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.
CCF Lung Cancer MD:
This is a tough question to answer without reviewing the specifics of your case.  Both chemotherapy and radiotherapy have benefit and can be complementary in the right circumstance.
Hi there doctors, I heard on the news that beta carotene can increase the risk of lung cancer. I take a multivitamin daily that has beta carotene, and I eat carrots, squash and other orange-colored foods. Should I be worried? Should I stop taking the multi, or change my diet? Thanks for your time and attention!
CCF Lung Cancer MD:
While there is evidence that extremely high doses of beta-carotene may increase the risk of lung cancer, the amount in a multivitamin and/or diet is unlikely to effect your risk.
Can smoking cigars and pipes lead to lung cancer?   Is it true that smoking a cigar is worse than smoking cigarettes?
CCF Lung Cancer MD:
Cigars and pipes can both increase your risk of lung cancer, in addition to oral cancers.  
What have scientists learned about the relationship between radon and lung cancer?
CCF Lung Cancer MD:
Radon exposure increases the risk of developing lung cancer, particularly in those who smoke cigarettes. There is no defined safe level of exposure. Be cautious in trusting company's that measure radon levels and also supply abatement packages.
My father has stage IV lung cancer and we have been told there is little hope for survival.  At what point would it be advisable to call in Hospice?  I've heard that the earlier, the better, but I don't know when that is.
CCF Lung Cancer MD:
I'm sorry to hear about your father. Generally, hospice is a reasonable choice for any patient who is no longer receiving active treatment for their advanced cancer. I think it is better to get them involved while the patient is still feeling well rather than waiting until they get very sick, so that they can help the patient maintain a good quality of life for as long as possible.
Is staging done by PET scan only? If they find cancer elsewhere, would only options be chemo and radiation? Is surgery ever curative?
CCF Lung Cancer MD:
It depends on the specific situation. PET scanning is a valuable tool to identify distant metastases, but often the spots identified on PET need to be biopsied to tell for certain if they are cancer or benign. If cancer has spread outside the chest, usually chemotherapy is the primary treatment to help prolong survival. In rare circumstances, metastatic lesions can be surgically removed but this should only be done under the care of a multidisciplinary team such as the Cleveland Clinic Chest Cancer Center,
What is a Lung Fat-Pad and is it something to be concerned about. I had one show up on a CT scan and the Dr. said it was nothing to worry about. I can't find out much about it.
CCF Lung Cancer MD:
We are not familiar with this term.  Generally, howver, fat collections in the chest have characteristic properties on CT and are benign.
Following a routine chest x-ray for a medical, the x-ray showed a shadowing and a spot about the size of a thumbnail on my left lung.  I haven't smoke for over 15 years, have not had a cold or chest infection for over a year - in fact am very healthy.  Is there any reason for concern?  
CCF Lung Cancer MD:
Spots in the lungs (called lung nodules) are very common and can be present for many different reasons. Usually they are benign scars but they can represent an early lung cancer. If you previously had a chest xray, the first step would be to see if the nodule was there in the past. If it was and has not grown over time then it is very unlikely to be lung cancer. If there are no old xrays to compare to then we would usually get a better look at the shadow with a chest CT. The next step would be based on the findings of the chest CT scan.
Can COPD be a mis-dx for lung cancer when X-rays and MRI's show seriously damaged or enlarged nodules?  Are symptoms similar?  Would a biopsy be preventative medicine?
CCF Lung Cancer MD:
The symptoms of COPD and lung cancer can be similar - coughing and shortness of breath in particular. The picture of lung cancer and COPD should not be similar and would be difficult to confuse with one another.
I had my aunt who never smoked and a good friend of mine died of lung cancer. Both of them in their early 50's. My aunt never smoked and my friend stopped smoking long time ago...From what I understand, it is not always smoking, I know my aunt was very stressed with a demanding husband, do we know today if stress can cause this type of cancer. Otherwise, what are the main causes? Thanks in advance.
Unfortunately, we only have time for one more question.
CCF Lung Cancer MD:
Currently the known risk factors for lung cancer include smoking, second-hand smoke exposure, asbestos exposure and radon exposure.  Stress is currently not known to cause lung cancer but can certainly lead to smoking.  15% of all lung cancers occur in nonsmokers.
What % of smokers get lung cancer?
CCF Lung Cancer MD:
There are many variables that contribute.  The lifetime risk of developing lung cancer in someone who smoked up to age 60 is approximately 15%.  If you can quit before age 50, the risk decreases by more than 50%.  Certainly there are other smoking related diseases that should be considered including heart disease, vascular disease, stroke, etc.  
That's all the time we have today. Thank you everyone for participating in today's chat and a big thank you to Dr. Pennell, Dr. Mazzone and Dr. Raymond for taking the time to answer everyone's questions!
CCF Lung Cancer MD:
Thank you for allowing us to participate in this discussion.
CCF Lung Cancer MD:
For more information about the Cleveland Clinic Chest Cancer Center or if you would like to talk to a cancer nurse, plase call the Cancer Answer Line at 866-223-8100.