Lung cancer is one of the most common and aggressive oncological diseases. According to the latest data of the Lithuanian Institute of Hygiene , about one and a half thousand new cases of lung cancer are diagnosed in our country every year, and even about 1300 of those who get sick from this disease die. More about this disease, its risk factors and the latest methods of treatment are told by the Lithuanian University of Health Sciences Hospital (LSMUL) Kaunas Clinics Doctor pulmonologist, oncologist-chemotherapist prof. Marius Žemaitis, head of the Thoracic Oncology and Interventional Pulmonology Sector of the Thoracic Oncology and Interventional Pulmonology Sector of the Pulmonology Clinic, and dr. Aurimas Mačionis, Head of the Sector of Minimally Invasive Radiological Procedures (MIRP), doctor radiologist.
The main cause of the disease is smoking
According to prof. M. Žemaitis, more than 90 per cent. lung cancer cases are caused by smoking. According to historical sources, at the beginning of the last century, this disease was extremely rare, and the global, to this day, ongoing lung cancer pandemic began along with the popularity of smoking. In the past, many more men than women contracted lung cancer, and this was associated with a higher prevalence of smoking among men. However, at present, due to the increasing number of women smokers in the Countries of the European Union, the death rate of women from lung cancer is already on a par with the mortality rate from breast cancer. It has been scientifically proven that the only effective lung cancer prevention measure that helps reduce the likelihood of developing or prevent lung cancer is to give up smoking
However, the professor notes that the risk of lung cancer is also increased by passive smoking, air pollution, work or contact with radon gas, asbestos (a substance used in industry, shipbuilding and buildings until the 1970s), other chemicals, concomitant lung diseases (by the way, also caused by smoking), heredity. Most often, lung cancer affects people aged 60-70 years, but in clinical practice it is not uncommon to encounter younger patients – 50-55 years old.
“When it comes to preventive screening for lung cancer, it is believed that in order to diagnose the disease even before its first symptoms appear, you should start screening from the age of 50-55. It is worth noting that a cancer plan has been published in the European Union, with a strong focus on the early diagnosis of lung cancer. There are certain guidelines that indicate that a screening of lung cancer should be introduced in all countries of the European Union, allowing the disease to be diagnosed earlier when it can be treated,” says the doctor pulmonologist.
Lung Cancer Treatment Options
Prof. M. Žemaitis says that the tactics of lung cancer treatment and the prognosis of the disease depend on its spread. The most effective – surgical treatment can be applied after the diagnosis of lung cancer in the initial stages. For this reason, early diagnosis of the disease, carried out using the latest technologies – from positron emission tomography, bronchoscopy of electromagnetic navigation to the most complex pathological and molecular research methods – is of particular importance.
In the presence of advanced lung cancer, combination or systemic therapy is applied. Therefore, when providing assistance to lung cancer patients, the principle of a multidisciplinary team is of particular importance. This year, a thematic group on thoracic tumors was established in Kaunas Clinics, which unites doctors pulmonologists, oncologists, chemotherapists, oncologists radiotherapists, surgeons, pathologists, radiologists, geneticists, rehabilitologists and specialists in other fields who seek to ensure the best oncological care for lung cancer patients or those suspected of this disease. The sector of minimally invasive radiological procedures is focused on the sustainable treatment of oncological patients.
“If only toxic chemotherapy was used a dozen years ago, then currently cancer is being treated with target therapy, which acts on certain molecular targets on tumor cells, but does not damage healthy cells. Target therapy in selected patients increases life expectancy, delays the progression of the disease and is significantly better tolerated compared to standard chemotherapy. Immunotherapy is also used to treat lung cancer, which helps to restore the human immune system, activate immune cells so that they themselves begin to fight lung cancer. The results of treatment with these methods are really encouraging. If earlier after chemotherapy treatment, the five-year survival rate was only a few percent, then after treatment with the new generation of methods it reaches about 30 percent,” says prof. M. Žemaitis.
Innovation in lung cancer treatment – thermal ablation
According to Dr. A. Mačionis, in addition to the already mentioned methods, the arsenal of modern lung cancer treatment options has been replenished with local destructive therapies: microwave ablation and cryoablation. These innovative and effective methods are used both in the treatment of primary lung cancer and in metastatic lung disease, when surgical treatment is impossible or risky due to possible complications, concomitant diseases or insufficient respiratory function of the patient.
“These are minimally invasive operations without an incision, during which special needles are introduced into the tumor through the skin and it is exposed to heat or freezing. In this way, the structure of the tumor is disrupted, as a result of which it becomes non-viable. These operations allow you to maximize the preservation of lung tissue and preserve respiratory function,” says the radiologist.
According to Dr. Aurimas Mačionis, thermal ablation operations are very well tolerated. The very next day after treatment, patients are released home, their working capacity is quickly restored, so people can return to their usual daily activities. Treatment of several malignancies can also be performed during one operation, and complications after these operations are extremely rare.
According to the Head of the Sector of Minimally Invasive Radiological Procedures, microwave ablation or cryoablation can effectively treat low-prevalence stage I lung cancer or metastatic lung disease, where the malignant disease is stopped through systemic treatment, and the goal of ablation is to finally destroy the remaining metastatic foci of the disease.
Dr. A. Mačionis points out that ablation of malignant tumors is most effective when their diameter is up to 3 centimeters. Meanwhile, larger tumors adjacent to dangerous structures in the central part of the lung should be treated by choosing other alternatives, for example, stereotactic radiation therapy, etc.
The radiologist says that digital technologies and artificial intelligence navigation systems help to perform the next generation of operations faster and more accurately. Thermal ablation operations are performed under the control of a computed tomograph, and with the help of a navigation system, the amount of X-rays permissible for the patient when scanning it is significantly reduced.
Direction of modern medicine – minimally invasive methods
“The direction of modern invasive medicine is methods that traumatize the patient less, the main goal of which is to achieve the same or better therapeutic effect, but to reduce the risk of complications and restore the patient’s working capacity faster. International clinical studies have shown that local destructive therapy using microwave ablation and cryoablation is an effective and safe method of lung cancer treatment, when surgical treatment is not possible. It has also been recognized that these treatment methods are effective, safe and sparing lung tissue in the treatment of metastases of malignant tumors of other organs in the lungs,” A. Mačionis emphasizes at the end of the conversation.
