There are 270,000 cases of lung cancer detected worldwide that are not related to smoking and the probability of suffering from lung cancer in the course of a lifetime is approximately 1 in 15 men and 1 in 17 women.
Andrea Crespo, medical manager for lung cancer at Roche Central America and the Caribbean, comments that although most cases are related to tobacco, 36% of this type of cancer is linked to factors such as environmental pollution, the presence of arsenic in water, and different types of toxins that can be harmful. In Guatemala and other countries in the region, cooking with firewood causes this health problem to develop.
According to the study Lung Cancer in Latin America: It’s Time to Stop Looking the Other Way, by The Economist Intelligence Unit, nearly 85,000 cases are diagnosed in the region and more than 60,000 people die each year.
“Lung cancer is a complex diagnosis because in its early stages, it is often asymptomatic or the symptoms are confused with other respiratory diseases,” says Crespo.
Walter García, a surgical oncologist at the Institute of Cancerology ( Incan ), explains that developed countries have a higher tobacco burden that increases the cases of this type of cancer and although Guatemala does not have updated national statistics, there is an incidence and “the more we smoke, the more we will develop this type of cancer,” he explains.
Causes and symptoms
Signs and symptoms of lung cancer usually appear when the disease is advanced. They usually include a persistent cough, coughing up blood, shortness of breath, chest pain, hoarseness, and weight loss, to name a few. Lung cancer can spread to other organs, often spreading to the brain, and can cause loss of vital functions, such as vision.
García explains that one of the first tests performed when people have a persistent cough is sputum cytology, which means that the cells found in the sputum (mucus and other substances expelled by the lungs when coughing) are evaluated to check for abnormal cells, such as lung cancer cells. He also clarifies that if the cells have not reached the bronchi, a diagnosis will not be possible and other evaluations will be needed.
“The diagnosis of lung cancer is made after a series of radiological examinations, CT scans, and a tumor biopsy followed by histological investigation. Accurate determination of the stage of the disease requires additional diagnostic procedures including ultrasound, PET-CT, and MRI, and in some cases, doctors look to find out if the cancer cells have specific genetic changes that would indicate that the cancer could be treated with certain targeted therapy drugs,” explains Crespo.
García explains that when making a diagnosis, three types of lung carcinoma are most common: epidermoid carcinoma, which is the most associated with tobacco, and adenocarcinoma, which is the most common form of lung cancer in women and in people who have never smoked.
There is also small cell carcinoma, which is the most aggressive malignant neoplasm of the lung. It represents 25% of all lung carcinomas.
Treatments
It is important to talk to your doctor about follow-up care that takes into account your overall health, the type of cancer, and how far it has progressed.
In some cases, surgery to remove the cancer, either in the area where it is located or a lobectomy to remove the lobe of a lung, may be an option. This option is viable when the cancer is still localized to a specific area. Crespo emphasizes that in most cases, more than 80 percent of patients are diagnosed in very advanced stages so this option would be out of the question.
If the disease has progressed or the tumor is large, chemotherapy or radiotherapy may be suggested before this process to reduce the size of the tumor or make it the main treatment.
Mayo Clinic explains that radiation therapy uses high-powered beams of energy, from sources such as X-rays or protons, to destroy cancer cells. During radiation therapy, the process involves lying on a table while a machine moves and directs radiation to specific points on your body.
While chemotherapy is given either through an injection into a vein in your arm (intravenously) or by mouth, a combination of drugs is usually given in a series of treatments for weeks to months.
Many targeted therapy drugs are used to treat lung cancer, although most are reserved for people with advanced or recurrent cancer.
One of the latest changes in the field of treatment is the work of scientists James P. Allison and Japanese scientist Tasuku Honjo, who demonstrated how the immune system can be used to fight lung cancer. This led them to win the Nobel Prize in Medicine in 2018 because the focus is not on cancer cells but on the immune system against them.
In the 1990s, Alisson began studying the CTLA-4 protein in his laboratory at the University of California (USA), which acts as a brake on the so-called T cells, which are key to the immune system.
Other researchers had discovered this property of CTLA-4 and applied the mechanism to autoimmune diseases, but Alisson had a different idea. After discovering an antibody that could bind to this protein and inhibit its function, he wanted to find out if he could release the brakes on the T cell and cause the immune system to attack cancer cells.
Using this technique, he was able to cure mice with cancer and, after his efforts to develop a strategy for humans, he achieved surprising effects in patients with advanced melanoma in 2010.
In parallel, Honjo discovered PD-1 at Kyoto University in Japan, another protein expressed on the surface of T cells: years of experiments showed that it worked as a brake, although with a different mechanism.
A study in 2012 demonstrated its effectiveness in treating patients with different types of cancer, including in cases where the disease was in the metastatic phase.
And new clinical trials indicate that combining both proteins in therapies may be even more effective, as is the case with melanoma patients.
Last September, the results of a study by researchers from the Spanish Lung Cancer Group (GECP) were published in The Lancet Oncology journal. These results open the door to a change in the therapeutic approach to lung tumors when they are in intermediate stages.
EFE data indicate that the research has yielded survival results that double those obtained to date with traditional treatment for this type of tumor (chemotherapy after surgery).
The study focused on patients with lung cancer in intermediate stages – those who can be operated on, but in whom the tumor has already spread to surrounding lymph nodes.
“We are talking about making potentially and mostly lethal tumors curable,” said Dr. Mariano Provencio, president of the Group and principal investigator.
The study has yielded very encouraging data for this type of patient: 89.9 percent of the patients included in the study survived two years and 77 percent did not experience disease progression during this period.
Additionally, 63.4 percent of the included patients had a complete pathological response of the tumor when surgery was performed (absence of tumor).
“These rates represent almost double the survival rate recorded to date with the traditional approach.
People who have died of lung cancer
In recent years, one of the cases that has had a worldwide impact is that of Dr. Paul Kalanithi, a young and promising neurosurgeon who lived in the United States. He received a devastating diagnosis of lung cancer in 2013, at the age of 35.
He went from treating patients to becoming one himself, and because he was in a very advanced stage of the disease he died in March 2015. During the process of his illness, he decided to write a book called When Breath Becomes Air, which has been translated as Remember that You Are Going to Die. Live and like The Good Doctor, he tells, on the one hand, how he faced his last cycle of life, the progression of his illness, the birth of his daughter, the relationship with those around him, and the inner process that led him to find himself. A reminder of the fragility of existence.
Other famous people in history have also died from this disease. Among them, was King George VI. He was a smoker and survived an operation in which his left lung was removed, and later died. He died on February 6, 1952.
Walt Disney, cartoonist, businessman, and creator of the famous Mickey Mouse and other characters, also joined the list. In 1966 he was diagnosed with lung cancer and died in December of the same year. His illness is associated with excessive cigarette consumption.
On April 20, 1993, Mexican comedian Mario Moreno Cantinflas also died from this cause. In 2014, a film dedicated to the life of this character was released.
Spanish actress Angelines Fernández from El Chavo del Ocho has also been included in the statistics of people who have died from this disease.
In 2001, it was also reported that George Harrison, one of the four members of the legendary Beatles, died after a battle with this cancer.
The best prevention
There is no doubt that a life with healthy habits reduces the risk of cancer. So it is important to eat healthily, maintain an active lifestyle, and not smoke.
Patients who smoke and quit smoking greatly reduce their chances of developing lung cancer.
It is also important to follow the guidelines for recommended screening tests, which are useful for detecting certain types of cancer in their early stages. Smokers are advised to seek out quit-smoking clinics and should undergo chest X-rays or X-rays to determine their health even if they do not have symptoms, due to the high toxic load they consume.