Cigarette Lung Cancer

[music plays]>>lori casey: coming up next on being well, dr. abdur shakir,director of the regional cancer center at sarah bush lincoln, returns for a discussionabout lung cancer. dr. shakir will tell us about the latest statistics,screening, and treatment options. that's just ahead on this edition of beingwell, so don't go away. [music plays]production of being well is made possible in part by: sarah bush lincoln health system,supporting healthy lifestyles. eating a heart-healthy diet, managing stress and regular checkupsare ways of reducing your health risks. proper health is important to all at sarah bush lincolnhealth system. information available at www.

sarahbush.org. additional funding by jazzerciseof charleston. welcome back to being well.i'm your host, lori casey. and today, dr. abdur shakir, the directorof the sarah bush regional cancer center is here to talk to us about lung cancer.thank you so much for coming back to being well.>>dr. shakir: thank you for having me.>>lori casey: well, let's talk about lung cancer.how does it rank as far as cancers in the u.s., as far as death rates?>>dr. shakir: when we actually just look at globally, wefind that lung cancer's a leading cause of

cancer related death in the world.roughly 1.6 million people died last year secondary to lung cancer.when we go specifically to the united states, there were 220,000 cases that were diagnosedlast year and 160,000 deaths. when we look at the genders specifically,we find that 87,000 men died last year of lung cancer, and 72,000 women died last yearof lung cancer. when we use that as a comparison to othercancers, more men died of lung cancer than prostate cancer, colon cancer, and pancreascancer combined. >>lori casey:and that surprises me, because i think a lot of the other cancers out there get a lot moreattention.

but lung is still huge.>>dr. shakir: absolutely, and i think it's a major epidemic.and i think now, it's become more into fruition of how do we decrease lung cancer rates inpatients. >>lori casey:okay, i know this is probably a very obvious question, but smoking causes lung cancer,is the number one cause? >>dr. shakir:correct, so 90% of lung cancers are secondary to smoking.there are alternative causes, but when we look at just the main causes, it is smokingthat causes lung cancer. >>lori casey:and how does secondhand smoke fit into your

increased risk of getting lung cancer?>>dr. shakir: it's very difficult to quantify how much secondhandexposure a patient or person gets. but we do know that the number of lung cancerdeath rates secondary to secondhand smoke is about 3,000 cases per year.there's actually other reasons outside of secondhand smoke that i also warn patientsabout, and that's actually environmental toxins. one being radon.it's a colorless gas, it's naturally occurring in the environment, but how patients get radonexposure is actually through their homes. when homes were built or are built on uraniumrich soil, or water, or rocks, this uranium after a certain period of time converts intoradon.

and after long-term exposure to radon, that'sactually the number one cause of non-smoking lung cancer, that's roughly 15,000 peopledie. so, people usually notice radon gas, usuallyat the time they sell their home or buy a home, there's a testing for radon then.and they're actually simple environmental test kits that can be done to look for radon.>>lori casey: okay, but still smoking...>>dr. shakir: yes, to make it clear, smoking is, the 90%cause is secondary to smoking. >>lori casey:well, let's talk about, is it ever, say someone has smoked a pack or two packs a day for thelast 30 years, and they figure, well it's

too late for me to quit, so why quit.>>dr. shakir: it's correct in saying that patients who smokea pack a day for 10 years have something called a 10-pack year or a 10 times risk of developinglung cancer than the normal individual. and when i hear that, or maybe if you hearthat, you first think, boy i better stop smoking. but most patients will think that it's toolate. i've done this for 20 years, the results aregoing to happen happened already. but what i explain to a patient is there arecertain things that happen to a body as soon as you stop smoking.so, within the first 20 minutes your heart rate and your blood pressure decrease.>>lori casey:

20 minutes?>>dr. shakir: first 20 minutes of stopping smoking.within the first 12 hours, a gas called carbon monoxide that builds up in your body beginsto decrease. within the first three months of stoppingsmoking, your lung function improves. within the first nine months, shortness ofbreath, cough improve. within the first one year of stopping smoking,your risk or coronary artery disease and stroke cut by 50%.within the first five years of stopping smoking, the risk of esophageal cancer, bladder cancer,and throat cancer decrease by 50%. the first 10 years of stopping smoking, yourrisk of lung cancer decreases by 50%.

so, it's never too late to stop.and this is a common scenario that physicians tell me, that it's actually too late thatthey should stop smoking, or patients tell me.so, that's a misnomer. patients should stop smoking when they can.>>lori casey: okay, so is it the same for someone who smokesa pipe or cigars? does that cause the same, can that also causelung cancer? are cigarettes really the worst?>>dr. shakir: great question.cigar smoking and pipe smoking can cause different forms of cancer.they have a higher incidence of throat and

mouth cancer secondary to cigar smoking.they have a lesser incidence of actually lung cancer, but that doesn't mean that they shouldcontinue to cigar smoke or pipe smoke. patients also think that filtered cigarettesare better, or low tar cigarettes are better. that's just an advertising campaign, and hasnothing to do with decreased lung cancer rates. >>lori casey:what about electronic cigarettes? >>dr. shakir:that's actually helpful for a transition to stop smoking.obviously, less tobacco, less nicotine. ideally, we want patients to stop smokingoverall. >>lori casey:so, are lung cancer rates, do you think they're

going to go down as like smoking rates aregoing down? so, like when our age group that doesn't smokegets to be 60, 70, will we see lung cancer rates go down, do you think?>>dr. shakir: the easy answer is yes.but how we got to this point was accurately quite simple.if you just look at history, in the 1920s tobacco companies, what they decided to do,and patients and people smoked before the 1920s, but they started targeting men.they said we're going to target men to smoke. and then, in 1950 the number one cause ofcancer related death in men was lung cancer. the tobacco companies then didn't realize,or they probably did realize that well, maybe

we should cut back on tobacco advertisement.but what they did then target was women. they said, okay we're going to start lookingat women and targeting them for smoking cigarettes. and then in 1975, the number one cause ofcancer related death for women was lung cancer. until 2005, the lung cancer rates have beenincreasing. but actually, as of 2005 there's been a 2%per year decrease in lung cancer death rates for men and 1% for women.so, we've done a fairly good job at advertising campaigns.everyone's seen the commercials. but i think we have to take the next step,and that is parents telling their children, teachers telling their students, physicianstelling their patients, hosts telling their

audience about the risk of smoking and lungcancer. >>lori casey:is smoking increasing in younger populations, or is it overall going down?>>dr. shakir: the american population right now, roughly20% smoke. what we hope for is over the next 20 yearsthat we can bring it down to 10%. and then 20 more years later, hopefully closerto 0%. >>lori casey:let's talk about the diagnosis and treatment. what are the basic signs of lung cancer?>>dr. shakir: so, what i tell my patients, and actuallyphysicians, is the first sign of lung cancer

is actually a cigarette.if you see a patient smoking a cigarette, that's your first sign of lung cancer.but there's actually five symptoms that i go through with family physicians and patients.the first being cough. if you have a cough that's now changed inproduction, the quality of the cough has changed, that's actually the number one symptom oflung cancer. roughly about 50 to 80% of patients will actuallyhave this symptom. the next is something called hemoptysis, whichis coughing up blood. that's an ominous sign that we do see in lungcancer patients, but it only occurs in about 20%.the third is repeated treatments of pneumonias.

so, if you see a patient, and you're familydoctor or you're a patient yourself, that has now three treatments of pneumonia overthe last three months, you have to start thinking is there something else going on in the person'slungs. the next, or the fourth is shortness of breath.it's a common symptom in lung cancer patients or in smokers, but when we see the shortnessof breath now change, where they were unable to walk to the bathroom without feeling shortof breath, but now just getting up in the bed, and they're now short of breath, that'sa symptom that's concerning. and last is chest pain.where the lungs are situated is actually by the ribs; the ribs are encapsulating the lungs.when a tumor develops in that lung, it causes

swelling of the lungs, and it pushes up onthe ribs, and it typically causes chest pain. people sometimes think they're having a heartattack, but it's sometimes actually different. >>lori casey:so, how do you go about diagnosing or, you know, different tests to see if, you know,someone has it? >>dr. shakir:so, it's typically a step-wise fashion. so, if a patient presented to their familydoctor with those symptoms, the usual first step is a chest x-ray.and if the chest x-ray does not show anything, which i compare to an old definition television,the next kind of ramp up would be a cat scan. a cat scan is kind of a higher definitionpicture of the lungs.

and if that is found or suspicious areas foundin the lung, the next step would then be a biopsy.and after a biopsy is performed, then we get an answer; is this lung cancer, or is thissomething different? and then, they're typically referred to acancer doctor. >>lori casey:okay, we're going to talk about treatment in a little bit.but i want you to explain the two different types of lung cancers.>>dr. shakir: okay, so there's actually two different types,and the main two types are something called non-small cell lung cancer and small celllung cancer.

non-small cell is the most common type.roughly 85% of patients with lung cancer will develop non-small cell, and 15% will developsmall cell. these days, we make a distinction for non-smallcell as well, that we further subdivide them. up until 2005, all cancer doctors would sayyou either have non-small cell or small cell. but after 2005, we realized that there's moresubsets of the non-small cell that are important. the first being non-small cell adenocarcinoma,which is the most common. roughly 50% of patients with non-small cellwill have this type. the second type is called squamous cell cancer.roughly 30 to 40% of patients will have that type.the reason why we make that distinction is

because the treatment is completely differentfor the two. >>lori casey:okay, so how do you go about treating the two?>>dr. shakir: non-small cell lung cancer, there's actuallythree different ways to treat. one being surgery, second being radiation,and third being chemotherapy. if you have non-small cell lung cancer, allof those are your options. when you have small cell lung cancer, it'seither chemotherapy or radiation. surgery in about 95% of patients does notplay a role n small cell lung cancer. when we talk about adenocarcinoma, the chemotherapytype is different, and when we talk about

squamous cell carcinoma, the chemotherapytype is different. >>lori casey:okay, so what are the, i know that, does lung cancer, like other cancers, do they divideinto stages? >>dr. shakir:yes. >>lori casey:okay. at what stage is it typically caught?>>dr. shakir: great question.so, the majority of lung cancers are found in the advanced stage, stage three or four.so, roughly about 75% of patients will be found in either a stage three or stage foursetting.

the classical staging of one, two, three,and four is done for non-small cell. there is something called limited stage andextensive stage, which is only done for small cell cancer.so, it fit's limited to the lung, it's called limited stage small cell.if it's outside of the lung, then it's called extensive stage small cell.for non-small cell, the traditional one, two, three, or four, that means if it's one it'sless than five millimeters, if it's two it's between five to seven millimeters with aninvolved lymph node. if it's stage three, its any number, any size,but involving the lymph nodes near the chest, as well as the opposite side of the chest.and if it's stage four, it's outside of the

lung; it's involving the fluid, the oppositelung, the brain, the bone, the liver, etc. >>lori casey:so, why are so many of them caught in those later stages?>>dr. shakir: the reason being is typically, small tumorsor small lung lesions don't cause symptoms. the patient's rest of the lung is able tomanage or to compromise with the other lung function.so, usually what happens is until that tumor causes a problem, like it's involving a lymphnode, or it's involving the fluid, or the opposite lung, or a brain, or a bone; untilthat symptom happens, most patients don't realize it.>>lori casey:

so, we talked before we started taping thatnow there's a movement to do high risk lung cancer screening to maybe catch it when it'sin stage one or two. can you talk about how that's evolved andwho that might impact? >>dr. shakir:sure, so screening, who we do right now for patients and has had effect is for breastcancer for women, colon cancer for both men and women, cervical cancer for women, andsome would debate psa's for prostate cancer for men.so, there was a trial called the national lung cancer screening trial.this was conducted by the national cancer institute.what they did was they took 53,000 patients

between 2002 and 2004.they divided the patients into two groups. one group received yearly cat scans for threeyears, and the other received free chest x-rays for three years.and then, they followed the patients for five years.and what they found was very interesting. they were able to reduce the lung cancer deathsin patients with early cat scans by 20%. but there's a certain group of patients thatshould be targeted. and this group of patients are between theages of 55 to 74 and have smoked 30 pack years, that's one pack a day for 30 years or twopacks a day for 15 years. and these patients should not have lung cancerin their history.

if they do have lung cancer in their history,we follow them a little bit more differently. but these patients should be targeted andlooked at for early lung cancer screening. we've actually just implemented this at thesarah bush lincoln hospital. >>lori casey:okay, so is that then, you think, going to cut down on, you'll see it in stages one ortwo. >>dr. shakir:correct, so if we just, the reason why we want to see it in stage one or two is becausethe prognosis dramatically changes between stage one and stage four lung cancer.>>lori casey: that's what i was going to ask.talk about survival rates for catching it

at stage one vs. at stage four.>>dr. shakir: so, when we're dealing with just stage onecancer, and we look at five years, what we call is a five-year survival rate, we knowthat 80% of patients are living at five years with stage one.if we look at stage two, 50 to 60%. if we look at stage three, 20% are livingat five years. and if you look at stage four, less than 5%.so, there's a dramatic difference between the two if we find a patient and stage oneand two, or stage three and four. so, it's important for us to, as patientsor family members, or even family care providers to target and hone in on these patients.>>lori casey:

so will you, do you see then like this highrisk cancer screening being as common as like mammograms and things like that?>>dr. shakir: absolutely.i think now it's at the time where we have to absolutely consider it for these patients,that it should be as routine as a colonoscopy or mammograms.but what i don't want this to take a place of is prevention of smoking.i don't want patients to think, boy if i still smoke, i can just get a cat scan every yearand be okay. no, still the number one way to prevent lungcancer, because it is a preventable cancer, is actually by stopping smoking and not smokingat all.

>>lori casey:let's talk about the treatment. what do you, what's the typical treatmentplan? how does it work?what are some common symptoms, side effects that your patients who are dealing with lungcancer deal with? >>dr. shakir:so, before we decide treatment for a patient, the most important thing, what you mentioned,was stage. and to determine treatment, we have to determinestage first. so, based on what stage, then we can determinetreatment. so, for example, if a patient was a stageone cancer, that patient would be geared towards

having a surgical operation.so, those patients are more geared to how do we cut this area of the tumor out, andmost of those patients do not require any chemotherapy.they're able to have the cancer cut out, and that's it.but it's a major operation. going through the lung and the chest, andgetting to the lung itself and removing the tumor is typically a major operation and takesweeks, four weeks at least to recover from that major surgery.when you have a stage two-lung cancer, the surgeon is typically involved still; we removethe tumor. but in those patients, we typically give chemotherapy.so, if you have stage two-lung cancer, they're

going to get chemotherapy after surgery.and chemotherapy has its own side effects. unfortunately, chemotherapy to the date forlung cancer in stage one and two is not a targeted chemotherapy; it's more of a shotgunapproach. is that, not only do you kill the bad cancercells that are there, you kill all the normal cells that are around, as well.when you have a stage three or stage four lung cancer, with a stage three particularly,surgery is not involved. that cancer has then spread to those oppositeside lymph nodes, and there's no reason to go in and do surgery on those patients.and those patients are typically treated with chemotherapy and radiation together.when you have a stage four-lung cancer, usually

surgery and radiation don't play a role.those patients are typically getting chemotherapy. >>lori casey:so, why is it that you often hear people who have cancer, maybe a different type of cancer,it spreads to the lungs? what is it about the lungs that cancer likes,i guess? >>dr. shakir:well, other cancers such as colon cancer, breast cancer, esophageal cancer, one is thatthe lungs are large organs, as compared to other organs that are there.and plus, a lot of blood supply happens to the lungs.so, how tumors travel is typically through the lymph glands or by blood.and that's where a lot of endings come through,

is through the lungs.>>lori casey: okay, so that's why you often hear peoplewith cancer spreading to multiple areas in the lungs.>>dr. shakir: correct, and one of them happens to be thelungs. >>lori casey:if you're talking to maybe family members out there, maybe a person suffering with lungcancer, what would you tell them if they're having a difficult time?and how can they manage it and get through it, and hopefully survive?>>dr. shakir: so, the most important thing, what i see asa cancer doctor's role in that scenario is

to determine what's a person's goal for treatment.so, the first meeting with your cancer doctor is the most vital.so, at that first meeting, you want to determine what's the goal of your therapy.is the goal to try to cure my cancer, or is the goal to try to control my cancer to delayits progression? after that goal is determined, then we canpush patients in a certain way. so, if my goal was to cure a patient, if i'vegot to carry them on my back, drive them to the office, we're going to try finishing uptherapy for that patient. vs. if the goal is to try to control theircancer, there's a tight rope that the patient and i are walking on.and that tight rope is balancing quality of

their life and quantity of their life.and that's where the importance of having your cancer physician available, in town,24 hours, seven days a week to have those discussions on a repeated basis, is what'simportant. >>lori casey:so, does lung cancer grow quickly? does it spread quickly?>>dr. shakir: so, with the two types, one being non-smallcell and small cell, small cell has a tendency to grow quite fast.in those patients, if i saw a patient like that in my office, we tend to start thingsquite soon, within typically a week's time of some form of therapy.so, small cell can grow actually very fast;

it's one of the fastest growing cancers thatwe have. >>lori casey:okay, talk about survival rates. i know that's the goal of any cancer doctor,is survival rates. it's, the earlier it's caught, the higherthe survival rate. >>dr. shakir:correct, so when we look at statistics for lung cancer, and i explain this to a patientby actually drawing a graph out. how we come up with statistics for lung canceris this statistician actually puts dots on the board and says, stage one cancer, theyhave this, they've died at this time. stage one could have died five years downthe road.

the real question for patients is where doestheir dot fall. are they going, if they're stage one cancer,are they going to live only one year, are they going to live five years, are they goingto live 10 years? and unfortunately with patients, we don'tknow where their dot's going to fall. we don't know where they're going to lie.so, what i tell patients is we can look at those statistics, what i quoted for stageone and stage four, but i have been treating lung cancer patients long enough to know thatit's very hard to predict how long a stage four lung cancer's going to live or how longa stage one cancer's going to live. but it's really important to focus on thetreatment, getting through treatment and understanding

what the goals of any form of treatment are.>>lori casey: and i'm assuming, just like any other in medicine,technology changes, medications get better. what's, are there new things on the horizonfor lung cancer treatment? >>dr. shakir:absolutely. so, if we look, not at stage one, two or eventhree lung cancer, stage four-lung cancer where a majority of the patients are foundin, there's been a whole slough of new treatments that are available.what we do at the sarah bush lincoln regional cancer center is if someone had a stage fourcancer, we're actually looking for targets. the generic chemotherapy is used in about80 to 90% of lung cancer patients.

but there's a certain group of patients thathave a target sitting on their cancer that we can switch the driver of what's causingtheir cancer off. so, it's very important if you're a patientor a family member, that if you do have stage four or even advanced stage three lung cancer,that you discuss with your cancer doctor; have they looked for a target on my cancer?because if you don't look for that target, you'll never find it.so, it's important that we as physicians look for that target, because it's a simple pillthat can actually switch off the cancer. >>lori casey:really? that's amazing.>>dr. shakir:

yes.so, and this has been well known at least since 2010 and onwards.>>lori casey: dr. shakir, we hear a lot of bad things aboutchemotherapy and what it does to the body, the side effects.can you talk about how maybe that's changed a little bit?>>dr. shakir: oh, so over the last 10 to 15 years we'vedone a remarkable job on tailoring the chemotherapy for the patient.15 or 20 years ago that shotgun approach of using standard doses was used for everybody,and we did not have good medicines for nausea. these days, our medicines are fantastic fornausea, and what i try doing for my patients

is that we try tailoring a dose that's rightfor them. so, what i tell patients is that the bestcooks don't follow the cookbook, that there's a standard dose for it that's recommended,but we look at the patient, we examine the patient, we see their other comorbidities,and then we make a decision of what's the best dose for this patient.>>lori casey: talk to me about the role of pet scans.first of all, p-e-t, what does it stand for, and how is it used?>>dr. shakir: positive emission tomography.so, what it is a more sophisticated way of looking at cancer in general.so, what we have now available at the sarah

bush lincoln regional cancer center is thepet scan. so, after someone gets diagnoses with cancer,even lung cancer, they typically have the chest x-ray and a cat scan.so, what we have available is this pet scan. what it is that we inject a sugar dye, andthat sugar dye is supposed to go to areas where the cancer is supposed to go at.so, it's a very sophisticated way of looking and seeing where else cancer is hidden at.so, we're able to examine basically anywhere below the neck to look for cancer.and it's a very good tool for a baseline for patients.so, we get an idea of where their cancer's at the beginning, and then after treatmentwhere is their cancer at afterwards.

>>lori casey:you've talked about the different stages. is there a stage at which it's not treatable?>>dr. shakir: great question.so, in patients who are incurable, the discussion of balancing quality and quantity of lifeis an important discussion to have with the patient.and that's where the skill of the cancer doctor in explaining the goals to the patient ofthe therapy is placed in. so, there is always a point, especially instage four, where you have to determine does the risk of the chemotherapy outweigh whatthe benefits are, or the risk of any form of therapy outweigh what the benefits are.and does the person's quality of life get

so affected that it makes no sense to improvetheir quantity of life. so, that discussion is usually a lengthy discussionwith your cancer doctor, but that discussion should happen typically at the first meeting.what are the goals of therapy, and then those discussions continue to go on.because, throughout the courses of chemotherapy, some patients tolerate chemotherapy and areable to work full time, and some patients are unable to tolerate therapy, are unableto do their normal activities. and then, we have to make that discussion,is this therapy worth it for them? so, that discussion is really important tohave with your cancer doctor. and sometimes, it's very open and honest toget a second opinion.

if a patient says, i'm not sure if i'm doingthe right thing with this chemotherapy, it's very, actually, i actually advocate it topatients who are unsure about doing something or not doing something is get a second opinion.hear what someone else has to say. >>lori casey:so, in these last few minutes, i want you to give our viewers out there a little bitof advice. what would you say to someone that, you know,has maybe smoked for 20 years, and they've never, you know, haven't seen the symptoms,but they might be a little concerned. what would you say to them?>>dr. shakir: what i would say is that lung cancer is apreventable cancer.

90% of the causes of lung cancer are smoking,and it's never too late to stop. we can see the risk of lung cancer deathsdecrease by 50% for patients that have stopped smoking for 10 years.it's also really important that you go to a place where you can get the appropriatework. the most difficult thing that we see in patientshow are smokers is that there's a delay in diagnosis.the patients, the family, even the physician sometimes thinks the shortness of breath isrelated to their smoking, or that chest pain is related to the smoking, or the cough isrelated to the smoking. but if they're concerned, doing a chest x-rayor cat scan is harmless.

>>lori casey:alright, well dr. shakir, thank you so much for, we enjoy having you on our show.and we hope to have you back again. >>dr. shakir:thank you. >>lori casey:thanks. production of being well is made possiblein part by: sarah bush lincoln health system, supporting healthy lifestyles. eating a heart-healthydiet, managing stress and regular checkups are ways of reducing your health risks. properhealth is important to all at sarah bush lincoln health system. information available at www.sarahbush.org. additional funding by jazzercise of charleston.being well is also available online at our

you tube channel, you tube.com/weiutv. justlook for the being well playlist. here you van view current as well as past episodes.