Lung cancer is the leading cause of cancer death in the US. Understanding lung cancer risk factors and symptoms can help you make a more informed treatment decision.
At Cancer Treatment Centers of America (CTCA), each patient is provided with a multi-disciplinary team of experts that help tailor lung cancer treatment to his or her unique tumor and concerns.
As patients navigate a diagnosis of cancer, Dr. Gershenhorn discusses how he works with patients to answer their questions, develop an individualized plan, and his advice on when to seek a second opinion.
For patients with lung cancer, seeking an integrated team can be particularly important—experts in nutritional counselling and interventional pulmonology are used in combination with other cancer treatments to relieve symptoms that may limit breathing or cause pain.
Selected Podcast
Navigating a Diagnosis of Lung Cancer
Featured Speaker:
Dr. Gershenhorn is board certified in medical oncology, hematology and internal medicine. He earned an osteopathic medical degree from the Philadelphia College of Osteopathic Medicine. He completed an internal medicine residency at Beth Israel Medical Center in New York, New York. In addition, Dr. Gershenhorn completed a fellowship at Montefiore Medical Center in Bronx, New York, where he served as Chief Fellow in the Department of Hematology/Oncology. He was honored with an award for his accomplishments as Chief Fellow. Before pursuing an education in medicine, Dr. Gershenhorn completed a bachelor's degree in biology at Lehigh University in Bethlehem, Pennsylvania. Among the types of cancer he treats are thoracic cancers, gastrointestinal cancers (e.g., cancer of the esophagus, stomach, pancreas), renal cell cancer and prostate cancer.
Transcription:
Navigating a Diagnosis of Lung Cancer
Melanie Cole (Host): Lung cancer is the leading cause of cancer death in the US. Understanding lung cancer risk factors and symptoms can help you make a more informed treatment decision, my guest is Dr. Bruce Gershenhorn, he's a medical oncologist with Cancer Treatment Centers of America. Welcome to the show Dr. Gershenhorn. Let's start. We are going to be talking about navigating the diagnosis of lung cancer, but I'd like you to give us a little bit of risk factors. Who is at risk lung cancer? And tell us some of the symptoms that might send us to the doctor.
Dr. Bruce Gershenhorn (Guest): Sure, first of all it's great to be here and thanks for having me. As far as risk factors for lung cancer, it's smoking, smoking, smoking. Prior to the advent of cigarettes being around, lung cancer was a very rare cancer. Since the advent of cigarettes, smoking has risen to a point where it's actually the leading cause of cancer death in the United States amongst men and women. There are some other risk factors that are associated with lung cancer, such as specific exposures, like asbestos exposure, other environmental exposures, but those are much less common. Cancer is a disease that happens to smokers and outside of smoking it's very unlikely to get the disease.
Melanie: But, are there non-smokers that do get lung cancer?
Dr. Gershenhorn: There are, there are. That population is slowly on the rise, but the vast majority of people who develop lung cancer are smokers. So, it is clearly the leading risk factor for developing this disease.
Melanie: Now, what about symptoms? Some people are coughers, some people are not. Some people have chest pain, but it could be anxiety. How do you know? And, when do you come see someone?
Dr. Gershenhorn: You know, that's a great question. Sometimes lung cancer develops in an asymptomatic person, meaning a person who develops no symptoms. But, the common presenting symptoms with lung cancer are cough, sometimes people even cough up little bits of blood. Sometimes people develop a little bit of weight loss. Shortness of breath or episodes of difficulty breathing and sometimes just an overall feeling of not well-being...people feel somewhat sick. But, the major symptoms at presentation are related to cough and shortness of breath.
Melanie: OK, so now if somebody gets that hideous diagnosis, that they don't want to get, but, they've gotten this diagnosis...they've gone to see you. You've determined this is what they have. Then, what's the first beginning treatment? Because, it's not necessarily a no hope situation that everyone thinks it is...is it?
Dr. Gershenhorn: No, no no. Symptoms and the disease management has changed dramatically over the past five to ten years. The first thing I would say, is when someone has a cancer diagnosis, is that obviously, the stress and the fear and the anxiety associated with it needs to be addressed, but you need to be educated. You need to understand what options are out there. Specifically, what type of lung cancer you have, because there are different types. The more we learn about the disease, the more we are subtyping this disease into different population. You need to know the stage. You need to understand exactly how advanced this is and what your options are based on the stage. So, you need to educate yourself and find a team of professionals around you that can give you the guidance and guide you through this difficult situation.
Melanie: Once you've staged it. Stage 1 being the earliest stage. Then, you look at the courses of treatments, so what treatments are out there for lung cancer?
Dr. Gershenhorn: For the first stage of lung cancer, the treatment revolves around surgery. Removing the tumor from the body, usually via a technique called a lobectomy. For the second stage of lung cancer, which is a little more advanced than the first stage, when the glands near the tumor become swollen with cancer, the treatment also revolves around surgery. Usually, after surgery for the second stage we do give chemotherapy, which will lower the risk of the cancer coming back. For the third stage of lung cancer, which is when the tumor usually involves some of the lymph nodes a little further away from the tumor called the mediastinum, the treatment mainly revolves around radiation and chemotherapy given together. The role for surgery in the third stage is a little bit more questionable and you have to address that with your specific medical provider. For the fourth stage, which is when the lung cancer actually spreads outside the lung to distant sites. For example, if the lung cancer spreads to the liver or if it spreads to the other lung, or the bones, or sometimes even the brain, the treatment revolves around chemotherapy.
Melanie: OK. So, targeted treatments. You know, there have been a lot of new advances. In lung cancer treatment, it's pretty exciting the things you can do now. Speak about some of the targeted treatments and targeted therapy.
Dr. Gershenhorn: You know, this is a great question. This is actually the key involving paradigm in lung cancer right now and where a lot of the advances are being made. There are specific driver mutations, as we call it in oncology. Which are basically the gas pedal, that make these cancers spread, that make them divide, that make them go to other places and makes them hurt people. There is cutting edge technology now, to try to determine what are the driver mutations in the cancer and are there drugs out there that are different from the typical chemotherapy drugs that kill cells that are undergoing cell division. They can actually target the driver and shut down the driver or put the brakes on and stop the cancer from growing and be much more targeted in that specific to the cancer in minimizing side effects. So, for example EGFR has been a huge advance. It's a mutation that is present in the cancer and predominantly this actually happens in non-smokers. I know we talked a little about smoking as a risk factor. But, in the non-smokers who develop lung cancer, EGFR mutations are actually fairly common. These mutations are again, what's driving the cancer and there's pills for example, Erlotinib or Tarceva is a pill that can shut down that driver and could profoundly affect someone's prognosis from the lung cancer. There are other drivers that have been determined now that also have targets, such as, ALK or alk as it's called. There are other ones, such as ROS1, such as B-RAF, such as HER2, there's a lot of other drivers that are being picked up, that are really sub-stratifying lung cancer into many different cancers. And, if we could find the driver that targetable via a drug, then we can do a lot to help these patients, rather than just use standard chemotherapy, that affects cell division and has the side effects that most people think of when they think of chemotherapy.
Melanie: Well, you segued beautifully into the next thing, Dr. Gershenhorn. Side effects, and when you talk about EGFR and ALK and people hear these things and they are terrified of the treatments side effects, not always only the treatment itself. We don't have a lot of time left, but can you please speak about dealing with those side effects.
Dr. Gershenhorn: Yeah. At Cancer Treatment Centers of America, we have a very integrative model, where we feel like naturopathic medicine, nutritional care, mind-body therapy, lots of other support services can help enable someone and get them more involved in dealing with some of the side effects from drugs. The typical chemotherapy side effects which include nausea, and sometimes hair loss and a poor appetite, low blood counts or risks of infection. We have newer and newer treatments available to target those side effects, to make the treatments more palatable.
Melanie: More palatable. That's so important and in the last twenty seconds, Dr. Gershenhorn, can you please just wrap it up , give the people listening some hope about the advances in lung cancer treatments.
Dr. Gershenhorn: So, I think that being an oncologist now that specializes in lung cancer, I'm very excited about the future. I think that learning more about specific targets that we can attack via certain drugs, learning more about the immune system and how to harness the power of the immune system to help fight cancer holds great hope for people that are fighting this difficult disease.
Melanie: You're listening to Managing Cancer. For more information you can go to cancercenter.com, that's cancercenter.com. This is Melanie Cole for Cancer Treatment Centers of America.
Navigating a Diagnosis of Lung Cancer
Melanie Cole (Host): Lung cancer is the leading cause of cancer death in the US. Understanding lung cancer risk factors and symptoms can help you make a more informed treatment decision, my guest is Dr. Bruce Gershenhorn, he's a medical oncologist with Cancer Treatment Centers of America. Welcome to the show Dr. Gershenhorn. Let's start. We are going to be talking about navigating the diagnosis of lung cancer, but I'd like you to give us a little bit of risk factors. Who is at risk lung cancer? And tell us some of the symptoms that might send us to the doctor.
Dr. Bruce Gershenhorn (Guest): Sure, first of all it's great to be here and thanks for having me. As far as risk factors for lung cancer, it's smoking, smoking, smoking. Prior to the advent of cigarettes being around, lung cancer was a very rare cancer. Since the advent of cigarettes, smoking has risen to a point where it's actually the leading cause of cancer death in the United States amongst men and women. There are some other risk factors that are associated with lung cancer, such as specific exposures, like asbestos exposure, other environmental exposures, but those are much less common. Cancer is a disease that happens to smokers and outside of smoking it's very unlikely to get the disease.
Melanie: But, are there non-smokers that do get lung cancer?
Dr. Gershenhorn: There are, there are. That population is slowly on the rise, but the vast majority of people who develop lung cancer are smokers. So, it is clearly the leading risk factor for developing this disease.
Melanie: Now, what about symptoms? Some people are coughers, some people are not. Some people have chest pain, but it could be anxiety. How do you know? And, when do you come see someone?
Dr. Gershenhorn: You know, that's a great question. Sometimes lung cancer develops in an asymptomatic person, meaning a person who develops no symptoms. But, the common presenting symptoms with lung cancer are cough, sometimes people even cough up little bits of blood. Sometimes people develop a little bit of weight loss. Shortness of breath or episodes of difficulty breathing and sometimes just an overall feeling of not well-being...people feel somewhat sick. But, the major symptoms at presentation are related to cough and shortness of breath.
Melanie: OK, so now if somebody gets that hideous diagnosis, that they don't want to get, but, they've gotten this diagnosis...they've gone to see you. You've determined this is what they have. Then, what's the first beginning treatment? Because, it's not necessarily a no hope situation that everyone thinks it is...is it?
Dr. Gershenhorn: No, no no. Symptoms and the disease management has changed dramatically over the past five to ten years. The first thing I would say, is when someone has a cancer diagnosis, is that obviously, the stress and the fear and the anxiety associated with it needs to be addressed, but you need to be educated. You need to understand what options are out there. Specifically, what type of lung cancer you have, because there are different types. The more we learn about the disease, the more we are subtyping this disease into different population. You need to know the stage. You need to understand exactly how advanced this is and what your options are based on the stage. So, you need to educate yourself and find a team of professionals around you that can give you the guidance and guide you through this difficult situation.
Melanie: Once you've staged it. Stage 1 being the earliest stage. Then, you look at the courses of treatments, so what treatments are out there for lung cancer?
Dr. Gershenhorn: For the first stage of lung cancer, the treatment revolves around surgery. Removing the tumor from the body, usually via a technique called a lobectomy. For the second stage of lung cancer, which is a little more advanced than the first stage, when the glands near the tumor become swollen with cancer, the treatment also revolves around surgery. Usually, after surgery for the second stage we do give chemotherapy, which will lower the risk of the cancer coming back. For the third stage of lung cancer, which is when the tumor usually involves some of the lymph nodes a little further away from the tumor called the mediastinum, the treatment mainly revolves around radiation and chemotherapy given together. The role for surgery in the third stage is a little bit more questionable and you have to address that with your specific medical provider. For the fourth stage, which is when the lung cancer actually spreads outside the lung to distant sites. For example, if the lung cancer spreads to the liver or if it spreads to the other lung, or the bones, or sometimes even the brain, the treatment revolves around chemotherapy.
Melanie: OK. So, targeted treatments. You know, there have been a lot of new advances. In lung cancer treatment, it's pretty exciting the things you can do now. Speak about some of the targeted treatments and targeted therapy.
Dr. Gershenhorn: You know, this is a great question. This is actually the key involving paradigm in lung cancer right now and where a lot of the advances are being made. There are specific driver mutations, as we call it in oncology. Which are basically the gas pedal, that make these cancers spread, that make them divide, that make them go to other places and makes them hurt people. There is cutting edge technology now, to try to determine what are the driver mutations in the cancer and are there drugs out there that are different from the typical chemotherapy drugs that kill cells that are undergoing cell division. They can actually target the driver and shut down the driver or put the brakes on and stop the cancer from growing and be much more targeted in that specific to the cancer in minimizing side effects. So, for example EGFR has been a huge advance. It's a mutation that is present in the cancer and predominantly this actually happens in non-smokers. I know we talked a little about smoking as a risk factor. But, in the non-smokers who develop lung cancer, EGFR mutations are actually fairly common. These mutations are again, what's driving the cancer and there's pills for example, Erlotinib or Tarceva is a pill that can shut down that driver and could profoundly affect someone's prognosis from the lung cancer. There are other drivers that have been determined now that also have targets, such as, ALK or alk as it's called. There are other ones, such as ROS1, such as B-RAF, such as HER2, there's a lot of other drivers that are being picked up, that are really sub-stratifying lung cancer into many different cancers. And, if we could find the driver that targetable via a drug, then we can do a lot to help these patients, rather than just use standard chemotherapy, that affects cell division and has the side effects that most people think of when they think of chemotherapy.
Melanie: Well, you segued beautifully into the next thing, Dr. Gershenhorn. Side effects, and when you talk about EGFR and ALK and people hear these things and they are terrified of the treatments side effects, not always only the treatment itself. We don't have a lot of time left, but can you please speak about dealing with those side effects.
Dr. Gershenhorn: Yeah. At Cancer Treatment Centers of America, we have a very integrative model, where we feel like naturopathic medicine, nutritional care, mind-body therapy, lots of other support services can help enable someone and get them more involved in dealing with some of the side effects from drugs. The typical chemotherapy side effects which include nausea, and sometimes hair loss and a poor appetite, low blood counts or risks of infection. We have newer and newer treatments available to target those side effects, to make the treatments more palatable.
Melanie: More palatable. That's so important and in the last twenty seconds, Dr. Gershenhorn, can you please just wrap it up , give the people listening some hope about the advances in lung cancer treatments.
Dr. Gershenhorn: So, I think that being an oncologist now that specializes in lung cancer, I'm very excited about the future. I think that learning more about specific targets that we can attack via certain drugs, learning more about the immune system and how to harness the power of the immune system to help fight cancer holds great hope for people that are fighting this difficult disease.
Melanie: You're listening to Managing Cancer. For more information you can go to cancercenter.com, that's cancercenter.com. This is Melanie Cole for Cancer Treatment Centers of America.