Lung Cancer

With lung cancer, there are a variety of symptoms that patients might experience. These include shortness of breath, a cough (generating blood in some cases), and weight loss. Some lung cancer patients present with pneumonia, but their symptoms persist after treatment with antibiotics due to lung cancer.

If lung cancer has spread to other parts of the body, a patient can have symptoms in those locations — such as pain in a certain part of the body. Additionally, other symptoms might appear. For example, the patient might start having headaches, balance issues or a loss of energy.

One of the ways to reduce the mortality of lung cancer is to do screenings. Currently, low-dose CAT or CT scans are used for this and can reduce the mortality rate by 20 percent.

However, not everyone qualifies for lung cancer screening and the criteria are evolving. But, for now, if you are between 50 and 80 and have smoked a pack a day for 20 years or more [or two packs a day for 10 years]— even if you have quit smoking within the past 15 years — you may qualify for screening. It’s important to ask your doctor if you meet the criteria because, with screening, we are able to detect more lung cancers at Stage I. This leads to more successful treatment with surgery or radiation.

Unfortunately, only a small percentage of qualifying patients get a CT scan screening for lung cancer. Sometimes it’s because they aren’t aware that they qualify. In other cases, it is due to a lack of access, the potential cost of the scan [if not covered by Medicare or private insurance], or the stigma around smoking.

There is a certain amount of shame when it comes to talking about lung cancer because patients know they shouldn’t be smoking. Most patients have tried to stop smoking many times. But patients should realize that there is absolutely no shame in seeking screening. We want them to talk with us about it. My job isn’t to judge people. I don’t believe anyone deserves to be sick or to suffer. Instead, we need to help patients and the public and educate them about the importance of screenings.

Another important thing for patients to know about a lung cancer screening is that it is not a one-time test. Instead, depending on the results of their initial CT scan, they will be put on a schedule for future screenings and repeat imaging. We also talk with our patients about smoking cessation programs if they are still smoking and interested in quitting.

Smoking is the No. 1 risk factor for lung cancer — not just cigarettes, but cigars and pipes, too. It’s also important to be cautious about vaping.

Exposure to second-hand smoke is a risk factor. And so is exposure to radon. This is especially the case in Indiana.

Lung cancer is rarely genetic. However, it can happen in non-smokers. About 10 percent to 20 percent of lung cancer cases worldwide occur in people who have never smoked.

The world of treating lung cancer has changed so much. There are so many more treatment options, and we understand the biology of lung cancer better now, including how it happens and how it spreads. Patients are living longer now than they did even as recently as 2009.

Treatment is determined on a case-by-case basis. Lung cancer isn’t just one disease. There are subtypes. Certain genes cause lung cancer to grow. If a patient has one of these genes that is driving growth, we can give them a pill or a targeted therapy. If the cancer responds to it, the patient can be on this targeted treatment for years.

If a patient doesn’t have a driver mutation, we use immunotherapy and/or chemotherapy to treat their lung cancer. Immunotherapy has revolutionized the way we treat cancer. It stimulates a patient’s own immune system to attack the cancer cells.

There has been progress in treating every stage of the disease. Things are literally changing daily. Today, we even have long-term survivors of Stage IV lung cancer.

Lung cancer still takes way too many lives, but there are a lot of things we can do. The earlier we can diagnose it, the better. Our goal is to cure lung cancer, reduce the suffering from it and if we turn it into a chronic disease, we want it to impact a patient's life as little as possible.

There is a lot of research being done regarding radiology techniques. For example, how can we improve the sensitivity of the scans? How can we better determine what should be biopsied and what shouldn’t?

There is also a lot of machine learning going on, as well as research around lung biomarkers that can be used to detect lung cancer earlier.

Ultimately, our goal is finding a cure. But, even now, there is a lot of hope regarding lung cancer treatment. There are so many experts out there who are working on this. So, even though a lung cancer diagnosis can be scary, it is important that patients don’t lose hope.

I had three uncles die from lung cancer. Cigarettes were a friend for them. They worked hard and provided for their families. They were good people. Life is hard and sometimes we revert to things that are so addictive and so very difficult to quit. While my uncles’ deaths didn’t influence my decision to focus on lung cancer, they certainly helped me have a better understanding of and compassion for lung cancer patients.

When I was in training, I worked with Dr. Larry Einhorn. He is exactly who I want to be. He is extremely smart, but humble. And he has a very good bedside manner. He had a significant influence on my decision to go into oncology — with a focus on lung cancer — because, like him, I want to contribute. I want to not just care for my patients but about my patients.

I grew up in Jordan where smoking is a huge problem. Through the work I do now, I feel like I am helping people back home.