Download Lung Cancer from the Radiologist`s Perspective

Lung Cancer from the Radiologist's Perspective
Brad Janson, MD
Radiologists of North Iowa, PC
Tobacco in general is responsible for huge percentage of illnesses we see in radiology and
medicine in general. From heart disease such as heart attacks, cardiomyopathy and heart
failure, neurovascular disease such as stroke, or peripheral vascular disease, which can lead to
amputations and high blood pressure, lung disease including emphysema and chronic
bronchitis, to cancers of the head and neck such as the mouth, larynx, and other cancers of the
cervix, pancreas, bladder, kidney, breast, esophagus and lung, tobacco is either partly or often
solely to blame for the illness. So because of tobacco, lung cancer is a common history given
for patients we see in radiology. We can see them from the time they are first diagnosed,
through the course of their therapy and subsequently as follow-ups are done after treatment
has ended.
There are 5 main types of lung cancer and their appearance on x-ray can be non-specific and
variable. Lung cancer starts from a single cell which must multiply over years before it is
large enough to show up on x-ray. So we may see it as a tiny nonspecific spot on a CT scan
that has to be followed to see if it grows or not, (most of these little spots we see are not
cancer) or the patient may not come in to have an x-ray until it's already grown into a large
mass, sometimes even grapefruit size. A lung cancer on x-rays can also look like a
nondescript tiny hazy density, lobulated nodule (round or bumpy shadow), and small bump on
a linear lung scar, thickening along the wall of a bronchus or along the surface of the lung
called the pleura. Sometimes it can appear as an irregular thick or thin walled cavity (air
containing nodule) in the lung. Really unlucky people can present with more than one lung
cancer at the same time in different areas.
It's the radiologists job to help the clinician make a diagnosis both by detecting the lesion and
by biopsy it if needed by imaging guidance. We can even be involved in treatment by
performing radiofrequency ablation (zapping the tumor with a heated probe) or chemoembolization (injecting material soaked with anti-cancer medication) through a needle or
catheter. Sometimes the pulmonary doctor will do the biopsy by passing a scope down the
throat into the smaller airways to get a needle biopsy of the tumor. Other times when the
tumor is smaller or is in a place they can't get at with a scope then the radiologist will pass a
thin biopsy needle into it through the skin usually using CT for guidance.
The radiologist also has to identify any other visible deposits of tumor spread elsewhere in the
body (metastases) by using x-rays, CT, ultrasound or MRI. Sometimes a metastatic deposit is
found and biopsied instead of the original tumor because it is found in a more approachable
location like a lymph node, the liver, adrenal gland, or bone, which are all common locations
where the tumor may spread. The 5 year survival rate for lung cancer is just 16% on average,
53% if localized to the lungs and just 3.5% if there are metastases outside the lungs. Over half
die within the year of being diagnosed. Non-smokers have a 20-30% greater chance of
developing lung cancer if they are exposed to secondhand smoke at work or at home.
It's always amazing to think about how much tobacco has and will continue to cost us in
medical care and in lives lost. It's probably played a role in at least half all the diseases we
see in the hospital. And with all the knowledge out there about its proven adverse effects, you
have to shake your head and wonder why people still smoke. Smoking causes 99% of all lung
cancers. Lung cancer is the leading cancer killer of both men and women. It causes more
deaths than the next three cancers combined (colon, breast and prostate). 106,000 died from it
last year, or about 400 full airliner crashes. It's gotten to the point where there are no more
excuses. It's a disease largely preventable if people would just stop using tobacco. Let the
farmers grow food instead. If you get it though, we'll take good care of you here at Mercy,
and only blame the tobacco companies.