- The Washington Times - Wednesday, January 10, 2007

Lung cancer, which kills more people than any other cancer, often spreads for months, if not years, without warning.

Modern science is still years away from offering patients a cure, but some new techniques hold promise for providing better detection methods as well as more effective treatment.

Dr. Norman H. Edelman, chief medical officer with the American Lung Association, says the biggest issue surrounding lung cancer is that too often it’s detected “beyond the point where a cure can be achieved.”

Early detection remains a holy grail for oncologists, something magnified by a study published recently in the New England Journal of Medicine by Drs. Claudia Henschke and David Yankelevitz. The doctors, who founded the International Early Lung Cancer Action Program, concluded after a 13-year study that 88 percent of lung cancer patients can live 10 years or more with early detection and treatment.

So news concerning the use of spiral CT scans to detect early stages of lung cancer marks a flash point for cancer specialists. A traditional CT scan uses X-ray images to create a cross-sectional look at a patient’s internal organs and structures.

A spiral CT scan, also called a helical CT scan, has the patient moving continuously through the scanning device and results in deeper resolution of structures such as blood vessels and internal tissues.

The notion of using spiral CT scans is a source of extreme debate among those battling lung cancer.

For starters, the scans aren’t cheap. The procedure can cost $800 to $1,800 and, for now, isn’t covered by insurance companies for this purpose.

Such scans also are far from foolproof. They may detect an old, noncancerous infection that will be biopsied by a doctor as a precaution.

“You end up biopsying a lot of tissue,” Dr. Edelman says. That practice comes with its own health complications, especially with older patients or those with stress concerns.

The American Lung Association’s position is to wait and see, he says, adding that a large controlled trial is under way involving the spiral CT scans. It should be completed by 2010, if not earlier.

If CT scans prove either inconclusive or cost-prohibitive, doctors can shed light on their patients’ lungs. Literally.

Dr. John E. McKnight, with Providence Hospital’s department of internal medicine, says another potential indicator for lung cancer comes from a new type of bronchoscopy.

Researchers are looking into using fluorescent bronchoscopies to light up the lungs and detect any changes taking place over time. The procedure requires a lit tube to be inserted through the mouth and fed toward the lungs. The device then sends images to a monitor for investigation. The reach of such a device is limited, though, based on the point of entry.

Some doctors rely on chest X-rays to locate lung-cancer growths, but this method isn’t exact and often spots tumors already growing out of control.

Doctors do have a much firmer grip on just who is at a higher risk for lung cancer.

Dr. McKnight says there’s “no question” tobacco use is the key factor in lung cancer cases. Smoking accounts for 85 percent to 90 percent of all lung cancer cases, he says, adding that the disease isn’t considered an inherited precondition.

For those who quit, risk levels diminish but may never approach the level of someone who never picked up the habit.

Yet Dr. McKnight says the number of people who end up with lung cancer from either secondhand smoke or an unknown genetic susceptibility is on the rise.

For those in the high-risk category, Dr. McKnight suggests being hypervigilant to any possible health changes.

“It’s common for patients to give me a story, ‘I just thought this cough was the same old smoking cough,’ ” he says.

“It may have been an indicator,” Dr. McKnight says. “We all see people whose cough has changed over the course of a year or they’ve lost weight.”

Dr. McKnight suggests that smokers be “honest to a fault” about their health.

Win Boerckel, lung cancer program coordinator with New York-based CancerCare, says smokers aren’t the only ones who should be concerned with this devastating form of cancer.

People who work in places that expose them to radon or other industrial gases can be at risk, says Mr. Boerckel, whose nonprofit provides free professional support to cancer sufferers.

Those who fall into the high-risk groups have begun clamoring for the spiral CT scans to become part of preventative health measures.

“If you take a look from the patients’ perspective, they’re saying, ‘Let’s get this thing going now,’ ” Mr. Boerckel says.

The lack of early detection proves fatal for many lung cancer patients, but the lack of early treatment isn’t the only reason lung cancer is so devastating.

“Any cancer detected at such a late stage has a much higher risk of death … but lung cancer is very aggressive,” Mr. Boerckel says.

“The lungs are one of the few internal organs continually exposed to the external environment. Normal lung cells are very hearty,” he says. “Once that cell becomes mutated, it’s a very hearty cancer cell.”

Dr. Mark Soberman of the Washington Hospital Center in Northwest says physicians are using a combination of therapies with lung cancer patients to help prolong lives.

Using chemotherapy, traditional surgery and radiation treatments on a case-by-case basis has increased survival rates, Dr. Soberman says, adding, “It’s changed the way I practice.”

He also holds out hope for more targeted treatments, such as the Cyberknife. The robot-guided treatments already are used to battle tumors in other parts of the body, but Dr. Soberman says more research needs to be done to see just how effective they can be in shrinking lung cancer tumors.

“Conceptually, the Cyberknife holds a great deal of promise,” he says.

Dr. Soberman says lung cancer eventually could be dealt with at the gene level.

The New England Journal of Medicine reported recently that Taiwanese researchers found that a “five-gene signature” can predict how some lung cancer patients will tolerate and thrive under certain treatments. The study examined patients who had had their cancers removed and looked into gene expressions during their recovery and follow-up treatment.

Dr. Soberman says gene research with these cancers has just begun.

“No doubt that at some date in the future, lung cancer will be treated with gene therapy or targeted therapy,” Dr. Soberman says. “Guys who do what I do will be dinosaurs.”

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