Robots, GPS and earlier screenings are the latest high-tech salvo in the war against lung cancer.
The American Lung Association lists lung cancer as the second-most diagnosed cancer in both women and men and the leading cause of cancer death in the country. Lung cancer accounts for 30 percent of all cancer deaths in America, killing more than 150,000 people annually.
In addition, lung cancer has a five-year survival rate of less than 16 percent, a substantially lower number than other major cancers such as breast, colon and prostate, which reach 90 percent or greater, according to the association.
Also, lung cancer has a stigma attached that other cancer victims don’t often face. When singer Donna Summer died from the disease earlier this year, many figured she must have been a smoker. She wasn’t a known smoker. And though smoking is by far the leading cause of lung cancer, 15 percent of people diagnosed with lung cancer have never smoked. (More women than men who have never smoked get lung cancer.)
“The perception that this is a smoker’s cancer is a bit outdated at this point,” said Dr. Rogerio Lilenbaum, chairman of the hematology/oncology program at Cleveland Clinic in Weston. “No one would say this about breast cancer, even though we do have some lifestyle issues that can impact on breast cancer. On the other hand, we don’t want to create this false idea that smoking is no longer relevant. It remains the No. 1 cause and if it were to be eliminated, this disease would go away one day, with few exceptions.”
Results of the National Cancer Institute’s National Lung Screening Trial (NLST) released in August 2011 showed that screening with low-dose spiral computed tomography (CT) scans compared to the previous option — chest X-ray — reduced lung cancer deaths among older heavy smokers by 20 percent. The key to survival is improved detection at the earliest stages.
“In our lifetime we probably won’t see anything potentially as much of a game-changer as this can be,” Lilenbaum said. “This hasn’t taken off at hospitals yet; they are trying to come up with appropriate guidelines, and the incidence of false positives is still quite high. But as screening with CT becomes more common, we’ll see decreased mortality. There’s a reason for optimism.”A simple test
Rita Seiff is one example of someone well-served by the new CT screening.
Seiff, 66, said she gave herself a great present for her 40th birthday: she quit smoking and never went back. She had begun smoking at about 13.
But having been smoke-free for 26 years, and feeling fine, Seiff, who lives in Boca Raton with her husband, felt she had no reason to think about lung cancer. Still, as a member of the Pap Corps, an organization that raises money for UM’s Sylvester Comprehensive Cancer Center, Seiff heard a lecture about the new screening program delivered by Dr. Tammy Baxter, a thoracic surgeon at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
“She gave a good talk and it felt like she was talking to me. I was sure
she was talking to me,” Seiff said. “I came home and said to my husband, ‘I should take this scan.’ I was in such denial. I had had a chest X-ray six months earlier that showed nothing. But this low-dose CT scan will pick up cancer at its earliest stages. Lung cancer doesn’t show its ugly little face until you’re in Stage 3 and coughing up blood. There are no symptoms.”
She met again with Baxter, this time in the doctor’s office. And this time, this simple test, which takes less than five minutes to administer, found something: Cancer.
Seiff had surgery on April 18. Baxter removed the upper right lobe of her right lung.
“I came out of the hospital, went to a luncheon that same day, went to get my hair done because that’s what women do,” Seiff said. “My life went on. She took me off oxygen and I haven’t looked back. I’m back to my golf and living my life.”
For Baxter, Seiff’s story is uplifting.
“My hope is we’ll start saving lives,” Baxter said, noting that 250,000 patients were diagnosed with lung cancer in 2010, the most current year for statistics from the American Lung Association.
The CT screening is a major breakthrough, doctors say.
“The study was stopped early because patients had such an improvement from CT scans, they thought it was unethical to just offer chest X-rays when they realized CT was so much better,” Baxter said.
The American Lung Association and American Society of Thoracic Surgeons, among others, recommend the test. Most insurance companies aren’t on board yet for the $350, five-minute outpatient test, but the medical community predicts the cost will soon be covered within the next year or so. “Insurance companies figure if we catch it early we can cure you and send you back to your jobs,” Baxter said.Robotics and GPS
The medical community is also excited about using GPS in patients diagnosed with lung cancer and in working with robots that allow surgeons to reach into previously inaccessible parts of the body.
Jonathan Muniz was, by all accounts, a healthy 16-year old boy. The Coconut Creek High School student had just completed 10th grade and was standing in line with his mom, registering for college-level classes for a dual enrollment program in mid-June, when he started breathing heavily.
His mother took him to his pediatrician who could barely hear him breathe from his right lung. An X-ray in the emergency room at Coral Springs Medical Center revealed a white mass in the lower part of his right lung.
“My heart dropped. My 16-year-old has lung cancer,” Elizabeth Muniz recalled.
Because the tumor was in a tricky spot, surgeons feared he could “bleed out” if traditional means were used to extract the mass. His mother was initially told the cancer was inoperable, she said.
Jonathan was airlifted to Miami Children’s Hospital and spent six days there on an incubator after his lung collapsed. Doctors looked for a surgeon skilled in robotics and found Dr. Mark Dylewski, Baptist Health South Florida’s medical director of robotic surgery.
Dylewski agreed to perform the surgery on a Tuesday at South Miami Hospital and removed the upper part of his right lung. By Friday, Jonathan was able to go home.
“He is breathing just fine, doing his regular activities, walking around,” Muniz said. “You would not think this kid had had major surgery and all he had was three small incisions by his tummy area on his right side. That’s it.2/3 of his lungs by being able to do this surgery.”
Robotics have been used for various medical procedures since the late 1990s but hadn’t been utilized for lung or chest surgery until 2010, Dylewski said.
“Thoracic surgery is going through a paradigm shift,” Dylewski said. Traditional lung surgery can inflict trauma to the body when the chest and its muscles are cut and the rib cage is split. Less trauma means reduced risk and quicker recovery time.
To perform Jonathan’s surgery, Dylewski made three small incisions, about eight millimeters in size, near his chest area to create a port. The da Vinci Surgical System’s robotic arm, basically a small stick, goes into the port into the body cavity and acts as a human hand.
“It’s intuitive. Behaves the way you want it to behave,” Dylewski said. “When using conventional video-assisted surgery, if you want to move your hands to the right, you have to move left. Many surgeons can’t adjust to that counterintuitive movement. Within the next five to seven years we will see a much more robust percentage of surgeons doing robotic surgery.”
Almost 70 percent of patients treated with this procedure can leave the hospital within three days after surgery and 35 percent can go home the next day, Dylewski said.
Similarly, GPS technology, using a forceps or needle probe, has proven useful in obtaining biopsy samples of nodules in the lung that often can’t be reached by radiologists through other means. The device, connected to a computer, is inserted through a patient’s windpipe and guided by GPS toward the nodule. The system creates a three-dimensional image of the lung as the patient reclines on a special gurney on a pad using an electromagnetic field.
“The computer tells us turn right, turn left, and you are there, like GPS,” said Dr. Mark Block, chief of cardiothoracic surgery for Memorial Healthcare System in Hollywood. The system can be used for biopsies and can also be paired with a cyber knife, a sort of laser beam, to target a nodule. The risk of piercing the lung is reduced.
“If the patient is breathing, the lung nodule is moving. It’s hard to hit a moving target. This uses a tiny piece of gold metal placed close to the tumor into the lung and that’s easily detected by the cyber knife, which can track the gold pieces and move on to target the tumor,” Block said.Honey, drugs
If you must face chemotherapy or radiation to treat lung cancer, a new study using Manuka honey, a specially formulated honey from New Zealand and Australia, is under way at Mount Sinai Comprehensive Cancer Center in Miami Beach. The study aims to determine whether this type of honey can prevent inflammation in the esophagus in patients with lung cancer who are undergoing chemo or radiation.
“It’s absolutely amazing and on the cutting edge of treatment,” said Dr. Laurie Blach, radiation oncologist at Mount Sinai Medical Center. “This is using something that was used for hundreds of thousands of years and taking it back into the clinic to reduce the side effects of treatment.”
The organic honey, unlike traditional store-bought varieties, has antibacterial and antifungal properties that could reduce the chance of getting infections in the esophagus and could potentially improve pain and discomfort, Blach said. The product is taken by mouth as a spoonful, four times daily. Tailored treatments
The continued study of gene mutations will lead to new drugs to personalize lung cancer treatment.
“In the past two decades, pretty much every patient was treated in the same way, but now we can identify very specific changes in the makeup of their tumors and this can allow us to use specific treatments and this will continue to grow,” Lilenbaum said.
Lilenbaum anticipates new drugs will come on board within the next five years to target these identified mutations. “One day someone diagnosed with lung cancer will have complete genetic analysis of the tumor and we’ll have drugs to attack the mutations that lead to the development of cancer. It’s very promising.” Follow @HowardCohen on Twitter