• Screening and treatment options for early stage lung cancer have seen vast improvements over the last five to 10 years.
• New guidelines expanded screening criteria so millions more people in the United States now qualify for routine lung cancer screening.
• After lung cancer diagnosis, a series of precise scans can direct treatment to either radiotherapy or surgery.

Screening and treatment options for lung cancer have advanced remarkably over the last decade. To find out more about the latest improvements, Danielle Hicks, chief patient officer from the Go2 Foundation for Lung Cancer, recently spoke with Dr. Jonathan W. Lischalk from New York University for the foundation’s Lung Cancer Living Room series. Dr. Lischalk specializes in radiation oncology and is the medical director of NYCyberKnife at the university’s Perlmutter Cancer Center.

As the webinar began, Hicks reminded attendees, “Educated and empowered patients do better.”

Improvements in Early-Stage Lung Cancer Detection

“Since I started working in radiation oncology, there has been a dramatic improvement,” said Dr. Lischalk about the diagnosis and treatment of lung cancer. The U.S. Preventive Services Task Force provided new guidelines in 2021 outlining who is eligible for lung cancer screening.

Under the new guidelines, individuals between 50 and 80 years old with a 20 pack-year smoking history are eligible for lung cancer screening if they currently smoke or have quit within the past 15 years. A 20 pack-year smoking history means a person has smoked the equivalent of a pack per day for 20 years.

Hicks and Dr. Lischalk pointed out that the new criteria make millions more people eligible for screening.

Dr. Lischalk observed that lung cancer, like many other types of cancer, is increasing in prevalence because health care providers screen more for it now than ever before. Chest X-rays, the previous method of detection, were less effective at detecting lung cancer, he explained.

Now, oncologists use a CT scan. “[It’s] a 3-dimensional X-ray, going section by section through the lungs to identify lesions that may be concerning,” Dr. Lischalk said.

This allows your doctor to see any abnormalities in real time with greater accuracy. For individuals at high risk of developing lung cancer, Dr. Lischalk recommended “getting these scans typically on an annual basis to identify if there are areas of concern.”

What Comes After Detection?

If a preliminary lung cancer screening turns up anything unusual, your doctor would likely recommend a series of follow-up scans. This may include additional CT scans, positron emission tomography (PET) scans to look at the metabolic activity of your tissues, or MRI scans to examine cross-sections of tissue in-depth. This process can also include a biopsy, which is the gold standard to determine if a lesion is cancerous.

Dr. Lischalk reminded attendees that diagnosis is complicated and differs from one person to another. Your case is unique, and you should discuss with your doctor any concerns or questions about which steps are right for you and how to move forward.

Treating Early-Stage Lung Cancer

Treatment options for lung cancer may include surgery, chemotherapy, radiation therapy, targeted medications, and immunotherapy — or combinations of these — depending on cancer stage and other health factors.

During the webinar, Dr. Lischalk discussed radiation and surgery for early stage lung cancer. Surgery to remove a tumor in the lung is considered the best option in cases where the cancer hasn’t spread. A person may undergo radiation after surgery to treat areas of cancer left behind or before surgery to shrink a tumor.

Certain types of radiation, such as stereotactic body radiation therapy — Dr. Lischalk’s area of expertise, are used to treat early-stage lung cancers in cases where surgery isn’t possible or desired.

Dr. Lischalk described CyberKnife radiosurgery, which he said is more precise and safer than previous radiation methods. CyberKnife is a type of stereotactic body radiation therapy device that delivers precise radiation. In a treatment session, an individual would lie on a table, while the CyberKnife or a similar machine sent radiation to the site of the lesion (determined by previous scans) for 10 to 40 minutes. After the treatment, the person is free to go home.

Dr. Lischalk said, “This isn’t your grandfather’s radiation.”

Your doctor can help you understand if you’re a candidate for surgery or radiation and what the benefits and drawbacks may be. You can also discuss potential timelines for treatment with your doctor. “With lung cancer, we try to move quicker.” Dr. Lischalk said. “We try to look at weeks or months.”