Lung Cancer Expert Shares Details on This Deadly Disease

Lung cancer is by far the leading cause of cancer death in the United States, accounting for about one in five of all cancer deaths. Each year, more people die of lung cancer than of colon, breast and prostate cancers combined.

While unsettling, those statistics tell only part of the story. “A little bit of good news here is that the incidence of lung cancer has been in decline for many years. And now, the survival rates are getting better,” says Baptist Health Miami Cancer Institute radiation oncologist Ana Cecilia Botero, M.D. 

Ana Cecilia Botero, M.D., radiation oncologist with Baptist Health Miami Cancer Institute

Dr. Botero, who is based at the Institute’s Plantation office, specializes in lung cancer and other cancer types. She notes that decades of research have yielded powerful advances, particularly in diagnostics, targeted therapy, immunotherapy and highly precise radiation technologies. Further improvements in lung cancer treatment are on the horizon.

“We have better tools as physicians to make an earlier diagnosis, which allows us to treat patients in a more efficient way,” Dr. Botero says.

Roughly 240,000 new cases of lung cancer will be diagnosed in 2023, according to estimates from the American Cancer Society. Lung cancer is expected to cause some 127,000 deaths this year alone, yet the survival rate – especially for patients whose cancer is caught before it spreads – is higher than ever.

In honor of the American Lung Association’s “Turquoise Takeover” Lung Cancer Action Week, which each year in May calls attention to lung cancer in hope of inspiring action to defeat the disease, an informational program was presented at the Baptist Health Wellness and Medical Complex in Plantation.

Those who attended the event had their questions answered and learned important information about this deadly cancer.

Baptist Health Wellness and Medical Complex in Plantation is home to a number of medical specialties, including cancer, cardiovascular, orthopedics and more

Q. How is lung cancer diagnosed and classified?

There are many different types of lung cancer. What’s really important is that the management of these cancers is very different based on their specifics. Depending on where in the lung a suspicious nodule is found, most patients will undergo a biopsy — either by bronchoscopy with a pulmonologist or an image-guided biopsy with an interventional radiologist.

We usually break lung cancer down into three groups: small cell lung cancer, non-small cell lung cancer or rare lung carcinoid tumors. Each kind typically has a different progression and prognosis. By far, the most common type is non-small cell lung cancer, which makes up about 85 percent of cases. Once we have a diagnosis, then we do staging, in which we figure out if the cancer has spread, and if so, how far. The stages range from Stage 0 to the more advanced Stage 4. The treatment for each of these stages is different.

Q. How do the treatment approaches differ?

Stage 0 and Stage 1 lung cancer are the earliest lung cancers. They’re usually isolated, small tumors. Most of these patients will be cured by either surgery, a surgical resection, or by stereotactic body radiation therapy (SBRT), which delivers very precise high doses of radiation to small targets.

With Stage 2 lung cancers, patients tend to have larger tumors for which surgery might not be an option initially. Some of these patients may be treated by chemotherapy with immunotherapy to reduce the size of the tumor, followed by surgery or by a combination of chemotherapy and radiation.

Stage 3 lung cancer is where we have more uncertainties. Usually, these patients are treated with chemotherapy and radiation. Some might be candidates for surgery if pretreated with chemotherapy and immunotherapy.

Stage 4 patients have more advanced cancer that has spread. The cancer may have moved to the bone, lymph nodes, spine, brain or liver. The main treatment for these patients is systemic control of the disease with chemotherapy, immunotherapy and targeted drugs. Those with limited sites of metastatic disease may benefit from local treatment to the site of metastases through surgical removal or SBRT.

Q. Is there any good news when it comes to lung cancer treatment?

Researchers are learning more about the inner workings that control the growth and spread of lung cancer cells. Molecular testing has shown us that there are different genetic drivers that fuel cancer growth, and this really has helped us target specific mutations. This has led to the availability of many new options for targeted therapy, with many more medications in development.

In some patients, depending on the genetic markers for their cancer, targeted drugs and immunotherapy can help their body fight back, evade or outsmart the cancer for years. These relatively new medications have really changed the landscape for the management of not only lung cancer but many other cancers as well.

Q. Is there a message the public needs to know?

Smoking is by far the leading risk factor for lung cancer, causing more than 80 percent of deaths. The best way to reduce your risk of lung cancer is not to smoke and to avoid breathing in other people’s smoke.

While not all lung cancers occur in smokers, people who currently smoke or who smoked in the past should ask their doctor about being screened. Early detection of lung cancer through a low-dose CT scan, which is easily available through Miami Cancer Institute.

The scans allow us to identify and treat very small nodules before they become problematic. Historically, the majority of patients diagnosed with lung cancer in the U.S. were at Stage 3 and Stage 4, which greatly impacted survival rates. With the implementation of low-dose CT scans, we’re catching more and more patients in the earlier stages – at Stage 1 and Stage 2 – when surgery can cure them.