Renewed Hope for Lung Cancer Cure

Lung cancer is a debilitating disease that may seriously affect a patient’s life. About 90% of lung cancer patients die within the same year of diagnosis. Each year, lung cancer causes higher mortality rate in both women and men worldwide. Tobacco is confirmed to be one of the risks factors for lung cancer, in addition to factors including environmental carcinogen exposure.

Common Types of Lung Cancer

There are two common types of lung cancer, namely small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).

A) Small Cell Lung Cancer

As small cell lung cancer is still very small in size, it can only be viewed under microscope. Smoking is by far the greatest risk factor and it’s rarely for non-smokers to develop this type of lung cancer. These cancerous cells can spread very quickly and often fast-growing.

B) Non-small Cell Lung Cancer

There are generally three main types of non-small cell lung cancer. (1) Adenocarcinoma: This cancer has become very common nowadays. It develops from the cells that produce phlegm (or mucus) in the lining of the airways; (2) Squamous cell carcinoma: This is another common type of lung cancer which develops within the cells that line the airways. Smoking is identified as its main risk factor; and (3) Large cell carcinoma: This cancer is characterized by features of rounded and large cells that can be seen when it is examined under the microscope.

Bronchioloalveolar cell carcinoma (BAC) of the lung is a subtype of adenocarcinoma that spreads in the lung, causing excess sputum production and shortness of breath. BAC is a form of NSCLC that is often considered to be resistant to chemotherapy.

First Warning Signs of Lung Cancer

At the early stage, lung cancer proceeds with no symptoms until it has reached refractory/advanced stage (stage 3-4). The final stage of lung cancer is also the stage when treatment is least likely efficient.

There is still no reliable screening test to detect lung cancer at its early stage. Imaging tests including CT (computer tomography) scans, X-rays and examination under the microscope of cells in the sputum are common tests used to diagnose lung cancer and to examine to what extent it might have spread. Besides that, bronchoscopy (passing a tube into the airways to examine the tissue) may also be performed to diagnose lung cancer.

Even though lung cancer does not usually have symptoms at its early stage, the following may indicate symptoms that may eventually appear as the cancer progresses:

• Persistent coughing or a cough that hardly goes away
• Loss of appetite
• Weight loss
• Fatigue
• Hoarseness or wheezing
• Recurring/repeated infections like pneumonia or bronchitis
• Shortness of breath
• Chest pain
• Fever without a known reason
• Coughing up blood
• Bloody or rust-colored sputum (like phlegm or spit)

Stages of Lung Cancer

A) Staging of Non-small Cell Lung Cancer

Non-small cell lung cancer or NSCLC is divided into 4 stages as follows:

Stage 1: Cancer present only in the lung. The size of cancer may either grow larger than 3cm or no larger than 3cm in size.

Stage 2: Cancer has spread to the nearby lymph nodes

Stage 3: Cancer has spread to nearby tissues, e.g. to the chest wall or tissues around the lung near to where the cancer started including the covering of the lung (pleura), the middle of the chest (mediastinum) or other lymph nodes near to the affected lung.

Stage 4: Cancer has spread to other parts of the body, e.g. to the liver, brain or bones.

B) Staging of Small Cell Lung Cancer

There are only 2 stages in small cell lung cancer or SCLC. Doctors could not see any spread of the cancer on your scans as the cancer cells are still small in size and have often not spread outside the lung at its earlier stage. Below are the two stages of small cell lung cancers:

Limited disease: Cancerous cells can only be seen in one lung or in the lymph nodes in the same side or in fluid around the lung (also called a pleural effusion).

Extensive disease: Cancer has spread outside the lung, either within the chest or elsewhere in the body.

Treating Lung Cancer

Based upon the stage, size, and type of tumor, an appropriate treatment is given. In treating lung cancer, doctors may introduce using chemotherapy (use cytotoxic drugs to kill cancerous cells by disrupting growth of cancer), surgery as well as radiotherapy (use high energy X-ray radiation to kill cancerous cells).

Surgery is always the most common form of treatment for NSCLC used to remove the tumor, especially in a condition that the cancer has not spread to other parts of body or the cancerous cells are still small in size. In case the cancer has spread surgery is impossible, so chemotherapy and radiotherapy are two suggested treatments (they may be used alone or in combination) to help reduce the size of the tumor and thereby controlling the symptoms. Chemotherapy is used to treat advance stage of NSCLC even though radiotherapy may be introduced to aid in the palliation of disease-linked symptoms.

As anti-cancer (cytotoxic) drugs used during the treatment of chemotherapy can be harmful to a variety of organ systems, and chemotherapy can create numerous unpleasant side effects. Another problem with chemotherapy is that it may cause negative effects of fatigue, dehydration, bleeding or bruising, sore mouth, anemia, nausea and hair loss. Also, chemotherapy can kill non-cancerous cells such as those cells of the gut lining and the bone marrow. The other downside for chemotherapy is that cancerous cells can be resistant to the drugs making the treatment unsuccessful.

EGFRs Drug Renews Hope for Lung Cancer Patients

The ongoing research with many clinical trials being held has finally improved cures for lung cancer patients with the discovery of a new class of anti-cancer drugs called epidermal growth factor receptors (EGFRs). This drug has been approved by over 20 countries for the cure of advanced NSCLC including Korea, Japan, USA, Canada and Australia and is available as a once-daily 250mg oral drug. This medication is also resistance to other therapies and is currently being regulatory reviewed by numerous regulatory authorities worldwide for its treatment of advanced stages of NSCLC.

EGFR has marvelous efficacy in comparison to doublet chemotherapy that can definitely improve the quality of lung cancer patients’ life. It helps stabilize the cancer by means of disrupting the progression of cancerous cells. The second benefit of EGFR is that it causes the shrinking of tumor, and thirdly, it enhances the tolerability of treatment. Many clinical trials have shown its safety, tolerability and efficacy as compared to chemotherapy. As such, EGFR promises the lung cancer patients with the freedom to perform their daily activities which would otherwise be unattainable while the patients are treated with ongoing cytotoxic treatment. Additionally, EGFR drug works by “erasing” the growth signal within the cells to inhibit tumor progression, the side effects are significantly reduced as compared to cytotoxic treatment which kills both cancerous and normal cells.

What are EGFRs? They are receptors that have a large protein that straddles cell membranes. They consist of a transmembrane domain, an extracellular binding domain and an intracellular domain that primarily consists of an enzyme called tyrosine kinase (TK).

The EGFRs work by allowing epidermal growth factor (EGF) which is a particular protein present in the body to attach to them. When EGF is binding with growth factors to the extracellular domain of EGFR, this process activates the tyrosine kinase enzyme by initiating an extracellular cascade of complex signaling pathways, which in turn transmits the message proliferate from the cell membrane via the genetic material deep into the cell nucleus. The signal then tells the cell to mutate. The EFDR medication works by preventing this signaling pathway which is a pathway for cancerous cell to grow and even mutate into a tumor. When drugs like EGFR antagonists attach themselves to the EGF receptor on the cell, they can block the activation of TK by effectively switching off the growth signal within the cells and this can help stop the cancerous cells from growing and mutating into a tumor so quickly.

The side effects with EGFR are significantly reduced as it can distinguish between normal and cancer cells and thereby having mild and reversible effects. The known effects are diarrhea, rash or acne.

Most importantly, EGFR shows mutation positive tumors among patients with longer survival rate without cancer progression than traditional cytotoxic-treated patients. That means the lung cancer patients now have a better option that provides considerable relief and higher survival rate, not only from the harmful effects of chemotherapy and cancer progression, but also with a better quality of life and the freedom to pursue certain activities which would not be attainable while undergoing doublet chemotherapy.

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As usual, stay well and healthy!