What’s new in non-small cell lung cancer treatment in India ?

Prevention

Tobacco

Prevention offers the greatest opportunity to fight lung cancer. Although decades have passed since the link between smoking and lung cancers became clear, smoking is still responsible for at least 80% of lung cancer deaths. Research is continuing on:

• Ways to help people quit smoking and stay quit through counseling, nicotine replacement, and other medicines
• Ways to convince young people to never start smoking
• Inherited differences in genes that may make some people much more likely to get lung cancer if they smoke or are exposed to someone else’s smoke

Environmental causes

Researchers also continue to look into some of the other causes of lung cancer, such as exposure to radon anddiesel exhaust. Finding new ways to limit these exposures could potentially save many more lives.

Diet, nutrition, and medicines

Researchers are looking for ways to use vitamins or medicines to prevent lung cancer in people at high risk, but so far none have been shown to conclusively reduce risk.

Some studies have suggested that a diet high in fruits and vegetables may offer some protection, but more research is needed to confirm this. While any protective effect of fruits and vegetables on lung cancer risk is likely to be much less than the increased risk from smoking,

Early detection

As mentioned in the section “Can non-small cell lung cancer be found early?”, a large clinical trial called the National Lung Screening Trial (NLST) recently found that spiral CT scans in people at high risk of lung cancer (due to smoking history) lowers the risk of death from lung cancer, when compared to chest x-rays. This finding has led to the development of screening guidelines for lung cancer.

Another approach now being studied uses newer, more sensitive tests to look for cancer cells in sputum samples. Researchers have found several changes often seen in the DNA of lung cancer cells. Current studies are looking at new tests that can spot these DNA changes to see if this approach is useful in finding lung cancers at an earlier stage.

Diagnosis

Fluorescence bronchoscopy

Also known as autofluorescence bronchoscopy, this technique may help doctors find some lung cancers earlier, when they may be easier to treat. For this test, the doctor inserts a bronchoscope through the mouth or nose and into the lungs. The end of the bronchoscope has a special fluorescent light on it, instead of a normal (white) light.

The fluorescent light causes abnormal areas in the airways to show up in a different color than healthy parts of the airway. Some of these areas might not be visible under white light, so the color difference may help doctors find these areas sooner. Some cancer centers now use this technique to look for early lung cancers, especially if there are no obvious tumors seen with normal bronchoscopy.

Virtual bronchoscopy

This imaging test uses CT scans to create detailed 3-dimensional pictures of the airways in the lungs. The images can be viewed as if the doctor were actually using a bronchoscope.

Virtual bronchoscopy has some possible advantages over standard bronchoscopy. First, it is non-invasive and doesn’t require anesthesia. It also helps doctors view some airways that might not be seen with standard bronchoscopy, such as those being blocked by a tumor. But it has some drawbacks as well. For example, it doesn’t show color changes in the airways that might indicate a problem. It also doesn’t let a doctor take samples of suspicious areas like bronchoscopy does. Still, it can be a useful tool in some situations, such as in people who might be too sick to get a standard bronchoscopy.

This test will likely become more available as the technology improves.

Electromagnetic navigation bronchoscopy

Lung tumors near the center of the chest can be biopsied during bronchoscopy, but bronchoscopes have trouble reaching the outer parts of the lungs, so tumors in that part of the lung often need to have a needle biopsy. This test can be a way to use a bronchoscope to biopsy a tumor in the outer part of the lung.

First, CT scans are used to create a virtual bronchoscopy. The abnormal area is identified, and a computer helps guide a bronchoscope to the area so that it can be biopsied. The bronchoscope used has some special attachments that allow it to reach further than a regular bronchoscope.

What are the Treatments for Lung Cancer?

Non-small Cell Lung Cancer

Surgery

Most early-stage non-small cell lung cancers are treated with surgery, in which thoracic surgeons remove a lobe, or section, of the lung containing the tumor. Dr. Yendamuri uses video-assisted thoracoscopic surgery (VATS) when possible due to its minimally-invasive nature. In a VATS procedure, Dr. Yendamuri makes a small incision in the chest and inserts a tube called a thoracoscope. The thoracoscope has a light and a tiny camera connected to a video monitor on which Dr. Yendamuri vies the lung tissue to be removed. He then removes the cancerous lung tissue through the scope, eliminating the need to make a large incision in the chest or cut the rib.

Chemotherapy & Radiation

In cases of non-small cell lung cancer where surgical removal is possible, evidence suggests chemotherapy after surgery, also called adjuvant chemotherapy, may help prevent the cancer from returning. The stage of the cancer helps doctors guide whether or not use of chemotherapy might benefit a patient with non-small cell lung cancer.

In cases in which surgical removal is not possible, doctors typically recommend chemotherapy along with radiation therapy. In very advanced cases, doctors typically use only chemotherapy but may recommend radiation therapy for palliation of cancer symptoms.

Multimodal Therapy

In an aggressive tumor like lung cancer, the best possible outcomes can only be achieved by coordinated care between all three modes of therapy. The integrated clinics at AOI enable the patient to be seen by the medical oncologist, the radiation oncologist and the surgeon, often on the same day. This enables the development of an integrated treatment plan and coordinated care.

Small Cell Lung Cancer

Surgery

In patients with limited-stage small cell lung cancer and no lymph node tumors may benefit from surgery, which is typically paired with adjuvant chemotherapy.

Chemotherapy & Radiation

For patients with small cell lung cancer, chemotherapy is an essential part of treatment. Radiation treatment may be in conjunction with it, depending on the stage of cancer. About half the cases of small cell lung cancer spread to the brain, and in those cases, radiation is often used before or after chemotherapy for lung tumors.

Multimodal Therapy

In an aggressive tumor like lung cancer, the best possible outcomes can only be achieved by coordinated care between all three modes of therapy. The integrated clinics at AOI enable the patient to be seen by the medical oncologist, the radiation oncologist and the surgeon, often on the same day. This enables the development of an integrated treatment plan and coordinated care.