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Lung cancer reality on the evening news
Peter Jennings' disclosure of his lung cancer diagnosis and his plans to continue his nightly news broadcast sets the stage for a shared national experience with one of the worst of all cancers. The public yet candid display of Jennings' battle against this insidious disease will be a sobering reality for many. Although medical advances seem to occur daily, the prognosis for most lung cancer patients remains grim because symptoms of lung cancer are typically nonexistent or relatively minimal until the cancer has become advanced.
For lung cancer, the best treatment options are available when the cancer is discovered at an early stage, before the tumor has spread. Unfortunately, the diagnosis of lung cancer typically comes after the tumor has become so advanced that surgery has little chance of eliminating the cancer. Although the details of Jennings' condition have not been disclosed, Rita Axelrod, director of pulmonary medical oncology for Thomas Jefferson University Hospital's Kimmel Center, posits that based on his hoarse voice and current treatment, "he could be in at least stage III of lung cancer". According to Axelrod, the life-expectancy for this diagnosis is 12 to 18 months with less than 9 percent living for five years after the diagnosis.
The National Cancer Institute estimates that 172,570 people will be diagnosed with lung cancer in the United States in 2005. Despite the dramatic reduction of smoking in the United States, lung cancer continues as the second most commonly diagnosed cancer and the leading cause of cancer-related death in both men and women in this country.
Nevertheless, improvements in the treatment of lung cancer have accelerated within the past year. For some lung cancers, the drugs erlotinib (Tarceva) and gefitinib (Iressa) have been found effective in halting the growth and spread of the cancer. Unfortunately these drugs are effective in only about 10 percent of the population with non-small cell lung cancer. However, Vincent Miller, MD, a thoracic oncologist comments, "Although these targeted therapies are initially very effective in this subset of patients, the drugs eventually stop working, and the tumors begin to grow again." This recurrent tumor growth is called secondary resistance (as opposed to primary resistance, which means the drugs never worked at all). Indeed, the ability of cancer cells to mutate in response to treatment is what makes treatment and cure of cancer so difficult.
A new treatment strategy emerging on the horizon is based on the finding that inhibition of estrogen in lung cancer patients appears to offer promise in improving survival from the disease. Research findings from the University of Pittsburg build upon the knowledge that since 1930, a 600 percent increase in death rates from lung cancer has been reported in U.S. women. Jill Siegfried, Ph.D., professor, department of pharmacology comments, "Our studies continue to show that lung cancer cells grow in response to estrogen and that stopping or slowing the spread of the disease may be dependent on blocking the action of estrogen." Preliminary studies have demonstrated that blocking of the estrogen receptors in addition to blocking areas on the tumor cells called epidermal growth factor receptors (a strategy used for breast cancer) may be effective for advanced lung cancer in women.
Another advancement in cancer treatment is the use of medications to inhibit the blood supply of tumors, effectively stopping their growth. The drug Avastin has shown promise in this regard, with preliminary results showing longer survival times in some forms of advanced cancer. However, Avastin has been shown to increase the risk of heart disease and stroke.
An innovative approach, funded by the Kentucky Lung Cancer Tobacco Settlement Foundation, involves the development of a vaccine to stimulate the body to reject the cancer cells. The vaccine is viewed as a potential method of reducing the high rates of recurrence and disease progression among the lung cancer population. Researchers from the University Of Kentucky College Of Medicine are developing a vaccine from the white blood cells of patients with lung cancer. The vaccine is then given to the patient, triggering the immune system to recognize and destroy cancer cells.
Currently, prevention is the best treatment for lung cancer. Avoiding the habit of smoking or cessation of smoking dramatically lowers the risk of lung cancer death. As treatments continue to evolve, early detection of lung cancer is an area of attention in medical science. Unlike breast cancer or prostate cancer, screening tests are not available for lung cancer. The development of such tests is the focus of emerging medical research.
Reviewed: April 07, 2005 William Rice M.D.