It is a classic that can be cheated. In addition, it is discriminatory: "a tumor in the lungs? It must have smoked everything …!" Who did not hear such phrases? As it turns out, 25% of the lung cancer (yes, in the plural, because not all of the same) suffers from failure. And in the non-tobacco group, she is the seventh cause of death.
"Among the people who use burning cookware, which is common in countries like ours, certain lung cancer is diagnosed," the oncologist said. Luis Corrales, from the Cancer Cancer Research and Management Center. They are also caused by radiation, inhalation of chemicals and hydrocarbon gases, and asbestos. "Corrales was one of the trainees at Pfizer's Buenos Aires-based Journalists' Academy, who was in charge of presenting the panorama of disease in the region and the challenges it creates, much because lung cancer is still the deadliest cancer.
In this harsh environment, there are good news that: available treatments allow in many cases, depending on the type of cancer being treated, more time and better quality of life.
Let's clear: smoking is not the only reason, but the main reason for avoidance; she was already clear in 1950. Oncogenesis is not so much because of the smokescence itself but by the mutations it causes in the cells (in this case, the lungs, but this is not the only organ that suffers from the consequences), burning at high temperatures and the substances that emit tobacco, its additives and paper at that moment, Corrales .
"These mutations are capable of promoting uncontrolled cell division and tumor development," he said. And one of the first shared regional data is ours: among Latin's, mortality is higher.
But thanks to molecular biology, he added, we know that what has long been considered as an isolated smoking-related disease is much more complex and is caused by various genetic changes.
"We can classify lung cancer in two large groups. First, there are small cell lines (SCLCs), more often in men, highly associated with smoking and with rapid growth, representing between 15 and 20% of cases."
"For a long time, there has been only surgery and chemotherapy, but a great deal of progress has been made with immunotherapy in our country in the process of approving the National Administration of Medicines, Food and Medical Technology (Anmat), highlighted at the seminar Diego Kaen, Head of Oncology at the Hospital School and Clinics of the La Rioja National University, who managed to explain the technical issues of molecular testing.
"The second 80%, non-small cell (Cpcnp), is divided into adenocarcinoma (85% of cases) and others, so 35% of adenocarcinoma patients are not smokers," claims Corrales. He added that 4% of these tumors develop in children under the age of 40.
The worst thing is early diagnosis; In fact, lung cancer is still called a "silent killer" because the symptoms are similar to those of other respiratory diseases (coughing lasting for three weeks or more, chest pain, difficulty breathing, flu-like conditions that last a lot of time, even with antibiotics, nasal bleeding) and queries takes a lot of time to arrive. That is why it is important, before any doubt, medical control: I hope to tell us that it is just rebellious bronchitis! (See "X-rays …".)
If the tumor is early discovered and removed without spreading, it can be cured and cured. But they are a minority (only 10%): as it is said Kaen, in Argentina, most cases were uncovered in phase III when it was not cured.
"But this does not mean that there are no possible answers. By 2014, when the door to the new paradigm was open, we only had chemotherapy. Now, molecular tumor testing allows formulated targeted therapies to improve the survival of patients with metastatic disease," he said.
What it is doing is moving directly to the tumor heart or helping the immune system to recognize cancer cells. And so, instead of attacking any fast-reproducing cell, even healthy, such as "kemo", can block their growth and propagation, hindering the action of specific molecules, called "molecular targets" that activate them, Kaen explained.
"Knowing and understanding the characteristics of different tumors before the start of treatment allows them to be much more effective," Corrales said. And while it is not being treated, in many cases the disease can be controlled for years (in the 1980s and no treatments were tried) with much less symptoms and good quality of life.
Knowing the tumor is, in the first place, knowing what kind of tumor is and what mutations are associated with it. Keep in mind, furthermore, that the tumor does not have to be homogenous, on the one hand and capable of mutating, on the other hand, therefore, 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 working, there are others who would try to replace it.
"One of the most common mutations is EGFR, a protein that, from the cell surface, helps to grow and share. When EGFR is mutated, cells grow faster," Corrales added. In these cases (more often in women, young people under the age of 40 and non-smokers), EGFR inhibitors and blocking signal that activate cell growth can be applied. "
"In Argentina, the EGFR mutation is between 15% and 20% of cases of this type of cancer," Kaen said. One of the great benefits of these therapies is that the pills are taken at home and the usual life. "
There is another 5% Cpcnp in which ALK mutated, which is generated by the generation of proteins that hyperstimulate the growth of malignant cells. Available treatments (also pills) can be used even instead of chemotherapy, significantly improving the quality of life.
Strengthen the defense
Another new alternative is immunotherapy. In the normal cellular process, T lymphocytes (type of white blood cells) identify and remove tumor cells. Our body all the time. But they learned to outsmart the system.
"Imagine that tumor cells have a" mask "that hides them, and lymphocytes, therefore, remain relaxed. Treatment blocks the receptor that allows the" mask "and makes the tumor cell visible to the immune system," Corrales explained.
Substances produced by the body or produced in the laboratory are used, such as monoclonal antibodies that can function by strengthening the immune system and by stopping or slowing cancer growth or by preventing their spread to other parts of the body (See "Immunotherapy").
> Female perspective The second cause of death in the world
Although it is generally likely that a woman who develops lung cancer during her life is one of 17, the numbers are changing and the disease increases in the female population. In Argentina, according to the National Cancer Institute (INC), the prevalence of illness is still significantly higher among men (68.45% for them and 31.55% for women), but particularly worrisome increased mortality from this type of cancer in women . Globally, this is the second most common cause of death among them, especially because their smoking habits were more common. By contrast, women seem to benefit from a marked decrease in tumor risk when they stop smoking.
> Immunotherapy We tell you what monoclonal antibodies are and how they work
They are molecules manufactured in a lab designed to act as substitute antibodies and are capable of restoring, improving or imitating the attack of the immune system on cancer cells. They are designed to bind to antigens that tend to be more numerous on the surface of cancer cells than in the healthy ones. Various antibodies of this type can detect cancer cells, destroy their membranes, block their growth or attack them. They can also block immune system inhibitors and can take radiation and chemotherapy in the tumor cell. They are administered intravenously, and the frequency depends on the type of cancer and the drugs being taken.
> X-rays do not reach If you can not leave the puff, at least ask for control "Unfortunately, a massive strategy of screening can not detect a disease in people without symptoms," admitted Diego Kaen. but at least the smokers should seek control over their family doctor. "The point is that it's not all useful to control:" It is proven that radiography does not work. We need special, low-density tomography, "he added, and included people with family history in the risk population. Quitting smoking reduces pre-cancerous lesions and reduces risk, but remains important for years after giving up, so controls should be the rule even if you do not smoke .