The lungs are two large organs made of spongy tissue, which lie above the diaphragm and under the rib cage. When you breathe in, your lungs absorb oxygen and deliver it to the bloodstream, where it’s pumped throughout the body. When you exhale, the lungs remove carbon dioxide, a waste gas, from the bloodstream. Lung cancer interferes with this vital process and can make breathing more difficult.
Even though lung cancer is one of the most common cancers in the U.S., many people are unaware of its reach and its impact. Did you know, for example, that lung cancer is the No. 1 cancer killer of women, according to the American Lung Association (ALA)? Over the past 37 years, the rate of new lung cancer cases has nearly doubled in women, and yet only 1 percent of women have the disease on their radar.
The American Cancer Society estimates that 222,500 new cases will be diagnosed by the end of 2017—116,990 in men and 105,510 in women. While cigarette smoking is an important factor, 28,000 Americans living with lung cancer have never smoked, according to the ALA.
But there's good news. Today, thanks in large part to improvements in diagnostics and treatments, thousands of people are surviving lung cancer. The key is to catch it early, when it has a much higher survival rate. Still, most cases are not diagnosed until later stages, which makes awareness initiatives around early detection efforts all the more important.
One medical advance that is offering oncologists new tools in the fight against lung cancer is immunotherapy. It uses the body's own immune system to detect and fight cancer cells. "Tumors have ways of protecting themselves and ways to get around the body's natural defenses to attack what's not normal," says Dr. Kendal Hervert, a Pulmonologist at our hospital in Tulsa. "These therapies are finding a way to shut down those defenses."
Checkpoint inhibitors like pembrolizumab (Keytruda®), which President Jimmy Carter took to treat the metastatic melanoma that spread to his liver and brain, work by tricking the body into doing what it was designed to do. Think of cancer cells as biological double agents. They are the body's own cells that have mutated and turned against their host. But because they are not foreign, they often sneak past the immune system's defenses. These double agents have a way of sending deceptive signals to antigen-fighting T-cells that they are not harmful. "Nothing to see here," they wink to T-cells that pass through various checkpoints in search of invaders. If not for these checkpoints, T-cells would run amok and hunt down healthy cells. But immunotherapy is designed to turn those checkpoints off and disrupt the cancer cells' signal, exposing them and unleashing the immune system to attack.
"Cancer is like a wolf in sheep's clothing," says Dr. Eugene Ahn, Medical Oncologist at Cancer Treatment Centers of America® (CTCA) near Chicago. "The body perceives it as a member of the flock. These medicines help remove the sheep's clothing." Other forms of cancer immunotherapy have been used over the years, and still more are being developed.
Another development involves the use of targeted therapy, which blocks cancer's growth by stopping cancer cells from dividing, or by killing them directly. "Targeted therapies allow people to continue on with their daily life, because they don't have to go in for chemotherapy infusions every two or three weeks," says Dr. Hervert. "Typically, it's a pill that they take on a daily basis, and it allows them to feel a little bit more like they're just having their routine."
Other improvements have been made in the area of diagnostics. For example, expedited diagnostic programs, like the one now being offered at our Chicago-area hospital and our Tulsa hospital, can cut down considerably on the amount of time patients have to wait for test results. With each hospital's rapid lung-nodule diagnostic program, a medical team—consisting of a medical oncologist, interventional radiologist, a pulmonologist and a thoracic surgeon, all working together under one roof—reviews relevant scans and records before the patient comes in. If more images are needed, a biopsy is performed that day and immediately reviewed by a pathologist. By day four, the medical team shares the diagnosis, and if cancer is found, recommends a personalized treatment plan specific to the patient's needs.
"We think it will improve quality of care if an early diagnosis is done efficiently, and it will improve the emotional and psychological stressers that go with knowing 'something's wrong and I don't have a treatment plan'," says Dr. Bruce Gershenhorn, Medical Oncologist at our hospital outside Chicago.