Usman Ahmad, MD
Usman Ahmad, MD

Peter Mazzone, MD, MPH
Peter Mazzone, MD, MPH

Gregory Videtic, MD
Gregory Videtic, MD

Thursday, November 15, 2018 | Noon


Lung cancer is a very challenging cancer to treat. The most critical factor in determining the survival rate is the stage at the time of diagnosis. Using a multidisciplinary approach to lung cancer care is vital to managing the disease. Take this opportunity to have your questions answered by thoracic surgeon, Usman Ahmad, MD, pulmonologist, Peter Mazzone, MD, MPH, and radiation oncologist, Gregory Videtic, MD.

Lung Cancer Prevention

Moderator: Can lung cancer be prevented?

Peter Mazzone, MD, MPH: The best way to prevent getting lung cancer is to avoid cigarette smoking or quit smoking if you are smoking. There are currently no medications, supplements or vitamins that have been shown to prevent lung cancer from developing.

Smoking and Lung Cancer

coleandhannah: If you grew up in a family of smokers, what are your chances of developing lung cancer?

Peter Mazzone, MD, MPH: If you are not a smoker yourself, the chances are quite low. Being exposed to other people's smoke is a risk factor for developing lung cancer, but much smaller factor than if you smoked yourself.

Moderator: Can nonsmokers get lung cancer?

Peter Mazzone, MD, MPH: Yes. Approximately 1 out of 10 men who get lung cancer have never smoked and approximately 1 out of 5 women who get lung cancer have never smoked. In other parts of the world where there is less smoking or more exposure to other risk factors such as cooking fumes, the rate of lung cancer in never smokers is even high here.

aroland: Smoking cigarettes vs. these have the same effect on the lungs?

Peter Mazzone, MD, MPH: The ill effects of vaping are unknown at this time. It is likely that there are some health consequences to vaping. Though they may ultimately prove to be smaller than the consequences of smoking, it is our recommendation to avoid vaping.

ballashrd: What is the relationship between "vaping" and lung damage or cancer? Is marijuana safer to smoke compared to tobacco?

Usman Ahmad, MD: All types of smoking are dangerous to the lungs. From a cancer standpoint as well as causing other lung disease.

Gregory Videtic, MD: The vaping is tricky because we don't know what the long term effects are on the lung tissues and given the fact that so many young people are vaping which sets them up for long term exposure – we are very concerned about long term effects of vaping.

ekinney240: I have been a non-smoker for 20 years, am I still at risk?

Gregory Videtic, MD: Unfortunately although stopping smoking is one of the best things a person can do for themselves, the risk drops but it does not drop back to normal risk so it is something to be mindful of so screening tests may be something to consider based on your health and the amount of smoking you have done.

coleandhannah: If someone smoked and has since quit, are they still a high risk for developing lung cancer?

Usman Ahmad, MD: Yes the risk of lung cancer remains high even after smoking has stopped.

Symptoms of Lung Cancer

Moderator: What are the symptoms of lung cancer?

Peter Mazzone, MD, MPH: One of the common symptoms of lung cancer are persistent cough, shortness of breath, chest pain. These common symptoms can be present for many reasons other than lung cancer. This is in part why it is often difficult to diagnose lung cancer early in its course. Later in its course, some of the symptoms include unintentional weight loss, coughing up blood, and new headaches.

Lung Nodules

Bob: I have been told I have a lung nodule – should I be concerned?

Peter Mazzone, MD, MPH: The scans of the chest have become so detailed that we often find small spots that are called lung nodules on the scan. The majority of these lung nodules are nothing more than little scars that will not hurt you or turn into a lung cancer. When your doctor looks at lung nodules, he or she looks at features of the nodule like its size, shape and location to determine how concerning that nodule is. Most nodules need only to be followed with scans done over time while the few that are worrisome may need additional tests including biopsies.

Radiation Treatment in Lung Cancer

ftrevar: In May 2013 I was diagnosed with stage 3 lung cancer. Dr. Stevenson, Dr. Videtic and Dr. Mazzone are all part of my amazing survival. My initial cancer metastasized three times to my brain and once to my adrenal gland. Recently I had a follow up brain MRI. There appears to possibly be another brain tumor. I’ve since had a follow up chest/abdomen CT and it was clean. I have also had my esophagus burnt and aortic valve stenosis requiring a valve replacement apparently due to my radiation treatments. Question one: How long can a rogue cancer cell dwell before being detected as another metastasized tumor? Question two: How often are there side effects like I had with radiation treatments and is there any medical advances towards lowering these side effects percentages? God Bless

Gregory Videtic, MD: Radiation therapy plays a role in every stage in lung cancer treatment. The majority of the time because of the nature of the cancer that people show up with we often help relieve symptoms as primary goal which as itself is important. As the cancer gets picked up earlier before it spreads, the role of radiation changes. We often act as a partner to surgeons who remove lung cancers that are potentially curable but require extra insurance after their removal due to the degree which it has spread. The biggest innovation in radiation therapy has been in the past 15 years where technology has allowed us to treat patients with early lung cancers that could not be safely removed surgically and treat them for cure of the cancer while minimizing the side effects to the patients.

Immunotherapy in Lung Cancer

Moderator: Can you talk about immunotherapy in lung cancer?

Gregory Videtic, MD: Traditional drug therapy for lung cancer has been chemotherapy which acts to balance killing the cancer directly while trying not to overwhelm the body's normal tissues including especially blood. In the last 5 years the biggest innovation in drug treatment for lung cancer has been the development of immunotherapy. Immunotherapy unlike traditional chemo, harnesses the body's immune system to fight the lung cancer. What has been exciting about this class of drugs is that so far it has shown in incurable patients their lives have been extended in ways not seen before while minimizing side effects. So immunotherapy is being explored extensively in the earlier potentially curable stages of lung cancer because of these findings in advanced patients.

Surgery for Lung Cancer

Luella456: Please discuss microcoil localization.

Usman Ahmad, MD: Because of increased use of imaging modalities we are detecting smaller nodules in cancers earlier on. With the increasing use of minimally invasive surgery we are able to remove smaller pieces of the lung. MIcrocoil localization is a very exciting method we have developed and used that can be used to find and localize these nodules on the day of surgery so that once the surgery starts we can find the area of the nodule with the minimally invasive approach and remove it safely and completely. The biggest advantage is the ability to avoid open surgery.

Moderator: Do you always require a big incision for lung cancer therapy?

Usman Ahmad, MD: There have been significant improvements and advances in chest surgery. These days the vast majority of surgery for early stage lung cancer surgery is done for minimally invasive approaches such as VATS and robotic approaches. These surgeries are performed through 3 or 4 smaller incisions and they allow early recovery and early return to activity and return to work.