Speaker 1 00:00:37 And good evening. Thank you for joining disability and progress, where we bring you insights into ideas about and discussions on disability topics. My name is Sam. I'm the engineer and producer of the show. If you'd like to be on our email list, you may email us at disability and progress at Sam, jasmine.com all written out tonight. We have a great guest in our studio, but I also want to announce that we have both my research team, Amber Johnson and Charlene doll in the studio. Thank you ladies for coming. And, um, we also have Dr. Abby venule and Dr. <inaudible> is a pulmonologist with, is it M physicians,
Speaker 2 00:01:21 The university of Minnesota health. Okay.
Speaker 1 00:01:23 And assistant professor of medicine, division of pulmonary allergies, critical care and sleep medicine at the university of Minnesota medical school. And she is with us tonight talking about breast cancer. And Dr. Vignette is also lung cancer, sorry, Ron cancer. Oh my goodness. And Dr. Danielle is also a member of the Masonic cancer center. So thank you for joining us. You're
Speaker 2 00:01:49 Welcome. It's my pleasure to be here.
Speaker 1 00:01:51 And I think w was it, is it, is it, or was it a national lung cancer month? So
Speaker 2 00:01:57 November is lung cancer awareness month.
Speaker 1 00:01:59 Excellent. All right, so we are timely. That's right. That's good to know. So can we just start out with a quick definition, first of all, can you tell us kind of, I know I read a whole bunch of stuff on your, on you, but what made you decide to go into this branch of medicine and what kind of led you up to that?
Speaker 2 00:02:18 Well, I, uh, my specialty is internal medicine and then beyond that pulmonary medicine and critical care medicine. So, um, I was, uh, attracted to the intensive care unit, uh, which I do spend time treating patients in the intensive care unit. Um, but even before then, I always felt drawn to treating patients with cancer. And, um, at that time I really didn't have any personal stories or personal experience, which, uh, drew me that way. So it's somewhat mystical. I think, um, I just have always felt most drawn to taking care of patients with cancer
Speaker 1 00:02:52 And a much needed thing at that. Can you give us a quick definition of what is lung cancer?
Speaker 2 00:03:00 Sure. Uh, so when we're talking about lung cancer, we talk about a cancer that originates in the lungs, um, and cancer is basically an overgrowth or out of control growth of, of cells that were once normal. So these cells sort of mutate and then grow out of control beyond the body's, um, control mechanisms. Thank you.
Speaker 1 00:03:20 You know, it's interesting that the lungs are so vital, but I just think a lot of people don't really think about like what they exactly do and where they are. So can you tell me, like, where are the lungs located and kind of give us a little description of what they look like?
Speaker 2 00:03:38 Okay, well, um, everybody is born with two lungs. Uh, they are in your chest behind the rib cage. So the rib cage is, uh, the, uh, protective mechanism for the lungs and the heart is actually centered right in between the lungs. So the two lungs are sandwiched around the heart. They are, uh, quite important. Um, every breath that you take, uh, your lungs are working. And so you don't even think about that. It's something that's just happening naturally and automatically, if you are lucky enough to have easy, comfortable breathing and no lung disease.
Speaker 1 00:04:11 So what do they look like? Like if you look at them on something,
Speaker 2 00:04:17 Well, if you were to look at the lungs up close, then you would usually see, um, kind of a pink fleshy material, um, kind of like an eraser, but softer, uh, and people who have been cigarette smokers or people who have been exposed to smoke either through environmental causes or other causes, uh, the lungs may have more, um, black deposits on them from the smoke or smog.
Speaker 1 00:04:41 So there are, I believe three lobes of lung on the right side and two on the left. Is that correct? You got it. That's
Speaker 2 00:04:49 Right. And so how
Speaker 1 00:04:50 Is that? Is there one side that does something different than the other? Why is that only two on the left?
Speaker 2 00:04:56 Um, the, well on the left side is a little bit where the heart is. So the heart's about in the middle of the chest, but a little bit more on the left side. So the left lung is a little bit smaller to accommodate the heart. Um, but they really do the same thing. And so we are actually born with some, uh, reserve if you will. And we have probably more function in our lungs than we need. And so people can actually, uh, have, have an entire lung removed and still do. Okay. And they, the other lung still does the work that needs to be done. So you are born with some extra to begin with. Ah,
Speaker 1 00:05:31 Wow. Probably a good thing for some people, Dr. Vineyard, can you just tell me a little bit about how one is diagnosed with lung cancer?
Speaker 2 00:05:44 Well, the diagnosis of lung cancer, uh, requires typically a biopsy of some kind, uh, to confirm the diagnosis. Um, the, uh, sometimes you might suspect, so we might suspect lung cancer in a person who has some specific types of symptoms, um, respiratory symptoms like cough or chest discomfort or difficulty breathing that is relatively new. And that would, uh, prompt a healthcare professional to do probably some imaging testing, like a chest x-ray or a cat scan. And then if we found an abnormality, then we would potentially biopsy it and that would confirm cancer.
Speaker 1 00:06:23 Alright, excellent. Can you describe, um, the cat scan and how that works?
Speaker 2 00:06:29 Sure. So a cat scan, um, also known as a CT scan or computed tomography is a three-dimensional scan of the lungs, uh, or any part of the body. So a cat scan of the chest would be done to look for lung cancer. Um, so a CT scan is done by, um, having the person who's getting the scan lay on a table, uh, and you, well, the table moves usually through, uh, something that looks like a donut, basically. Uh, usually a CT scan is pretty fast. Uh, CT scans can be done for a lot of different specific purposes, and that would change a little bit about how long it takes and whether or not you have to get something through the vein and IV contrast dye to help what you're looking for, show up better. Um, for the lungs you don't typically need contrast dye through the vein.
Speaker 1 00:07:14 Oh, there, I know there's more than one different type of, of lung cancer. Can you talk about the different types and how they various?
Speaker 2 00:07:22 Sure. So the most common distinction and the types of lung cancer is, um, small cell lung cancer, uh, like tiny cells and non-small cell lung cancer. That's, uh, in some ways, a little bit of an outdated, uh, description about lung cancer. Uh, and it dates back to when we knew less about cancer and had, uh, less ability to refine more specifics about cancer. Um, so small cell lung cancer, uh, is called that because the cells are, are small. Um, and then non-small cell lung cancer has a variety of types of lung cancer that fall within that. So the most common type is called adenocarcinoma. And, um, you can develop adenocarcinoma in other parts of the body as well, that refers to a type of a normal cell that mutates or changes and grows into cancer. Um, uh, the next most common type of non-small cell lung cancer is squamous cell cancer. Um, so these, these words, adenocarcinoma and squamous referred to the types of cells that grow and, and, um, become abnormal. So those are the most common ones.
Speaker 1 00:08:26 Um, okay. Is that the same as, um, lung carcinoid?
Speaker 2 00:08:32 Uh, so carcinoid tumor is a different type of non-small cell lung cancer. Um, and that would be a less common type. And so, uh, carcinoid tumors may be, um, a little bit less, uh, aggressive than the other types of lung cancer. Um, but so that, that falls into the non-small cell lung cancer category.
Speaker 1 00:08:53 So here's the part that you'll love to get out there is let's talk about causes of lung cancer.
Speaker 2 00:09:02 Sure. Um, so I think most people probably think they know the cause for lung cancer, um, and certainly exposure to smoke a cigarette smoke or other types of smoke is the leading cause of lung cancer. Uh, but it is not the only cause of lung cancer. Um, other the second most common cause of lung cancer is probably radon exposure. Uh, here in Minnesota, we actually have higher than, uh, national average levels of radon. Uh, anybody here know what radon is? Show of hands. No. Okay. Yeah. So radon is, uh, is a gas, it's a naturally occurring gas. Uh, it occurs in the environment it's odorless, it's colorless. You can't smell it, you can't see it. Um, and it is found in certain, um, certain parts of the country and more, uh, in higher quantities than other parts. So, like I said, Minnesota, uh, we have higher than national average rates of radon and it's estimated that probably two out of five homes in Minnesota have, uh, elevated or dangerously high levels of radon.
Speaker 1 00:10:09 Oh. So, um, that leads me to say everyone, go get radon tests for your house or wherever you're living. Uh, talk about statistics. Um, what are the statistics now for on-camera?
Speaker 2 00:10:31 So in the United States, about 160,000 Americans died from lung cancer last year, uh, in Minnesota, probably about 2,500 Minnesotans have died and worldwide about 1.7 million people last year died of lung cancer. Um, lung cancer is responsible for more deaths than breast cancer, colon cancer and prostate cancer combined.
Speaker 1 00:10:55 It's funny cause you, well, it's not funny, but I mean, it seems like you hear about lung cancer last
Speaker 2 00:11:01 That's exactly right. Um, so I want to say that again, more than breast cancer, more than prostate cancer and more than colon cancer combined. Um, so lung cancer is the number one cancer killer. You mentioned that you don't hear about it very much. Uh, lung cancer awareness month is November. And I bet a lot fewer people knew that then people who knew why we were wearing pink ribbons in October. Um, so, uh, you're absolutely right. Many people are uninformed about lung cancer and I'm really, uh, that's why I'm so grateful for this opportunity to, um, talk to your listeners today about it. So
Speaker 1 00:11:34 Understanding is that statistically for smoking lung cancer from smoking has gone down, but has it gone down for those other causes?
Speaker 2 00:11:46 Uh, that's an interesting question. I, you know, when you look at statistics for lung cancer, you have to be a little specific about what area you're looking at, different parts of the country, um, different, uh, racial groups, men versus women. The numbers are a little bit different. Um, you're right overall, the numbers are slightly declining. Um, and that probably is related to smoking habits and how those have changed over time. So a few decades ago people started smoking less. And so we are seeing a little bit of a decline in that. Uh, but certainly we, uh, are seeing, um, more non-smokers, uh, diagnosed with lung cancer than we have in the past. And we don't understand exactly why that is, um, a recent paper showed, um, they looked at lung cancer trends and actually showed in the United States that there were two hotspots where lung cancer was not declining. Like it wasn't other groups and Minnesota was in one of those. And so in women, uh, lung cancer, uh, does not seem to be declining as much as it has in the past that paper. Wasn't able to say why, why that is the case. Um, but certainly I, uh, and other people that I know we talked before the show, uh, recognize, uh, that people without lung cancer, uh, excuse me, people who have never been smokers, um, are developing lung cancer and it's, uh, increasingly a problem.
Speaker 1 00:13:06 And is it just as likely that, um, secondary smoke is doing does as much damage to someone's lungs as somebody who smokes?
Speaker 2 00:13:16 So certainly secondhand smoke contributes, um, to, uh, the risk for lung cancer. We also mentioned radon exposure. Um, other things that might increase a person's risk for lung cancer would be, uh, exposure to certain types of, um, chemicals may be in an, in a workforce place, uh, diesel as Bestos, things like that. Um, and family history does play a part in it. We don't totally understand exactly how genetics work for lung cancer, but a family history is important. And so, um, many people who are, are not smokers who have lung cancer do have a family history of it.
Speaker 1 00:13:54 Talk about people who have pack years. Can you explain that concept and how it works?
Speaker 2 00:14:01 Sure. So when, um, you are trying to put a number to, to quantify, to measure how much someone has smoked cigarettes over their lifetime. We use, um, a measurement called pack year. So a pack year is the equivalent of a person smoking a package of cigarettes per day for a year. So someone who smoked a pack a day from the time they were 18 until let's say they quit when they were 58 and they smoked one pack a day, pretty much every day, most of that time would be a 40 would be, have a total of 40 pack years.
Speaker 1 00:14:35 And how does that work with their body heal? They tell you that if you stop your body starts to heal itself, does it really?
Speaker 2 00:14:43 Yes and no. Um, after quitting smoking your, uh, your risk of developing lung cancer does go down over time. Um, but the, you will never get back to the place of, of the average person who has never smoked cigarettes. Right? The other thing we know about pack years is it's really an imperfect measurement. Um, people smoke cigarettes differently in terms of their behavior, the way that they smoke. Um, you, uh, some people smoke cigarettes in such a way that they are lighting a pack of cigarettes a day, but they might not smoke the whole thing down all the way to the end or other people are, um, you know, smoking it all the way down and getting every last bit out of it.
Speaker 1 00:15:26 Let's talk about the trend that has been happening about vaping. Um, what are your feelings on vaping as far as is it, I realized there's some amount of dangerous stuff that's been happening, but beside that, is it just as dangerous to be vaping as far as the smoke goes?
Speaker 2 00:15:47 So that's a really complicated question. Um, I think when you're talking about cancer, uh, we really do not know the answer to that. Vaping is so new, um, that exposure to any sort of an agent that's going to cause cancer happens over years and years and years. So vaping has not been around for years and years. So we do not have any evidence to tell us whether or not vaping is as dangerous as smoking cigarettes in terms of the risk of developing cancer. Uh, you know, in this area, there are a lot of passionate people who have differing views, uh, certainly, uh, Minnesota and other states around here recently have, uh, and, and nationwide, we have seen, uh, some really devastating deaths, very, um, very sick or, um, even lethal, um, situations where young people who are vaping, uh, get very sick. So, uh, it certainly has the potential to be very dangerous. We still don't totally understand what's going on with that. Um, so that's, uh, that's a cautionary tale, but there are other people who believe that, um, vaping is a safer alternative to smoking cigarettes and for somebody who's smoked for a long time and has tried everything else to quit, that vaping might be, um, something that's not as harmful as smoking cigarettes that might help them quit smoking. Uh, so I think it's, uh, it's a little bit of a touchy subject right now.
Speaker 1 00:17:11 Does it still put out fumes that one should be worried about if they're the second person by they're not smoking? I know you really can't seems like you can't smell it so bad, but are there fumes? We can't smell and we should.
Speaker 2 00:17:28 I don't think we know the answer to that. I really don't think we know the answer to that in terms of how it affects the other people around you.
Speaker 1 00:17:34 Okay. We need to take yet another short station break and we will be right back
Speaker 3 00:17:42 Programming on KFC supported by Metro transit. Metro transit now offers use of app that connects blind and low-vision customers to a live agent for navigation assistance during transit trips, more information at Metro transit dot O R G slash a I R a.
Speaker 1 00:18:07 All right. Last question on this heartbeat subject, as far as smoking, but is marijuana as bad as cigarettes.
Speaker 2 00:18:16 Uh, that also depends. Um, since joining medicine I've become quite a politician. When I answer a question, I can't really give a straight answer anymore. Um, so the, uh, the difference probably lies in the fact that people, most people smoke marijuana differently than people smoke cigarettes. Um, so if you, uh, smoked with the frequency and regularity, you know, multiple, um, whatever joints or something a day, um, for many years, probably so, um, because the smoke itself is what is causing the problem. Um, but most people don't smoke marijuana that way. Um, the other thing that complicates the evidence and us trying to understand how, uh, smoking marijuana is related to lung cancer is that many people who smoke marijuana also smoke tobacco cigarettes. So it's quite murky.
Speaker 1 00:19:12 Okay. So how often is a lung cancer misdiagnosed?
Speaker 2 00:19:20 Um, that is an excellent, uh, question. Um, you know, we don't have good answers for that, but I do believe that lung cancer misdiagnosis is a very real problem. Um, before the show, uh, Amber and I were talking about this and she shared a personal experience. Um, but I think this happens, uh, quite frequently. And I think it especially happens to people who have not been smokers, so
Speaker 1 00:19:45 Would be like, what would they see that would misdiagnose it? What would, what might be a cause of that?
Speaker 2 00:19:52 Um, you know, I want, uh, I first want to clarify that w w lung cancer does not typically cause symptoms when it is early on. Um, so at the first, uh, the beginnings of cancer, there are not typically any symptoms that you would know that it's lung cancer. Uh, so lung cancer typically has to spread and become more advanced for symptoms to develop. Uh, but I have, um, certainly heard and treated many patients. And this is a well-known that, uh, people, especially people who have not been smokers again, people who, people who even healthcare professionals, or even themselves think, oh, this couldn't possibly be cancer. I've never been a smoker. Um, my goal on with symptoms for a long time, uh, so they might have a cough that's new, or they might have chest discomfort, that's new, or, um, difficulty breathing and, you know, cough it up, uh, or attributed to, oh, I'm out of shape or I'm getting older or I've gained some weight or I've allergies, something like that.
Speaker 2 00:20:48 Um, so I certainly don't want to frighten everybody who has some, you know, minor changes that are new, but if you have a persistent symptom it's really important to get checked out. And I think if you have a cough, for example, that's new and is not going away, uh, you need to get checked out. And the only way to know for sure is a CT scan. So, um, I think the best way to avoid misdiagnosis is that, um, if you have a sense that something is not right with you and something is new and you're not being taken seriously, that you have to advocate for yourself and, um, push, uh, your doctors, the people taking care of you to listen to what you're telling them.
Speaker 1 00:21:28 So let's talk about the, the screening process. Um, you talk about the CT scan. How does one actually, I mean, is it really that easy or do you have to go through a bunch of hoops to say, I feel like I'm at high risk, I need to be screened. What, how would someone discover or decide you were at a higher risk for screening?
Speaker 2 00:21:54 Um, so that one, uh, so lung cancer screening is a relatively new service. Um, we have an organization in the United States called the United States preventative services, task force, and their job is to review evidence available for screening tests and make recommendations. And because of those recommendations, uh, if they get a good score, if a screening test gets a good score or a good grade, then, um, insurance companies will pay for that test to screen for a specific condition. So for lung cancer, um, the United States preventative services, task force has been recommending since 2013 to screen some high-risk, um, current and former smokers for lung cancer. So even though we've talked to that, you don't have to smoke to get lung cancer, certainly that increases your risk. So for a screening test, we are looking to identify the people who are at highest risk to develop lung cancer.
Speaker 2 00:22:51 And what we want to do is test those people early, to screen them, to look for signs of cancer before it has a chance to cause any symptoms. So there are some specific criteria, uh, that screening is recommended for based on evidence that we have, that it will help these individuals. So the people who should be screened for lung cancer are men and women who are aged 55 to 80, over the age of 55, who have smoked cigarettes for a total of 30 pack years. Like we talked about, so about a pack a day for 30 years or half a pack a day for 60 years or two packs a day for 15 years. And, um, if they have quit smoking, they should not have quit smoking for more than 15 years. As we said over time, your risk does go down. So if you are a long-term, um, uh, long-term quitter, uh, then screening is not recommended for you. If you meet these criteria, you should be screened. And, um, insurance, insurance companies should pay for it. That's a Medicare, um, in Minnesota, Medicaid covers lung cancer screening and, um, all private insurance companies should cover for people that I described. Well,
Speaker 1 00:24:02 That feels to me like that leaves a lot of people out, you know, because especially those people that are not diagnosed because of smoking. So what happens there,
Speaker 2 00:24:13 Sam, you're very insightful. This is, um, this is a hot topic right now in the field, um, experts in the field disagree. And, uh, the reason that these recommendations are what they are is because those are the, those are the people that we have hard data to say, this is who it definitely helps. Um, there are some downsides to screening. Uh, you get radiation exposure from the CT scan. Um, you might have, what's called a false positive where you have a, have a finding, have a spot on a CT that's not cancer. Um, and you might go through additional testing and have additional worry from that. So it is a little bit of a balance, uh, but you're absolutely right. There are many people who are not covered by the screening recommendations as they currently are. So,
Speaker 1 00:24:57 I mean, you've been, some of those people have been in a secondary people who have had the secondary smoke in homes for a long time or a spouse of somebody who has smoked. So that seems, I don't know. And, and as I told you before, the person I knew who was recently died, um, she was never a smoker. And so that is a little bit scary to me. Can you talk about the term that I hear that when you get to someone who's dealing with, um, helping with, uh, treatment a dosimetrist, what is that and what part did they play
Speaker 2 00:25:43 A dosimetrist
Speaker 1 00:25:44 Medical dosimetrists like somebody who is that part of when you're doing radiation or anything? Is that,
Speaker 2 00:25:51 Um, I, I don't actually know what a December trust is. Um,
Speaker 1 00:25:56 I'm like, oh, I, uh,
Speaker 2 00:25:58 Yeah, I, I'm not sure what that is. Okay. Then
Speaker 1 00:26:01 Move on. Well, you never know. I mean, I saw the term there. I presume that they were talking about, um, chemo or radiation.
Speaker 2 00:26:10 Yeah. I mean, radiation is involved. Of course, radiation is involved in testing, low dose radiation in the CT scan, but radiation is one type of treatment for lung cancer. Um, and so the radiation dose is something that we are, um, conscientious of, uh, what it is and keeping track of it and minimizing it to the best ability that we can.
Speaker 1 00:26:33 So I'm maybe wrongly presuming, but what let's talk about, um, lifespan was lung cancer.
Speaker 2 00:26:46 So, um, lung cancer, uh, is, uh, is, can be a devastating disease. Um, as we talked to is responsible for more deaths than many other cancers combined. Um, the, uh, when we talk about cancer and the lifespan, um, I'm really careful to say that, you know, I can't predict any specific person. It's certainly natural to want to know that, but, um, everybody is different. Uh, but when we talk about it from the statistical perspective, we, um, look at a number called the five-year median survival. So that basically means how many people at five years from diagnosis of lung cancer. And this is all comers, people who have advanced stage cancer, people who have early stage cancer. Um, how many people with lung cancer are alive after five years after diagnosis, and the number for lung cancer is shockingly low. Um, it is about 18%. So, um, under one in five people will be alive five years after the good news is I think this is changing. I think we are at a really, um, exciting and pivotal time in lung cancer where we understand more than we ever have. And even over the last 10 years, things are really changing dramatically in terms of treatments that are available and in terms of how people respond to treatment. And so I fully expect that number is going to be increasing in, uh, certainly during my career in the foreseeable future. Do you have any
Speaker 1 00:28:14 Statistics on, um, number of peoples that are caught early? Like what's considered caught early and what's considered caught later stages. What's a w first of all, why don't you, why don't we step back and say, what's a more common stage to catch it at, and then we'll go from there. What would be considered early?
Speaker 2 00:28:34 So, um, like most cancers, um, lung cancer is staged on a one to four system. So a stage four is considered the highest, the most advanced stage. So that typically means, um, the cancer has spread outside of the lung maybe to another part of the body or to the other lung, for example. Uh, and so stage four is the worst, um, because lung cancer is, uh, it doesn't cause any symptoms and without screening lung cancer would be more likely to present at an advanced stage. So we're talking about stage three or stage four. Um, so, uh, left to, uh, the natural history of the disease, um, and finding it through symptoms and, and getting tested because of symptoms. Uh, most patients would be, um, most people would be diagnosed with lung cancer at the, uh, stage three or four. And so, um, at that, at that time, uh, there's a much lower chance for cure,
Speaker 1 00:29:35 But you can catch somebody at an earlier stage.
Speaker 2 00:29:39 That's right. So purpose of screening is to catch, um, catch lung cancer at an earlier stage. So, um, different screening studies have shown, um, something a little bit different, but, uh, 50, 60, 70% of the lung cancers detected through screening might be a stage one, which is a earlier stage, has a much higher chance for cure. And so that's, our goal is to start identifying these cancers earlier with screening so that we can start, um, talking more about cure and improve that five-year survival rate.
Speaker 1 00:30:15 Can we dive into treatments? Um, how did treatments work and how did they differ and do they, do they change depending on the stage?
Speaker 2 00:30:27 Yes, they definitely do. Um, so as we mentioned, stage one is of course, where you have the best chance of cure. So in lung cancer, what we consider to be the gold standard treatment, the best treatment is surgical resection. So if you have a cancer that is small enough and is able to be surgically resected, uh, and you're healthy enough to undergo surgery, that is usually the number one recommendation. And that's your best case scenario
Speaker 1 00:30:51 Resected, but mean taken out
Speaker 2 00:30:53 That's right. Thank you. Um, so, uh, removed with surgery. And so, as we mentioned, you can certainly remove parts of the lung and can still do okay with what's left. So, uh, if you have any lung disease and the state of health of your lungs before surgery is of course considered, uh, and if we think that you will be able to withstand surgery and still do okay. Afterwards with what's left, then that would be the best case scenario. Um, another treatment option for lung cancer is we touched on this briefly is radiation therapy. Um, so that is, you know, high beam energy that's, um, uh, shot at the cancer from outside the chest, uh, to kill it that way. Um, so radiation treatment, uh, is also, um, an option and that, uh, depends a little bit on the stage of the cancer as well.
Speaker 1 00:31:42 So you talked about surgery for perhaps early stages, or I'm not sure when you would do that at what stage was that also called a low back pain?
Speaker 2 00:31:50 So a low back to me is the type of surgery that's right. So what that means is a lobe of the lung is resected is removed. Uh, so, uh, you, you would usually do a lobectomy for cancer. And we talked earlier that there were five loaves in the lung. So you can take one of those out, uh, the lobe that contains the cancer. In some situations, the cancer might extend from one lobe to another, into two lobes. So you can take out two, or you can take out, um, the entire lung depending on where the cancer is and what you need to remove to get, um, to get all of the involved areas out. Um, another treatment option for, uh, lung cancer is chemotherapy. Um, so, uh, traditional chemotherapy, I think many people have an idea about what that is, uh, very strong, very toxic drugs, uh, that are given to people, uh, kill off the cancer cells.
Speaker 2 00:32:41 And those typically have a really serious side effects as well, um, and can make people sick and lose their hair, um, and stuff like that. Uh, with lung cancer, we have some newer treatments which are, um, available now that are medications, um, but are, uh, less toxic than chemotherapy in most cases. And so we have a couple of classes of those. Um, one is called targeted therapy, so a variety of medications and classes of medications to treat specific, very specific types of lung cancer. So when you get a biopsy and you confirm lung cancer, the pathologist will do additional tests on the cancer cells to, uh, learn very specific individual features of those cancer cells. And then we do have some, uh, very specific targeted treatments to treat specific types of lung cancer. Um, some of those are even pills and those, uh, can be much easier to take than, than traditional, um, toxic chemotherapy. And also, um, a really new burgeoning field is, um, something called immunotherapy. And so, yeah, immunotherapy is I think really gonna revolutionize lung cancer and it is also revolutionizing other cancers as well. And so immunotherapy is a, basically a way of activating your body's immune system to fight the cancer. Um, so our immune systems are an important part of fighting off cancer. And so immunotherapy, uh, certainly can have some side effects, but, uh, is really in some patients I'm working wonders and I think is going to really revolutionize the field.
Speaker 1 00:34:17 So how I realized that immunotherapy is pretty new, but it is currently being used.
Speaker 2 00:34:23 That's right. It's definitely being used.
Speaker 1 00:34:25 How do they decide what therapy is going to be for home?
Speaker 2 00:34:29 So the, uh, the first thing that we have to look at is the stage, as I mentioned, surgery is usually the best option and usually what we want to offer if that's possible. Um, and then the, the pathologist will do several tests on the biopsy of the cancer. So they will look for these targets for the targeted therapy. So that's very specific genetic mutations that the cancer might have, which will essentially demonstrate a weakness. Um, the Achilles heel of the cancer that you can treat with a targeted therapy to remove it, um, for immunotherapy. Uh, we also look at, uh, another, another marker it's called PD-L1, uh, programmed death ligan, but it's, it's a, it's a marker of, uh, whether or not the cancer will respond to immunotherapy. So once you've had a biopsy and you've had all these additional tests done, then, um, the medical oncologist, the doctors who treat, uh, cancer will make a decision about which one is the best one for you and your specific cancer.
Speaker 1 00:35:31 And I'm wondering about, I know, depending on, you know, when somebody is in an accident, they have like the ability sometimes to do transplants. Why isn't there any lung transplants
Speaker 2 00:35:46 For cancer? You mean for,
Speaker 1 00:35:48 Is there lung transplants in general? Yes.
Speaker 2 00:35:51 Transplants are definitely an option for treating people with lung disease. That's not cancer. Why
Speaker 1 00:35:56 Not? So,
Speaker 2 00:35:58 Uh, the reason is that, as I mentioned, your immune system is important to helping your body fight cancer. So when you get a transplant of any type, um, the natural response of your body, your immune system would be to reject that foreign object in your body, that foreign thing. So people who receive transplants, um, usually have to get immunosuppression medications. They have to take medicines to S to suppress and calm down their immune system. So it doesn't reject or fight off the transplanted organ. So in, in cancer, if you, uh, get a transplant and you have to take immune suppression medications, then that means that the cancer is going to have a better chance to, um, either come back or to spread. Uh, so, um, lung cancer and lung transplant are mutually exclusive.
Speaker 1 00:36:51 So I'm just curious, I don't know if you've, I'm sure this has been talked about or thought about, but sometimes they talk about growing in Oregon. So is there any thought of like taking a healthy part of the lung and growing that, or do we assume that all of it's kind of contaminated once you're, once you're, you know, diagnosed
Speaker 2 00:37:15 Well? Um, so we're not doing that. You know, it's not ready for prime time, so to speak, it's not something that's happening in, in, uh, in hospitals and clinics now, uh, there are certainly researchers working on ways to address this problem. Uh, but it's, uh, I would say very early phases, um, of, you know, trying to grow lungs from cells or grow new lungs. Um, but that is quite experimental. Gotcha.
Speaker 1 00:37:41 All right. So can we talk about metastatic? Can you talk about what that term means and how it works?
Speaker 2 00:37:50 So, uh, metastatic means, um, that something has spread. Um, so we talked about stage four, lung cancer is advanced lung cancer. And so stage four of any cancer means metastatic for every cancer. The staging definitions are a little bit different. So depending on the original site of the cancer and, um, its usual growth pattern, what is defined as stage four will differ. Uh, but uh, metastatic lung cancer is cancer that has spread outside of the lung basically. So it might have spread to the lining of the lung. It might have spread to the other lung from the original lung it's went to the other side. Um, and other common places that, uh, lung cancer will spread to if it's not caught in time, are, um, the liver and the brain and the bones,
Speaker 1 00:38:41 Which leads to many other complications. Uh,
Speaker 2 00:38:44 Yes, definitely.
Speaker 1 00:38:47 When somebody is diagnosed, do you guys do anything with diet or do you think that diet plays any role in this?
Speaker 2 00:38:55 We don't have a lot of evidence for diet and lung cancer. Um, there are some studies that show that some of the chemicals found in cruciferous vegetables like broccoli, Brussels sprouts, uh, might help to prevent cancer. Um, but there's not a lot of specific nutritional advice for people with lung cancer. Uh, that being said, I, I definitely personally believe that your diet is an important part of your health and that, um, following a healthy diet and you know, lots of whole plant-based foods is good for everybody and, um, is helpful to, uh, reducing your chance of getting disease and improving your body's response to treatment. But for lung cancer, we don't have a lot of specific nutritional advice that we know is beneficial.
Speaker 1 00:39:42 How about exercise?
Speaker 2 00:39:44 Uh, similarly it's always good. Uh, certainly I don't tell people to limit themselves. Um, but I don't, we don't have any specifics for lung cancer, but I think it's important to, uh, keeping your body strong. It's important to keeping your, um, your mind and your mental state and psyche strong. Uh, so I definitely encourage, um, all of my patients to exercise regularly.
Speaker 1 00:40:10 Do you have, if we haven't touched on it lightly already, do you have a, can you give me, uh, a concept of epigenetic therapy?
Speaker 2 00:40:21 Uh, well, epigenetics, what epigenetic means is, um, it, it basically refers to the environment around the genes. And so you might know that the genes are the, uh, your, the basic building blocks of your body. Um, the genes are like the script, um, and then those, uh, in code for proteins that make everything happen in your body. So epigenetics refers to the environment basically. So something that is happening in your body, that isn't just the genes, it's not, what's written in your genetic code, but it's something in the, uh, something in the environment, both the environment inside your body or the environment outside your body and how those two things play together.
Speaker 1 00:41:07 Is there a more common age where somebody might be diagnosed with lung cancer than another
Speaker 2 00:41:14 Most people, most people who are diagnosed with lung cancer are a little bit older, um, 50, 60, 70. So the risk increases with increasing age basically. Um, but certainly, um, almost anybody can get lung cancer. I have treated people in their thirties and forties who have lung cancer, uh, but for the most part it's, um, uh, older individuals, because the risk increases with increasing age
Speaker 1 00:41:42 When somebody comes in and they're diagnosed what happens, not just what happens. I mean, I'm presume you start talking about, you know, maybe the stage and what treatments, what happens with the families.
Speaker 2 00:41:58 So, uh, most of the times when I am, uh, diagnosing somebody with lung cancer or might be diagnosing them with lung cancer, their families are present. Um, I frequently see people in the clinic with a room full of people and we have to get some extra chairs because of course, uh, it's a serious condition and everybody has questions and everybody is concerned. Uh, so we definitely, uh, want to treat the entire family because this is happening to everybody. Uh, you know, we mentioned a biopsy is typically done. Um, and then you'll get results from the biopsy and then talk about the next steps. So after you confirm a diagnosis of cancer, then you, um, probably will do additional tests to figure out the stage of the cancer. So this might be some additional scans to look and see if the cancer has spread anywhere else.
Speaker 2 00:42:47 Uh, once you have that information, then you're talking about treatment options and that's where we get into, uh, surgery versus chemotherapy or immunotherapy or radiation, and, uh, making that decision with, um, not only the patient and their family, but also, um, other professionals. And so, uh, lung cancer is best treated and addressed in what we call a multidisciplinary team. Uh, so we have, um, a multidisciplinary team at the university of Minnesota. We, I'm a, I'm a pulmonologist, I'm a lung doctor. I work with medical oncologists. Those are the specialists who treat cancer and prescribed chemotherapy specifically. And, um, thoracic surgeons. So chest surgeons who would be helping us to, uh, remove the cancer, radiation oncologist. Those are the cancer specialists who administer radiation treatment. Um, we have radiologists, so the specialists who, uh, look at the scans and we all work together to come up with what we think is the best treatment plan for the patient. And of course incorporate the patient and their families, um, wishes in that, um, cancer center has of course nutrition and, um, spiritual health and palliative care, uh, and other, um, support for patients and their families when they're going through cancer.
Speaker 1 00:44:06 I think a lot of people hear about chemo and side effects of that, but I don't hear as much about side effects with radiation or immunotherapy. Could you talk about those?
Speaker 2 00:44:16 So, um, radiation, uh, treatment for lung cancer, there's, uh, different radiation protocols that you might undergo. Um, many people who get radiation treatment, um, experienced some burning on the skin. That's a temporary, uh, most people who get radiation may have some, uh, some scar tissue adjacent to the area where the cancer was. So the, uh, side effects of radiation do vary depending on where the cancer is. Um, for example, if you receive radiation for a cancer, that's very close to the esophagus, that's the food tube, which also runs in between the two lungs. Then you might have inflammation of the esophagus, which would cause some difficulty swallowing, some pain with swallowing. Uh, if you have a radiation treatment that is close to the heart, you can have some damage to the heart. Um, and this is the case with radiation, for any specific type of cancer, that it, it does depend a little bit on the areas.
Speaker 2 00:45:16 Of course, the radiation oncologists do everything that they can to plan how they give the radiation to minimize, uh, damage to any other part of the part of the body that's nearby. Uh, you mentioned for immunotherapy. So again, for most people, uh, much better tolerated. You don't typically lose your hair or get very sick. Uh, but there are some common, um, problems with that as well. A skin rash is one possible, uh, problem. You can actually get inflammation in the lungs from the immunotherapy. Um, so as you might imagine, somebody who already is struggling with lung cancer, uh, to get, uh, to get another lung problem related to the immunotherapy can be problematic. Um, and that happens not infrequently. Um, maybe between 10 and 20% of people might have some degree of, um, this, uh, lung inflammation. Um, you can have, um, gastrointestinal problems related to immunotherapy. So, uh, everybody's different. But, um, some of those, those are some of the common, more common things
Speaker 1 00:46:18 It feels like, or it sounds like immunotherapies often better tolerated. Is there a reason why they don't jump to that? What's the percentage of patients that it doesn't work for.
Speaker 2 00:46:29 So, uh, immunotherapy, uh, is, is relatively new right now. Um, it's recommended to be used for people who don't have a targeted mutation. So we talked about the, um, those specific genetic mutations, the Achilles heel of the cancer. Uh, and so if you don't have one of those, uh, then immunotherapy basically is an option for you. Um, and if you're going to get chemotherapy and you can't get a targeted, uh, treatment, then, uh, maybe immunotherapy would probably be part of your treatment plan, uh, whether or not you would also get, um, some of the more traditional chemotherapy, um, depends on, um, that marker. I mentioned the PD-L1, so that's a, that's a feature of the cancer biopsy itself, uh, which shows the characteristics of the cancer and how, um, susceptible we think it will be to the immunotherapy alone,
Speaker 1 00:47:19 Does not being able to have a target treatment mean that it's more spread and you can't just easily target a spot or,
Speaker 2 00:47:28 Um, no,
Speaker 1 00:47:29 The T the, the targeted treatment is not like a physical target. So don't think like a, bulls-eye think like, um, if you've got a sweet tooth, um, I've got a sweet tooth. So if you have a sweet tooth and you go into the cabinet and you see a bunch of salty snacks and veggies and other stuff, it's just not going to really hit the right spot. Um, so a targeted therapy means that your cancer has a specific characteristic, like a, like a, um, a biochemical characteristic that makes it more susceptible to that, uh, targeted therapy. Um, so it doesn't necessarily have to do with the spread of the disease. Um, you know, whether it's widespread or whether it's, uh, locally, you know, it's focused. Um, it has to do with, uh, more of a, uh, an intrinsic characteristic of the cancer. If, what do you tell people if they're unsure, if they should get tested or
Speaker 2 00:48:27 Not. So, um, re-screening, you're talking about, so, uh, yes, if you think you should be screened, you should definitely talk to your doctor about that. Uh, there are, um, resources available and I, and I want to share what those are, um, here in the twin cities. Um, there are several, uh, most of the major healthcare organizations do screening. Certainly we do screening at the university of Minnesota. Um, most of the other, uh, healthcare organizations here do it as well. So you should talk to your doctor, um, for lung cancer screening, you do have to have a doctor's order. So you have to have a referral from your doctor that you are eligible for screening, and that you should have it. Um, if you don't have insurance or you don't think your insurance will cover screening, um, there are some institutions, uh, some organizations in Minnesota that have a screening grants.
Speaker 2 00:49:13 So I'm involved with an organization called a breath of hope lung foundation. It is a locally based nonprofit organization that is focusing on lung cancer, awareness and advocacy, and they have awarded screening grants to Hennepin county medical center and to the university of Minnesota and to essential health, which is more common in Northern Minnesota to screen patients who are eligible for screening, but don't have insurance that will cover it again. Most insurance companies will cover it. So if you have health insurance, they should cover screening without a copay, but you do have to talk to your doctor first. Uh, you can, um, look on the, uh, university of Minnesota cancer care website for lung cancer screening, many organizations, um, the American lung association, American cancer society have resources for lung cancer screening. Again, a breath of hope is, uh, their website is a, B O R I'm sorry. It's a breath of hope.org. And, um, there's information about screening there. Uh, there's also information about lung cancer. They actually have a really great, um, animated, uh, video resource for people who are facing lung cancer or people who want to learn more about it. Cool.
Speaker 1 00:50:27 How common is a false positive when being screened?
Speaker 2 00:50:31 Uh, so for lung cancer screening, uh, false positives are, are, are very common. Um, probably most of the positive findings, most of the positive exams are, um, not actually cancer. So the false positive rate is, um, 60% and higher. Uh, so that means if you do get a screening exam and you have an abnormality, um, that's pretty common and it may not in fact be cancer. Um, the CT scan is not able to very well distinguish what is cancer and what is not cancer. So when you have a positive finding, we, um, depending on what it, what it looks like and the size of it, we'll sometimes just keep an eye on it and see if it's growing or see if it's, uh, possibly a scar that's been there for a long time.
Speaker 1 00:51:16 Uh, if it has anything that makes you worried, it's the next step then after watching a biopsy typically,
Speaker 2 00:51:24 Yes. Okay.
Speaker 1 00:51:26 Is there anything else you'd like to cover that I missed?
Speaker 2 00:51:30 Um, you know, the one thing I wanted to mention, like I said, November is lung cancer awareness month. Uh, I think many people are unaware of the fact that you don't have to be a smoker to get lung cancer. I think there's a lot of stigma around, uh, lung cancer. I talk to people, uh, every day who have lung cancer, who are never smokers. And the first thing they always get asked is, well, were you a smoker? Um, which is really, uh, a blame game that doesn't have any role in this really serious disease. Um, the, uh, so if you, if you know somebody who has lung cancer or you hear about somebody having lung cancer, um, don't jump to conclusions, um, because of the stigma of lung cancer is very underfunded. Uh, even though it's the most deadly cancer, it receives less funding than, uh, breast cancer and other cancers. So, um, lung cancer is very underfunded. And so you can, uh, talk to your elected representatives about giving some more money to, uh, research lung cancer treatments.
Speaker 1 00:52:30 That's amazing to me that it's so, but I suppose not being talked about as much, please do not being funded as much.
Speaker 2 00:52:37 I think that's right.
Speaker 1 00:52:40 Well, we love you guys at the U because you guys come on and talk about all these things as difficult or whatever they might be. And, um, it all plays into the health of somebody. So thank you so much for coming in. I really appreciate that. I'd like to also think, uh, crystal barber, who does a lot of our setting up of you guys. So thank you again.
Speaker 2 00:53:05 It's my pleasure to be here. It's a short train ride away. Um, and I would like to say, if you're on Twitter and you want to learn more about lung cancer, you can follow me at <inaudible> on Twitter, and I'll just keep you entertained all the time.
Speaker 1 00:53:19 Thank you. This has been disability and progress. The views on the show are not necessarily those of KPI or its board of directors. My name is Sam and the host of this show. Thank you so much for tuning in Charlene doll and Amber Johnson or my research woman. And if you'd like to hear us, you may hear us by downloading the app or go to cafe.org. And if you like to be on our email list, you may email
[email protected]. We were speaking with Dr. Abby <inaudible>, um, pulmonary specialist in regards to young lung cancer boy,
