More non-smokers – especially women – are developing lung cancer. Ben Medicine is leading the charge to treat them early

Perceptions about lung cancer have long been shaped by the prevalence of smoking as a significant predictor of disease, but clinicians are becoming increasingly concerned about the increasing number of cancer cases among non-smokers.

Many of these new diagnoses are the result of disease development quite different from the tell-tale signs seen in long-term smokers. Often hard to detect, they stem from a medical finding known as ground glass opacities (GGOs), which are fuzzy-looking spots in the lungs that show up on CAT scans.

“This is quickly becoming one of the biggest problems we find in CT scans,” he said Dr. Sunil Senegal, director of the Center for Microsurgery at the Abramson Cancer Center in Penn Medicine and chief of the division of thoracic surgery.

Oncologists who treat lung cancer in smokers are accustomed to seeing solid, well-defined lesions in the lungs that often have associated symptoms. In patients with GGOs, the risk level from these misty clouds in the lungs can be minimal and nothing to worry about, or it may be a sign of premalignant, slow-progressing carcinoma.

Ltd - Sunil Senegal, MD

Sunil Senegal, MD

GGOs can exist due to a number of reasons. For example, they can result from a minor cold, inhaling a harmful substance or developing pneumonia from a viral infection such as COVID-19. In most cases, the body is able to clear the infection and the GGOs usually dissipate. However, there are rare cases in which GGOs start out as small precancerous nodules that can become cancerous within five to seven years.

“For an unclear reason in the United States, non-smoking women suffer from an epidemic of crushed glass opacity that progresses to lung cancer. Scientists and clinicians don’t understand why this happens,” Singhal said.

Younger women in their twenties and thirties who have never used tobacco may have no reason to believe they have macular patches in their lungs. If years pass without detection of these spots – sometimes they are found accidentally during unrelated scans – they can become a serious and life-threatening illness.

Singhal likened the discovery of GGOs to detecting ductal carcinoma in situ (DCIS), a pre-invasive form of breast cancer that can be treated proactively through early detection. Another comparison might be the presence of colon polyps, which are often discovered during a colonoscopy. They can be monitored and removed later due to the risk of eventual malignancy.

Although computed tomography (CAT) scans are becoming more common in the United States, both women and men, especially non-smokers, with GGOs are at increased risk of being overlooked. While lung cancer patients have historically been easy to identify, they have become a much more diverse population.

“It’s a bit of a shift — because there’s a stigma in the United States and around the world that people who get lung cancer are smokers,” Singhal said. The problem you should be aware of is

Non-smoking women with cancer are among the fastest-growing types of cancer in the United States

Smokers who develop lung cancer and who have solid tumors can be treated with a combination of surgery, chemotherapy, radiotherapy, and immunotherapy. Deciding when and how to deal with GGOs has never been so easy.

For example, GGOs do not respond well to chemotherapy because pre-malignant lesions are too slow to grow to effectively target cell division. Radiation has been used in GGOs or has failed because it is often unclear which spots are likely to become cancerous, and thus difficult to determine which ones should be targeted for such intensive treatment. Also, these treatments do not provide important genetic material that can have serious downstream consequences.

“Surgery is the best way to treat these tumors,” Singhal said. “The only positive aspect of ground glass opacities is that most people who are aggressively treated with surgery are cured. One of the reasons people think lung cancer survival statistics are improving is that we are seeing more ground glass opacities as we catch them earlier. Others, we are attracting more people in the first stage.”

Singhal and his group at Penn Medicine have pioneered a new surgical method for removing GGOs that improves on a more aggressive procedure that has been a favorite of years past.

A decade ago, surgeons treating ground glass opacities believed that the best approach was to remove a large portion of a patient’s lung to prevent the spread of GGOs.

Singhal’s team
Microsurgery Center
A new imaging approach has been tested through clinical trials that enables them to visualize what is cancer and what is not cancer during the procedure. Using a special injectable dye, the surgical team gets a more defined picture of the boundaries around the GGOs that helps them more accurately determine what needs to be removed. The precision approach at Penn Medicine does not include radiation for imaging during the procedure and usually involves reduced recovery time in the hospital.

“If you have ground vitreous opacities, you can really take out small portions of the lung where the problem is, and you can leave the majority of the lung to the patient,” Singhal said. “Not only do they breathe better, but the initial data from clinical trials suggests that the survival outcomes are the best.” itself”.

The good news for patients with GGOs is that they are considered to be more treatable than the lung cancers observed in tobacco users.

Singhal is optimistic about progress in treating GGOs and hopes the pandemic will serve as a reminder to people not to neglect their health.

“Covid-19 complicates everything,” Singhal said. “People need to continue their routine medical care.”

As Senegal and his team develop new and innovative approaches to treating lung cancer, he is also excited about moving on to the latest technology. wing in the university city.

“Patient care will be better coordinated in the ward because a number of different specialist physicians will be co-located together, which is convenient for the patient and allows for frequent conversations and knowledge sharing that is not found in most places,” Singhal said. “The amenities are great and there are also more advanced tools available for personal biopsies and imaging. Expanding personalized medicine is a priority for everyone in Pennsylvania and the new building is a reflection of our progress.”


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