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Lung cancer remains the most deadly, but not always caused by cigarettes.



This is a classic that can be faked. And besides, it is discriminatory: “a tumor in the lungs? Of course, he smoked everything …! Who has not heard such phrases? As it turns out, 25% of lung cancers (yes, in the plural, because they are not all the same) suffer from smoking. And in the group that did not even touch tobacco, it represents the seventh cause of death.

“Among people who use wood burning for cooking, which is common in countries like ours, some lung cancers are diagnosed,” the oncologist explained. Luis corrales, from the Center for Research and Management of Cancer in Costa Rica. They are also caused by radiation, inhalation of chemicals and hydrocarbon gases and asbestos (asbestos). " Corrales was one of the trainers at the Pfizer Academy for Journalists in Lung Cancer, conducted by Pfizer in Buenos Aires. He was responsible for presenting the panorama of the disease in the region and the challenges it poses, which are many, because lung cancer is still the most deadly cancer.

There is good news in this harsh environment: affordable treatment allows for a large number of cases, depending on what type of cancer is being treated, more time and a better quality of life.

oncogenesis

Let's explain: smoking is not the only reason, but the main reason that can be avoided; it was already clear in 1950. Oncogenesis is not so much due to tobacco itself, but rather from mutations that it causes in cells (in this case, the lungs, but it is not the only organ that suffers from the consequences) of combustion at high temperatures. Corrales emphasized that the substances that secrete tobacco, its additives and paper.

“These mutations can contribute to uncontrolled cell division and tumor development,” he said. And one of the first regional data is ours: mortality is higher among Hispanics.

But thanks to molecular biology, he added that we know that for a long time it was considered an isolated disease associated with smoking, much more complicated and caused by various genetic changes.

“We can classify lung cancers into two large groups. First, there are small cell lines (SCLC), more frequent in men, which are strongly associated with smoking and with rapid growth, ranging from 15% to 20% of cases. "

“For them, for a long time, there was only surgery and chemotherapy. But great progress has been made in the field of immunotherapy, which in our country is in the process of approval by the National Administration of Medicines, Food and Medical Technologies (Anmat), which was emphasized at the seminar Diego Caen, Head of Oncology Hospital School and Clinic of the National University of La Rioja, who managed to understand the understandable technical problems of molecular testing.

“The other 80%, non-small cells (Cpcnp), are divided into adenocarcinoma (85% of cases) and others. Well, 35% of patients with adenocarcinoma are not smokers, ”Corrales insisted. He added that 4% of these tumors develop in children under 40 years of age.

Problems

The most difficult is early diagnosis; In fact, lung cancer is still called “silent killer” because the symptoms are similar to those of other respiratory diseases (a cough that lasts three weeks or more, chest pain, shortness of breath, flu-like conditions that take a long time to improve, even with antibiotics, nosebleeds), and the query takes a long time. That's why medical control is important before any suspicion: I hope this tells us that this is just rebellious bronchitis! (See "X-ray …".)

If the tumor is detected at an early stage and surgically removed without spreading it, it can be treated and cured. But this is a minority (only 10%): as reported Kaen, in Argentina in most cases, is found in phase III, when it is not curable.

“But this does not mean that there are no answers. Until 2014, when the doors to the new paradigm were open, we only had chemotherapy. Now, molecular testing of tumors allows formulating targeted treatment methods to improve the survival of groups of patients with metastatic disease, ”he said.

Precision Medicine

It is about going directly to the heart of the tumor or helping the immune system to recognize cancer cells. And so instead of attacking every rapidly reproducing cell, even healthy ones, such as chemo, can block their growth and spread, interfering with the action of certain molecules, called “molecular targets,” that they activate them, explained Kahen.

“Knowing and understanding the characteristics of various tumors before starting treatment allows them to be much more effective,” said Corrales. And although it is not cured, in many cases the disease can be controlled for many years (in the 1980s and without any treatment) with much fewer symptoms and a good quality of life.

Target therapy

Knowing the tumor, first of all, knowing what the type of tumor is, and what are the associated mutations. And besides, remember that a tumor cannot be homogeneous, on the one hand, and that it can mutate, on the other hand, so it is necessary to control it during treatment to make sure that it is still effective (see Liquid Biopsy). It's good that in many cases, if one treatment stops working, there are others to try to replace it.

“One of the most frequent mutations is EGFR. It is a protein that helps them grow and divide from the surface of cells. When EGFR mutates, cells grow faster, ”added Corrales. In these cases (more often in women, young people under 40 and non-smokers), EGFR inhibitors can enter and block a signal that activates cell growth. "

“In Argentina, the EGFR mutation occurs between 15 and 20% of cases of this type of cancer,” said Cahen. And one of the great advantages of these treatments is that they are pills that are taken at home and normal life. ”

There is another 5% Cpcnp in which the ALK gene is found to be mutated, which causes it to generate a protein that over-stimulates the growth of malignant cells. Available treatments (also pills) can even be used instead of chemotherapy, significantly improving the quality of life.

Security enhancement

Another new alternative is immunotherapy. In a normal cellular process, T-lymphocytes (a type of white blood cells) identify tumor cells and eliminate them. Our body does it all the time. But they learned to outwit the system.

“Imagine that tumor cells have a“ mask ”that hides them, and then the lymphocytes remain just as relaxed. The treatment blocks the receptor, which makes the “mask” possible and makes the tumor cell visible to the immune system, ”Corrales explained.

Substances produced by the body or manufactured in the laboratory, such as monoclonal antibodies, which can work by strengthening the immune system, and also by stopping or slowing the growth of cancer cells or preventing their spread to other parts of the body are used (see "immunotherapy").

> Women's perspective | | The second cause of death in the world
Although the overall probability of a woman developing lung cancer throughout her life is 1 to 17 years, the numbers vary, and the disease increases among the female population. In Argentina, according to the National Cancer Institute (INC), the prevalence of the disease is still much higher among men (68.45% for them and 31.55% for women), but this is particularly alarmingly an increase in mortality from this type of cancer in women. Globally, it is the second most common cause of death among them, especially because they are more often used to smoking. In contrast, women seem to benefit from a more pronounced reduction in the risk of developing a tumor after they quit smoking.

> Immunotherapy | | | We will tell you which monoclonal antibodies and how they work
These are molecules produced in laboratories, designed to be used as antibody substitutes and capable of restoring, improving, or imitating the attack of the immune system on cancer cells. They are designed to bind to antigens that tend to be more numerous on the surface of cancer cells than in healthy ones. Various antibodies of this type can detect cancer cells, destroy their membranes, block their growth or attack them. They can also block immune system inhibitors and are able to take radiation therapy and chemotherapy into a tumor cell. They are administered intravenously, and the frequency depends on the type of cancer and the medication taken.

> X-rays do not reach | | If you can not leave fluff, please ask “Unfortunately, a massive screening strategy is not possible to detect the disease in people without symptoms,” Diego Cahen admitted. but at the very least, smokers should ask their family doctor to supervise. ” The fact is that not all management is useful: “it is proved that radiography does not work. We need a special tomography with a low density, ”he added and included people with a family history at risk. Smoking cessation reduces precancerous lesions and reduces the risk, but remains important for many years after leaving, so control should be the rule even if you no longer smoke.


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