Lung Cancer

Lung Cancer: Making the Turn to Hope

It wasn’t that long ago when patients diagnosed with lung cancer were given little to no hope. But that has changed — drastically.

Research is advancing rapidly.

Treatments have improved.

Patients are living longer.

However, lung cancer remains the leading cause of cancer death worldwide. In the U.S. alone, an estimated 238,340 individuals will receive a lung cancer diagnosis in 2023. And in Indiana, it’s the No. 1 cause of cancer-related deaths.

So, where is the hope in these statistics?

It can be found in the fact that not only are cases of lung cancer steadily decreasing, but so are mortality rates. Prevention, screening and improved therapies are all playing a role in knocking lung cancer out of the race. And, while there are still more laps to go, the finish line is getting so much closer.

A Pit Stop with Shadia Jalal, MD

Putting the brakes on lung cancer is what Dr. Shadia Jalal is working to do every single day. As an oncologist, Dr. Jalal treats patients who have been diagnosed with a thoracic cancer, which includes esophageal cancer and lung cancer. She’s currently conducting research that she hopes will lead to a better understanding of how to treat small cell lung cancer more effectively.

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’re 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’ve 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’re 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’s 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’s 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 them.

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

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.

My job isn’t to judge people. I don’t believe anyone deserves to be sick or to suffer. Instead, we need to help them.

Shadia Jalal, MD

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’s driving growth, we can give them a pill. 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’s been progress in treating every stage of the disease. Things are literally changing daily. Data testing is being done on different treatment protocols. 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 — or at least make it a chronic disease with which patients can live a relatively normal life.

There’s 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’s 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’s 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’s important that patients don’t lose hope.

I had three uncles die of lung cancer. Cigarettes were a friend for them. They worked hard and provided for their families. They weren’t bad 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’s exactly who I want to be. He’s 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 make people feel less judged.

I grew up in Jordan where smoking is a huge problem. Through the work I do now, I feel like I’m helping my people.

Shaping the Future of Lung Cancer

At Indiana University, researchers are chasing down lung cancer with the goal of stopping it in its tracks. They’re focusing on three major themes: personalizing therapy for individual patients, maximizing the impact of immunotherapy in early-stage lung cancer, and overcoming resistance to platinum-based therapies.

Current research is exploring:

  • Whether patients with early-stage lung cancer could benefit from immunotherapy.
  • How biomarkers can be used to determine how long a patient should receive treatment after surgery.
  • The role DNA repair inhibitors might play in sensitizing cancer to chemotherapy.
  • There are also multiple lung cancer clinical trials being conducted at Indiana University. You can learn more about them here.

When it comes to beating lung cancer, the researchers at IU are going full throttle – because this is a race they intend to win.

Racing Highlights

  • Nineteen percent of Hoosiers smoke, contributing to Indiana placing 41st out of 50 in America’s Health Rankings 2020.
  • The cancer center’s End Lung Cancer Now initiative is committed to supporting lung cancer prevention, screening and research. You can join this program as an advocate and increase lung cancer awareness within your own community.

Please complete the form to access a downloadable version of “Your Racing Strategies for Cancer Prevention and Early Detection.” Take a victory lap when you share it with your family and friends.


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