Health Chats
Lung Cancer: Diagnosis and Treatment Options
Wednesday Nov 02, 2011, 01:00PM - 02:00PM (EST)
Lung cancer is the most common malignancy worldwide, with more than 1 million cases diagnosed yearly. In the United States, an estimated 200,000 new cases were diagnosed in 2009 and more than 150,000 deaths were due to lung cancer – making it the leading cause of cancer death in both men and women. <br><br> The Cleveland Clinic Chest Cancer Center, which includes specialists from the Respiratory Institute, Taussig Cancer Institute and Heart and Vascular Institute, uses a multidisciplinary approach to cancer care, focusing the entire team’s expertise and energy on providing the best outcomes for each patient. Take this opportunity to learn more about lung cancer, including diagnoses and treatment options, and have your questions answered by Dr Peter Mazzone, Dr. Nathan Pennell and Dr. Daniel Raymond from the Cleveland Clinic. <br><br> Peter Mazzone, MD, MPH, is a Pulmonologist and Director of Education at Cleveland Clinic's Respiratory Institute. In addition, he is the Program Director of the Pulmonary and Critical Care Fellowship Program, Director of the Lung Cancer Program for the Respiratory Institute, and Director of the Pulmonary Rehabilitation Program. Dr. Mazzone is board-certified in internal medicine, pulmonary medicine and critical care medicine. His specialty areas include lung nodules, lung cancer and intensive care unit medicine. Research interests focus on breath analysis, lung cancer diagnostics, lung nodule evaluation, lung physiology assessment and lung cancer screening. <br><br> Nathan Pennell, M.D., Ph.D. is a board certified medical oncologist who joined the staff of the Taussig Cancer Center in 2008. He specializes in the treatment of thoracic malignancies with a focus on lung cancer. Dr. Pennell's research interests include clinical trials using novel therapies, with a goal of facilitating the movement of new treatments from the laboratory to the clinic. <br><br> Daniel Raymond, MD, is a thoracic surgeon in the Department of Thoracic and Cardiovascular Surgery in the Sydell and Arnold Miller Family Heart & Vascular Institute. He is board-certified in general and thoracic surgery. Dr. Raymond is a member of the American College of Surgeons Oncology Group and the Society of Thoracic Surgery and is a Fellow of the American College of Surgeons and the American College of Chest Physicians. He is a member of the Thoracic Surgical Directors Association Curriculum Committee.
Hello everyone and welcome to today's Lung Cancer Health Chat with Dr. Nathan Pennell, Dr. Peter Mazzone and Dr. Daniel Raymond.  The health chat will begin shortly.
CCF Lung Cancer MD:
Thank you for having us!
Hello. I am a female, 45 years old with mild asthma. I have not smoked in 16 years.  I have had a cough for over a year, frequently with green phlegm.  Doc said it was post nasal drip.  I had an x-ray one month ago and it was clear.  I have had chest pain upon inhaling and burning sensation. Doc gave me antibiotics and the phlegm isno longer green. chest pain is worse.  had a ct no contrast. it reads on supine inspiratory images, there is an ill defined area of ground glass opacity in the lateral segment of the left lobe and there is a non-calcified nodule measuring approximately 8mm , with surrounding ground glass opacity in the inferior central aspect of the anterior segment of the right upper lobe.  There is no bronchial wall thickening, bronchiectasis, orinterstitial fibrotic change.  Impression: air trapping on the expiratory images, suggesting reactive airways disease.  small ground glass infiltrate in the left lower lobe. Does this mean i have lung cancer?
CCF Lung Cancer MD:
CCF Lung Cancer MD:
THis does not mean that you have lung cancer.  There are many different etiologies for pulmonary nodules.  Given your smoking history, lung cancer is certainly a concern.  Generally we would consider serial imaging to see if the nodules persist and grown. In that circumstance, additional investigation may be warranted.  DR
I smoked for 8 years before quitting 10 years ago, what are my chances of getting lung cancer?  I'm 35 now.
CCF Lung Cancer MD:
FIrst of all, congratulations on your decision to quit smoking! Basically, people who quit by the age of 30, still have roughly double the risk of developing lung cancer as someone who hasn;t smoked. But, your odds of developing cancer by the age of 75 is 90% lower than if you would continued to smoke through out your lifetime.
I've heard that certain types of thyroid cancer can move to the lung and/or brain.  If that happens is it considered thyroid cancer or lung cancer?
CCF Lung Cancer MD:
In this scenario, it would be considered metastatic thyroid cancer, not lung cancer.
CCF Lung Cancer MD:
Cancers are generally named after where they start... not where they move.
My grandma was recently diagnosed with lung cancer, she is 78.  What clinical trials are available to her if any?  Thanks!
CCF Lung Cancer MD:
Clinical trials are highly variable based on where you are located. I would recommend speaking to your local onlcologist about the trials available in your area based on the type and stage of cancer.
CCF Lung Cancer MD:
You can also consider obtaining a second opinion at a local  academic medical center. For information about the clinical trials at Cleveland Lcinic, you can contact our Cancer Answer Line at 866-223-8100
Do people who have lung cancer generally have symptoms that bring them to their doctor or is it found on x-rays taken for other reasons like pre-surgery workups, etc.?
CCF Lung Cancer MD:
Symptoms do not generally occur with lung cancer until an advanced stage.  As a result, up to 70% of patients present with Stage III or IV disease.  Often, more early stage lesions are found incidentally.  Lung cancer screening CT may offer a means of catching cancers earlier, there is ongoing study of this modality with promising results.
What can we do, as the population, to help increase awareness to help people catch this awful cancer early by recognizing the symptoms, etc.
CCF Lung Cancer MD:
Participation in local events sponsored by various organizations including the American Cancer Society (e.g. The Great American Smokeout) and the American Lung Association.
I recently had a CT scan due to abdominal pain. I was diagnosed with diverticulitis, but the scan incidentally showed a lesion in the pleural cavity of my right lung. The radiologist recommended I return in a year to have the CT repeated, but my doctor said he wasn't comfortable with waiting that long and is having me return in September for another scan. My husband's father died of lung cancer, so this is his worst nightmare...he's not sleeping at night. My mother smoked 2-3 packs of cigarettes a day and I lived with her my first 20 years. What percentages of lung lesions are cancerous? Should I have any more tests done? What else could this be?
CCF Lung Cancer MD:
The recent National Lung Cancer Screening Trial revealed, in patient with a 30 pk-yr smoking history (packs x # of years) and age 55-74, nodules were identified in approximately 30% of patients.  Only 2-3% were actual lung cancers.  Your risk is probably less given your exposure, however, follow up imaging is certainly warranted.
Is there a risk of lung cancer from exposure to asbestos?
CCF Lung Cancer MD:
Yes, it is a significant risk factor which is magnified by smoking.
Which type of lung cancer is more treatable, non-small cell or small cell?
CCF Lung Cancer MD:
It depends on many factors.  Overall, non-small cell is more often detected at an earlier stage and therefore more options are available.  At advanced stages, prognosis is similar.
My aunt has lung cancer (adenocarcinoma) stage 1 and was told that there was nothing to do right now and that she should wait a year and then come back. This doesn't sound like a good idea as I can't imagine the cancer will go away. Are there any treatment options while it is still early stage?
CCF Lung Cancer MD:
THe gold standard for treatment of stage I lung cancer is surgical resection.  If the patient is not a candidate for resection, radiation therapy is an effective alternative.  If you would like a second opinion, please call CCF Cancer Answer Line at 866-223-8100.
My name is Vernon. I was just told that I probably have lung cancer based on a CT scan done at the ER. I was coughing up blood and had other symptoms so went in, admitted to hospital for 3 days, came home yesterday. Had endobronchial ultrasound bronchoscopy and will get results of biopsies on Friday. The mass is in my RLL growing into the right bronchus, estimated size is 3cm x 5.9cm. I also have COPD and PAH both just recently diagnosed. What questions should i be asking at my upcoming appt? What treatment options are available?
CCF Lung Cancer MD:
Vernon, I am sorry to hear about your ordeal.  Your cancer therapy would be determined by the cell type (biopsy result) and the stage of the cancer.  Your physician will then decide on the best treatment strategy which could include surgery, chemotherapy and or radiation therapy.
Hi,  I'm  a 50 year old female.  I have been a smoker for 22 years 1pack or less per day. Recently quit.  My main question is.  3 years ago I had a ct scan of my neck.  Incidental finding of "granuloma" left lung apex.  My doctor was unconcerned I asked her to please do a complete chest ct.  I had the Ct chest done  with and without contrast. The finding were:  small granuloma left apex otherwise unremarkable.  My doctor dismissed it with nothing more needed.  I now am concerned because my sister age 67 (x smoker for 20 years) has stage 4 lung cancer.  Doing research for her I have found that many sites I have visited suggest that I should have follow-up imaging to make sure that the "granuloma" docent change over time.  Should I be concerned?  Should I have another ct to make sure it hasn't changed?
CCF Lung Cancer MD:
Without looking at the scan, it is difficult to determine.  Granulomas can have a charactericstic appearance on CT scan (calcification) and further imaging is not always necessary.  If you are concerned, I would speak further with your physician regarding the need for follow-up scans.
My grandfather died of lung cancer eight years ago and it was really painful watching him die. I'm wondering if there are any new technologies or treatments out there for lung cancer now? How has the field advanced in the last decade?
CCF Lung Cancer MD:
We are sorry for your loss.  There have been many recent exciting developments in the field of lung cancer including early detection with screening, stereotactic radiosurgery, minimally invasive surgery, and targeted drug therapies which have greatly prolonged survival in subgroups of patients with lung cancer.
My doctors and I are in the process of deciding what course of treatment I should take.  What are the pros and cons of both chemotherapy and radiotherapy?  Why would you choose one over the other and what are potential complications I need to know?