Lung cancer in never-smokers: a hidden disease (2019)
journals.sagepub.com
journals.sagepub.com
What was your pathway to diagnosis? Was it picked up in a routine checkup, or did you feel symptoms that convinced you to see a doctor?
My PCP did a clean EKG which showed nothing, then it showed up on X-Rays. I immediately got PET scans which showed 2 masses. I then had a bronchoscopy to ensure it was malignant where they noticed additional lymph nodes. I then had a mediastinoscopy showing spread in 3 clusters of chest lymph nodes. I went through 6 weeks of chemo and radiation that resulted in a 25% reduction in the primary tumor and no change in the metastases in a hilar lymph node. I'm now scheduled for a bi-lobectomty to remove my superior and middle lobe on the right side, as well as however many lymph nodes they can get a hold of (check out "da vinci thoracic surgery" to see the robot beast the surgeon will be using).
I have almost no symptoms outside of a slight cough and still run 1-2 miles per day.
I've generally been a grin-and-bear-it guy when it comes to my health. Please suck up your pride and stay on top of your health.
Best of luck with your impending encounter with the da Vinci bot and life after cancer.
It was a tough few months, but because of my trying times I think I got stronger in my faith and I would say it was worth it. It's a good feeling to live life knowing that God is by you, makes one more empathetic and puts value back on the important things like family.
Everyone has their own journey, I just want to encourage you :)
I which you the best of luck and a long life after your encounter with that incredibly scary yet fascinating robot!
It may be a pipe dream, but I'm hoping to hold on long enough that some of these new mRNA approaches start offering clinical trials I might be able jump in on.
I have experienced three cases in my close relationships where spreading was not picked up for a long time due to being in different body parts.
In one of the cases asthma medication and physiotherapy was prescribed for a year before an unrelated shoulder x-ray caught the attention of the radiologist, and further images showed the cancer had spread to lungs and spine...
Regarding "holding on long enough" -- something that there has been shoddy but interesting evidence for over a number of years in dragging yourself further to the right of a Kaplan-Meier plot is dietary modification. As you probably know, one of the hallmarks of cancer is metabolic dysregulation [1] -- specifically a shift towards "anaerobic" glycolysis, that is, the increased uptake of glucose and an increase in the proportion of which ends up as its ultimate metabolic fate as lactate rather than entering the TCA cycle as pyruvate and being oxidised. Some thing that has been explored in the past is providing the organism with ketones as a primary fuel source (which enter the TCA cycle directly as either beta-hydroxybutyrate or acetoacetate) and do not get transported through the glut glucose transporters: in non-cancerous cells with some degree metabolic flexibility there is significant scope for generating other needed metabolites from the TCA cycle and a series of beautiful pathways to let that process happen. As a result, there are a series of papers that indicate that a purely ketone-based diet (exogeneous or endogenous) may be associated with an increase in life expectancy [2, 3, 4; or google scholar GS1] as -- the narrative goes -- cancer cells can't utilise the alternative fuel source as effectively. In mice, with a well controlled tumour xenograft, this has shown to extend survival, fairly significantly.
However, take this with a large grain of salt: there is some evidence that ketone utilisation might be associated with "stemmness" and baddness in general [5, 6] which (and herein starts a "I am hypothesising" warning) may be due to a selection pressure for metabolic flexibility and the return to a more fetal phenotype. The diets are also very difficult to adhere to in patients. These diets are just starting to be assessed properly, in people, in RCTs (e.g. [7]), but I can't find any evidence of a trial in lung cancer patients without a background of smoking specifically.
The most recent major review on the topic I can easily find [8] does seem to hint quite strongly that it might be worth considering, and there is some evidence that it potentiates tumours to other chemotherapies. If I were in your unfortunate position, I would personally discuss the concept with the oncologist in charge of my care – the basic idea "makes sense" to me, at least.
---- [1] https://www.sciencedirect.com/science/article/pii/S009286741... or https://sci-hub.st/https://www.sciencedirect.com/science/art...
[2] https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.28809 or https://sci-hub.st/https://onlinelibrary.wiley.com/doi/pdfdi...
[3] https://nutritionandmetabolism.biomedcentral.com/articles/10... or https://sci-hub.st/10.1186/1743-7075-4-5
[GS1] https://scholar.google.co.uk/scholar?hl=da&as_sdt=0%2C5&q=ke...
[4] https://link.springer.com/article/10.1007/s12032-017-0930-5 or https://sci-hub.st/https://link.springer.com/article/10.1007...
[5] https://www.tandfonline.com/doi/abs/10.4161/cc.10.8.15330 or https://sci-hub.st/10.4161/cc.10.8.15330
[6] https://www.tandfonline.com/doi/abs/10.4161/cc.9.17.12731 or https://sci-hub.st/10.4161/cc.9.17.12731
[7] https://www.mdpi.com/2072-6643/10/9/1187
[8] https://www.sciencedirect.com/science/article/pii/S221287781...
https://www.saronarameka.com/ https://www.frontiersin.org/articles/10.3389/fonc.2020.00578...
https://www.amazon.com/How-Starve-Cancer-Jane-McLelland/dp/0... seems to be recommended as an introduction, but I still didn't finish it.
I agree that interest in diet is an increasing vogue – and I would never recommend replacing a medical therapy with dietary modification, but some of the citations I linked to above indicated that it may potentiate the effect of some other chemotherapies, particularly those that themselves have a metabolic effect. I agree with you about the difficulty in funding such trials, and the difficulty in both monitoring patient compliance with them and obtaining a robust and reproducible readout of their effects. Cancer is a heterogenous disease of life, and its response to therapy is too.
So far we added Metformin [1][2] (not as diabetic drug), Aspirin[3], Vitamin D, low glycemic index, no red meat, mediterranean diet, freshly made juices from vegetables and fruits with anti-angiogenic or confirmed anti-cancer properties (e.g. kale, brocolli, apples, carrots, celery, turmeric, red grapes, berries). Metformin has been confirmed with an endocrinologist.
One issue with things like Keto is that it is too extreme to convince a regular 50+ years old person to consider such approaches. And frankly, neither of us has medical training, so we are afraid of trying too-unconventional approaches. Some other medications or supplements I heard recommended, but we didn't decide to include yet are reservatol, simvastatin, altrexone, doxycycline, boswellia, quercetin, keto, intermittent fasting.
1. https://jamanetwork.com/journals/jamaoncology/article-abstra...
2. https://www.frontiersin.org/articles/10.3389/fonc.2020.01605...
3. https://www.lungcancerjournal.info/article/S0169-5002(20)305...
According to Vince DeVita (ex head of NCI) it was the way they did things in the early days. Make people survive until something new came up.
Hopefully with the advances in medical research things will accelerate.
Best wishes
His doctor's approach has been using them to reduce the cancer to near-zero, and then radiation (and in future, chemo) to knock down any stray masses that get a foothold.
Good luck for your treatment and recovery.
High-dose vitamin C enhances cancer immunotherapy https://stm.sciencemag.org/content/12/532/eaay8707
Scroll down to cancer treatment: https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessiona...
What the mouse model suggests is that you need an immune system in the first place to get the benefits of high dose IV vitamin C (HDIVC), since the mice lacking an adaptive immune system didn't get the effect. It's unclear how exposure to different amounts of chemo, which messes with the immune system, disrupts the effectiveness of HDIVC. i.e should it be tried first, or in what combination?
Quote...
"During the 1970s, studies by ... Pauling suggested that high-dose vitamin C has beneficial effects on quality of life and survival time in patients with terminal cancer. However, some subsequent studies—including a randomized, double-blind, placebo-controlled clinical trial ... did not support these findings. ...patients with advanced colorectal cancer who received 10 g/day vitamin C fared no better than those receiving a placebo. The authors of a 2003 review assessing the effects of vitamin C in patients with advanced cancer concluded that vitamin C confers no significant mortality benefit."
Alecensa is freaking expensive. Even with Medicare, it's costing her about $10,000 a year in deductibles and copays.
I wish you all the best for your treatments.
That's just conjecture on your part. Some people are lucky, others are not, it's not always due to behavior. 3 cigarettes a day is also extremely low - the average is apparently 14[1] right now.
[1] https://www.cdc.gov/media/releases/2018/p0118-smoking-rates-...
I don't believe there is any harmful information but the whole picture is that most folks cannot smoke a few per day. Eventually cigarettes will own most smokers.
Nicotine, CO and radioactive toxicity have a long half-life, where primary radical damage or reactive carcinogen burden is dose dependent stochastics.
Also people forget, you are much, much more likely to die from cardio-vascular damage or COPD as a consequence of smoking, than lung cancer.
The addictive nature of cigarettes makes it very hard to stick to 3 a day.
My mean, spiteful and horrendous grandmother in law was nothing but pure bile and hatred. Every day she lived her life in perpetual outrage and never had a moment's peace.
She lived to 96.
I fear most evil folks sleep well at night.
Karma is something people invented for some temporary solace.
In Europe, coal typically kills more than 20,000 people _every year_: https://www.theguardian.com/environment/2013/jun/12/european...
[ And yet Germany and Belgium decided to end nuclear energy because people are afraid of the "risks", but keep coal plants. ]
Nuclear is remarkably well-regulated by comparison. I understand why people may want to get rid of it eventually, but compared to coal, it's sunshine and rainbows.
During the same time, nuclear is down from 17% to 13%. https://energy-charts.info/charts/energy_pie/chart.htm?l=en&...
Still too little too late in my opinion, but one has a hard time arguing that nuclear plays a role here at all.
The nuclear security agency in France is one of the toughest in the world, and is independent. They notably demand "current" state-of-the art security for all nuclear plants (vs. state-of-the-art at the time of building in the US, typically)
French nuclear plants typically never killed anyone (and will never), unlike German coal plants (which are at least partially responsible for the 22,000 coal-related premature deaths every year)
Nuclear energy is a very emotionally polluted debate (no pun intended), but facts tend to shows that this is the cleanest and safest energy.
The future is uncertain, and I hope the German people don't suffer shortages of electricity as a result of these phase-outs.
Belgium doesn't have coal plants.
Belgium's nuclear plants are/were scheduled to close because they've surpassed their initial lifespan. An extension was added but that has almost been surpassed as well. These are plants which have been in operation for 40-50 years.
Replacements aren't being build because they are "unsafe". They aren't being build because it's economically not viable to do so in a country like Belgium. Not at this moment in time, not in the past 20 to 30 years.
Belgium's major energy operators are also largely controlled by French energy conglomerates such as ENGIE.
Great for socialising though . Smokers have more fun at parties since you end up chatting to other smokers whilst outside in sub zero weather sucking on your death stick.
And damn do I miss a cig after dinner
It was exactly the social aspect of smoking that I liked the most, now that I look back at it.
Smokers have an easier time establishing a bond, when placed in new groups like work or school. They meet up at the designated smoking spot and chat while smoking. It's a great ice breaker.
I found that I had an easier time, when having to do group work, than non-smokers since there was already a loose connection with the other smokers. It was always the non-smokers, who were having difficulty finding group mates.
I now vape on an e-cigarette instead. Still go with the smokers, so I have not lost the social benefits :)
I highly recommend giving e-cigarettes a try, for any of you smokers out there, who are having a difficult time, quitting the habit.
I'm aware that it's in no way healthier, but am convinced that it's less damaging. Anecdotal, yes, but it sure feels like a better alternative. Tried nicotine gum, band-aids etc., but I guess there was more to my addiction than just the nicotine. The rituals of inhaling and fondling with something. It's the only thing that's worked for me.
"I know that it's in no way HEALTHY*, but..."
You also are only burning tobacco and inhale almost no plant matter. I would give it a try. I feel better with that than with e-cigs.
But I agree otherwise. My wife’s parents both lived into their late 90’s but had lost most of their cognitive ability for the last 5 years - so much they couldn’t live independently. Not sure that’s a great alternative death.
The results were quite bad I seem to recall (I may be mis-remembering according to [0]) Our house was in rural Cork and was build by my parents in the 80's.
My father died from lung cancer but he was a heavy smoker; my mother smokes very occasionally and she's fine.
However, my aunt, who lived next door, maintained a very healthy lifestyle and also died of lung cancer; her husband is also fine.
Radon levels vary a lot. In Pennsylvania, the worst areas lie along the Appalachians, but even then neighboring houses can have huge differences in radon. So even if your soon-to-be neighbors didn't have a problem, do the test.
As article says, genetic mutations are much more common among non-smokers. Exon 19 deletion egfr mutation was detected, so she started on Osimertinib that works very well. Sadly Osimertinib will work for a year or two, and then cancer mutates and gains resistance.
"Over 16% of lung cancer deaths are attributed to radon exposure in Canada. It is estimated that more than 21,000 Canadians will die from lung cancer this year, and more than 3,000 of those deaths are because of exposure to radon indoors."
Really sorry to hear what your family is going through. This kind of stuff is never easy to deal with.
His death is one reason I really hate smoking. In Manhattan it's especially annoying when you have to go past an honor guard of smokers wreathed in a carcinogenic miasma cloud of smoke when you enter or leave office buildings, or if you're walking in a tightly packed crowd and someone ahead of you decides to light one up and cropdust everyone behind with a blessing of cancerous smoke.
I saw this study mentioned which showed negligible risk for passive smoking unless you are actually living with a smoker. https://www.forbes.com/sites/danielfisher/2013/12/12/study-f...
Also people likely smoked indoors in the office when he was working. Indoor no smoking bans didn't come until later in his career, and even today I think enforcement is much more lax compared to the US.
This is so sad. Unless he didn’t like his family.
The study found no statistically significant relationship between lung cancer and exposure to passive smoke, however. Only among women who had lived with a smoker for 30 years or more was there a relationship that the researchers described as "borderline statistical significance." Over at the Velvet Glove, Iron Fist blog, however, journalist Christopher Snowden notes "there's no such thing as borderline statistical significance. It's either significant or it's not," and the reported hazard ratio was not.
https://www.iarc.who.int/wp-content/uploads/2018/07/AirPollu...
The EPA issued new regulations such that all new stoves manufactured after 2020 emit far less smoke and particulate both indoors and out.
The American Lung Association actually runs programs that will pay you to replace your old wood stove, which probably says something about their potential impact on health.
The compounding factor with woodstoves is that they are indoors and they are often the primary source of heat for months on end, meaning they they emit smoke and particulates into the air you breathe all day and all night.
Hell of a claim. Sources?
https://www.health.state.mn.us/communities/environment/asbes...
> Necroscopic studies have led to the determination of asbestos fibre load and the demonstration of a dose related effect, thus making improbable the argument that mesothelioma only requires one fibre of asbestos for initiation of the malignancy.
Furthermore, asbestos exposure in urban settings is very common: https://www.atsjournals.org/doi/10.1164/arrd.1980.122.5.669
> We isolated uncoated asbestos fibers from the lungs of 21 urban dwellers who had fewer than 100 asbestos bodies/gram of lung, a level shown previously to be associated with environmental rather than occupational exposure to asbestos
The truth is, it's hard to unravel: especially with 100s of billions of dollars on the line in liability, there is probably some "sugar science" going on - maybe on both sides even.
What I _do_ know is that: 1. It's harmful af (regardless of "how much" the research says, the fact is: harmful af). 2. Everyone thinks it's banned, but it's not. 3. Some people make billions of dollars continuing to use it (enabled by #2) 4. I'm not in the set of people described in #3
I'd like it to be banned.
* In July 1984 the Health and Safety Executive (HSE) published an update to guidance note EH10, Asbestos – Control Limits, measurement of airborne dust concentrations and the assessment of control measures, which introduced a limit value of 0.01 fibre/ml.*
That’s 100 fibers/liter, so at least that with every breath you take.
Because of that, I think that, if that claim is true, it only is if you wouldn’t die of something else first.
> There is a lack of scientific consensus as to whether there exists a threshold of exposure to asbestos below which a person is at zero risk of developing mesothelioma. However, there is evidence from epidemiological studies of asbestos exposed groups that any threshold for mesothelioma must be at a very low level - and it is fairly widely agreed that if a threshold does exists then it cannot currently be quantified. For practical purposes HSE does not assume that such a threshold exists.
https://web.archive.org/web/20111030182149/http://www.hse.go...
Actual cancer would depend on a lot of different additional factors.
I was a bit astonished by that claim since I had thought that the entire developed world has banned asbestos usage for decades... turns out that while the US does have bans on certain products, there is no federal ban on the stuff (https://en.wikipedia.org/wiki/Asbestos_and_the_law_(United_S...).
Jesus. WTF?
The only thing special about asbestos is its extremely low cost.
https://duckduckgo.com/?t=lm&q=map+of+lung+cancer&iax=images...
helps getting an idea of environmental impact
If I recall correctly, 1/3 to 1/2 of all cancers don’t have a cause. Just bad luck.
I'd be quite surprised if breathing in microplastics does not contribute to the risk of lung cancer -- and essentially every human being is exposed.