Lung cancer treatment in Australia: diagnosis, therapy and surgery

Lung cancer diagnosis and treatment in Australia is popular due to modern medical infrastructure and famous clinics and institutes, which are concentrated mainly in Sydney and Melbourne.

What is lung cancer?

The disease occurs as a result of cellular mutations that cause uncontrolled cell division. Because of the relatively late diagnosis and ineffective treatment in advanced stages, it remains the most deadly cancer in the world. In almost 90% of cases, the disease is caused by smoking.

Lung carcinoma may be primary (originating from lung tissue) or secondary, or metastatic (malignant cells originating from distant organs and tissues).

Primary lung tumors are divided into two types:

⦁ non-small cell carcinoma: approximately 9 out of 10 cases
⦁ small cell carcinoma (SCLC): rare, but rapidly spreading cancer

The effectiveness of treatment for each type of disease depends on the stage at the time of diagnosis, the results of laboratory tests and proper complex treatment.

Typical symptoms of lung cancer

The disease develops unnoticed for a long time, so lung tumors in the early stages are rarely diagnosed. In many cases it is an accidental terrible finding. If you notice a warning signs listed below in yourself or loved ones, contact your general practitioner as soon as possible.

Typical symptoms of lung cancer include:

⦁ Shortness of breath
⦁ Unusual hoarseness
⦁ Chronic cough
⦁ Chest pain
⦁ Hemoptysis
⦁ Weakness and fatigue
⦁ Frequent respiratory infections
⦁ Loss of appetite
⦁ Unexplained weight loss

Sometimes lung tumors can manifest themselves in complex of unusual symptoms:

⦁ Horner's Syndrome: damage to the nerves of the face and eyes
⦁ Syndrome of the superior vena cava: dilatation of the face and trunk vessels
⦁ Paraneoplastic syndromes: highly active products of the tumor's metabolism affect the endocrine glands and brain, causes thrombosis, thickening of bones, and nerve disorders.

Unfortunately, most lung malignancies are diagnosed in the late stages, when 5-year survival is extremely low. In metastases, the technical opportunities of modern oncology are limited.

MacArthur Cancer Service in Sydney

Located in the state of New South Wales, the MacArthur Cancer Service provides high-tech oncological care for residents of the south eastern part of Australia. The service is famous for its technology advances in chemotherapy (like electronic control systems), stem cell transplantation, diagnostics and radiation therapy (high-precision computed tomography, powerful linear accelerators, and the latest agents for brachytherapy).

It offers professional psychological counseling for cancer patients and a wide range of complementary medicine options, including massage, hypnotherapy, and reiki.

Lung cancer treatment innovations in Australia

To defeat the deadly disease, local government and private companies have established unique research institutions. Among them is the world-famous Flinders Centre for Innovation in Cancer (FCIC) in Adelaide and the Lung Cancer Research Network.

The latter includes two dozen scientific groups that develop new technologies for high-precision diagnostics and lung carcinoma treatment. Translational studies leads by Australian scientists are designed to deliver the latest biomedical solutions to the patient's bed.

Lung Cancer Research Network works in three strategic directions:

1. Airway stents

After surgery, many patients need a stent, which keeps the airways open. But over the past 50 years, the design of airway stents almost did not change. They are easily displaced. They integrate into surrounding tissues, making removal difficult and risky.

3D printed airway stents for the respiratory tract consisting of modern biocompatible materials are being developed today. These unique products will be easily installed and removed. Moreover, the procedure will become much cheaper!

2. Painless early diagnosis

Although cancer screening has improved significantly in recent decades, the progress in early diagnosis of lung carcinoma is slow. Doctors need a simple and affordable device for painless detection of tumors and routine screening patients at risk. Scientists of Lung Cancer Research Network applied the latest achievements in genetics, molecular biology and electronics to create such a device. Their laboratory test is now looking for subtle genetic mutations in cells assessing the risk of malignancy.

The purpose of the project is to create a reliable test, which can be used even at home.

3. Advanced chemotherapy

Current chemotherapy agents work throughout the body.

This is an advantage and a curse at the same time. “Chemo” kills everything, including healthy cells. Australian scientists are trying to improve modern methods of drug delivery to make cancer treatment less toxic to healthy organs and tissues. Local chemotherapy technologies allow delivering high doses of drugs directly to the tumor, achieving the best possible clinical results with minimal side effects.

What causes lung cancer?

The cause of cancer is an accidental DNA mutation that disrupts the cycle of cells life. Most often, these mutations occur under the influence of tobacco toxins, industrial chemicals and radioactive substances (radon). The bases of carcinogenesis have not been fully understood.

The main known risk factors include:

⦁ Smoking, including secondary smoking
⦁ Industrial and environmental toxins
⦁ Chronic obstructive pulmonary disease
⦁ Genetic predisposition

But the main cause of carcinoma of the lungs is tobacco smoking.

One cigarette contains about 70 carcinogenic compounds, which increases the risk of lung carcinoma by 30 times. Secondary smoking increases the risk by 25-30%. Moreover, smokers are more likely to die from cancer of the esophagus, mouth and throat. 

Classification of lung tumors

Different types of malignancies require a different approach to treatment. The only way to determine the type of cancer and its sensitivity is to perform a biopsy with tissue study.

Non-small cell lung cancer (NSCLC)

85-90% of all primary neoplasms in the lungs are non-small cell carcinoma (NSCLC), which is divided into adenocarcinoma, large- and squamous-cell tumors. Adenocarcinoma develops in the mucous membrane lining the bronchi. Squamous-cell carcinoma, affects squamous cells on the surface of the airways; it usually affects the central part of the lungs.

Large-cell carcinoma is called so because of the size of the cells under a microscope. There are also undifferentiated tumors, which look "underdeveloped".

Small cell lung cancer (SCLC)

This is a relatively rare type that occurs in 10-15 cases per 100 patients.

Most often, SCLC is diagnosed in smokers. This deadly tumor is especially aggressive, rapidly growing. SCLC forms metastases in other organs and tissues early.

Olivia Newton John Cancer Center

Located in the city of Heidelberg, this center offers unique wellness programs for cancer patients. Standard therapy here is focused at maintaining a high quality of life and well-being. A holistic treatment of body and spirit – that’s how we can describe the principles of Olivia Newton John Cancer Center. Exclusive comfort, the latest methods of immunotherapy and stem cell therapy, genetic lab tests, and ultramodern operating theatres.

The center works closely with the famous Ludwig Institute for Cancer Research. Thanks to this partnership, local doctors use the most advanced technologies and medications.

Diagnosis of lung cancer in Australia

A huge investment in the development of oncology is placing Australia among the world leaders in lung cancer survival rates. The early diagnosis program reveals more and more tumors at stages I-II.

Sputum cytology

Cytology is a microscopic examination of sputum for the presence of malignant cells. The patient simply expectorates sputum, and it is sent to the lab. Samples are usually collected for several days to improve the accuracy of the diagnosis.

No pain, no needles, no complications.

The sputum cytology is technically simple and cheap, but its accuracy is relatively low. The chance of false positive results of cytology is up to 1-2%, and false-negative results – up to 35%. Therefore, cytology is usually combined with other, more accurate tests.



This test is more accurate for centrally located squamous cell carcinomas.

Tumors growing in small peripheral bronchi are less likely to be detected by cytology.

Visualization (imaging)

To visualize a suspicious mass, doctors use a number of imaging techniques

There is no best option.

Each of them has certain advantages and disadvantages:

⦁ Chest X-ray: the simplest test that finds primary tumor and metastases. If the neoplasm is large enough (the size of a coin), it can be detected as a gray mass on a black background. X-ray is nonspecific: the abscess and the cancer may look very similar.
⦁ Computed tomography: CT is a scanning of the organ by numerous X-rays directed from different sides. CT with a radiocontrast agent provides the doctor with valuable information about the size, shape and location of the neoplasm.
⦁ PET / CT: Positron emission tomography allows visualizing metabolic processes in cells and tissues. Combined with modern computed tomography, it becomes useful technology for imaging of small tumors and metastases throughout the body.
⦁ Magnetic resonance imaging: MRI is based on the nuclear resonance in a strong magnetic field (NMR). Leading Australian clinics use powerful scanners which provide high-quality images. For example, University of Queensland use 7 Tesla MR scanners for clinical applications, and their scientists use "micro-MRI" with 16,4T magnets.

Bronchoscopy and lung biopsy

Bronchoscopy is one of the endoscopic techniques which is widely used to study the internal surface of the bronchi and take samples of suspicious tissue. This procedure is performed by a bronchoscope – a thin flexible tube with a video camera and surgical instruments at the top. With local anesthesia, the patient does not feel any pain.

Another method can be used for sampling, which is called fine needle biopsy (FNA).If the tissue cannot be reached by a bronchoscope, the doctor inserts a special needle into the lung through the skin, collecting sample with the syringe. The procedure requires local anesthesia.

Then the samples are examined for the presence of malignant cells. Specially trained doctors determine their type, the presence of mutations and their sensitivity or resistance.

Peter Maccallum Cancer Center in Melbourne

This is one of the best cancer clinics in Australia. Peter Maccallum Cancer Center includes five divisions with a total staff of 2,500 people, among which there are five hundred scientists. This clinic is proud of the high professionalism and technical equipment.

High-precision radiation therapies, modern surgical theatres, stem cell transplantation, unique pathology lab, machine for apheresis (separation of malignant cells circulating in the blood).

Lung cancer treatment in Australia: technologies and medications

The treatment strategy is always depends on the particular type and stage of the disease, the overall health of the patient, and personal preferences. Before starting therapy, you should openly tell your oncologist your wishes and discuss every possible option. The main treatment option for lung cancer is surgical removal (resection) of the tumor. Only surgery allows you to completely get rid of the disease. Depending on the situation, surgery is combined with chemotherapy, targeted therapy, immunotherapy, and radiation therapy.

Non-small cell lung carcinoma in the early stage is usually treated with surgery alone or even with radiofrequency ablation (RFA). Radiotherapy, “chemo”, immunotherapy and targeted agents (aimed at specific mutations in tumor cells) are very useful in combination therapy.

Small cell carcinoma, which has spread throughout the body, is usually treated with chemotherapy. Radiotherapy is also used, including prophylactic cranial irradiation (PCI) to prevent metastases.

Mesothelioma is poorly respond to most treatment methods. In the late stages of this deadly malignancy, aggressive chemotherapy and palliative procedures are used.

Epworth Radiation Oncology in Melbourne

Epworth Radiation Oncology is one of the best radiotherapy centers in Australia. ERO specializes in high-precision radiation therapy, including IMRT. Thanks to advanced computer-aided planning systems, Melbourne doctors make irradiation extremely accurate, effective and safe for the patients.

Here are presented the expensive technologies, including the IGRT system for radiotherapy localization Calypso ™ 4D. Similar equipment is used in the Cleveland Clinic (USA).

Immunotherapy, molecular diagnosis, innovative targeted drugs, bone marrow transplantation, complementary medicine - everything is available in ERO. 

Surgery

At the beginning of the disease, surgical resection is usually enough to completely cure lung carcinoma. But surgery is also used to alleviate the symptoms in metastatic cancer.

Surgery is not indicated for treatment of patients with pulmonary function test results and certain severe chronic diseases.

Will he survive the procedure? That is the question.



Sleeve resection, segmentectomy, lobectomy (removal of the lobe) and pneumonectomy (removal of the lung) are used. The choice depends on the stage of the process and patient’s health. Disseminated cancer cannot be cured surgically, so your doctor will try to slow it with chemotherapy, immunotherapy, and radiation.

Australian surgeons prefer minimally invasive techniques called laparoscopic of keyhole surgery. Using thin probe surgeon removes the tumor through tiny incisions on the chest. Keyhole surgery reduces blood loss, the overall risk of complications and recovery time.

Radiofrequency ablation (RFA)

Radiofrequency ablation is based on heating the tumor with high frequency radio waves. RFA is sometimes used in patients with NSCLC who are not candidates for surgery.

The procedure looks simple: the surgeon inserts a thin probe through the skin reaching the tumor. Radio waves heat the tissue from the inside, and the tumor dies. This treatment does not guarantee 100% success, but in many cases it can replace the scalpel.

Australian cancer clinics also use:

⦁ Laser therapy: removal of tumors by focused laser beams
⦁ Cryosurgery: destruction of malignant tissue by low temperature
⦁ Photodynamic therapy: using special medicines in combination with light
⦁ Electrosurgery: destruction of tumors by high-frequency electrical current

These options are especially useful when surgery is contraindicated.

Genesis Cancer Care Center in Sydney

Genesis Cancer Center is considered the best radiation therapy clinic in New South Wales. The network includes two dozen locations in several cities, which provide patients with advanced diagnostic imaging, brachytherapy, IMRT, and stereotactic radiosurgery (Gamma-Knife).

Radiation therapy

Radiotherapy is based on high-energy rays, which destabilize the genetic material of cancer cells and disrupt their division. Oncologists widely use radiation to destroy small tumors, reduce their size before surgery (neoadjuvant therapy) and prevent relapses (adjuvant therapy).

Computer simulations and high-precision technologies provide high safety of modern radiotherapy. Smart devices search for a target, keep a record of the radiation load and even automatically correct the direction of the rays in case of accidental movement of the patient during the procedure.

Radiation therapy for lung cancer is given as one session (radiosurgery) or several sessions a week for a certain period. Side effects, such as burns and weakness, can be controlled by therapy.

Oceania Oncology in Maroochydore

The specialized center for radiation therapy Oceania Oncology is located in a resort town on the east coast of Australia, north of Brisbane. There are powerful computer-controlled linear accelerators and ultramodern equipment for radiotherapy planning.

Oceania Oncology means highly qualified radiation oncologists and unsurpassed service.

Chemotherapy for lung cancer in Australia

Chemotherapeutic drugs are very toxic agents that deprive malignant cells of certain nutrients or directly damage them. Chemotherapy acts on the primary tumor and the so-called micrometastases, which spread throughout the body in the late stages of the disease. Among these drugs are platinum compounds (carboplatin and cisplatin), taxanes (paclitaxel, docetaxel), vinorelbine, pemetrexed, gemcitabin and dozens of other names.

Systemic chemotherapy is usually administered intravenously under the supervision of medical personnel, and therefore requires regular visits to a special clinic (chemotherapy infusion center).

Toxic “chemo” has a harmful effect on rapidly dividing cells and tissues including blood cells, mucous membranes, and hair follicles. Therefore, hair loss, nausea, anemia, leukopenia, bleeding, general weakness and fatigue are frequent side effects.

Australian oncologists are constantly improving chemotherapeutic drugs and routes of delivery, making systemic treatment more effective and safe.

Targeted therapy

So-called targeted drugs act on specific mutations of malignant cells. Their effectiveness depends on the presence of certain genes and proteins, which can only be determined during histopathological examination.



Proper targeted drugs can slow even resistant tumors for a long time.

Here are some molecular targets:

⦁ Tyrosine kinase: afatinib (Gilotrif),
⦁ Mutant BRAF gene: dabrafenib (Tafinlar)
⦁ Vascular endothelial growth factor: bevacizumab (Avastin)
⦁ Epidermal growth factor: gefitinib (Iressa), erlotinib (Tarceva)
⦁ Anaplastic lymphoma kinase: alectinib (Alecensa), ceritinib (Zykadia)
⦁ ALK and epidermal growth factor: brigatinib (Alunbrig)
⦁ MEK1 and MEK2 kinases: trametinib (Mekanist)
⦁ ALK and ROS1: crizotinib (Xalkori), etc.

Biopsy with histopathological examination is the key to successful treatment.

Patricia Ritchie Center

This famous clinical center is located on the campus of Mater Hospital, the oldest Catholic hospital that was founded by the Sisters of Mercy in 1906.

These days, Patricia Ritchie Center for Cancer Care & Research work specializes in medical and surgical oncology, palliative care and support for people who survived cancer. Numerous clinical trials are conducted here; new lung cancer treatment technologies are being studied.

Immunotherapy

Immunotherapy teaches immune cells (leucocytes) to fight tumors. The problem is that many malignant cells avoid our immune system. Modern treatments, such as immune checkpoints inhibitors, block this defense mechanism.

Immunotherapy is considered as an auxiliary method of treating pulmonary carcinoma in later stages. With advanced NSCLC, clinical results are more promising, but scientists do not stop the development of immune methods against small cell lung cancer.

Four main directions of immunotherapy:

⦁ Monoclonal antibodies
⦁ Therapeutic cancer vaccines
⦁ Immune checkpoint inhibitors
⦁ Adoptive T-cell transfer

Australian oncologists use atezolizumab (Tecentriq), nivolumab (Opdivo), pembrolizumab (Keytruda), as well as durvalumab (Imfinzi) and a number of other promising agents.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator