Insidious lung cancer does not only hit smokers: the professor advised how to detect it in time

Sometimes the fact that it is detected at an early stage is almost like a miracle. The situation would improve if people took better care of their health.

“Lung cancer is a serious disease, difficult to cure, and sometimes incurable. Mortality from this disease is high, possibly higher than mortality from breast and colorectal cancer combined. Therefore, this problem is very relevant not only in Lithuania, but also worldwide, ”said Professor Saulius Cicėnas, deputy director of the National Cancer Institute (IMI).

Last year, 19.3 million people were diagnosed worldwide. new cases of lung cancer and 9.96 million deaths from this disease. Twenty years from now, new cancers are projected to increase to 30.2 million and deaths to 16.3 million.

In Lithuania, according to data from 2012-2013, up to 1,500 new cases are diagnosed per year and around 1,200 people die with lung cancer. At the European level, Lithuania is in third place in terms of morbidity, below the red line in terms of mortality, that is, we do not reach the averages required by the European Union.

Professor S. Cicėnas observes: In Lithuania, the median 5-year survival from lung cancer is only 9 percent. in all cases. This is a low rate. Therefore, Lithuanian doctors regularly participate in the international conference on lung cancer, where specialists from different countries share their experience.

On June 18, IMI together with its partners in Vilnius organized the 12th European Regional Conference on Breast Oncology “What we can really do during the COVID-19 pandemic”, where the pandemic affected breast oncology patients not only in Lithuania but also in Europe. The focus is on the prevalence, prevention, and causes of lung cancer, detection, early diagnosis, surgical treatment, molecular changes, and changes in lung cancer genes. The latest treatments for advanced and non-advanced lung cancer, immunotherapy, which is a new field in lung cancer, pharmaceutical company seminars, presentations by young researchers presenting what they have discovered in molecular treatment or immunotherapeutic of tumors.

“With this conference, we want to remind all Lithuanian people once again about this serious and incurable disease,” explained the professor.

We spoke with Professor S. Cicėnas about why lung cancer is so widespread in Lithuania, what would change the situation and what are the possible treatments for this disease.

– What determines that Lithuania has one of the worst indicators of incidence and mortality from lung cancer in Europe?

– The main reason is that patients are late. They wait until some symptoms appear and lung cancer is a disease where symptoms already appear in locally advanced or advanced disease. Until then, there are no symptoms and people do not request it.

People in Lithuania do not care about their health and apply only when they feel pain or start coughing up blood, start to lose weight, and include weakness. This is typical of advanced lung cancer.

The situation was exacerbated by the coronavirus pandemic. The pandemic made it difficult for people to go to doctors, they did not see them in time. As a result, we have seen an increase in neglected cases and a decrease in those diagnosed with lung cancer at an early stage.

The second reason the situation is so bad is that people in Lithuania smoke a lot. However, they do not go to the doctor, they smoke, they believe that everything will be fine.

If people arrived earlier, if preventive health checks were done, the situation would improve. It doesn’t take much. It is enough to take a photo of the lungs once a year to see the changes.

Those patients who were operated on in the early stages were found at random after a preventive health check because they had no symptoms. And today we operated on a woman who had a tumor in the lower lobe of her left lung. He found it when a woman went for a preventive health check and, after taking a picture of her lungs, noticed changes. The woman was referred to a pulmonologist, after which she was admitted to the IMI. Here she was operated on when the disease was still in its early stages.

– So this is one of those silent oncological diseases, when symptoms appear after it has progressed?

– Yes. Lung cancer is not the only disease. But it is dangerous in the case of other diseases, that period of silence is still not so dangerous, it is still possible to help a person even in the later stages and the results are not bad, and in the case of lung cancer, the prognosis . and the results of the treatment deteriorate remarkably.

If the number of initial stages were greater, the life expectancy of our patients would increase.

We do everything possible to detect lung cancer as early as possible: we give lectures, we invite patients. Unfortunately, a lung cancer screening program has not yet been implemented, which could possibly produce tangible results and the disease could be detected earlier.

But the most important thing is to stop smoking. In countries where smoking has decreased, the incidence of lung cancer has also decreased. Not only regular cigarettes, but also electronic cigarettes, glowing tobacco – all of this causes lung cancer. This has been recognized by everyone, by all societies.

– How does COVID-19 work in people with lung cancer?

– This is the worst combination we can have when a patient with lung cancer, regardless of the stage, whether after surgery or who has not undergone surgery, develops COVID-19. Of all the patients we treated for lung cancer who developed the COVID-19 infection that we learned about, only one survived. All the others died.

It’s especially important when patients are receiving immunotherapy – it already affects the lungs, causes lung complications, and if COVID-19 is added, patients die very quickly. Therefore, we vaccinate all National Cancer Institute patients against coronavirus and urge those with cancer to get vaccinated before or after treatment to reduce the risk of COVID-19 infection, as lung cancer and COVID-19 are a deadly combination.

– Smoking, as you mentioned, is the biggest risk factor for lung cancer. And what else increases the chances of getting it?

– Only about 10-12%. people with lung cancer have not smoked before. The disease can also be caused by the environment in which we live: the air we breathe, the water we drink, the radiation we have in the background; Radon is one of the causes, the chemicals that we receive.

About 8 percent. cases are determined by inheritance. We recently operated on a patient who was prophylactically examined because her brother, father, and another relative had lung cancer. She never smoked, but she was scared because she had so many sick people around, so she checked and found a peripheral formation in her lungs. So she came to us, we operated on her and we found cancer.

– Is lung cancer genetically linked to other oncological diseases?

– We recently published a scientific article on lung cancer as a second tumor, that is, the development of lung cancer in women with breast cancer or in men with prostate cancer. Lung cancer presents as a second primary tumor. It is not about the spread of that disease to the lungs, as is commonly thought, but about a new cancer. Therefore, there are genetic links. A report on this was also read at the June 18 conference.

– At what age and gender are people most likely to develop lung cancer?

– Previously it was said that lung cancer – a disease of the elderly – those over 70 years. Unfortunately, lung cancer is getting younger. We also observe healthy people ages 45 to 50 who get it.

There is also an increase in the incidence of lung cancer in women in Europe and around the world. In Lithuania, this is not statically visible yet, but there are more cases and we see that we are approaching a statistical increase. We found a number of women around the age of 50 who develop lung cancer, although they have never smoked, they have not lived in a toxic environment, not even anyone around them, since one of the causes of the disease can be passive smoking when a person does not smoke but often breathes tobacco smoke. There are many versions of why lung cancer affects more and more non-smokers.

– Is there still good news in this area? Perhaps there has been an increase in effective new treatments?

– Undoubtedly. Science does not stop. The main problem is how to cure people with locally advanced or advanced lung cancer. Despite the fact that Lithuania lags behind in the amount of drugs used to treat these diseases (Lithuanian patients receive these drugs in the clinical trials in which they participate), a sufficient amount of drugs is reimbursed and therefore they contribute annually to meet European standards in treatment. lung cancer.

In the case of one or another mutation, there are already first and second generation drugs that compensate. We try different treatment options.

But lung cancer is becoming resistant to new drugs. For example, when immunotherapy was started, there was a blow: very good results were achieved, the tumors of the patients shrunk and year after year we began to see resistance. The same happened with inhibitors. Lung cancer is a heterogeneous and insidious disease that can adapt to any treatment and spread further.

Those resistance mechanisms are one of the world’s biggest problems: why do drugs help one patient so well and don’t work at all for others? This was also discussed at a conference in Vilnius.

– Does the appearance of new therapies improve the survival and prognosis of the patient?

– We do not have a sharp jump in improving forecasts and it is too early to talk about it. Until now, and in the whole world, there is no such miracle that has improved dramatically. However, the fact that a large number of international clinical trials are being carried out, where various drugs are being tested, shows that the search for the optimal option would significantly improve the survival of these patients.

But if we take the fourth stage, it was practically 6-8 months before death, 10-15 years ago, regardless of the treatment. Now, with new treatments, molecular diagnoses, morphology, we have 5 years or more survival in people with advanced stage 4 lung cancer. There are not many of these people, as others develop resistance to treatment. It is not yet clear why one person lives 7 years with one treatment and the other only survives 3-4 years. But it’s been a few years, not a few months, as it used to be. Advances in cancer treatment are already here!

We have very good results, but in general, those good results remain isolated and only represent up to 10%. Other patients do worse. However, different approaches are being explored, different drugs are being tested and IMI, together with universities in Norway, Denmark and Finland, is involved in many studies investigating different drugs to apply them to a larger number of patients and obtain tangible results.