US Pharm. 2017;42(7)9-10.

Screening Reduces Metastases, Risk of Death

Cancer of the lung is the leading cancer killer in both men and women in the United States, causing more deaths than colon, breast, and prostate cancers combined. There are two main types of lung cancer: small cell lung cancer (SCLC) and non–small cell lung cancer (NSCLC), so named because of their appearance under a microscope. The most common type, NSCLC, accounts for over 85% of all lung cancers. Even though the symptoms and causes are similar, doctors make a distinction between the two types of lung cancer because the treatment approaches differ.

Caused by Smoking—But Not Only Smoking

Most people are aware that the number-one risk factor for lung cancer is smoking. Both the length of time a person smokes and the number of cigarettes smoked each day are important in determining the risk of lung cancer. Quitting smoking at any age has been shown to lower the risk of developing lung cancer, and avoiding smoking or second-hand smoke altogether could prevent more than 85% of lung cancers. Smoking is not the only cause of lung cancer. As many as 20% of people who die from lung cancer in the U.S. every year do not smoke or use any other form of tobacco. Second-hand smoke, asbestos, radon gas, and workplace hazards such as vinyl, coal products, gasoline, arsenic, and uranium have all been known to cause lung cancer in nonsmokers.

Symptoms May Not Be Present

Lung cancer is often called a “silent killer” because symptoms do not typically appear in the early stages of the disease. When symptoms are present, they are usually not specific to lung cancer and include a persistent cough, lung infections, shortness of breath or chest pain on deep breathing, blood in the sputum, hoarseness, and weight loss.

Because of the absence of specific symptoms, many lung cancers are discovered only after spreading to other parts of the body, known as metastasis. For this reason, many medical organizations recommend screening for lung cancer in higher risk individuals. A current or former heavy smoker aged more than 55 years can undergo screening with a test known as a low-dose computed tomography scan, which has been proven to lower the risk of dying from the disease. Other screening methods are in development that can detect lung cancer earlier, including one method that looks at sputum samples for changes in lung DNA associated with cancer.

Recent Advances in Lung Cancer Treatment

Many different diagnostic tests are used to determine whether cancer is present, the type of cancer, and its stage. If a doctor suspects that a patient has lung cancer, he or she may order imaging tests (such as x-ray and MRI), assess sputum under a microscope to look for cancer cells, or remove a sample of abnormal cells from the lung in a procedure called a biopsy. NSCLC is divided into four stages that define how advanced the cancer is and whether it has remained in the lungs or has spread to other areas of the body. Once diagnosed, the stages help patients and physicians choose the best treatment plan.

Treatments for lung cancer include surgery to remove cancerous tissue, chemotherapy to kill cancer cells or stop further division, and radiation or laser therapy to destroy cancer cells. Depending on the individual patient, one or more of these treatments may be used. Scientists have learned a lot about the mechanisms that control the growth and spread of lung cancer cells. This knowledge has been used to develop a new group of drugs for NSCLC called targeted therapies. They work by targeting specific abnormalities in cancer cells and are often used in combination with other chemotherapy drugs. Some targeted therapies include afatinib (Gilotrif), bevacizumab (Avastin), ceritinib (Zykadia), crizotinib (Xalkori), erlotinib (Tarceva), nivolumab (Opdivo), and ramucirumab (Cyramza).

Your local pharmacist is here to help! If you, a friend or family member has questions about medications used to treat lung cancer or is interested in smoking cessation, ask a trusted pharmacist or another healthcare provider.

To comment on this article, contact rdavidson@uspharmacist.com.