Who suffers from lung cancer and how is it treated?

What is the proportion of lung cancer patients who have never smoked? And do women get lung cancer as often as men?

Here we need to talk about the different subtypes of lung cancer. Clinically, there are two major groups: non-small cell lung cancer, which accounts for about 85% of cases, and small cell lung cancer. The most common types of non-small cell carcinoma are adenocarcinoma and squamous cell carcinoma. In addition, the number of adenocarcinomas is increasing and in many countries, including Latvia, they are in the first place among all lung cancer subtypes in terms of prevalence. And it is this subtype, adenocarcinoma, that is less correlated with smoking – up to a third of patients have never smoked. This subtype is more common in women and, unfortunately, in increasingly younger patients. Other subtypes, in particular both small cell and squamous cell carcinomas, are common in smokers or smokers. They are much more likely to affect men.

How often is the main method of treatment surgical? How many surgeries related to formations in the lungs are currently performed in your clinic?

The main treatment for first- and second-stage tumors is surgery. In general, a multidisciplinary approach is very important for lung cancer patients. At our clinic, about 600 patients undergo lung surgery each year, and about two-thirds of them are patients with oncological diseases. These oncology patients include lung cancer, metastatic tumors, mediastinal tumors, and benign tumors, which are not always immediately distinguishable. Speaking of primary lung cancer, our clinic operates about 200 patients a year. This is about one fifth of the new cases of lung cancer detected in Latvia every year.

How have surgical treatment options, radiation and medical therapies improved?

It should be emphasized once again that a multidisciplinary approach is very important for the treatment of lung cancer. Speaking specifically of surgery, we are increasingly performing surgeries with a minimally invasive approach using video-assisted thoracoscopy (VATS). This minimally invasive surgery is playing an increasingly important role in the treatment of lung cancer, with more than half of lung cancer patients already undergoing this approach. It is also gratifying that reimbursement of newer drugs has been started for chemotherapy, ie targeted therapy preparations and also for immunotherapy. Immunotherapy has also given hope to patients who are already late or even relapsed with a longer life. Immunotherapy may not always cure the disease, but it may slow it down or stop its progression and spread. Radiation therapy has also evolved. Especially when we are talking about stereotactic radiation therapy, which provides a high dose of ionizing radiation precisely in the tumor and allows to cure small-scale tumors without causing complications of radiation therapy in adjacent healthy organs. These methods are becoming more precise and it is possible to combine them more with other methods. As well as in cases where the risk of surgical treatment is too great, sometimes this method can even replace surgical therapy.

Do you think it is possible to improve the diagnosis of lung cancer in Latvia? What methods could be used to improve this and what is needed to implement them?

Everything can and must always be improved. It may be worth talking about how it is missing. We need to understand that the formation in the lungs is not always clearly recognizable. Histological verification of the formation by biopsy is very important. Peripheral localized tumors are not always achievable with conventional fibrobronchoscopy, which is the most common way to obtain biopsy materials. One of the methods that could improve this, which we have been hoping for for a long time, is the so-called navigation bronchoscopy. It is a special system that allows you to navigate the bronchoscope much more accurately and get to the desired location without seeing the formation itself, to perform an accurate biopsy and obtain a diagnosis.

Determining the stage of the tumor is also very important. We already have a lot in this area. We can perform PET / CT scans, which allows us to plan invasive scans more accurately and purposefully to clarify the stage of the tumor. This, in turn, allows to determine the correct stage of the tumor and choose the most appropriate treatment tactics. Mention should also be made of the endobronchial ultrasound method (EBUS). During bronchoscopy, we can use ultrasound to locate mediastinal lymph nodes or formations and perform a transbronchial biopsy.

Mention should also be made of lung cancer screening programs. The specificity of lung cancer is that the disease often does not cause any symptoms at first, making it difficult to detect. For this reason, in most cases, lung cancer is detected at a late stage. Lung cancer screening programs with low-dose computed tomography scans are not widely accepted and comprehensive in any country in the world because they require large amounts of funding and can only operate with full government support.

How do you assess the potential of the green corridor for patients with lung cancer? How has the introduction of the green corridor changed the treatment options for patients with pre-existing oncological disease?

Any opportunity for faster in-depth examinations of patients with suspected lung cancer is to be welcomed. The green corridor is more relevant for first-time patients who have not yet been diagnosed and has yet to be installed. Unfortunately, this does not affect those who are already diagnosed with lung cancer and have started treatment, but dynamic monitoring is also very important in these patients. Access to examinations is very important. Lung cancer can metastasize, it can relapse or recur. Unfortunately, these patients are no longer eligible for the green corridor.

Given that lung cancer is often diagnosed at a late stage when the disease cannot be completely treated, what advice do you recommend for patients who are in this situation?

Patients who are unfortunately already at an advanced stage of lung cancer should not lose hope. One should not rely on listening to paramedical, sometimes even charlatan advice. Despite the fact that the overall prognosis is not good, modern chemotherapy and immunotherapy are constantly evolving, which in turn gives more and more hope to stop the disease.