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How they cause lung cancer

How they cause lung cancer

When you hear the word “genes,” you can think of the ones you inherited from your parents. But again, genes and lung cancer if they are linked, the few known genes may transfer a greater chance of lung cancer from parent to child.

“We don’t see them [people] very often, for the most part [people] they have no hereditary cause of lung cancer, ”says Kerry Kingham cancer Genetic advisor at Stanford Health Care.

He says there are some exceptions. When multiple members of a family have a lung cancer with no obvious external cause (e.g. smoking), you may see a genetic counselor.

“But even in those [people], we don’t often find the cause. ‘

Only about 1% of these cases show hereditary mutations.

“And when we find hereditary mutations and are able to test other family members, there’s no good guideline that doesn’t tell us what to do without being examined in detail,” Kingham says.

He says it is much more important to test cancer cells.

A more ordinary tie

Small pieces of previously healthy genetic material (which your doctor may call “proteins”) lungs tissue cells can be altered or “mutated” to form cancer cells. As cells divide, these changes, or “mutations,” continue to be transmitted to new cells that form tumors.

Doctors do not know what causes these mutations. But you don’t inherit them from your parents and you can’t pass them on to your children. It’s not your fault if you get it. These mutations “just happen,” Kingham says. They’re not done or done for something you didn’t do.

“It simply came to our notice then. It’s not what you ate. For most people, it’s not because you’ve looked at the moon badly or because you’ve lived an unhealthy lifestyle, ”he says.

“Sometimes cells make mistakes when they break down.”

When gene testing is most important

Some lung cancer gene mutations can help doctors come up with a treatment plan. Doctors call these mutations “biomarkers”.

Heather Wakelee, MD, thoracic oncologist, professor and head of the Division of Medical Oncology at Stanford University, director of the Stanford University Medical Center, are important biomarkers of lung cancer that are important to understand and treat differently.

EGFR (epidermal growth factor receptor) is probably the most common. 10-15% of non-small cell lung cancers are EGFR positive, which is a mutation in the EGFR gene.

It’s what doctors call a “driver mutation,” which is the reason for having cancer. This mutation occurs in some people with lung cancer, such as:

  • Smokers
  • Women
  • People with Asian or East Asian heritage
  • Those with lungs adenocarcinoma (a type of lung cancer)
  • Young adults with lung cancer (half of these cases are EGFR positive).

Wakelee says everyone with a diagnosis of small cell lung cancer (NSCLC) should take the EGFR test, not just those in those high-risk groups.

“It’s really critical to test every small cell lung cancer tumor with EGFR, regardless of the stage,” he says.

And not just for the EGFR. There are at least seven more biomarker genes that your doctor should test if you are diagnosed with lung cancer.

They are:

  • ALK
  • ROS1
  • MET
  • BRAF
  • NTRK
  • HER2

Each takes up to 5% of NSCLC cases.

The reason these tests are so critical for people with NSCLC is that they were designed by scientists cancer therapies for tumors with these particular gene mutations.

“If we find a tumor mutation, we can treat it better medications – drugs that are often better tolerated are more effective, “says Wakeleek.” That’s true now in eight different genes, so it’s very important to test tumors before starting treatment, whenever possible. “

In simple terms, these drugs are targeted and “turned off” by a protein that is “activated”.

You can take most of the medications you receive as a pill instead of at home chemotherapy by IV hospital. Wakelee says that in addition to being more effective, they are much easier on your system than other cancer treatments.

When there is a viable genetic target, these therapies shrink tumors with chemotherapy or immunotherapy, and the treatment often works better.

For people with initial NSCLC who have surgery, an EGFR drug called osimertinib (Tagrisso) may be less likely to delay the return of cancer and spread the cancer brain.

IV. People with NSCLC positive for EGFR can also get Tagrisso because they are more likely to shrink the tumor and work longer than any other type of treatment.

Small cell lung cancer has not yet been approved for targeted therapy clinical trials continue to explore the possibility.

The importance of patience

Along with the genetic panel of the tests (sometimes called “molecular tests”), the doctor should look at another biomarker called PD-L1. Levels of this protein suggest whether they may respond to treatment immunotherapy drugs.

This can make things harder, Wakele says, because PD-L1 results usually come much earlier than mutation results.

High PD-L1 often means immunotherapy can be successful.

“And so it’s tempting to act on that,” Wakele says. But that’s not always the best way. If you have some mutations, like EGFR, immunotherapy can do more harm than good. And future-oriented therapies can make them more toxic to your system.

That’s why, says Wakele, it’s important to wait until you get back all before making decisions about the results.

That is an example of possible complications. In some cases, there are complex factors in your tumor health care the group will team up with a group called the molecular tumor board:

  • Medical experts
  • Medical oncologists
  • Surgeons
  • Radiation therapists
  • Researchers
  • Geneticists
  • Pathologists

“It simply came to our notice then Stage IV lung cancer“Waiting can be terribly stressful,” says Wakeleek. “Most people want to start treatment right away. But it’s very important to understand the best way to wait to get the full story about the tumor.”

He is not the only smoker

The ugly stigma can be caused by smoking if you have lung cancer. That’s unfortunate, says Yasir Y. Elamin, MD, thoracic medical oncologist and assistant professor of thoracic medical oncology at the MD Anderson Cancer Center at the University of Texas.

He also says it’s fake.

Smoking is still the biggest risk factor for the disease (outside of age), with 1 in 5 people dying from lung cancer each year never smoking. This puts lung cancer near the top of the list of the most deadly cancers in the United States among people who have never smoked.

“I don’t think anyone deserves to have lung cancer, whether they are smokers or non-smokers. But I think we need to understand more and more that lung cancer is not just a smoking-related disease, ”says Elamine.

This is especially true of lung cancers that respond to therapy that is true.

“For the most part, they are not related to smoking.” Elamin says. “I think it’s very painful that lung cancer isn’t just related to smoking. So hopefully it will help us get rid of some of the stigma surrounding it. ”

The Future of Target Therapies

Focused therapies can improve quality of life with fewer side effects and better results. But there are frustrations with these treatments. One of them is that people tend to create resistance against them.

“It’s one of the saddest realities of targeted therapy,” says Elamine.

It may take 2 to 3 years, but eventually almost all people who take targeted therapies develop resistance, especially those who begin treatment in the later stages of the disease. A lot of new research is exploring how to overcome this issue.

“We’re looking at how and why resistance develops,” Elamin says.

The hope is to find ways to delay or overcome resistance, or rather to avoid it.

Overall, Elamin is hopeful. A new study on the drug Alectinib (Alecensa), Therapy aimed at the ALK biomarker. According to the study, more than 60% of people with late-stage NSCLC who have received treatment have lived at least 5 years longer.

“Imagine the difference,” he says. “When I was doing my training, the 5-year survival of the same team was between 5% and 6%. It’s unbelievable.”

Of course, 60% is not the goal, but Elamin remains excited.

“We expect it to be 90% or 100% one day. But I think we’ve made progress, and in this case, the numbers speak for themselves.”



Heather Wakelee, MD, thoracic oncologist, professor of medicine, Stanford University Medical Center.

Yasir Y. Elamin, MD, thoracic oncologist, assistant professor of thoracic medical oncology, MD Anderson Cancer Center.

Kerry Kingham, Stanford Health Care Cancer Genetics Consultant.

American Cancer Society: “Risks of Lung Cancer for Non-Smokers,” “Tests for Lung Cancer.”

CDC: “Among people who never smoked lung cancer.”

American Lung Cancer Foundation: “What is EGFR-positive lung cancer and how is it treated?”

Memorial Sloan Kettering Cancer Center: “Genomic Evidence for Lung Cancer (EGFR, KRAS, ALK).”

UC San Diego Health: “Molecular Tumor Table, Center for Personalized Cancer Therapy.”

© 2021 WebMD, LLC. All rights reserved.

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