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While lung cancer was once viewed as a disease with poor survival, significant strides have been made over the past 20 years in personalized treatments and targeted therapies, which have dramatically improved survival rates for patients facing this disease. In just the past five years, the survival rate has increased by 26% nationally to 29.7% among men and women.

In November, we recognize Lung Cancer Awareness Month as a time to raise awareness of these exciting advancements and to share essential information about this disease, which accounts for more than 226,000 new cancer cases in the U.S. per year.

 We spoke with Patrick Nana-Sinkam, M.D., to learn more about how to identify lung cancer, tips to reduce your risk, screening procedures to follow and more. Nana-Sinkam is a pulmonologist and physician-scientist serving as the Associate Vice President of Clinical and Translational Research at VCU Health and the VCU School of Medicine, as well as the Linda Grandis Blatt Endowed Chair in Cancer Research and a member of the Cancer Prevention and Control research programs at VCU Massey Comprehensive Cancer Center.

How did your interest in lung cancer begin?

During my pulmonology fellowship training, I was researching another type of respiratory disease. One of my mentors asked if anyone in the lab wanted to study a molecule that was thought to drive risk in lung cancer, and I volunteered.

At that time, lung cancer was seen as a disease with very few treatment options and poor outcomes, but fortunately, science and medicine have come a long way in the past 20 years. Lung cancer is no longer seen with the same pessimism, and there are many different treatment options available now.

What brought you to Massey?

Prior to my arrival at VCU, I served on the faculty at the Ohio State University in Columbus. There, I had the opportunity to partner with some inspiring medical oncologists who primarily cared for lung cancer patients. I was eager to return to my home state of Virginia, so the opportunity to join Massey could not have come at a better time. Our son was also young at the time, and we wanted to be closer to family.

I was particularly attracted to the institution’s deep commitment to serving the community through outreach and engagement. Massey is truly dedicated to serving and helping foster meaningful partnerships that are essential to our success.

What are the different types of lung cancer?

Over twenty years ago, lung cancer was considered as one disease with a limited number of therapies, but over time, investigators have determined that lung cancer represents several types.

Currently, lung cancers are divided into small-cell and non-small-cell lung cancers. Small-cell lung cancer is characterized by small, round cells that tend to spread quickly. Non-small cell lung cancer is a broader category of lung cancer that includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, which tend to grow more slowly.

Researchers have also discovered that varying cancer cell mutations drive the behavior of the cancer and guide the selection of various types of treatment for specific patients.

What are the common symptoms of lung cancer?

Importantly, lung cancers may present with or without symptoms. However, patients should be aware of specific symptoms that warrant further evaluation. For example, a persistent cough that cannot be attributed to a virus or cold or other benign condition, hoarseness, unexplained shortness of breath or unintentional weight loss should all be evaluated.

Ideally, you want to diagnose the cancer prior to the development of noticeable symptoms. The presence of symptoms may suggest more advanced disease.

Is there any standard screening for lung cancer?

The standard of care for people aged 50-80 who have a history of smoking (either active or quit within the last 15 years) is to be screened with a low-radiation CT scan and repeat it annually until age 80. This helps to detect any spots on the lungs that might appear and catch cancer early, if it is there. Importantly, most spots that are detected during screening are determined to not be cancerous.

While the current lung cancer screening eligibility criteria identify a large percentage of those at risk, they do not take into consideration those younger than 50 or those who may not have a history of smoking. While 80% of lung cancers are smoking-related, we do see cases of people who get lung cancer despite never having smoked. Family history and occupational history represent additional risk factors that must be considered as we work to develop more accurate models for risk assessment.

Individuals who meet screening criteria are encouraged to discuss this with their health care provider.

Learn more about the Early Detection Lung Cancer Screening Program at VCU Health here.

What are the treatment options for lung cancer?

Lung cancer care has significantly evolved over the last two decades. Our knowledge of what distinguishes lung cancers from one another to guide treatment has expanded exponentially. We now have over a dozen therapies, including immunotherapy, which are helping patients live much longer and fulfilling lives.

Chemotherapy, radiation and surgery remain the three most common treatment options for patients with lung cancer. However, there are also targeted therapies available for patients. We decide how best to treat each patient by determining what type of lung cancer is present and how far it has spread, then create a customized treatment plan from there.

What are the side effects of lung cancer treatment?

One treatment option, known as EGFR tyrosine kinase inhibitors (TKIs), blocks the epidermal growth factor receptor protein that can cause cancer cells to grow and divide. However, TKIs can also affect healthy skin cells, so they can often cause a rash in patients taking these drugs.

With immunotherapies, sometimes the body doesn’t know whether it’s fighting off the cancer or if it should be fighting off the therapy, which can result in inflammation of the organs, similar to what one may experience with an autoimmune disease. But at Massey, the care team is very well versed in these symptoms, so they can adjust course if any issues arise.

What are some common misconceptions about lung cancer?

• All lung cancers are the same - The reality is that there are several types of lung cancer, and recent discoveries demonstrate that, based on genetic profiles, some lung cancers may be more responsive to specific new therapies compared to others. Lung cancer has entered the era of “personalized medicine,” in which, through specific testing, we can match a patient's lung cancer with a particular therapy. This approach has significantly improved outcomes.
  
  
• Lung cancer is a smoker’s disease - While it is true that smoking remains the number one risk factor for lung cancer, we do see a significant number of cases among those who have never smoked. This raises the importance of conducting a thorough assessment for lung cancer risk, which should include family history, occupational history and presence of lung disease. Additionally, large studies demonstrate a strong link between pollution and lung cancer risk.
  
  
• Lung cancer survival is short - With the advent of new therapies and improved screening, the five-year survival for lung cancer has improved dramatically. The outlook for lung cancer care is much brighter.

Are there any steps people can take to reduce their risk of lung cancer?

Smoking cessation is certainly the number one way to reduce your risk of lung cancer. Beyond that, it’s also important to consider environmental factors. For example, if you have a job where you’re exposed to a lot of airborne contaminants, be sure to take the proper precautions to protect yourself.

In general, it’s also important to maintain a healthy lifestyle and weight to minimize your overall risk of cancer. Things like staying active and eating a healthy, well-rounded diet can help reduce the likelihood of cancer.

How does Massey collaborate across specialties to deliver comprehensive cancer care?

Comprehensive lung cancer care requires a multidisciplinary approach. Recognizing this, Massey physicians, including oncologists, thoracic surgeons, pulmonologists and radiologists, collaborate to ensure that patients receive leading-edge and personalized care in screening, diagnosis and treatment.

Is Massey conducting any clinical trials for lung cancer?

Massey offers one of the largest selections of clinical trials in Virginia led by nationally-recognized researchers and providers, including many that are investigating novel therapies and treatment strategies for lung cancer.

For more information related to Massey’s approach to lung cancer treatment, click here.

 Written by: Tatiana Del Valle