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Lung Cancer

Lung Cancer

October 25, 2012
12:00 p.m. – 1:00 p.m. (EST)

  • Rogerio Lilenbaum, MD

Cleveland_Clinic_Florida_Host: Today's Live Web Chat, "Lung Cancer" with Rogerio Lilenbaum, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Florida_Host: Welcome to our Online Health Chat "Lung Cancer: Prevention and Treatment Options" with Rogerio Lilenbaum, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.

ameenah: Hello Dr. How do you rule out other lesions, like Wegner’s granulomatosis?

Dr_Lilenbaum: A biopsy is required for the diagnosis of lung cancer or Wegener's Disease - they are usually distinguishable under the microscope.

haitilove: A family member was diagnosed with Stage IV adenocarcinoma suspected of non-small cell lung cancer. Diagnosis was made after a visit to the ER due to severe back pain. The cancer is in the lungs, spleen and spine. We are currently awaiting a treatment recommendation and have been given pain meds for the back pain. Fatigue is a MAJOR issue. Do you have any recommendations for relieving fatigue for the time being?

Dr_Lilenbaum: At this time, prior initiating treatment, fatigue is usually a symptom of the disease, and is difficult to control without specific anti-cancer therapy. It tends to get better if the treatment works.

Randz24: good day I have a question about my chest x-ray result it says 'Hyperaerated lungs,Atheromatous thoracic.

Dr_Lilenbaum: It is hard to comment on specific test results - "hyperaerated lungs" can be normal or an indication of emphysema - please check with your doctor.

SpringbokJ: What is your position regarding CT scan testing for smokers 50 and older? Do most health insurances polices cover this? (i.e. Medicare) Thanks!

Dr_Lilenbaum: I believe this is a very positive development -to the best of my knowledge, insurance companies are not yet covering the cost of the scan, but many facilities offer it for less than $100.

Cleveland_Clinic_Florida_Host: For those now joining us, we are currently chatting with Rogerio Lilenbaum, MD, who is taking your questions about Lung Cancer. To ask a question, type in the box below and then click 'Ask'

LibbytheRN: What can I expect as a caregiver for a 79 year old woman with squamous cell carcinoma in her left lung who will have lung resection surgery to remove her lower left lobe? How can I be prepared?!?

Dr_Lilenbaum: Typically, patients 3-5 days in the hospital, and recover at home for another 2 weeks. There is some degree of pain involved, which can be controlled with medications; cough and/or shortness of breath can also occur.

tkboston: Can you speak on using treatments such as Iressa (gefitinib) and Tarceva instead of chemotherapy or radiation?

Dr_Lilenbaum: Gefitinib is not approved in the US - only Erlotinib. It is used in patents with advanced disease instead of chemo in patients whose tumors harbor a certain type of mutation; it is also used later on for patients who already received chemotherapy.

votingforobama2012: How long after lung surgery can a patient fly home?

Dr_Lilenbaum: Usually 2 weeks assuming no complications.

chris: Is blood in the mucus a sign of lung cancer when coughing? I just recently when in for a lung cancer screening?

Dr_Lilenbaum: It can be a sign but it is not always indicative of lung cancer. Please consult your physician.

Cleveland_Clinic_Florida_Host: For those now joining us, we are currently chatting with Rogerio Lilenbaum, MD, who is taking your questions about Lung Cancer. To ask a question, type in the box below and then click 'Ask'

sports_caster: I have been diagnosed with a 1.8 cent. nodule in my right lower lobe. Can you tell me what the treatment will be for this. Can I come to CCF to have this done?

Dr_Lilenbaum: Usually, if proven to be cancer, it is removed surgically. Other patients have radiation instead. You're welcome to come to CCF.

karo1: My 82 year mother has adenocarcinoma Stage 4, and my father died at 76 from Stage 4 lung cancer. They both smoked. My sister and I have never smoked. Are we still at high risk for lung cancer? What screenings would you recommend and when?

Dr_Lilenbaum: Although a family history may impact on the risk of lung cancer, it is possible to quantify it. Patients who have never smoked are usually not candidates for screening.

rivermaid: Chemo was ineffective for me and I am not a candidate for radiation. Right lung stage 4. Is the removal of the lung an option? Since conventional medicine doesn’t seem to have an treatment option for me, is there anything else to offer me?

Dr_Lilenbaum: Very difficult to provide specific recommendations - there are several types of chemotherapy. Usually, surgery is not an option for patients with stage IV disease, but you should discuss this with your doctor.

clara: What symptoms does one have with lung cancer? My father lost his voice with lung cancer. Is this a typical symptom?

Dr_Lilenbaum: It is a possible symptom - usually because the tumor "pinches" the nerve that controls the vocal cord.

spatula99: Can you get lung cancer from doing dip?

Dr_Lilenbaum: It is controversial - many studies have shown an increased risk but not as high as with smoking

FIUMedStudent: Can other lung diseases like COPD, emphysema or chronic bronchitis lead to lung cancer? Thank you Dr. Lilenbaum.

Dr_Lilenbaum: COPD does not lead to lung cancer - however, because it is usually seen in smokers, they also have a higher risk of lung cancer.

Cleveland_Clinic_Florida_Host: For those now joining us, we are currently chatting with Rogerio Lilenbaum, MD, who is taking your questions about Lung Cancer. To ask a question, type in the box below and then click 'Ask'

heatherW: What is a wedge resection surgery? My aunt is scheduled for one next week

Dr_Lilenbaum: It is the removal of a smaller part of the lung, usually around the tumor, as opposed to the removal of a whole lobe (lobectomy).

valmallmom: I heard that Cleveland Clinic Florida has a transplant ward now. My mother was diagnosed with lung cancer, would a lung transplant be an option for her?

Dr_Lilenbaum: Only very rarely lung cancer is treated with a lung transplant.

bofftovsky: I read an article about a study that was done that dogs can smell lung cancer? Is there any validity to this?

Dr_Lilenbaum: It is correct - it is not yet validated or available in clinical practice but studies have indeed shown that dogs can identify patients with lung cancer.

rodger54: We know that tobacco in the smoking form is a causative agent for lung cancer. Are there any substances that can be added to tobacco to reduce the risk of lung cancer?

Dr_Lilenbaum: Not to my knowledge.

karo1: My mother that has Stage 4 lung cancer coughs up blood frequently from the tumor. Is there anything to help relieve the cough?

Dr_Lilenbaum: Radiation treatments can help; sometimes doctors can look inside the bronchial tubes and stop the bleeding.

AGL: What treatment options and facilities does Cleveland Clinic in Weston offer?

Dr_Lilenbaum: We have a whole array of treatments for patients with lung cancer, ranging from standard options to cutting edge research projects. Patients are evaluated by a group of specialists who specialize in lung cancer.

frodo: My husband’s kidney cancer is now in his lungs. Will the cancer behave the same way primary lung cancer does?

Dr_Lilenbaum: No - the treatment is based on the primary source of the cancer.

vishnup: My brother-in-law was diagnosed with lung cancer last week. How do you determine whether he needs radiation, chemotherapy or surgery?

Dr_Lilenbaum: It depends on the stage (or the extent of the disease) - he needs to be evaluated by a medical oncologist.

AngelaSantos: How exactly does one get involved in a treatment study/clinical trial? Does Cleveland clinic provide any current studies? I’d like to enroll my father who is not responding well to conventional to treatments.

Dr_Lilenbaum: Clinical trials are available at certain institutions - the Cleveland Clinic Florida has a comprehensive menu of trials for patients with lung cancer. Specific cases are best discussed with the oncologist. For more information on Cleveland Clinic Florida's Cancer trials, please visit http://my.clevelandclinic.org/florida/clinical_research

Cleveland_Clinic_Florida_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

jodi_horowitz: Is a PET scan a certain test for cancer nodule in the lungs?

Dr_Lilenbaum: The PET scan can be used for a nodule in the lungs - depending on the results, the likelihood that the nodule is malignant may go up or down but it is not always a definitive test.

bobntrish: What can be done to help coughing with a lung cancer patient being treated by chemo. The coughing fits can get really bad with a lot of mucus.

Dr_Lilenbaum: There are several medications that can be used for a persistent cough, including codeine-based syrups. It is sometimes a difficult symptom to control in patients with lung cancer.

Olivia: What research/investigations have been don to show that screenings should be done regularly to detect early stage lung cancer?

Dr_Lilenbaum: The best study was sponsored by the National Cancer Institute and published in the New England Journal of Medicine last summer - it showed a 20% reduction in mortality with the use of screening CT scans.

Cleveland_Clinic_Florida_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

JRod: I have been a casual smoker for about 25 years, smoking on the weekends or when I have drinks. Do I have an increased chance of getting lung cancer?

Dr_Lilenbaum: The more people smoke the higher the risk but even casual smoking can lead to an increased risk of lung cancer.

ZECHR: With Stage IV lung cancer, what other treatment options are available when chemotherapy does not work and the patient is too weak to continue with further treatments?

Dr_Lilenbaum: Difficult to comment on specific cases but when the patient and the physician agree that further treatment is unlikely to help, supportive care measures become the mainstay of the care.

Cleveland_Clinic_Florida_Host: I'm sorry to say that our time with Rogerio Lilenbaum, MD is now over. Thank you again, Dr. Lilenbaum, for taking the time to answer our questions today about Lung Cancer. To make an appointment with Dr. Lilenbaum, or any other specialist at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.