Lung cancer: early diagnosis leads to better targeted treatment
Despite the fact that lung cancer is such a large-scale problem the disease has previously been partially overlooked by the research community says Johan Staaf, associate professor at the division of Oncology and Pathology and, together with colleague Maria Planck, project manager of the research group for lung cancer at Lund University.
“However, this is about to change”, says Johan Staaf. “There is currently a big push in lung cancer research and it may be the area of oncology where most things have happened in the past few years.”
A large part of Maria Planck and Johan Staaf’s research is based on the mapping of lung cancer’s genome (set of genes) and developing molecular methods of diagnosis. This is because lung cancer is not one, but many different diseases which, among other things, is categorised by what the cancer cells look like and what their origin is in the lung tissue.
The goal is being able to make an early diagnosis of this type of cancer and to decide which treatment should be put in place. It is therefore important to understand what is happening in the genetic material, the DNA, when the cells become cancer cells.
“By collecting tumour tissue and blood tests from many different patients with lung cancer who are receiving a particular kind of treatment we hope to be able to see connections between the type of tumour, the treatment and how the patient is responding”, says Maria Planck, also an associate professor at the division of Oncology and Pathology at Lund University.
Aided by the blood samples which are taken throughout the treatment, researchers can follow patients over a long period of time.
“It is a very important future piece of the puzzle for us to understand what happens in the bodies of patients”, says Johan Staaf. “We can even study how the cancer cells react to the medicines and develop resistance to certain drugs.”
Significant research focus lies on increasing knowledge of the reasons behind the development of the disease. The fact that smoking is the most common cause has been known for a long time – the connection was made way back in the fifties. And it is precisely for this reason, says Johan Staaf, that there has not previously been much research on the disease. What causes it and the treatment methods available have not received the same level of media attention as, for example, breast cancer.
“However, of those affected 10 to 15 per cent of patients have never smoked”, says Maria Planck.
In other words, smoking is not the only cause. Researchers are unsure why these people develop the disease, but contributing factors may be, for example, air pollution and other environmental factors. Radon exposure has even been viewed as a possible cause and new results point at there being hormonal explanations.
Given that the average age of the patient group of non-smokers is often lower than among smokers, who often become sick around seventy years of age, researchers are also studying whether there is an underlying genetic cause.
Historically, the prognosis for a patient affected by lung cancer was very poor since most patients are diagnosed when the disease has already managed to spread to other parts of the body.
“The disease has often been present for a long time before symptoms occur”, explains Maria Planck. “These are then often mistaken for signs of other common and less serious diseases such as influenza or the common cold.”
Of all diagnosed cases of lung cancer only around twenty per cent are operable – in many cases there are too many medical complications for it to be possible. The five year survival rate for those affected is around fifteen to twenty per cent and the risk of relapse is very high.
Three main groups of treatments are used for the majority of patients with metastatic lung cancer: cytostatics (chemotherapy), immunotherapy and a type of targeted treatment which targets a specific defect in the cancer cells to fight the cancer.
In order to administer this specific treatment effectively it is an advantage to know which change or changes to the genes in the patient are behind the cancer since some treatments may not be effective if administered to the wrong patient. The research being conducted in Lund has contributed to making this process more reliable.
“With targeted treatment we are now beginning to see positive results”, says Maria Planck. “We now have a completely new group of patients comprising long-term survivors even in patients where the cancer has spread – something which is indicated by, among other things, patient associations becoming bigger and stronger.”
For lung cancer patients it is therefore vital to be able to determine the type of cancer quickly in order to be able to take appropriate action. Receiving a quick diagnosis and the right treatment can make a big difference to the outcome of the disease.