an in-depth review of lung cancer
Caring for the Whole Patient, Not Just a Disease
We are very grateful to have the opportunity to talk about the great things going on and in development for the Marian Regional Medical Center and Arroyo Grande Community Hospital providing the most comprehensive cancer program. It is a privilege to work alongside a dedicated team of healthcare professionals who strive for the very best in cancer care for each patient. As an accredited cancer program by the Commission on Cancer of the American College of Surgeons, we set high standards for cancer care and continually review processes and outcomes to ensure we are meeting or exceeding those standards. We integrate cancer prevention and early detection in our community outreach efforts through education and screenings. We employ the latest technology for the diagnosis of cancer. We offer a multispecialty team approach to coordinate the best treatment options. And, we provide a Cancer Registry that offers lifelong patient follow up. We are true to our vision to care for people and improve the quality of life in the communities we serve. By offering comprehensive services, the latest technology, highly-trained physicians and experienced staff, we are fulfilling our vision and ensuring that the highest quality cancer care is available close to home. We have continued to see more growth this past year. As our volume grows we continue to add more staff (both clinical and non-clinical) to support the expanding and evolving needs of our patients. We care for the whole patient and not just the disease.
A Multispecialty Team Approach to Care
Marian Regional Medical Center and Arroyo Grande Community Hospital are each accredited as a Comprehensive Community Cancer Program by the Commission on Cancer (CoC) of the American College of Surgeons. Receiving care at a CoC-accredited cancer program ensures that a patient will have access to:
• Comprehensive care, including a range of state-of-the-art services and equipment
• A multispecialty, team approach to coordinate the best treatment options
• Information about ongoing clinical trials and new treatment options
• Access to cancer-related information, education, and support
• A cancer registry that collects data on type and stage of cancers and treatment results and offers lifelong patient follow up
• Ongoing monitoring and improvement of care
• Quality care close to home
A multispecialty team approach is best demonstrated by two weekly Tumor Conferences. The conferences allow for recently diagnosed cancer cases to be discussed with Radiation Oncology, Medical Oncology, Surgery, Radiology, Pathology, and other medical specialties. Attendees offer advice on treatment or further diagnostic studies after determining the stage of the disease. Treatment recommendations utilizing national treatment guidelines are also reviewed.
Cancer Registry Our Cancer Registry has been collecting cancer data for all patients diagnosed and/or treated at our facility since 1988. The Cancer Registry is an essential component of the Commission on Cancer (CoC) accredited cancer program. Data collected by the Cancer Registry is an invaluable tool in the fight against cancer and is utilized by physicians, administration, and other healthcare professionals. National Comprehensive Care Network (NCCN) treatment guidelines are used to achieve excellence in cancer care. We are enrolled in the Rapid Quality Reporting System (RQRS) to support our efforts in maintaining a high level of evidence based cancer care. By collecting data for our top sites on a real time basis, the data can be used to develop interventions in order to enhance the quality of care in our cancer program.
Thorough documentation of cancer information is essential to the Cancer Registry and is included in the patient abstract. The abstract contains demographic information including age, gender, race/ethnicity, and residence. Medical, family, and social histories include physical findings, family cancers, occupation, personal history of cancer, and exposure to carcinogens. Diagnostic findings list types, dates and results of procedures used to diagnose cancer. Information specific to a patient’s current cancer diagnosis includes the primary site, histology, and staging. Treatment lists cancer-directed therapy, including surgery, radiation therapy, chemotherapy, hormonal therapy, and other modalities. Any palliative care is also documented. Follow-up data records annual information about treatment, recurrence and patient status, and provides accurate survival data. This information is reported to the California Cancer Registry and the National Cancer Data Base. The Cancer Registry staff participates in ongoing cancer-related education at the local, state, and national levels to maintain abstracting skills and to maintain credentials in their field.
In 2013, 1628 new cases were added to the registry, with 1077 of those being analytic (cases diagnosed and/or treated at the medical center for the patient’s first course of treatment). Nonanalytic cases (cases receiving first course of treatment at other facilities and receiving subsequent treatment at our medical center) counted for the remaining 551 cases. Only analytic cases are used for statistical analysis and reporting. The top five sites for 2013 were breast, lung, colorectal, prostate, and non-hodgkin’s lymphoma. There were 715 new males and 913 new females diagnosed/treated with cancer at our medical centers.
Lung Cancer Basics
Although lung cancer is a largely preventable medical condition, it is the most common cancer mortality in both men and women in the world. In 2014, 228,000 new lung cancer diagnoses and 159,000 deaths due to lung cancer have been projected. Lung cancer represents approximately 27 percent of all United States cancer deaths and will be the largest cancer “killer” over the next 30 years. Twice as many people will be living with lung cancer in 2040 than in 2010. This is mainly due to longer life spans and cancer being more common as we age.
Fortunately for us, lung cancer death rates have begun to decline. Risk factors have not changed much over the years and smoking is present in 90 percent of all lung diagnosed. Other lung cancer risk factors include radiation, genetics, diet, HIV infection, emphysema, scarring of the lungs, and environmental toxins. Toxins include second-hand smoke, asbestos, dust exposure, and radon which is radioactive gas produced by decay of uranium in soil.
Tobacco smoking is responsible for nearly one in five deaths in general. The smoking rate in the U.S. has dropped by half from 1965 to 2012. At the height of adult U.S. smoking, it was estimated that 42 percent of the population smoked. Now that estimate has dropped to 18.1 percent. However, in developing countries, tobacco consumption is rising at 3.4 percent per year as of 2002. Young adults are the most likely to start smoking with new onset of older smokers showing a marked decline.
Prognosis in lung cancer is generally poor because of not being able to diagnosis it due to lack of symptoms until it is in advanced stages. One year survival after diagnosis is at approximately 43 percent and five year survival is at 17 percent. Most cases are in patients greater than 65 years of age when diagnosed and has already been developing for several years.
What Is Lung Cancer?
Lung cancer is the abnormal growth of abnormal cells in one or both lungs. These abnormal cells do not carry out the functions of normal lung cells and do not develop into healthy lung tissue. As they grow, the abnormal cells can form tumors and interfere with the functions of the lung which provides oxygen to the body via the blood.
What Are the Types of Lung Cancer?
Non Small Cell Lung Cancer (NSCLC) accounts for approximately 85% of all lung cancers
— Adenocarcinoma: the most common type of lung cancer in the U.S among men and women
— Squamous Cell (also called epidermoid cancer): usually forms in the lining of the bronchial tubes.
— Large Cell: often occur in the outer regions of the lungs and tend to grow more rapidly and spread more quickly than Adenocarcinoma or Squamous Cell.
Small Cell Lung Cancer (SCLC) accounts for approximately 15% of all lung cancers in the U.S. Occurs primarily from smoking and grows more rapidly and spreads to other parts of the body earlier than NSCLC. It is also more responsive to chemotherapy.
Staging for Lung Cancer?
Stage I – Cancer that is confined to the lung.
Stage II & III – Cancer that is confined to lung and lymph nodes.
Stage IV – Cancer that has spread outside of the lung to other body parts.
Ten million individuals nationwide are eligible for lung screenings.
1. Symptoms Show Up Late
Lung cancer shows no symptoms in the early stages. But in those early stages, it’s very treatable. Most lung cancers are first diagnosed based on late stage symptoms, when there’s far less chance for cure. Symptoms of lung cancer are not very specific and generally reflect damage to the lungs’ ability to function normally. The most common symptoms are a worsening cough that will not go away and chest discomfort. Other symptoms include shortness of breath, coughing up small amounts of blood, unexplained weight loss, back pains, decreased appetite and general fatigue.
2. Lung Cancer Can be Screened
Unlike mammography for breast cancer or colonoscopy for colon cancer a widely accepted screening tool for early stage lung cancer has not been available until recently. Regular chest x-rays are not reliable enough to find lung tumors in their earliest stages when many doctors believe the tumors are at their smallest and most curable. Recent guidelines from the American Society of Clinical Oncologist (ASCO) suggest annual screening with low dose CT scan for smokers and former smokers who are high risk for developing lung cancer.
3. More Than Smokers
Smoking is a leading cause of lung cancer. But thousands of non-smokers die of lung cancer every year. Other factors can be just as critical, including exposure to certain chemicals at work, prolonged exposure to second-hand smoke, a family history of lung cancer and more.
As opposed to other cancers, where screening tools such as mammography, colonoscopy, and PSA levels are available, lung cancer screening has been slow to develop. However, that changed in 2013 when the United States Preventive Services Task Force published new guidelines that recommend physicians discuss lung cancer screening in high risk individuals (see page 11). It is recommended that testing be completed with low dose computerized tomography (CT) in a facility experienced in lung cancer screening. It is also emphasized that screening is not a substitute for quitting smoking; the most effective way to lower lung cancer risk is to stay away from tobacco.
Early detection can save your life.
Lung cancer is the number one cancer killer in the United States. More people die from lung cancer than from breast, colon, pancreas and prostate cancer combined. The early-stage survival rate is 53.5%; unfortunately, however, only 15% of lung cancer cases are currently found in the early stage. A sad fact is that most cases are not diagnosed until later stages, when survival rate drops to only 3.9%. That is why Lung Cancer Screening is so important!
Recent federal guidelines recommend that long-term, pack-a-day smokers receive an annual screening for lung cancer using low-dose spiral computed tomography (CT) imaging. The guidelines are based on findings from a large study conducted by the National Cancer Institute that proved screening people at high risk for developing lung cancer with low-dose CT scans reduced mortality from lung cancer by 20%. This study estimates that early detection and treatment could save over 70,000 lives per year.
Who should be screened?
Lung cancer screening is not appropriate for everyone. You may qualify if you fall into one of these categories:
• Those between the ages of 55–74 years of age
• Currently a smoker or have quit within the past 15 years, and
• Have smoked at least the equivalent of a pack of cigarettes a day for 30 years or more.
• Those between the ages of 50–74 years of age
• Have smoked at least the equivalent of a pack of cigarettes a day for 20 years or more, and
• Have one additional lung cancer risk factor (not to include second-hand smoke exposure).
Frequently Asked Questions:
What is a low-dose screening CT scan of the chest and what are the associated risks?
A low-dose screening computerized tomography scan of the chest, commonly called a CT or CAT scan, produces detailed images of the lungs and other structures located inside your chest. The low-dose scan exposes you to less radiation than you would receive from a normal CT scan of the chest. It only takes 15 minutes.
What is the cost to me? Low-dose CT scans of the chest are not currently covered by all insurances, but low-cost, cash pricing is available.
What if I have an abnormal finding?
At Dignity Health, each abnormal CT scan is reviewed by a dedicated multi-disciplinary team of physicians who specialize in the treatment and diagnosis of lung cancer. After review, our physicians will discuss the results with you and your primary care doctor, and will discuss options for further evaluation and treatment if necessary.
What if something other than cancer is found on a low-dose screening CT scan of the chest? CT scans may detect other findings, such as infections or emphysema. This will be reported to your doctor for appropriate treatment.
What can I do to reduce my risk of cancer? People with a family history of lung cancer have an increased risk of developing lung cancer by twofold; however, it is uncertain whether this is from genetics or from second-hand smoke. The most important thing you can do to reduce your risk of developing lung cancer is to stop smoking or to never start smoking in the first place. Following a healthy diet, regular check-ups and getting adequate exercise is also very important.
WITHIN 20 MINUTES: Blood pressure and pulse rate drops to normal. The temperature of your hands and feet increases to normal.
WITHIN 8 HOURS: That delightful smoker’s breath disappears, the carbon monoxide level in your blood drops (yes, this is the same chemical your car produces as a waste product) and the oxygen level rises to normal.
WITHIN 24 HOURS: Well done! Your chance of a heart attack decreases.
WITHIN 48 HOURS: The nerve endings start to regroup. Your ability to taste and smell improves. For your tastebuds, it's like switching from black and white to technicolor!
WITHIN 3 DAYS: Breathing is easier for you. Finally you can run without wheezing.
WITHIN 1 to 9 MONTHS: Sinus congestion and shortness of breath decrease. Cilia that sweep debris from your lungs grow back, increasing your lungs’ ability to handle mucus, clean the lungs and reduce infection. Your energy increases.
WITHIN 1 YEAR: Your excess risk of coronary disease is half that of a person who smokes.
WITHIN 2 YEARS: Your heart attack risk drops to near normal.
WITHIN 5 YEARS: Lung cancer death rate for the average former pack-a-day smoker decreases by almost half. Your risk of having a stroke reduces. Your risk of developing mouth, throat, and esophageal cancer is half that of a smoker.
WITHIN 10 YEARS: Lung cancer death rate is similar to that of a person who does not smoke. The precancerous cells are replaced.
WITHIN 15 YEARS: Your risk of coronary heart disease is the same as a person who has never smoked.
Choices and Chances: Daily Habits Make a Difference
• Avoid cigarette, cigar, and pipe smoking.
• Stay away from second-hand smoke.
• Avoid exposure to radon, asbestos, arsenic, chromium, nickel, beryllium, cadmium, tar and soot.
• Reduce your exposure to air pollution as much as possible.
• Avoid Beta Carotene supplements which cause an increased risk of cancer especially in smokers.
Recommendations for General Cancer Prevention
• Be as lean as possible without becoming underweight.
• Be physically active for at least 30 minutes every day. Limit sedentary habits.
• Avoid sugary drinks. Limit consumption of energy-dense foods.
• Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
• Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
• If consumed at all, limit alcoholic drinks to two for men and one for women a day.