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Lung cancer remains deadliest, but not always due to cigarettes



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This is a classic that can be lost. And in addition, it is discriminatory: "a tumor in the lungs? I must have smoked everything …!" Who did not hear such words? It turned out that 25% of lung cancer (yes, in the plural because they are not the same) suffer from a non-smoker. And in this group, which did not even touch tobacco, it represents the seventh cause of death.

"Among people who use burning wood for burning, which is often in countries like ours, some types of lung cancer have been discovered," said an oncologist. Luis Corrales, from the Center for Research and Cancer Management in Costa Rica. These are also the result of radiation, inhalation of chemicals and hydrocarbons and asbestos (asbestos). "Corrales was one of the leaders at the Academy of Journalism on Lung Cancer conducted by Pfizer in Buenos Aires. He led the presentation of panorama disease in the region and the challenges it creates, which is a lot because lung cancer is still the deadliest cancer .

There are good news in this difficult environment: the available medicines allow in many cases, depending on the type of cancer treatment, more time and better quality of life.

Oncogenesis

Explain that smoking is not the only cause but the main cause that can be avoided; As early as 1950 it was clear. Oncogenesis is not so much due to tobacco, but the mutations that it causes in the cells (in this case, the lungs, but not the only organ that suffers consequences), combustion at high temperatures and substances that at that time emit tobacco, its additives and paper is stressed Corrales.

"These mutations are capable of promoting uncontrolled cell division and tumor development," he said. And one of the first regional data we share is ours: among Latin, mortality is greater.

But, thanks to molecular biology, he added, we know that what has long been considered as an isolated disease associated with smoking is much more complicated and is the result of various genetic changes.

"Lung cancer can be classified into two large groups: in the first case, small cell lines (SCLC) are more common in men who are very related to smoking and fasting, representing between 15% and 20% of cases."

"For a long time, there was only surgery and chemotherapy. Much progress was achieved with immunotherapy, which is in our country in a procedure approved by the National Administration for Medicines, Nutrition and Medical Technology (Anmat), emphasized at the seminar Diego KaenHead of the oncology of the hospital school and clinic of the National University of La Rioji, who succeeded in understanding the technical problems of molecular testing.

"The remaining 80% of those who are not small cells (Cpcnp) are divided into adenocarcinoma (85% of cases) and others. Well, 35% of patients with adenocarcinoma are not smokers," insisted Corrales. He added that 4% of these tumors develop in children under the age of 40 years.

Challenges

The hardest thing is an early diagnosis; In fact, lung cancer is still called a "silent killer" because the symptoms are similar to those in other respiratory diseases (coughing lasting three weeks or more, chest pain, shortness of breath, flu-like conditions that last for a long time, antibiotics, bleeding from the nose) and the search takes a long time. Therefore, before any suspicion, it is important medical supervision: I hope it tells us that it is only persistent bronchitis! (See "X-rays …").

If the tumor is discovered early and is surgically removed without spread, it can be cured and healed. However, minorities (only 10%): as reported Kaen, in Argentina, most cases are detected in Phase III, when it is not curable.

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

Precision medicine

What is going on goes directly into the heart of the tumor or helps the immune system to recognize cancer cells. Thus, instead of the attacks of any fast-propagating cell, it can even be healed, such as "chemotherapy," blocking their growth and reproduction, and affect the functioning of certain molecules called the "molecular targets" that activate them, Kaen explained.

"Knowing and understanding the characteristics of different tumors before starting treatment gives them much more efficiency," said Corrales. And although it does not cure, in many cases the disease can be controlled for many years (in the 1980s and without interfering with treatment) with far fewer symptoms and good quality of life.

Targeted treatment

Knowing the tumor means, first, to know what kind of tumor is and what the mutations associated with it are. In addition, remember that the tumor may not be homogeneous on the one hand and that it is able to mutate on the other side, so it should be monitored during treatment and checked if it is still effective (see: "Current Biopsy"). The good thing is that in many cases, if one treatment stops working, there are others that try to replace it.

"One of the most common mutations in EGFR is a protein that helps the cell surface to grow and divide from the surface of the cells. When EGFR mutates, cells grow faster," added Corrales. In these cases (more commonly in women, younger than 40 years of age and non-smokers), EGFR inhibitors can be inhibited and blocking the cell-activating signal. "

"In Argentina, the EGFR mutation is between 15% and 20% of cases of this type of cancer," said Kaen. And one of the great advantages of these therapies is that they have pills they take at home and in normal life. "

There is another 5% Cpcnp in which it is found that the ALK gene mutated, producing a protein that hyperstimulates the growth of malignant cells. Available medicines (including tablets) can also be used instead of chemotherapy, which significantly improve the quality of life.

Strengthen defense

Another alternative is immunotherapy. In the normal cellular process, T lymphocytes (a type of white blood cell) identify tumor cells and eliminate them. That's what our body does all the time. They learned to switch to the system.

"Imagine that tumor cells have a" mask "that hides them, and then the lymphocytes remain so relaxed. The treatment blocks a receptor that allows a" mask "and allows the tumor cell to be visible to the immune system," explained Corrales.

The substances manufactured by the body or produced in the laboratory, such as monoclonal antibodies, which can act with strengthening of the immune system and also by stopping or slowing down the growth of cancer cells or by preventing spread to other parts of the body, are used (see: "Immunotherapy").

> Women's perspective The second cause of death in the world
Although, in general, the likelihood of a woman developing lung cancer throughout her lifetime, one to 17, figures are changing and the illness is increasing in the female population. In Argentina, according to the National Institute of Cancer (INC), the prevalence of illness is still much higher in males (68.45% for them and 31.55% for women), but particularly worrying is the increased mortality due to this type of cancer in women . Globally, this is the second most common cause of death among them, especially as smoking has become more common. In contrast, women seem to benefit from a more pronounced reduction in tumor risk when they quit smoking.

> Imunotherapy | We tell you what monoclonal antibodies are and how they work
They are molecules produced in a laboratory designed to act as replacement antibodies and are capable of restoring, improving or impinging the immune system's attack on cancer cells. They are intended to bind to antigens that are higher on the surface of cancer cells than in healthy ones. Various antibodies of this species can detect cancer cells, destroy their membranes, block their growth or attack them. They can also block the immune system inhibitors and are able to treat radiation and chemotherapy of the tumor cell. They are administered intravenously, and the frequency depends on the type of cancer and the medicine to be taken.

> X-rays do not reach | If you can not leave the pucho, at least ask for controls "Unfortunately, a massive screening strategy can not detect disease in people without symptoms," admitted Diego Kaen. but at least smokers should ask their family doctor for supervision. "The point is, not all controls are useful:" It has been shown that radiography does not work. We need special special tomography with low density, "he added, adding people with a family history to a risky population. The cessation of smoking reduces pre-cancerous injuries and reduces the risk, but remains important for several years after departure, so the rule should be checked, even if not smoke more.

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