Q&A

On Cancer: Questions and Answers about Lung Cancer

By Nabil Rizk, MD, Thoracic Surgeon  |  Friday, November 22, 2013
Pictured: Nabil Rizk Thoracic surgeon Nabil Rizk

In the past few weeks we have received many great questions about lung cancer on our Facebook page. Thanks to all Memorial Sloan Kettering fans who engaged!

Here are some of these questions and my answers. 

Both of my parents have smoked for more than twenty years. What kind of tests should they have as part of lung cancer screening? 

This depends on your parents’ ages and the total amount they have smoked.

Our screening program provides low-dose CT screening for people who are between the ages of 55 and 74 and who have smoked 30 or more pack years. Pack years is the number of years someone has smoked multiplied by the number of packs of cigarettes they smoked per day. For example, one pack per day for 30 years or two packs per day for 15 years is equal to 30 pack years. 

If your parents are not in those categories, there is no evidence that screening will benefit them.

What role do the services offered at the Bendheim Integrative Medicine Center play in the treatment plan? 

Integrative medicine therapies do not treat the cancer; instead, they reduce the symptoms caused by cancer and its treatment, using massage and mind-body therapies, yoga and t’ai chi, and physical fitness classes for patients at all levels

Breathing difficulties related to lung cancer can be reduced with these evidence-based therapies, and research shows that fitness activities also can produce survival benefits.

In addition, some of the offerings at Bendheim, including relaxation techniques, can help people quit smoking. At Memorial Sloan Kettering we offer a Tobacco Cessation Program that is open to everyone — people with cancer as well as others who would like to quit. 

Which chemotherapy agents are used for lung cancer? 

The type of drugs you receive will depend on what kind of lung cancer you have— adenocarcinoma, squamous cell carcinoma, large cell lung cancer, or small cell lung cancer. 

What is the benefit of having DNA from a lung tumor sequenced?

At Memorial Sloan Kettering we routinely analyze the DNA of all non-small cell lung cancer patients we treat. The genetic targets that we are able to identify for the most part do not inform the type of standard chemotherapy agents that are administered, but we can target tumors with specific drugs when certain mutations are identified.

Is lung cancer that is not linked to smoking genetic? Or is it a type of cancer that can happen to anyone even if there's no cancer history in the family?

There is an inherited genetic component to lung cancer, independent of smoking. A family history of lung cancer is associated with a higher risk of lung cancer, both in smokers and in nonsmokers.

Our Clinical Genetics Service can help you understand your risk for lung cancer. We offer genetic counseling and testing and can assist you in making informed medical decisions.

Would regular chest x-rays help detect lung cancer in earlier stages? Does the modern x-ray pick up lung cancer earlier than it did 25 years ago?

Having a chest x-ray has been proven in multiple trials to be no better than not having a chest x-ray in terms of being able to detect lung cancers at an early enough stage, where detection can have an impact on survival. Only low-dose chest CT scans should be used for the purpose of lung cancer screening.

Are there early warning signs of lung cancer? 

Unfortunately, most lung cancers do not cause symptoms until they are more advanced in stage. Patients who present with symptoms almost always have a more advanced stage. This is why screening rather than waiting for symptoms is so important for those who are at highest risk of developing the disease.

I smoked for about 25 years and I quit about 15 years ago. Am I still at risk of lung cancer? 

I’m glad to hear that you quit! Some of the damage done to the lungs from smoking can be permanent, some damage is reversible with time after quitting, and some damage may continue to progress despite quitting. The risk to getting lung cancer is partly due to how much you smoked and how long ago you quit.

If someone is in her eighties and diagnosed with lung cancer, are you still able to operate?

At Memorial Sloan Kettering, we don’t consider age as a reason to not operate on a lung cancer patient. Rather, my fellow surgeons and I use objective tests such as lung function tests and also look at the patient’s overall health to determine if an operation can be done safely.

I’ve been diagnosed with advanced lung cancer. Should I consider participation in a clinical trial?

This is a question to discuss with your physician. There are standard and effective first-line treatments for patients who have been newly diagnosed with advanced-stage lung cancer. Clinical trials are most commonly reserved for patients who did not benefit from standard treatments.

Comments

What a wonderful addition to the information available at MSKCC. Keep up the good work!

In October of 2011 I was diagnosed with lung cancer which has matastasized to my adrenal glands. My oncolgist has had me on avastin along with a clinical trial drug (met pack). The treatment is showing mostly positive results. The first three cat scans showed improvement the fourth scan showed the cancer increasing and the last one showed that it had stabilized. The side effects are that I suffer alot from Chemo Brain and neuropathy. My question, sir, what do you think of Avastin I have beern told that it is the best drug out there for lung cancer, and would very much kike to know your opinion.

Dear Robert, we are not able to answer personal medical questions on the blog. If you would like to make an appointment with a lung cancer specialist at Memorial Sloan-Kettering for a consultation, please call our Physician Referral Service at 800-525-2225. You may be interested in visiting the National Cancer Institute's listing on Avastin for more information about the drug, as well as clinical trials for people with lung cancer: http://www.cancer.gov/cancertopics/druginfo/bevacizumab
Thank you for your comment.

My wife under treatment with lung cancer(adercarconima)
She is in third stage when she diagnosed.
After 4 cycle of chemo dr do her sergery
, but unfortunately they can not remove the portion of lung , because
Is in 4 th stage , what can I will do for her to
Treat my wife. Pls advise
Syed

Syed, unfortunately we are unable to answer specific medical questions on our blog. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. If you are outside the United States please contact our International Center (1-212-639-4900) or go to http://www.mskcc.org/cancer-care/international-patients Thank you for your comment.

I am a 61 yr old teacher. i had stage 0 breast ca followed by a mastectomy in 1998. Lung CA in 2004 upper left lobe removed - bronchioaveola. Chemo was with cisplatin In sept 2013 R lung Ca Andeno carcinoma 2 tumors removed (1 in upper lobe-1 in lower lobe) No lymph-node involvement in all 3 cancers.My oncologist did genetic testing and no one van say if this recent lung ca is stage 1 - two primary lung Ca or stage 3) Is there anything else I can do . the tumor board said chemo would not be beneficial as all ca was surgically removed. Your thoughts please! Thank you!

Janet, unfortunately we are unable to answer specific medical questions on our blog. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

Is Chemo typically prescribed after successful Stage IB lung cancer lobectomy surgery?

Hi Vic, we sent your question to Dr. Rizk, and he said that in most cases chemotherapy is not given after surgery for stage 1B lung cancer. Thank you for your comment.

Thank you for your response. How does this sync with National Cancer research that says chemo after the surgery can increase survival odds even if they think they 'got it'? I'm a bit confused by the two sides to this.

Hi, Vic, we forwarded your question to Dr. Rizk, who said,

"There are risks associated with chemotherapy.
In order to derive a benefit from chemotherapy, there needs to be a significant risk for recurrence. Stage IB does not have a high enough risk of recurrence to justify the added risks of chemotherapy."

Thank you for your comment.

I have 4 nodules in my lungs biggest 4mm glass like appearance. I had a ct scan in 2012 showed emphezem in top of both lungs and a spot not identified. Had another ct scan in dec 2013 showing these nodules I mentioned. Having another scan June 2014 these are all reg ct scans no low dose or contrast. Am I having the correct follow up? If new scan shows growth or more nodules what is the next step that should be done. I don't want to wait till they get too big then be a bigger problem. I am a long time smoker trying to quit. I just want to get the best care and advice. Any imput about follow up would be appreciated

Lynn, unfortunately we are not able to answer individual medical questions on our blog. If you'd like to make an appointment to speak to one of our doctors about your situation, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information.

You also mention that you are trying to quit smoking. If you would like to learn about our Tobacco Cessation Program, you can go to http://www.mskcc.org/cancer-care/counseling-support/tobacco-treatment.

Thank you for your comment.

Worried

Lynn, you might also be interested in viewing our videos about managing anxiety related to medical scans. You can learn more about them here: http://www.mskcc.org/blog/coping-scanxiety-during-and-after-treatment

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