• October 31, 2014

Scott & White gives insight to cancer

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Posted: Monday, July 1, 2013 4:30 am

This year, about 228,190 new cases of lung cancer will be diagnosed in the United States.

An estimated 159,480 people will die from the disease in 2013, accounting for 27 percent of all cancer deaths, according to the American Cancer Society.

Scott & White will see about 400 new lung cancer cases in 2013, said Dr. A. Clay Gowan, Scott & White medical oncologist.

Unfortunately, most of those cases will have already reached an advanced stage. That’s the nature of lung cancer — few symptoms until late in the disease process.

“In most cases it’s not a curable disease,” Gowan said. “We try to approach it as a chronic disease that we can treat and help the patient live with.”

The primary goal in treating diseases that cannot be cured is to improve symptoms, delay the onset of new symptoms and to extend life, he said.

For those who are fortunate enough to have had their lung cancer discovered early, surgery and radiation therapy are options.

The standard of care for people with localized Stage 1 lung cancer, which means it only involves the lungs, not the lymph nodes or the chest wall, is surgery, said Dr. Philip Rascoe, cardiothoracic surgeon and surgical oncologist.

“They have a very good cure rate, probably in excess of 70 percent with surgery alone,” Rascoe said.

Stereotactic body radiation therapy uses high dosage of precisely targeted radiation to treat patients with localized lung cancers that aren’t surgical candidates.

Probably 90 percent of all lung cancers are a direct result of smoking and about 10 percent of the lung cancer patients seen at Scott & White have never smoked, he said.

“One of the first things we ask in those cases is about second-hand smoke exposure — either a parent or a spouse smoking in the home,” Rascoe said.

Absence of that, the questions become about workplace exposure.

“At the VA we ask about Agent Orange exposure,” he said.

Two classes

Lung cancer is separated into two classes: nonsmall cell and small cell.

There are a number of subtypes in the nonsmall cell cancers, the most common being adenocarcinoma, which makes up 60 percent of the cases. The second most common is squamous cell carcinoma, which accounts for up to 30 percent of lung cancer cases. Large cell carcinoma makes up 10 percent of lung cancers.

The response rates in chemotherapy are similar, but there are some that work better in certain subtypes,

Chemotherapy has been the backbone of treating advance stage lung cancer for years, Gowan said. Observation and scientific evidence has shown it’s what works best.

“Over the last few years we’ve learned a lot about the molecular markers that certain lung cancers harbor,” he said. “Not only are we able to test for those particular makers, now we have drugs that target those biomarkers. Those drugs provide a higher response rate and are less toxic.”

Clinical trials

There are also ongoing clinical trials available to certain patients in certain situations.

“The only way we’re going to reduce mortality in lung cancer is by prevention and detecting it at an earlier stage,” Gowan said.

Until recently, no studies have consistently shown a reduction in mortality by implementing a screening strategy, he said.

However, the three-year National Lung Cancer Screening Trial did indicate that deaths could be reduced by 20 percent by screening certain high-risk individuals with low dose CT scan.

“I would encourage patients to discuss with their primary care provider whether they are a good candidate for implementing a screening strategy,” Gowan said.

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