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Lung cancer is still the deadliest, but not necessarily caused by cigarettes



It's classic, which can be fake. And besides, it is discriminatory: "the tumor in the lungs? In fact, he smoked everything …!" Who did not hear phrases like this? As it turns out, 25% of lung cancers (yes, plural because they are not all the same) suffer from non-smoking. And in the group that did not even interfere with tobacco, it is the seventh cause of death.

"There is a certain amount of lung cancer diagnosed among people who are using firewood for cooking, which is widespread in countries like ours," the oncologist explained. Luis Corrales, from the Costa Rican Cancer Research and Management Center. They are also caused by radiation, inhalation of chemicals and hydrocarbon gases and asbestos (asbestos). "Corrales was one of the academy academics for lung cancer journalists conducted by Pfizer in Buenos Aires, who was responsible for displaying the disease's panorama in the region and the challenges it poses, which is a lot because lung cancer is still the most deadly cancer.

In this difficult environment, there is good news to provide: the available treatment methods allow in many cases, depending on the type of cancer being treated, more time and a better quality of life.

Oncogenesis

Let's find out: smoking is not the only reason, but the main reason that can be prevented; it was already clear in 1950. Oncogenesis is not only due to the fact that the tobacco itself itself, but also the mutations that it causes in the cells (in this case, the lungs, but not the only organ that suffers from the effects), high temperature combustion, and substances that release tobacco at that time, its additive and paper, stressed Corrales.

"These mutations are capable of promoting uncontrolled cell division and tumor development," he said. One of the first regional data is ours: Between Latinos, mortality is higher.

But thanks to the development of molecular biology, he added: we know that it is long been considered that the smoking-related isolated disease is much more complicated and caused by different genetic changes.

"We can classify lung cancer in two large groups, in the first case there are small cell lines (SCLCs), more often in men who are very closely involved with smoking and rapidly growing, ranging from 15% to 20%."

"For a long time, there was only surgery and chemotherapy. However, great progress has been made with immunotherapy approved by the State Administration of Medicines, Food and Medical Technology (Anmat) in our country, which was emphasized at the seminar Diego KaenLarry's National University Hospital School and Clinic Oncology Head, who managed to understand the technical issues of molecular testing.

"The remaining 80% of non-small cells (Cpcnp) are divided into adenocarcinoma (85% of cases) and others. Well, 35% of patients with adenocarcinoma are non-smokers," said Corrales. He added that 4% of these tumors develop in children under the age of 40.

Challenges

The most difficult is early diagnosis; In fact, lung cancer is still referred to as a "silent killer" because the symptoms are similar to those of other respiratory diseases (cough lasting for three weeks or more, chest pain, shortness of breath, flu-like conditions, which require a long time to improve even with antibiotics, bleeding from the nose), and the query takes a long time. Therefore, before any suspicion, it is important to control medical control: I hope that it indicates to us that it is just rebellious bronchitis! (See "X-ray …".)

If a tumor is early discovered and surgically exported, if it is not spread, it can be treated and cured. But they are a minority (only 10%): as reported Kaen in Argentina is most often found in Phase III, when it is not curable.

"But this does not mean that there are no possible answers. By 2014, when we opened the door of a new paradigm, we only had chemotherapy. Now, a molecular test for tumors allows formulating targeted therapies to improve the survival of patients with metastatic disease," he said.

Precision medicine

What it is, goes directly to the tumor's heart or helps the immune system to recognize cancer cells. So, instead of attacking any fast-paced cell, even healthy people, such as "chemo," can block their growth and propagation, disturbing the activity of certain molecules, called "molecular targets" that they trigger, Kaens explained.

"Knowing and understanding the properties of different tumors before starting treatment can be more effective," Corrales said. And although it is not cured, in many cases, the disease can be controlled for years (in the 1980s, trying to avoid any treatment) with fewer symptoms and a good quality of life.

Targeted therapy

Knowing the tumor means, firstly, knowing what kind of tumor it is and what the associated mutations are. In addition, keep in mind that, on the one hand, the tumor may not be homogeneous and that it is able to mutirovate, on the other hand, therefore it is necessary to control it during treatment to ensure it remains effective (see "Liquid biopsy"). The good thing is that in many cases, if one treatment stops working, there are others who try to replace it.

"One of the most common mutations is EGFR, which is a protein that helps them grow and break down from the cell surface. When EGFR mutates, the cells grow faster," added Corrales. In these cases (more often women, young people under 40 and non-smokers) EGFR inhibitors can be administered and blocked by a signal that activates cell growth. "

"In Argentina, EGFR mutation has been detected in between 15% and 20% of cases of this type of cancer," Kaens emphasized. And one of the biggest benefits of these therapies is that they are pills that are used at home and in normal life. "

There is another 5% of the Cpcnp, which detects that the ALK gene is mutated, producing a protein that stimulates the growth of malignant cells. Available treatments (including pills) can be used even at the site of chemistry, greatly improving the quality of life.

Enhance protection

The second new alternative is immunotherapy. In the normal cell process, T lymphocytes (white blood cell types) identify tumor cells and destroy them. Our body does it all the time. But they have learned to overcome the system.

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

Use substances produced by the body or produced in a laboratory, such as monoclonal antibodies that can work to strengthen the immune system, as well as by stopping or slowing the growth of cancer cells or preventing their spread to other parts of the body (see Immunotherapy).

> Women's perspective | The second cause of death in the world
Although women who develop lung cancer throughout their lives are likely to be 1 out of 17, the numbers are changing and the number of illnesses is increasing among women. In Argentina, according to the National Cancer Institute (INC), the prevalence of malnutrition remains much higher among males (68.45% for women and 31.55% for women), but it is particularly worrisome for women to increase mortality from this type of cancer. Across the globe, this is the second most common cause of death, especially as they made smoking more habits more frequent. Women, on the other hand, seem to be more likely to have a tumor risk when they have quit smoking.

> Immunotherapy | We tell you what the monoclonal antibodies are and how they work
These are molecules that are produced in a laboratory that act as substitute antibodies and are able to regenerate, enhance or imitate an immune system attack on cancer cells. They are intended to be associated with antigens that tend to be more than healthy ones on the surface of the abdominal cells. Various antibodies of this kind are able to detect cancer cells, destroy their membranes, block their growth or attack them. They can also block the immune system's inhibitors and are capable of radiation therapy and chemotherapy in a tumor cell. They are given intravenously, and the frequency depends on the type of cancer and the medication used.

> X-rays do not reach | If you can not leave the putsch, at least ask for control "Unfortunately, a massive screening strategy is not possible to detect a disease in people without symptoms," says Diego Kaens. but at least smokers should ask their family doctor. "The point is that not all controls are useful:" It has been shown that radiography is not working. We need special low-density tomography, "he added, adding that people at risk included people with family history. Smoking cuts reduce pre-cancerous damage and reduce risk, but it's still important to quit a year later, so control should be normal even if you no longer have do not see


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