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Lung cancer remains the most deadly, but not always caused by cigarettes



This is a classic that can be faked. And besides that, it's discriminatory: "a tumor in the lungs? Surely he smokes everything …!" Who doesn't hear phrases like this? Apparently, 25% of lung cancers (yes, plural, because they are not all the same) suffer from non-smoking. And in that group that didn't even touch tobacco, that was the seventh cause of death.

"Among people who use firewood for cooking, which is common in countries like us, certain lung cancers are diagnosed," explained the oncologist. Luis Corrales, from the Cancer Research and Management Center of Costa Rica. They are also caused by radiation, inhalation of chemicals and hydrocarbon gases, and asbestos (asbestos). "Corrales is one of the trainers at the academy for journalists about lung cancer, carried out by Pfizer in Buenos Aires. He is in charge of presenting a panoramic view of the disease in the region and the challenges it produces, which are many, because lung cancer is still the deadliest cancer .

In this harsh environment, there is good news to give: available treatments are possible in many cases, depending on the type of cancer being treated, more time and a better quality of life.

Oncogenesis

Let's be clear: smoking is not the only cause, but the main cause that can be avoided; it was clear in 1950. Oncogenesis is not so much because of tobacco itself, but for mutations that cause cells (in this case, the lungs, but not the only organ that suffers the consequences) burning at high temperatures and substances substances which at the time were removing tobacco, additives and paper, Corrales stressed.

"This mutation is able to promote uncontrolled cell division and tumor development," he said. And one of the first regional data shared is ours: among Latin languages, mortality is greater.

But thanks to molecular biology, he added, we know that what has long been considered an isolated disease associated with smoking is far more complex and is caused by different genetic changes.

"We were able to classify lung cancer into two large groups. In the first, there was a small cell line (SCLC), more often in men, strongly associated with smoking and with rapid growth, which represented between 15% and 20% of cases "

"For this for a long time there were only surgery and chemotherapy. But major progress has been made with immunotherapy, which in our country is in the process of being approved by the National Medical, Food and Medical Administration (Anmat), highlighted in the seminar Diego Kaen, Head of the La Rioja National University Hospital's School of Clinics Oncology, who successfully understands the technical problems of molecular testing.

"The other 80%, that non-small cells (Cpcnp), are divided into adenocarcinoma (85% of cases) and so on. Well, 35% of patients with non-smokers adenocarcinoma," Corrales stressed. He added that 4% of these tumors developed in children under 40 years.

The challenge

The most difficult is early diagnosis; In fact, lung cancer is still called the "silent killer", because the symptoms are similar to other respiratory diseases (coughs that last for three weeks or more, chest pain, shortness of breath, flu-like conditions that take a long time to improve, even with antibiotics, bleeding from the nose) and the request takes a long time to arrive. That's why it's important, before there is suspicion, medical control: I hope it tells us that it's only rebellious bronchitis! (See "X-rays …")

If the tumor is detected early and removed surgically without spreading, it can be treated and cured. But they are a minority (only 10%): as reported Kaen, in Argentina most cases are detected in phase III, when they cannot be cured.

"But that does not mean there are no possible answers. Until 2014, when the door to the new paradigm was opened, we only underwent chemotherapy. Now, tumor molecular testing allows formulating targeted therapies to improve the survival of groups of patients with metastatic disease," he said.

Precision medicine

What happens is directly to the heart of the tumor, or helps the immune system to recognize cancer cells. So instead of attacking every cell that reproduces quickly, even healthy ones, such as "chemo", can block their growth and propagation, disrupting the action of specific molecules, called "molecular targets", which they activate, explained Kaen.

"Knowing and understanding the characteristics of different tumors before starting treatment allows them to be much more effective," Corrales said. And while it doesn't heal, in many cases this disease can be controlled for years (in the 1980s and no treatment was tried) with fewer symptoms and a better quality of life.

Targeted therapy

Knowing the tumor means, first, knowing what type of tumor is and what mutations are associated with it. And keep in mind, moreover, that the tumor may not be homogeneous, on the one hand, and that it is capable of mutating, on the other hand, so it is necessary to control it during treatment to see if it is still effective (see: "Liquid biopsy"). The good thing is that, in many cases, if one treatment stops functioning, someone else tries to replace it.

"One of the most common mutations is EGFR. This is a protein that, from the cell surface, helps them grow and divide. When EGFR mutates, cells grow faster," Corrales added. In this case (more often in women, young people under 40 and non-smokers) EGFR inhibitors can be given and block signals that activate cell growth. "

"In Argentina, EGFR mutations are found in between 15% and 20% of these types of cancer," Kaen stressed. And one of the big advantages of this therapy is that they are pills, taken at home and normal life. "

There is 5% of Cpcn where it is detected that the ALK gene has mutated, which makes it produce a protein that hyperstimulates the growth of malignant cells. Available treatments (pills too) can be used even in chemo sites, greatly improving the quality of life.

Strengthen defense

Another new alternative is immunotherapy. In normal cellular processes, T lymphocytes (a type of white blood cell) identify tumor cells and eliminate them. Our bodies do that all the time. But they have learned to outwit the system.

"Imagine that tumor cells have a mask & # 39; that hides them, and lymphocytes, then, remain relaxed. This treatment blocks the receptors that make up the 'mask' maybe and makes tumor cells visible to the system immunity, "Corrales explained.

Body-produced substances or produced in the laboratory are used, such as monoclonal antibodies, which can work by strengthening the immune system and also by stopping or slowing the growth of cancer cells, or by preventing them from spreading to other parts of the body (See "Immunotherapy").

> Women's perspective | The second cause of death in the world
Although in general the possibility of a woman developing lung cancer throughout her life is 1 in 17, these numbers change and this disease increases in the female population. In Argentina, and according to data from the National Cancer Institute (INC), the prevalence of this disease is still much higher among men (68.45% for them and 31.55% for women), but it is very worrying. increased mortality from this type of cancer in women. Globally, this is the second most common cause of death among them, mainly because they make the habit of smoking more often. In contrast, women seem to benefit from a clearer reduction in tumor risk after they stop smoking.

> Immunotherapy | We tell you what monoclonal antibodies are and how they work
They are laboratory-produced molecules designed to act as replacement antibodies, and are able to restore, repair or mimic an immune system attack on cancer cells. They are designed to bind antigens that tend to be more on the surface of cancer cells than healthy ones. Different antibodies of this type can detect cancer cells, destroy their membranes, block their growth or attack them. They can also block inhibitors of the immune system and are able to take radiation treatment and chemotherapy to tumor cells. They are given intravenously, and the frequency depends on the type of cancer and the drug taken.

> X-rays don't reach | If you can't leave Pucho, at least ask for control "Unfortunately, a massive screening strategy is not possible to detect disease in people without symptoms," Diego Kaen admitted. but at least smokers must ask their family doctor for control. "The point is that not all controls are useful:" it is proven that radiography is not functioning. We need special low density tomography, "he added, and include people with a family history in a risky population. Smoking cessation reduces precancerous lesions and reduces risk, but remains important for years after quitting, so control must be a rule even if you don't smoking again.


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