Let’s talk about lung cancer: a Q&A with a clinical oncologist

Cancer, and in particular lung cancer, can be a daunting topic and one that many would rather avoid. But as awareness of the disease increases and diagnostic and treatment techniques improve, the outlook is getting better. We talk to Dr Paula Wells, one of London’s top clinical oncologists, to find out more…

Top Doctors: What is a clinical oncologist?

Dr Paula Wells: As a clinical oncologist, I give radiotherapy and chemotherapy treatments for lung cancer.

TD: How does lung cancer start?

PW: Lung cancer is a disease where cells become transformed into malignant or cancerous tissue.

TD: What are the warning signs of lung cancer?

PW: The symptoms are hidden; usually a cough that is present for many years. We should notice a change in the cough pattern – this is very important. Other symptoms include: coughing up blood, which requires urgent investigation by a specialist in a hospital setting, a persistent, or gradually increasing unexplained chest pain, and persistent or unresolving chest infections.

TD: What causes lung cancer?

PW: It’s well established that smoking is the major cause of lung cancer – this data has been available to us since screening studies performed in the 1950s.

TD: Who is most at risk?

PW: Historically, rates of lung cancer in men have been higher due to a higher prevalence of smoking. This is still the case, but numbers are decreasing in men as they give up smoking, whilst sadly in women it is increasing as they are taking up smoking at a higher rate and starting much younger.

TD: How is lung cancer treated?

PW: Treatment depends on the type and the stage of the disease; the latter defines how advanced the disease is – whether it has spread beyond the chest, into the lymph glands or elsewhere in the body.

TD: What types of lung cancer are there?

PW: There are two main groups of lung cancer, small cell lung cancer and non-small cell lung cancer.

TD: How is non-small cell lung cancer treated?

PW: If the disease is localised to the chest and it’s possible to operate, the patient will be offered a surgical option. This is the main curative treatment and is offered in about 20% of cases in the UK.

The second main curative option is radiotherapy, which is x-ray treatment from outside the body directed at the cancer.

The next group of treatments are really what we call palliative, or symptom control treatments which include x-ray treatment, or radiotherapy, with small numbers of treatments to help with symptoms such as pain or breathlessness, a cough, or bleeding, and also chemotherapy.

TD: How does this differ for patients with small cell lung cancer?

PW: This group is more aggressive. They are more likely to spread around in the blood stream at an earlier stage, so therefore chemotherapy is the main treatment that we offer. For those patients in which the disease is localised to the chest and the response to chemotherapy is good, we offer radio therapy.

TD: What can I do to reduce my risk of getting lung cancer?

PW: The main thing you can do is to give up smoking if you are a smoker, or never start if you are a non-smoker.

A good diet with fresh fruit and vegetables, a good exercise regime and a generally healthy lifestyle can help improve outcomes with cancer.

TD: What is the outlook for lung cancer?

PW: Changes in practises over the last 5 to 10 years with regard to improvement in the diagnostic pathway for patients and the availability of all treatment options, the outcomes for lung cancer are improving.

There are a number of target-specific therapies now available dependent on the features seen on the patient’s pathology sample.  

In addition, there are important developments in technical radiotherapy such as the use of Stereotactic Ablative Body Radiotherapy (SABR) which can cure early lung cancer and in some cases can be used to treat small volume advanced disease.

TD: What are target specific therapies?

PW: Target specific therapies are designed to attack specific molecules that are involved in cancer growth. Specific mutations are tested for at the time of the diagnosis of lung cancer and include Epidermal Growth Factor (EGFR), Anaplastic Lymphoma Kinase (ALK) translocation and Programmed Death Ligand-1(PDL1) which all have specific drugs that target them. 

The outcome of patients with even advanced lung cancer can be dramatically improved if they have these changes (mutations), as they respond well to these new targeted therapies which in many cases have fewer side effects than standard chemotherapy.