By Laura Freeman

It’s the most lethal cancer in the United States. However, advances in screening, diagnostics and new therapies are at last improving the prognosis for lung cancer—if it can be detected in time.

“We saw a 20 percent reduction in mortality in a national research program using low dose CT for early screening of patients who are most at risk,” UAB radiology professor Nina Terry, MD said. “Based on those findings, new guidelines suggest an annual screening CT between the ages of 50 and 80 (50 and 77 for Medicare patients) who smoke 20 packs per year or more, and those who have quit smoking for less than 15 years. Since the CT is low dose, we can screen annually, like we do for breast cancer.”

If there is a questionable area on the image, it can be either watched with follow-up scans or biopsied. Advances in biopsy technology are also making this more comfortable for the patient, as well as more accurate.

Interventional pulmonologist Aline Zouk, MD said. “Robotic bronchoscopy allows us to get answers in a less invasive way. Patients can go home the same day, and there’s no external incision or scarring.

“If we need to biopsy a suspicious node, the new robotic bronchoscopes allow us to get into much smaller areas to access very small nodules in the early stages of change. We also have a specially designed CT to guide our placement and make sure we are exactly where we need to be to get the most accurate sample. From there, testing the tissue can tell us a lot about what we’re dealing with.”

Lung cancer may be non-small cell, which is more common, or small cell, which tends to be more aggressive. There can also be differences in cells that are specific to the patient, and genetic testing of the tissue can offer insights into which types of treatment is likely to be most effective.

If the patient is facing a diagnosis of lung cancer, the multidisciplinary tumor board reviews the case and begins mapping out the course of treatment that is considered most likely to be effective. Clinicians will continue to follow the patient’s progress, making adjustments to fine-tune therapies as needed.

Surgical removal of an abnormal node with good margins and examination of nearby lymph nodes is usually part of the treatment plan. Until recently, chemotherapy was standard for most patients, but advances in immune treatment are expanding its role in teaching the body’s own immune cells to fight back.

“Our options are not one-size-fits-all anymore,” Maya Khalil, MD, associate scientist in the O’Neal Comprehensive Cancer Center, said. “We’ve learned a lot about the biology of the cancer of the specific patient in front of us and how to treat it best. No two patients are alike.”

Immune therapy is usually less toxic and easier to tolerate. An infusion of antibodies activates the body’s immune system to kill cancer cells. For some patients who do not get a good response to immune therapy, novel medications in clinical trials may improve response.

“It’s crucial to perform molecular or genetic testing on cancer tissue from patients presenting with metastatic lung cancer to identify drivers early on,” Khalil said. “Targeted therapies are available that seek out and block certain pathways that drive cancer growth caused by genetic mutations. Highly specialized drugs work on specific proteins and inhibit their division. There are many new generations of these drugs with multiple different targets. The options we have available today are changing the prognosis for lung cancer.”

The O’Neal Comprehensive Cancer Center is a powerhouse of research with a large portfolio of ongoing clinical trials. This offers oncology patients opportunities to participate in cutting edge therapies.

Risk factors for lung cancer include smoking, family history, and exposure to cancer-causing agents including chemicals, radon and second hand smoke. Although coverage for screening is geared to current and former smokers, testing to rule out symptoms in patients with other risk factors may be a consideration.

Increasing awareness of new screening guidelines among physicians and patients who smoke could save many of the 236,740 people who will be diagnosed with lung cancer this year. The surest cure for lung cancer is still prevention. Don’t smoke. But if you do, test.