Lung Cancer Awareness

Podcast Transcript

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Dr. Ahmad: Good afternoon. My name is Dr. Usman Ahmad. I'm one of the cardiothoracic surgeons. I'm one of the surgeons who takes care of and deals with lung cancer. As we all know, November is lung cancer awareness month, so a few of us got together to discuss how lung cancer presents, what causes lung cancer, and how to treat it best in this day and age. We're very fortunate to have Dr. Peter Mazzone, who is an expert pulmonologist, join us today, who's going to discuss some of the changes related to smoking and how lung cancer occurs, and how we find out about it. We also have our head of radiation department, Dr. Gregory Videtic, who's going to tell us about the nonsurgical treatment options. Then we will discuss some of the surgical treatment options afterwards.

Jumping right into our discussion, Dr. Mazzone, can you please tell us a few things about how smoking is related to lung cancer, what we know about it, and what patients should look out for, especially if they have a history of smoking?

Dr. Mazzone: Yeah, absolutely. Cigarette smoking is the most common risk factor, the most important risk factor for developing lung cancer. Around 9 out of 10 men who develop lung cancer have been smokers at some point in their life. Around 8 out of 10 women have been smokers at some point in their life. The best way to avoid getting lung cancer would be never to start smoking, and if you're currently smoking, do everything he can to quit.

Lung cancer often doesn't have very specific symptoms early in its course. Perhaps someone will be coughing a little bit more than usual, perhaps a little more short of breath, symptoms that can be excused way for other reasons. "I'm a smoker and that's why I cough." If you notice new symptoms, or symptoms that don't go away despite what normally would help them to get better, then talk to your doctor about it. Be sure that you're not missing a chance to detect an early cancer. Later in its course the symptoms may become more specific. Unintentional weight loss, coughing up blood, new chest pain, new headaches, these sorts of things can make you really concerned that someone has more advanced lung cancer and you should seek attention.

Today we hope to identify lung cancer before it gets to that late stage. If you have risks for lung cancer, if you're in the right age range and if you've smoked a lot, lung cancer screening is now standard of care, where we do a scan of the lung before you have any symptoms or signs of lung cancer in hope of finding it early. If you're age 55 to 77, you've smoked at least an average of a pack a day for 30 years, and you've been a smoker in the last 15 years, talk to your doctor about getting a screening scan. Otherwise, cancers may be found if you've had a scan for a different reason, a nodule, little spot in the lung, or bigger spot is found. Then we do a biopsy of that spot, or if you present with symptoms and you're found to have something in the chest, that leads to a biopsy.

Dr. Ahmad: I'm really glad, Peter, that you brought up the early detection of lung cancer because once we have diagnosed lung cancer or we find lung cancer, our best shot or our best results are in the situation where we can find it early and treat it well. In those lines, whenever a cancer is found, whether it's lung cancer or any cancer for that matter, there's a huge difference between how those cancers are treated early on, if they're found in early stages, or if they're found at later stages. That's why it's very important when somebody is found to have one of those diagnosis, especially lung cancer, to be in a place where all of those treatment options are available, where all that expertise is available, where the patient can see a surgeon, a pulmonologist, a cardiologist perhaps, a radiation oncologist and a medical oncologist.

If the cancer is found at very early stage and all the tests show that it has not spread anywhere else, then the decision comes whether we should do surgery to remove that cancer and the other things that go in that operation are the lymph nodes, et cetera, or if somebody is not healthy enough to tolerate an operation for lung cancer, we go to our radiation colleagues and seek their help in treating that cancer almost as good and as well as surgery would. But it's a very fine discussion, which is a continuous dialogue between the surgeons and the radiation oncologists to find out who will benefit from what treatment best. Let's hear from Dr. Videtic as to what options we have in this day and age, what advances advances we've made in the radiation treatment for lung cancer.

Dr. Videtic: Thanks Usman, I appreciate talking about this. I want to piggyback a little bit again on how important a team assessment is. We've talked about establishing what the cancer is behaving like by doing all these tests, but it's not just the tests that tell us how well somebody does.

Dr. Ahmad: Absolutely.

Dr. Videtic: The critical role for you, for me, for all of us is how does that person function and how do they behave when they're doing normal things. Sometimes people normally are surprised when we ask them about can I walk a certain distance, can I climb stairs, and how that has a bearing on their decision is relevant. That's why Peter and his people will often have a big role in helping you and me make a decision on what's the right choice that we can offer patients.

As you said, we're both very happy to offer the best care when we know how that best care is going to be delivered. Certainly when lung cancer is detected early, our goal is cure. There's no question that most people when they have that diagnosis want to know that they can potentially be cured, so we always match the discussion of cure with minimizing harm. I think that's just as important as talking about what the best kind of care is for the cancer because traditionally there really were very few options.

In fact, there was only probably one major option. If somebody was lucky enough to be found to have an early lung cancer, then they would have gone directly to a thoracic surgeon, and that should happen today as well. I think the biggest innovations have been in actually understanding the relationship between the person and their cancer as much as saying we can get it out. Is that effective? Not only effective, but is it safe?

In the last 15 to 20 years at the Cleveland Clinic, it's been actually, one of our big goals is picking the right people for the right treatment. That's matched to development in radiation, for example, where we now have a very focused, targeted, very specialized way of delivering radiation, which offers the potential for curing a lung cancer in the same mindset as the surgeon, which is I want to get it all. But we offer it especially for people where the harm of the surgery, which doesn't mean the surgeon deliberately does something to the patient to harm them, it means that the burden of the surgery is more than the benefit of cutting out the cancer, where we have an alternative, where maybe the radiotherapy, if it's delivered in an effective way, can minimize the amount of injury to the patient, let them have the opportunity for cure, but also let them be able to get through the process without suffering the consequences of the side effects.

This has been something that we've been engaged with for about 15 years and have kind of established ourselves as very experienced in making those kinds of choices with patients. Partially because we have this kind of collaborative discussion, and also because we've been very eager to support the clinical research that allows us to make those decisions. We've actually been part of the national groups that have helped us understand where the right choice can be made for having a discussion with a surgeon, or having a discussion with the radiation doctor on what the right care would be for an early curable lung cancer.

By definition, as Peter had mentioned, this often is a diagnosis that's picked up early, but usually by chance, if not by screening. Most of the patients that we see will not unfortunately be in a position where only one form of treatment will be necessary. Typically, lung cancer tends to be more advanced when we detect it, and so again, the collaborative discussion usually has to do with not simply one therapy, whether it's surgery or radiation, but usually other therapies as well, especially chemotherapy as part of a global management approach to a cancer that's more widespread than we would like, but actually is the most common way that we look after patients.

Dr. Ahmad: Thank you Dr. Videtic. No, those are all really important points. Quite honestly, if I were a patient and I've recently been diagnosed with lung cancer as an example, I would want all of my physicians to be perfectly honest with me, and I would like to go to a place where I get all the treatment options that are available in this day and age to be offered to me and short of ... Not only that, but I like my physician team to talk to each other so that they can all make a combined recommendation. That would be our recommendation to somebody who has been diagnosed with lung cancer, to go to a place where all these options and all these facilities that are available.

I'd like to highlight the fact that just like radiation treatment, the other specialties that treat lung cancer, pulmonology, medical oncology and surgery, the advances in medicine were part of that. The surgeries are becoming less invasive. Now the vast majority of early lung cancer surgeries at the Cleveland Clinic are done robotically or minimally invasively, and our patients are going home the next day or the following day. But again, that's the biggest and the most important part of this puzzle is that the physician team works together to choose the treatment that fits that patient best. That may be surgery, that may be radiation, that may be a combination of things. I think that's something that is very important to keep in mind.

But getting back to the root of the problem, I'd love to hear from Dr. Mazzone as to what options patients have when they want to quit smoking. Would you like to shed some light on our program that helps them quit smoking?

Dr. Mazzone: Yeah, absolutely. Quitting smoking is more important for an individual person's health, whether they've been diagnosed with lung cancer or not, than than anything else that we do. There is no doubt that you'll minimize your chance of getting lung cancer, minimize your chance of heart disease, other lung disease, if you're able to quit smoking. It is very difficult and we've not been universally successful at finding great tools to help our patients with this real difficult task, so the Cleveland Clinic Health System has developed a smoking cessation program that uses multiple means to try to help someone quit.

Everyone's not the same. Some people want a face to face visit, someone to partner with. Some people want to do it over the computer. Some people just want periodic advice, or need medication support. The Cleveland Clinic's Smoking Cessation Program can help you with whatever fits your particular needs. For your own health, if you're listening to this and you not even concerned about lung cancer, smoking cessation is the best thing possible for you.

Dr. Ahmad: Well, that's great Peter. One of the other things that highlights how well a center treats cancers in this day and age are clinical trials. I think that's something else that patients should look for when they're choosing where to go. Greg, do you want to shed some light on the importance of looking for and enrolling in clinical trials when possible?

Dr. Videtic: I think the only way that we've known how to make advances is by sharing with patients that we don't have all the right answers right now. I think one of the things that strikes me is patients are often interested in not just their own care, but also trying to understand how to look after others better.

Dr. Ahmad: Sure.

Dr. Videtic: That benefits them at the same time as they're struggling with a really hard diagnosis.

One of the advantages of a large center and a group practice like ours is that we carry out very well integrated clinical trials. Obviously, I would do radiation trials. You'd be involved in surgical trials. Peter would have trials that might reflect other components of helping people, lung cancer, medically. Our colleagues in chemotherapy obviously would have drug trials. But the nice thing is that we try and make sure that these trials are often well managed with respect to offering care. The important thing is is that we not just talk about the standards but actually are able to introduce clinical trials early on into the idea about how people can do better. Because we're a large institution, we have a very large portfolio of trials.

One of the other things that I think is really important in terms of how we help guide patients is if we don't have a particular trial that might be of interest, we'll actually facilitate a lot of times participation in other institutional trials, where we're actually lucky because we cooperate with our academic institution here at Case Western Reserve University and their hospital system in terms of running and participating in clinical trials, so there's an open highway, if you like, for access. I think, again, being honest and sharing that with patients kind of I think increases their interest because we're looking out for them, not just for ourselves.

Dr. Ahmad: No, I think we're very fortunate that we're practicing medicine and taking care of lung cancer patients in this day and age where we have so many treatment options available. I think our joint advice would be to look out for it if you fall into the risk category and that type of smoking history and so forth. And you know, look out early, seek help early. All of us are on social media. We're Available via Twitter and other modalities available through the Cleveland Clinic and we'd be happy to help in any way.

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