Lung Cancer: Detection

by Food and Drug Administration (FDA)

Five years ago, when Ken Giddes was vacationing with his wife in Vancouver, British Columbia, the 61-year-old resident of Atlanta began feeling short of breath. But since he was "running around quite a bit," Giddes chalked up his problem to being an overachieving tourist. When he returned home, though, his shortness of breath persisted. The cause — uncovered by an x-ray — was a collapsed lung.

But it wasn't until he underwent surgery to repair his lung, that the cause of the collapse was clear: lung cancer had eaten a hole in the air sack of his lung. After surgeons removed his lung in an effort to contain the cancer, they checked Giddes for any traces of cancer every three months. Within a year there was more bad news: a CT scan revealed 13 spots on his remaining lung.

Surgery revealed the cancer had spread throughout his remaining lung. Giddes recalled that he was given less than a 30 percent chance of living another two years. But he decided to battle the cancer "with all the energy, hope and positive attitude I could muster." After 30 weeks of chemotherapy, he was told his cancer was in remission.

Today, he's glad he didn't give up because he's beaten the odds, surviving five years since his cancer was diagnosed. And as the head of the Caring Ambassador Program, sponsored by Republic Financial Corporation, he's helping other cancer survivors wage war on lung cancer, too.

Survival and Detection

Lung cancer is the leading cause of cancer deaths among both men and women, according to the American Cancer Society. Since 1987, more women have died each year of lung cancer than of breast cancer.

Detecting lung cancer in its early stages is difficult in some cases because the disease spreads very quickly and symptoms often don't appear until the disease is advanced. Only about 15 percent of lung cancers are found before the cells have spread to lymph nodes or distant organs.

Still, the survival rate for the disease has improved over the years. The one-year survival rate for patients is about 40 percent today compared with 32 percent in 1973. And five-year survival is up from 8 percent in the 1960s to 14 percent today. Improvement in survival rates can be attributed, at least partially, to diagnostics and new drugs that the Food and Drug Administration has approved.

Lung cancer can be diagnosed by:

• a chest x-ray or CT scan to check for spots on the lungs
• a microscopic analysis of phlegm cells
• a bronchoscopy, which involves passing a lighted tube through the tubes that carry air to the lungs to see if tumors or blockages exist.

If suspicious tissue or spots are detected, a needle biopsy is typically performed, so that a sample of the tumor can be obtained to confirm the diagnosis of lung cancer.

There also are two other diagnostic tools that may be used in place of a biopsy.

The Xillix LIFE-Lung Fluorescence Endoscopy System is a medical device FDA approved in 1996 for detecting bronchial tissue abnormalities in patients with previous, current or suspected lung cancer. A tube inserted through a patient's mouth into the bronchi (tubes leading from the trachea to the lungs) delivers a blue laser light to the bronchial tissue. The image the laser reveals is projected onto a video monitor. While normal tissue appears green, abnormal tissue will appear reddish brown. Suspicious areas can then be biopsied. The system was approved for use in conjunction with conventional white light bronchoscopy. While the illumination provided by the white light helps doctors identify tissue that looks abnormal, the new blue laser system detects more tissue changes than can be seen with the white light alone.

The approval of this device is significant, says Harry Sauberman, chief of the ear, nose and throat devices branch in FDA's Center for Devices and Radiological Health. It can spot moderate to severe dysplasia (irregular tissue), "some of which may turn out to be malignant and you'll have a case of lung cancer," he explains. Patients with dysplasia can then be closely monitored, and if cancer appears, it can be treated in its earliest stages.

The second diagnostic tool is an imaging agent called Nofetumomab (verluma). Approved by FDA in 1996, it can determine the extent of disease in patients already diagnosed with small cell lung cancer through a biopsy but who have not yet been treated. Nofetumomab is a fragment of a monoclonal (synthetic) antibody that, when tagged with a radioisotope, can detect a protein found on the surface of most small cell lung cancers. The antibody collects in tumor sites and other areas of the body where protein is detected and, using special cameras, doctors can see the areas as "hotspots." This information helps physicians see how far the cancer has spread without exploratory surgery or other diagnostic tests and allows them to develop a more effective treatment plan.

According to Patricia Keegan, M.D., deputy director for the division of clinical trials design and analysis in FDA's Center for Biologics Evaluation and Research, the major advantage of using the imaging agent is that it allows doctors to do a full body scan of a patient. "The disadvantage is that it isn't as sensitive in any one area as other scans," she says. "It's not as good as a CT scan for picking up every liver metastasis. And it isn't as good as an MRI or CT scan of the head to pick up brain metastasis. But if all you want is a quick and dirty answer about whether the cancer is widely disseminated or not, it's a relatively simple test to do."

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.