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Here’s what women should know about lung cancer, which is overlooked too often.
Dr. Douglas Widman of Columbus cyberKnife with the CyberKnife machine.
Dan Trittschuh
Although some other types of cancer are much more widely discussed, lung cancer is the leading cause of cancer death in women. An estimated 109,690 women will be diagnosed with lung cancer in 2012 in the United States, accounting for about 14 percent of all cancer diagnoses in women, according to the American Cancer Society. Those diagnoses likely will lead to approximately 72,590 deaths in 2012, or roughly 26 percent of cancer deaths in women. In comparison, 67,240 women likely will die this year from breast, ovarian, uterine and cervical cancers combined.
“As much as any other commonly considered ‘female’ cancer, lung cancer has to be considered a women’s cancer,” says Dr. Gregory Otterson, a medical oncologist at the Ohio State University Comprehensive Cancer Center—Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. Men’s lung cancer rates began dropping in 1990, Otterson says, but women’s rates continued to climb through the mid 2000s. Rates recently have begun to fall after staying at a plateau since roughly 2005, he says.
Prognosis
Some forms of cancer are highly curable. Unfortunately, lung cancer—unless it is caught early—is not one of them. “It is definitely lethal in any form,” says Douglas Widman, medical director of Columbus CyberKnife, a service of Mount Carmel. “Lung cancer is always aggressive, and the key is to be able to catch it when it is still small and still curable. There is no in between—it is either isolated and very small, or not. Once it has spread, it goes everywhere.”
Widman says lung cancer has few symptoms, so early detection often happens by accident. When symptoms do develop—often shortness of breath and a cough—it means the cancer has been there for quite some time. Sometimes a car accident or injury necessitates a chest X-ray and doctors find the cancer by sheer coincidence. “If we are lucky and catch it early, we have a really good chance of curing it,” Widman says. “If it is detected early and it is cured, it is truly cured, as in never coming back.”
The prognosis depends upon how large the tumor has grown and whether the cancer cells have spread. “In general, early stage lung cancer—stage I or II—has a significant cure rate,” says Dr. Jeanna Knoble of the Mark H. Zangmeister Center. “Patients with stage IV metastatic disease generally cannot be cured and treatment is aimed at prolonging survival by stabilizing and slowing the cancer and maintaining quality of life.”
Causes
It comes as no surprise that tobacco use is a leading cause of lung cancer. What stands out is the dramatic difference in how smoking affects men and women. Knoble says smokers are 25 times more likely to develop lung cancer than nonsmokers. “Interestingly, women are at higher risk than men, being twice as likely to get lung cancer given the same tobacco exposure as men,” she says.
About 20 percent of women who are diagnosed with lung cancer have never been smokers, Otterson says. Anyone who has smoked fewer than 100 cigarettes falls into that category, he says.
“In these women, and indeed in any particular patient, the causes are enigmatic,” he says. “There are lots of lung carcinogens that have been identified, including secondhand smoke, asbestos and radon, but the exact contribution to the epidemic and to an individual patient is challenging to determine.”
Treatments
Treatment is mostly dependent on stage, but the type of lung cancer also plays a role. The types are categorized as “small cell” (15 to 20 percent) or “non-small cell” (80 to 85 percent).
Next, doctors must discover the stage to which the cancer has grown. Stages I and II generally call for surgery and/or chemotherapy and sometimes radiation therapy, Otterson says. Stage
followed by surgery, or chemo-radiation followed by surgery.
“Finally, for stage IV disease, treatment is typically based upon some type of systemic therapy with the judicious use of surgery or radiation to alleviate symptoms,” Otterson says. “Patients with stage IV cancers are typically not cured with therapy, but we are able to prolong life and quality of life.”
Widman sees a number of early stage lung cancer patients in his work at Columbus CyberKnife. The CyberKnife procedure uses a precise robotic delivery system to target cancer cells with intense radiation. “It’s a unique tool in that it allows us to very accurately deliver extremely large doses of radiation without damaging the surrounding tissues,” he says. High-energy X-rays damage the cancer cells, and the cells eventually die because of that damage.
The patients who arrive in his office typically have small tumors in challenging areas that make them unfit for surgery or traditional radiation treatments. Like cancers in the brain, spine or eye, tumors in the lungs respond well to CyberKnife. What would be a seven-week course of treatment with traditional radiation therapy is condensed to just a few treatments with CyberKnife.
Melody Campbell, treated with the CyberKnife procedure this past May, was one of the lucky ones whose cancer was discovered by accident. In 2008, she was being treated for acid reflux and, thanks to a chest X-ray, doctors discovered a tumor in the upper lobe of her right lung. A CT scan revealed a second tumor. She underwent a number of rounds of chemotherapy, which ravaged her system and hospitalized her for nearly a week.
In 2011, tests revealed that the cancer was shrinking, and she and her doctors made the decision to go after it with CyberKnife. Campbell traveled the 60 miles from her home to the CyberKnife office in Westerville five days in a row, often driving herself. “I started on a Monday and finished on a Friday,” she says. “The next day, I mowed the lawn.”
Since her diagnosis, she has refocused on improving her health and living with strength and purpose. She is more active, walking several miles almost every day. “When I was on . . . chemo, it was a chore just to move around the house,” she says. “Now I exercise every day, and it’s truly a blessing to be able to do it.”
On the horizon
Experts say there are many new agents being evaluated that doctors hope will improve the treatment of lung cancer.
Knoble says two new drugs—both in pill form—have been shown to slow growth of cancer cells better than traditional IV chemotherapy. “These targeted pills are called Erlotinib and Crizotinib and target mutations called EGFR and
“These agents have fewer side effects and improved efficacy when compared to traditional chemotherapy,” she says. “This is helping to improve quality of life for cancer patients, which is such an important factor.”
“Future treatments are, more and more, being directed toward particular molecularly defined subsets of lung cancer,” Otterson says. “We have found that not all lung cancers are the same.”
New developments are occurring all the time, he says. “This is why, at the James and other cancer centers, our focus is on the application of new knowledge through the use of clinical trials,” he says. “One hundred percent of our new drugs have been developed as a result of clinical trials, emphasizing why it is so important for us to be doing them and, frankly, for patients to enroll in them.”
Screening procedures for all sorts of cancer are hotly debated in the medical community. Opponents say routine screening can lead to unnecessary biopsies, infection, undue worry and unnecessary expense. Proponents, however, say screening saves lives.
“A major new finding, published in 2011, was the demonstration that low dose CT scans as a screening tool are worthwhile,” Otterson says. Experts studied 50,000 at-risk patients (smokers and ex-smokers ages 55 to 74) and found that annual low dose CT scans (compared with chest X-rays alone) decreased the risk of death from lung cancer by 20 percent in the screened group—and decreased all-cause mortality by nearly 7 percent, Otterson says. “Our stance, and that of the National Comprehensive Cancer Network, is that low dose CT scans are appropriate and should be performed in at-risk patients,” he says.
Social/emotional effects
It’s not just the body that is affected by a cancer diagnosis. The spiritual and emotional self may suffer even more of an impact when the diagnosis is made. Luckily, there are organizations that work alongside medical professionals to support cancer patients in their emotional and psychosocial struggles with the disease.
“Our mission is to ensure that all people affected by cancer are empowered by knowledge, strengthened by action and sustained by community,” says Bev Soult, president and CEO of the Cancer Support Community Central Ohio. “Our programs and services are always free of charge, to ensure that we do not increase the financial burden of those already coping with life-threatening issues.” The community serves all cancer patients and survivors, as well as their families, Soult says.
“Our comfortable setting helps people find a sense of community among others with whom they can share, learn and improve their quality of life, with, through and beyond cancer,” she says. The community designs its programs based on scientific research, and Soult cites a 2007 study, Cancer Care for the Whole Patient, which proposed the idea that social and emotional support are as important as medical care in the face of a cancer diagnosis.
Nina Lewis, clinical program director of the Cancer Support Community Central Ohio, says women suffer a number of side effects from cancer, including fatigue, loss of ppetite, depression and sexual and reproductive changes. Most troubling for many women, though, is hair loss, Lewis says.
Social support helps patients respond courageously and gives them a place to be vulnerable and understood. Sometimes cancer patients feel blamed for their disease, Lewis says.
“There is the issue of social stigma specifically to lung cancer,” she says. “Many people with lung cancer believe that others think their behavior caused the disease when in fact one-fifth of women and one-twelfth of men diagnosed with lung cancer have never smoked.”
Lung cancer generally is treated with a variety of therapies, Lewis says. When it comes to spiritual issues, both men and women will seek what feels comfortable to them. Experts may not push patients in a particular direction when it comes to spiritual matters, but they do have something to say about diet.
“There are some of the special dietary concerns related to stomach, colorectal, throat and other such cancers due to challenges to swallow and digest food,” Lewis says. “Lung cancer is not part of the digestive system, but for some women and men, there may be discomfort and reduced appetite as a result of particular treatments, making eating challenging.”
“When women have often been the person in the household who prepares nutritious food for others, this can be tricky,” she adds. Vitamin and mineral supplements provide nutrients that diet may not and offer a boost where illness may have depleted the body. Supplementation plans often include nutrients that may help support the immune system and reduce toxic side effects.
Life after cancer
It is possible to return to normalcy after a life-and-death battle with cancer, but support is important—particularly for women, who, in many cultures, put the well-being of others ahead of their own health.
“As a result of the underlying influences in our social norms, women often seem to struggle to focus on themselves and their own well-being first, easily being compelled to look after others instead,” Lewis says. “This is especially egregious when a woman has had lung cancer or any cancer, is in survivorship and must contend with these deeply internalized patterns of behavior.”
There are an estimated 10 million cancer survivors in the United States today, and more than 400,000 have beaten lung cancer. There is life on the other side, Lewis says. “Accept the diagnosis,” she adds. “Reject the verdict.”
Kristin Campbell is a freelance writer.
