Family Health Magazine - Spring/Summer 2003 - Saint Barnabas Medical Center

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Family Health Magazine - Spring/Summer 2003

A Multidisciplinary Approach to Lung Cancer

Although respiratory system cancers are not the most frequently diagnosed form of cancer–– cancers of the digestive system, genital system and breast cancer are twice as common––they are the most deadly. Lung cancer is the leading cancer killer in both men and women in the United States, with an average five-year survival rate of only 15 percent.

"There is no effective screening test for lung cancer, and in the early stages lung cancer frequently does not cause any symptoms," says Linda Danieu, M.D., medical oncologist at The Cancer Center of Saint Barnabas Medical Center. "Typically, lung cancer is in an advanced stage by the time of diagnosis."

Of the estimated 171,900 patients to be diagnosed with lung cancer in 2003, it is estimated that 157,200 will succumb to this virulent form of cancer according to CA: A Cancer Journal for Clinicians.

A Team Effort

To aggressively meet the challenges of lung cancer, specialists at The Cancer Center of Saint Barnabas have created a multidisciplinary team that carefully reviews and assesses each new patient. The team is comprised of medical oncologists, thoracic surgeons, respiratory therapists, radiation oncologists, radiation therapists, pulmonologists, intensivists, and staff involved in smoking cessation programs. Each week the entire team focuses on the best treatment plan for every patient with newly diagnosed lung cancer.

It is essential for physicians to have accurate means of staging a person’s lung cancer to create the best plan of treatment. The combined efforts of the team at The Cancer Center result in the most accurate staging possible. From sampling the lymph node tissue to the use of mediastenoscopy and PET Scans, oncologists and surgeons use a variety of diagnostic tools for staging.

For patients with Stage 1 or Stage 2 lung cancer, about 25 percent of the total group, immediate surgery is required. Patients who fall into Stage 3 or 4 are often better served by a combination of chemotherapy or radiation, or both.

"We are more accurate in our staging; therefore we do not put people through surgery that will not help for their stage of the disease," says Dr. Danieu.

Lung cancer patients at Saint Barnabas can also participate in a variety of clinical trials and benefit from The Cancer Center’s participation in oncology research groups across the country. One current clinical trial examines the addition of an oral medication in combination with chemotherapy as treatment for those with lung cancer in Stage 3B or Stage 4. Another clinical trial provides an oral chemotherapy drug to Stage 4 patients who previously underwent traditional chemotherapy.

Patients With Lung Cancer: A Profile

Though most individuals with lung cancer have been smokers at some point in their lives, or are currently smokers, about 15 percent of those diagnosed with lung cancer have never smoked. The more you smoke and the longer you smoke, the greater your risk of lung cancer. But if you stop smoking, the risk of lung cancer decreases each year as abnormal cells are replaced by normal cells. After ten years, the risk drops to a level that is one-third to one-half of the risk for people who continue to smoke.

A recent study published in a March 2003 issue of the Journal of the American Medical Association, found that long-term exposure to air pollution significantly raises the risk of dying from lung cancer and is about as dangerous as living with a smoker.

Signs and symptoms of lung cancer include any of the following:

Chronic cough
Hoarseness
Coughing up blood
Weight loss & loss of appetite
Shortness of breath
Fever without a known reason
Wheezing
Repeated bouts of bronchitis or pneumonia
Chest pain

Patients with these symptoms are given a chest X-ray to locate any abnormal spots in the lungs. The physician may insert a bronchoscope through the nose or mouth and down the throat, to look inside the airways and lungs and take a sample, or biopsy, of the tumor. CT Scans are also used to spot small lung cancers. They are generally more sensitive than a regular X-ray and can detect small tumors.

There are two major types of lung cancer: non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer is much more common. It usually spreads to different parts of the body more slowly than small cell lung cancer. Dr. Danieu says that lung cancer is most often diagnosed in the seventh decade of life, although she has also treated patients as young as 38 and 42.

The Future of Lung Cancer

Looking ahead, the medical community hopes to find an effective screening program for lung cancer, one that will catch cancer in earlier stages. Studies have failed to show that annual chest xrays or tests of sputum (expectorated respiratory discharge) are indicators of early lung disease.

"Physicians are looking to chest CT scans and gene probes to examine sputum for cancer cells," says Dr. Danieu. "Research is ongoing in these areas."

For an appointment with The Cancer Center of Saint Barnabas, please call (973) 322-5200. To reach the Tobacco Dependence Treatment Program of Saint Barnabas Health Care System, please call (973) 926-7978.

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