of lung cancer. One is a small cell lung cancer and the second is the non-small cell lung cancer and they are treated slightly differently. For small cell lung cancer, typically surgery is not recommended because by the time the patient is diagnosed, it’s too late for surgery. For non-small cell lung cancer we try to do surgery whenever we can. If a person has a bad emphysema, COPD because of the smoking and they cannot have surgery, they can have local radiation therapy to the cancer in the lung and that can cure those patients also. But, say, the person is not lucky enough to have an early stage lung cancer. In that situation, we do a combination of chemotherapy and radiation or, if it’s Stage IV lung cancer, it is chemotherapy alone.
Melanie: What are some general outcomes that you can give hope to people about the outcomes with these type of treatments?
Dr. Rajurkar: Lung cancer still continues to be a very aggressive and deadly type of cancer. Yes, the survival has improved over the last 20-30 years but we still have a long ways to go. For Stage I lung cancer, there is a 90% chance of curing the cancer with the surgery. For Stage II, it’s about 70%. For Stage III, about 40-50% and for Stage IV the chances of surviving five years are less than 5%. So, obviously, Stage IV lung cancer is bad news. However, for Stage IV lung cancer, over the last year or two we have had new treatments that have been developed and are FDA approved, that have improved the outcomes and survival as compared to what we had before. A lot of these treatments are immunotherapy based treatments where we use the patient’s immune system to fight the cancer cells. That’s definitely the most exciting part of treatment at this time.
Melanie: What else are you doing that’s really exciting there at City of Hope?
Dr. Rajurkar: We have a lot of clinical trials for patients whose cancers have grown despite FDA approved treatment. So, that is definitely something that we at City of Hope are able to offer that other facilities are not able to. We also have a very strong laboratory based research program where our scientists are working really hard to find the next best treatment so it can be studied in clinical trials in the future. We have amazing surgeons, radiation oncologists and medical oncologists, like myself, who are dedicated to be associated with the treatment of lung cancer and give the best outcomes for them.
Melanie: That’s fascinating and it’s such great information, doctor. Thank you so much for being with us today. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
What You Need to Know About Lung Cancer
Melanie Cole (Host): If you have been recently diagnosed with lung cancer or are looking for a second opinion, you and your family may be facing a lot of difficult questions. City of Hope’s lung cancer specialists can walk you through the treatment process, address your concerns and create a personalized plan designed to give you the best possible results. My guest today is Dr. Swapnil Rajurkar. He’s a thoracic oncologist at City of Hope. Tell us about lung cancer and the world today. Are you seeing more lung cancer than you used to? Or less?
Dr. Swapnil Rajurkar (Guest): First of all, Melanie, thank you for having me on your show and, yes, you’re absolutely right. We are seeing lung cancer. It happens more frequently and I am seeing a lot of new cancer patients, especially women, who never even smoked. So, there is clearly something going on that we do not understand at this time.
Melanie: Okay. So, if somebody has been a smoker or if they are somebody whose family--is there a genetic component doctor?
Dr. Rajurkar: At this time the genetics are really not important for lung cancer. There could be some new information coming out soon but, at this time, there really isn’t a genetic test that can help us guide and see if any person is at a higher risk for getting lung cancer.
Melanie: Okay. So, then, back to the question I was going to ask you. If somebody is a smoker, and we’ve heard lately about lung cancer screening, who can get this screening and is it helping you docs to detect lung cancer earlier?
Dr. Rajurkar: Absolutely. There are very specific criteria as to who should get lung cancer screening. First of all, this is a low dose CT scan and these CT scans should be ordered in people between the ages of 55-74 who have smoked at least 30 pack years and, if they are a former smoker, have quit within the last 15 years.
Melanie: What does 30 pack years mean? People hear those terms and they’re not sure what that even means.
Dr. Rajurkar: If a person smokes one pack a day of cigarettes for about 30 years, that would be called a 30-pack year smoking history.
Melanie: If someone has been that, then this is the criteria and is this something they ask their doctor if they can have this screening and at what age?
Dr. Rajurkar: This is approved to be done between the ages of 55 and 74 years, first of all. Secondly, whenever we see a new patient, we get this history in their initial paperwork and if a person thinks he’s at a high risk of getting lung cancer because of the high risk of smoking, they should bring this up with their primary care physician so that this scan can be ordered for them.
Melanie: So, you do the screening. What are the symptoms of lung cancer doctor that people might, if they haven’t been screened, or if they’ve been a smoker or they just feel something’s not right, what are some red flags for lung cancer?
Dr. Rajurkar: Sure. So, shortness of breath, chest pain, cough, coughing up blood, losing weight significantly without trying to lose weight. These are all possible symptoms of lung cancer.
Melanie: You mentioned coughing up blood, does every lung cancer patient cough or sometimes it cannot have a cough accompanying it?
Dr. Rajurkar: That’s correct. Not every lung cancer patient has a cough or even has shortness of breath. Sometimes, lung cancers are diagnosed incidentally. Say, for example, a patient is going to have a surgical procedure and the surgeon orders a pre-operative chest x-ray. That, incidentally, picks up a mass in the lung. A lot of patients who have lung cancer don’t even have any symptoms. That’s the scary part.
Melanie: Wow. That’s the scary part. Now, if somebody hears that diagnosis--and what a scary diagnosis it would be--but it’s not always the death sentence that it used to be 50 years ago. Tell us what’s going on in the world of lung cancer treatment now.
Dr. Rajurkar: Sure. Say a person has a CT scan which shows a mass in the lung. The first step is to get a biopsy of that mass. It’s usually done by putting a needle in the mass from outside or through a bronchoscopy where a camera is passed in the airway. One of these ways we get a biopsy and confirm if it is lung cancer or not. Once it is confirmed to be lung cancer, we get a full body scan called a PET scan and we also get a MRI of the brain to make sure the cancer has not spread anywhere else in their body. Once we have these results, we know the exact stage of the lung cancer. There are four stages. Stage I, II, III, IV and the treatment of the cancer depends on the stage of the cancer. Also, it is important to know that there are two major types of lung cancer. One is a small cell lung cancer and the second is the non-small cell lung cancer and they are treated slightly differently. For small cell lung cancer, typically surgery is not recommended because by the time the patient is diagnosed, it’s too late for surgery. For non-small cell lung cancer we try to do surgery whenever we can. If a person has a bad emphysema, COPD because of the smoking and they cannot have surgery, they can have local radiation therapy to the cancer in the lung and that can cure those patients also. But, say, the person is not lucky enough to have an early stage lung cancer. In that situation, we do a combination of chemotherapy and radiation or, if it’s Stage IV lung cancer, it is chemotherapy alone.
Melanie: What are some general outcomes that you can give hope to people about the outcomes with these type of treatments?
Dr. Rajurkar: Lung cancer still continues to be a very aggressive and deadly type of cancer. Yes, the survival has improved over the last 20-30 years but we still have a long ways to go. For Stage I lung cancer, there is a 90% chance of curing the cancer with the surgery. For Stage II, it’s about 70%. For Stage III, about 40-50% and for Stage IV the chances of surviving five years are less than 5%. So, obviously, Stage IV lung cancer is bad news. However, for Stage IV lung cancer, over the last year or two we have had new treatments that have been developed and are FDA approved, that have improved the outcomes and survival as compared to what we had before. A lot of these treatments are immunotherapy based treatments where we use the patient’s immune system to fight the cancer cells. That’s definitely the most exciting part of treatment at this time.
Melanie: What else are you doing that’s really exciting there at City of Hope?
Dr. Rajurkar: We have a lot of clinical trials for patients whose cancers have grown despite FDA approved treatment. So, that is definitely something that we at City of Hope are able to offer that other facilities are not able to. We also have a very strong laboratory based research program where our scientists are working really hard to find the next best treatment so it can be studied in clinical trials in the future. We have amazing surgeons, radiation oncologists and medical oncologists, like myself, who are dedicated to be associated with the treatment of lung cancer and give the best outcomes for them.
Melanie: That’s fascinating and it’s such great information, doctor. Thank you so much for being with us today. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.