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We’ve made great progress in recent years when it comes to lung cancer. As noted in trends data from the Centers for Disease Control and Prevention, the percentages of people diagnosed with or dying from lung cancer has decreased significantly from 2003 to 2012. But more people still die from lung cancer in this country than any other cancer. Here in Washington, D.C., our rates for people diagnosed with and dying from the disease are lower than the national average, but we still have a long way to go.
Constant vigilance is key to catching lung cancer early, when we have the best chance at successful treatment. We follow lung cancer screening guidelines established by the American Cancer Society (ACS) for screening patients who are considered at higher risk for developing lung cancer than the average person. These guidelines help us minimize unnecessary screening in patients at lower risk while increasing our chances of finding cancer early in patients who are at high risk.
Who benefits from lung cancer screening?
We perform lung cancer screening using low-dose computed tomography (CT) scans. Because CT scans do involve exposure to radiation, we don’t recommend screening everyone for lung cancer. These tests also can cause unnecessary stress and expenses for people who might not benefit from testing. That’s why the ACS guidelines recommend testing only those patients who are considered at higher than average risk for lung cancer. The following factors can increase a patient’s risk, even if they don’t show any symptoms of the disease:
- Age between 55 and 74
- Currently smoking or having quit smoking less than 15 years ago
- Smoking history equivalent to smoking a pack of cigarettes per day for 30 years (for example, smoking half a pack per day for 60 years or smoking two packs per day for 15 years)
Other factors, such as a family history of lung cancer or significant exposure to asbestos or secondhand smoke, also can increase a patient’s risk.
What are we looking for during lung cancer screening?
One of the main things we look for in our low-dose CT scans are suspicious nodules in a patient’s lung. A lung nodule is a growth or lesion inside the lung. Benign, or noncancerous, nodules can form from inflammation after lung infections or diseases. But we’re looking for abnormal, cancerous nodules. Some of the telltale signs we watch for are:
- Nodules that are tethered to the chest wall
- Nodules located in the center of the lung
- Nodules with a ground-glass appearance or those with solid component
What we find on the CT determines the next step for the patient. Sometimes it’s best to monitor a suspicious nodule regularly to see if it changes. Sometimes we find something that’s potentially more serious and need more information right away. So those patients are followed up with a positron emission tomography/computed tomography scan, or PET-CT scan. This test involves injecting the patient with a small amount of radioactive sugar. For the most part, tumor cells are more active than normal cells, and they need sugar to grow, so they’ll absorb this injected sugar and light up on the scan. Therefore, PET-CT scans can tell us the size and location of suspicious lung cancer tumor cells as well as demonstrate if a patient has metastases (where the tumor spreads to another organ).
If a PET-CT scan identifies a suspicious cancerous growth, the next step is to perform a biopsy. This involves taking a small sample of the growth and having the specimen be examined under microscopy by a trained pathologist to determine if it’s cancer. Interventional radiologists can take this biopsy through the chest with a long needle. If the nodule is not peripheral and is very centrally located, an interventional pulmonologist or a trained surgeon can perform what’s called an endobronchial biopsy or transbronchial biopsy. This involves using a long, flexible tool called a superD navigational bronchoscopy to go down the windpipe and into the lung to take the sample directly.
If the pathologist identifies the sample as cancerous, the next step is to decide if the patient is a candidate for surgery to remove the tumor. If the cancer is detected early and hasn’t spread outside the lung, we can remove the cancerous tissue and give chemotherapy or radiation to destroy any cancer cells that may remain depending on the final pathology. If the cancer, however, is more advanced and has spread to lymph nodes or other organs, we have to rely on chemotherapy or radiation plus or minus surgery to treat the disease.
Early detection of lung cancer is key to getting treatment when cancers are easier to treat. That’s why it’s critical for those who are most at risk to get screened according to the national guidelines.
Request an appointment for more information about your lung cancer risk or to get screened.