Lombard for News Dr. Kenneth Rosenzweig, Chairman and Professor Department of Radiation Oncology.
The chairman of the Department of Radiation Oncology at Mount Sinai Hospital, Dr. Kenneth Rosenzweig, specializes in treating cancers of the chest. Over his 15-year career, he has provided care for 5,000 patients with lung cancer.Who’s at riskMore Americans die of lung cancer than any other cancer. Last year the disease killed about 160,000 people, which is an average of 437 deaths per day. “Lung cancer is just what it sounds like — a cancer in the lung,” says Rosenzweig.”We divide lung cancer into two main types: small-cell lung cancer, which tends to be treated with chemotherapy and radiation, and all other types, which are grouped together as non-small-cell lung cancer and treated with a combination of surgery, chemo and radiation.”The biggest risk factor for lung cancer is smoking. “If there were a top-10 list of causes of lung cancer, numbers one to nine would be smoking and other tobacco use,” says Rosenzweig. “About 10% of people who develop lung cancer never smoked.” Environmental factors like radon exposure can increase risk, and some people are genetically predisposed. “The main thing is smoking, smoking, smoking — there’s a correlation between how much you smoke and your risk of developing lung cancer,” says Rosenzweig. “People who quit smoking are at lower risk than a life-long smoker.”Although 10,000 more men are diagnosed with lung cancer than women, it’s still the leading cause of cancer death in women. “70,000 women a year die of lung cancer,” says Rosenzweig. “That’s more than deaths from breast, ovarian and cervical cancer combined. The deadliest woman’s cancer is actually lung cancer.” About 220,000 cases are diagnosed in the U.S. each year, and most people who develop lung cancer die of the disease.Signs and symptomsThe textbook warning sign of lung cancer is persistent shortness of breath and a cough. “The most common symptoms are similar to a pneumonia that’s not getting better,” says Rosenzweig. “However, around this time of year, millions of Americans have a cough and fever, and almost none of these people have lung cancer.” Signs that you might have more than a garden-variety cold also include coughing up blood. “If your cold-like symptoms drag on for weeks to months, you should be evaluated by a doctor and perhaps get a chest X-ray,” say Rosenzweig.once lung cancer becomes more advanced and invades other parts of the body, it can cause nonpulmonary symptoms. “It can invade the nerves of the arm and cause arm pain,” says Rosenzweig, “Or, if it affects the nerve to the vocal cord, you can get a hoarse voice.” once a lung cancer gets big enough to cause problems, it usually makes itself known within months, not years.Traditional treatmentThe first step for treating or preventing lung cancer is the same: stop smoking. “It’s important to realize that there’s never a bad time to stop smoking,” says Rosenzweig. “If you think of cigarettes as a poison that you keep exposing yourself to, stopping will help you feel better.” as any smoker will tell you, quitting cold turkey is extremely difficult, and it only works about 10% of the time. “Seeing a doctor can help you quit, especially now that there are medicines that can help,” says Rosenzweig.After a diagnosis of lung cancer, treatment options depend on the stage. “An early-stage lung cancer could present as a small dime-sized lesion in the lung that hasn’t spread to any lymph nodes or outside of the lung,” says Rosenzweig. “The good news is that this is a very curable situation — the best long-term cure is to have it surgically removed.”For people who can’t tolerate surgery due to heart and lung problems, the standard treatment is radiation. “Radiation has improved dramatically over the past five years,” says Rosenzweig. “It used to mean getting treatments every day for six weeks, with a 50% success rate. now we can deliver just three large doses, with a 90% success rate for early-stage tumors.”For more advanced cancers that have larger tumors or have spread to lymph nodes, most patients undergo a combination of surgery, chemotherapy and radiation. “It used to be that the chemotherapy drugs were hard to tolerate,” says Rosenzweig. “Now, some of the best therapies offer targeted treatment that’s effective without causing a lot of side effects.” in some cases, chemo can be delivered as a pill that the patient takes at home.once cancer has spread too far to be curable, then doctors work to keep it in check with chemotherapy alone. “Fifteen years ago, most people only lived six months after being diagnosed,” says Rosenzweig. “Now, the medicines we use have improved so dramatically that survival has more than doubled, and we even see some long-term survivors.”Diagnosing lung cancer early, however, is still the key to improving the odds of a cure.Research breakthroughsOne of the biggest advances in lung cancer treatment has been the use of stereotactic body radiation therapy. “This allows us to do extremely precise radiation therapy treatments,” says Rosenzweig.”Previously we’d have to give a margin around the tumor of almost an inch; with the new precise pictures we’ve cut the margin down to 2 millimeters.” Treating less of the patient’s normal lung makes treatment less toxic and safer. “This improved the survival rate to almost 90%,” says Rosenzweig. “Before, we were probably missing tumors because we didn’t have good pictures.another breakthrough that is sought is the use of CT scans to screen for lung cancer before it becomes incurable. some recent studies suggest that if you are a heavy smoker, it may help to get a screening CT scan, but a general policy on when to do this hasn’t been set yet.Questions for your doctorIf you’ve been diagnosed with lung cancer, a key question to ask is, “What are the alternatives for treatment?” For some patients with early-stage lung cancer, radiation can take the place of surgery. be sure to ask about new surgical techniques: “Am I candidate for a more minimal surgery?” and since the drugs are changing every year, ask “Am I a candidate for a new or experimental procedures.What you can doConsult a specialist.Find a medical team that specializes in treating lung cancer.”The field is changing very rapidly, and only specialists can keep up with the technology,” says Dr. Kenneth Rosenzweig.Quit smoking as a preventive.“The only lifestyle change that makes a big difference is not to smoke,” says Rosenzweig. Doctors haven’t found an association in terms of a food to eat that would cut your risk.Quit smoking if you’re in treatment.Patients diagnosed with lung cancer often think they may as well keep smoking because the damage is done. “There’s a lot of evidence that smoking sabotages the treatment we give,” says Rosenzweig. “So even if you have a lung cancer, you can improve your odds by stopping smoking.”