Why you should schedule a lung cancer screening, even with no symptoms
cancer is the leading cause of cancer deaths in both men and women, making up 25% of all cancer deaths. Screenings are crucial to early prevention. This is why Hartford HealthCare is working to increase awareness of these screenings so that cancer can be detected before it’s too late.
“If you’re already experiencing symptoms, such as coughing up blood and being short of breath, very often that means that the cancer has progressed to a point where it becomes a lot harder to treat,” says Dr. Mario Katigbak, chief of thoracic surgery at Hartford HealthCare.
When doctors look at cancers, they take several steps. The first is making an accurate diagnosis, and the second is to “stage” the cancer as accurately as they can. Lung cancer staging takes into account three elements, called “TNM”: T stands for the size and extent of the primary tumor, N stands for the lymph nodes and M stands for metastasis to distant sites (whether the cancer has spread to a different part of the body).
There are four basic lung cancer stages: Stage 1 is relatively small cancer that hasn’t spread to the nearby lymph nodes. Stage 2 is a bit larger; this cancer may have spread to the lymph nodes. Stage 3 cancer has spread deeper into the lymph nodes in the chest, and stage 4 has spread to other parts of the body.
The treatment plan depends on the individual and the stage of cancer, Dr. Katigbak says. Stage 1 cancer can usually be treated directly with surgery, while stages 2 and 3 tends to involve a combination of treatments including chemotherapy, immunotherapy, radiation and surgery. By the time lung cancer has progressed to stage 4, it is considered incurable but can still respond to chemotherapy and immunotherapy.
Although technological advancements have been made in lung cancer screening and surgery, researchers have found no clear genetic marker for hereditary lung cancer. But as part of their approach to individualized and personalized care, Hartford HealthCare physicians extensively check the genetic profile of each lung cancer case.
“This helps us figure out which combination of chemotherapy and immunotherapy might bemost effective,” Dr. Katigbak says.
Lung cancer screening options
People ages 50 to 80 with a 20 “pack-year” smoking history who currently smoke or who have quit in the past 15 years are eligible for lung cancer screenings. A pack-year is a measurement of how many cigarettes someone smokes in one year. Someone who has smoked a pack a day for the last 20 years, or two packs a day for the last 10 years, has 20 pack-years.
For those interested in receiving a lung cancer screening, the test of choice is a low-dose computed tomography (CT) scan, which uses X-ray to make precise cross-sectional images of the body. Unlike regular X-rays, which take one or two pictures, CT scans take many pictures to show a full image of the affected area. CT scans can also be used to guide a biopsy needle into a specific area of the lung to get a tissue sample.
A recent study by the National Lung Screening Trial of more than 50,000 patients found that low-dose CT scans in high-risk patients reduced cancer deaths by 20%.
Since CT-guided biopsies aren’t applicable for all cancers (like those that are very deep or are near major blood vessels), robotic navigational bronchoscopy can be a more precise option.
Additionally, endobronchial ultrasounds allow doctors to see the lymph nodes around the airway and biopsy them with a needle.
Why lung cancer screenings are not common
Although a disease like breast cancer has multiple genetic markers like the BRCA genes, this is not the case with lung cancer. It can be difficult to tell if someone will inherit lung cancer from a family member.
This is just one of several barriers to lung cancer screenings, but Dr. Katigbak says the biggest hurdle is the lack of awareness surrounding screenings, which are covered by most insurance plans. One of his patients did not feel any symptoms but decided to receive a screening. A screening CT scan found signs of stage 1 cancer in the patient, and surgeons were quickly able to biopsy it.
Unfortunately, only around 8% to 10% of those eligible for screenings in Connecticut are actually receiving them. “Screening is terribly, terribly important because people might not feel anything, and so they aren’t aware,” Dr. Katigbak says. “One of our biggest thrusts this year is getting the word out about screenings through our primary care networks. In addition to regular mammograms and wellwoman exams, we can add lung cancer screenings to the list.”
Advancements in lung cancer surgery
Technological advancements in lung cancer screenings have also meant finding less invasive ways to perform a successful surgical operation. This includes video-assisted thoracoscopic (VATS) surgery, which is laparoscopic surgery in the chest, and robotic surgery.
More than half of lung cancer surgeries at Hartford HealthCare are performed robotically. Dr. Katigbak says this procedure allows surgeons to visualize the structures better.
“The robotic tools give us a little more maneuverability and flexibility in the chest, and so that allows us to perform the same cancer operation with less pain and less blood loss,” he says. “People bounce back more quickly.”
Surgeons also aim to remove as little lung as possible since lung tissue doesn’t regenerate like live tissue.
Katigbak points out that not only early screenings but also having a stellar multidisciplinary medical team are keys to successful lung cancer treatment. At Hartford HealthCare, pulmonologists, surgeons and radiation oncologists gather weekly to discuss patients with cancers of the chest and discuss treatment options.
Call 855-255-6181 to learn more about Lung Cancer Screening and Diagnosis. Tune into the Hartford HealthCare Facebook Live on Jan. 18 at 12:30 p.m.