Lung cancer treatment in the United States
- 04 June
- Diagnosis & Treatment
Medical tourists know that lung cancer treatment in the United States means high quality standards, latest medical advances and patient-centered care.
Lung cancer is a malignant tumor that originates from lung tissue.
The difference between small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) plays a crucial role in the treatment and prognosis of the disease.
Malignant tumors of the lung either come directly from the lung tissue, or they are secondary tumors of other organs (metastases to the lungs). In this article, we discuss only primary malignant lung tumors that arise from lung tissue, especially from the cells that line the airways (bronchi).
Lung cancer can spread to any organs, giving rise to metastases.
Malignant cells grow and divide uncontrollably, so that they quickly penetrate adjacent organs and surrounding tissues, such as the pleura.
Through the lymphatic vessels, individual cancer cells enter the lymph nodes. Through the blood vessels, they enter distant organs, where they can settle and form secondary tumors. In this way, metastases affect the liver, brain and bones.
Lung cancer costs the United States $ 14 billion each year. Government institutions and US private companies are investing huge amounts of money in the development of new methods of screening, diagnostics, treatment and monitoring.
American scientists gave the world many effective methods and medications, including lung cancer immunotherapy and targeted therapy.
Best lung cancer centers in the United States:
• Cleveland Clinic.
• Dana-Farber / Brigham and Women's Cancer Center.
• Johns Hopkins Hospital in Baltimore.
• Mayo Clinic in Rochester.
• Memorial Sloan-Kettering Cancer Center.
• University of Texas MD Anderson Cancer Center.
Scientific efforts produce impressive results. American hospitals offer their patients a full arsenal of modern tests, drugs and procedures. Survival of lung cancer patients in the United States is one of the highest in the world.
Despite all the advances, the lung cancer treatment in the United States in the presence of metastases is not effective enough. As a rule, life expectancy of patients in such cases is several months.
If the disease is diagnosed in stage IV, the main goal of the doctors is to make the last months of the patient's life as comfortable as possible. The earlier the diagnosis is made, the better the prognosis.
What is the difference between NSCLC and SCLC?There are two main types of disease: small cell lung cancer and non-small cell lung cancer. These two types of cancer differ in their course, so they must be treated differently.
If patients want to understand the prognosis and treatment options, they need to know the type of cancer.
Non-small-cell lung cancerNSCLC is a much more common type, which is found in about 85 out of 100 cases of lung cancer.
The subtypes of non-small cell lung cancer are:
• Squamous cell carcinoma originating from the upper layer of the mucous membrane.
• Adenocarcinoma, which arises from the glandular cells of the respiratory tract.
• Large cell lung cancer, the origin of which is still unclear.
Small cell lung cancerSCLC is much less common - in about 15 out of 100 cases of lung cancer.
It often grows very quickly and spreads early through the lungs to other organs.
Surgical treatment of small cell lung cancer is generally ineffective.
Possible symptoms of lung cancerAmerican oncologists note that lung cancer often causes symptoms only in the later stages.
This delays the diagnosis of the disease and makes treatment more difficult.
Symptoms of lung cancer are varied, but not specific. The same complaints are found in many other diseases. There are no symptoms that clearly indicate lung cancer.
Depending on the location, size, spread of the tumor and the presence of metastases, lung cancer manifests itself in different ways.
A lung tumor (primary tumor) causes the following complaints:
• Chronic cough, which increases despite treatment.
• Chest pain, especially with deep breaths.
• Dyspnea and a whistling breath sound (stridor)
• Cough with bloody sputum (hemoptysis)
• Accumulation of fluid in the pleural cavity (pleural effusion).
• Pressure on the superior vena cava.
• Pain and weakness of hands.
• Sore throat.
Metastases of lung cancer are often formed in the bones, liver, adrenal glands, lymph nodes, brain or spinal cord.
Metastases can cause the following complaints:
• Bone pain.
• Neurological disorders
• Confusion of consciousness.
• Convulsive seizures.
• Swollen lymph nodes.
Common symptoms of lung cancer:
• Weight loss.
• Night sweats.
Symptoms that are not directly related to cancer (paraneoplastic syndromes, especially with SCLC):
• Electrolyte imbalance.
• Immune system dysfunction.
• Metabolic changes.
• Neurological disorders.
Lung cancer diagnosis in the United States: tests and proceduresSometimes lung cancer is detected by chance during an X-ray. If lung cancer is suspected based on medical history, physical examination, blood tests, symptoms and lifestyle, further research will be conducted to confirm the diagnosis of lung cancer.
American cancer centers are known for advanced medical imaging and molecular genetic diagnosis of lung cancer. Using these methods, local doctors diagnose the disease at the earliest stages and choose the optimal treatment as quickly as possible.
Medical imagingChest radiograph ($ 200- $ 400 or more): The most simple and affordable method for detecting structural changes in the lungs and surrounding tissues.
Bone scintigraphy ($ 1,000 or more): This is a nuclear medicine procedure that identifies areas of bone tissue with increased metabolism that is characteristic of malignant tumors. The method is used to search for metastases in lung cancer.
Computed tomography (up to $ 1500): This is a specialized X-ray technique that determines the exact location of the tumor, its size and the presence of metastases in different parts of the body.
Positron emission tomography (up to $ 4,000): A nuclear medicine procedure that can provide information about the intense metabolic activity of suspicious tissues; in combination with CT, this method makes the diagnosis of lung cancer more reliable.
Magnetic resonance imaging (up to $ 2000): This method uses strong magnetic fields to create three-dimensional images of the body. MRI is widely used in the diagnosis of lung cancer, including the search for metastases in the brain.
Tissue examination proceduresMicroscopic examination of sputum: sputum may contain tumor cells that can be identified by microscopic examination; this is simple and affordable method.
Bronchoscopy with a biopsy ($ 2,000 or more): during this procedure, a thin flexible tube with a camera (bronchoscope) is inserted through the trachea into the bronchi. Using special instruments on the bronchoscope, doctor takes tissue samples from suspicious areas for histological examination in the lab.
Fine needle biopsy ($ 500 or more): If the tissue is not available with a bronchoscope, doctor can get a tissue sample through the chest wall under the control of ultrasound or CT with a special thin needle.
Molecular genetic methodsMany cancer cells contain specific changes (mutations) in its genetic material. Tissue or blood samples are checked in special laboratories for the presence of these mutations, also known as biomarkers. They are a decisive factor when choosing a lung cancer treatment in the United States.
Based on the obtained tissue or blood samples, an accurate diagnosis can be made.
What type of lung cells did the tumor originate from? How do specific tumor cells differ from their normal form? What is the difference in their metabolism? What mutations do they carry?
This information, along with the stage of the cancer, is crucial for choosing the right treatment.
Molecular genetic tests may become necessary during the course of the disease, because tumors can change their properties. After testing, the therapy is adjusted according to the properties of the tumor.
Lung cancer molecular testing in the United StatesIn recent years, many innovative treatments for lung cancer have emerged. Great advances have been made in the treatment of advanced non-small cell lung cancer (NSCLC). This was made possible thanks to a better understanding of molecular biology and genetic changes in the tumor cell.
The so-called biomarkers are involved or even responsible for the development of cancer. Therefore, drugs have been developed that act on tumor cells through these biomarkers. Using molecular genetic testing, American oncologists choose the optimal targeted therapy for specific mutations.
In addition to traditional biopsy, biomarkers are determined by circulating in the blood of tumor DNA (liquid biopsy). This blood test is especially important when it is impossible to take a suitable sample of tumor tissue. This is a convenient and effective technique.
Since the cost of targeted therapy for NSCLC in the United States can be $ 10,000–20,000 per month, molecular testing of the tumor before starting treatment plays an important role.
In NSCLC, there are several cancer-promoting genetic alterations for which targeted drugs are approved:
• Mutations in the epidermal growth factor receptor gene (EGFR)
• Change in the structure of the gene ROS1
• The fusion of genes EML4 and ALK.
Each of these changes leads to uncontrolled tumor growth.
There are also features that the tumor uses to avoid the body’s immune defenses. Currently, American oncologists recommend PD-L1 testing before prescribing lung cancer immunotherapy.
EGFR mutation testingIn patients with advanced non-small cell lung cancer, EGFR mutation testing should be performed prior to initiating therapy. This ensures high efficiency of treatment.
Mutations in the epidermal growth factor receptor (EGFR) gene lead to uncontrolled tumor growth. These mutations are more common in women, nonsmokers, and patients with stage IV adenocarcinoma. EGFR mutations occur in 10-15% of all patients with NSCLC.
This lung cancer mutation is determined in a special laboratory using tumor tissue samples.
If the EGFR mutation is confirmed, tyrosine kinase inhibitors (TKI) can be used. These targeted drugs bind to the receptor instead of a growth factor and thus inhibit tumor growth. If the initial targeted TKI therapy is no longer effective, then additional EGFR mutation testing is needed.
The test result is available approximately 1-2 weeks after receiving a tumor or blood sample.
Mutation T790MTargeted therapy with tyrosine kinase inhibitors (TKI) is a major advancement in the treatment of NSCLC patients with EGFR gene mutation.
However, after 8-16 months, all the available TKIs lose their efficacy. During treatment, genetic changes develop, and the tumor becomes resistant. In 60% of cases, EGFR T790M mutation is responsible for this resistance. Until recently, only chemotherapy was offered to such patients.
This mutation can be detected using tumor samples or, alternatively, a blood test. In the presence of a T790M mutation, targeted therapy is sometimes prescribed using third-generation TKI instead of chemo.
EML4-ALK and ROS1 testingIn patients with non-small cell lung cancer, two genes may fuse in tumor cells. The ALK (anaplastic lymphoma kinase) enzyme gene is fused to the EML4 protein gene.
The fusion of EML4 and ALK leads to uncontrolled growth of tumor cells and occurs in 3-5% of NSCLC patients. Non-smokers, women and the elderly most often have a tumor with this genetic change.
EML4-ALK status is determined on tumor tissue or in blood samples in laboratory. When an EML4-ALK fusion is confirmed, doctors prescribe a targeted therapy with an ALK inhibitor that halts tumor growth.
Like the EML4-ALK fusion, mutations in tumor cells can lead to the activation of the ROS1 tyrosine kinase. In this case, targeted therapy with ROS1 inhibitors is used.
PD-L1 TestingSometimes tumor cells are able to avoid the body's defense system. They can produce more proteins that stop the immune response. The central role is played by the protein PD-L1 (programmed death ligand 1).
This is part of a complex system for balancing the immune response. In non-small cell lung cancer, an elevated level of PD-L1 lead to the situation that the immune system will no longer recognize the tumor cells as “foreign” and, therefore, the patient’s body will not fight with them.
PD-L1 testing is performed in special laboratories using tumor tissue taken during biopsy. This is a very important test that is recommended before starting lung cancer immunotherapy with modern drugs. New drugs use this mechanism to stop the growth of tumors. They block the PD-L1 protein, making the tumor vulnerable to the immune system.
Modern lung cancer treatment methods in the United StatesIn the early stage of the disease, surgical intervention is attempted to completely remove the tumor and cure the disease. Depending on the clinical situation, targeted drugs, systemic chemotherapy, radiation therapy and experimental methods of treating lung cancer can be used.
Surgical removal of the tumor ($ 10,000 or more)Surgery plays an important role, especially in non-small cell lung cancer. The surgical removal is especially appropriate for young healthy patients with small tumors without metastases.
Health status plays an important role in the choice of treatment. In particular, severe lung and heart diseases may limit the possibilities of surgical treatment.
Pulmonary function tests are performed before surgery to ensure that the remaining lung tissue can support respiratory function. For very large tumors, the surgeon has to remove the whole lung.
Chemotherapy ($ 5,000 or more)Chemotherapy is an important part of lung cancer treatment. After surgical removal of the tumor, patients with NSCLC usually receive cytotoxic drugs to destroy the remaining tumor cells in the body.
In the later stages of lung cancer, chemotherapy is often combined with radiation therapy (radiochemotherapy) to prevent or alleviate the symptoms associated with the disease.
In NSCLC, cytostatic chemotherapy can be combined with targeted therapy. Small cell lung cancer (SCLC) is usually treated with chemotherapy because it is particularly sensitive to cytostatic drugs.
Chemotherapy is based on the use of drugs that inhibit the proliferation of cancer cells.
Chemotherapy is systemic, that is, it works all over the body. Substances are distributed to all organs, destroying primary tumors and metastases. The treatment is carried out in cycles at regular intervals.
Some chemotherapy drugs prescribed for the treatment of NSCLC in the United States:
Although cancer cells are most sensitive to cytotoxic drugs because of their high rate of division, chemotherapy also damage healthy cells.
Cells with high proliferative activity are especially vulnerable, including cells of the oral mucosa, cells of the mucous membrane of the stomach and intestines, hematopoietic cells of the bone marrow and hair follicle cells.
Possible side effects of chemotherapy include nausea, vomiting, loss of appetite, diarrhea and abdominal pain, hair loss, anemia and bleeding, an increased risk of infections and weakness.
However, there are effective therapeutic measures that can alleviate or even prevent some side effects.
Be sure to talk to your doctor about the side effects of chemotherapy.
If necessary, he can prescribe medication for you.
Radiation therapy ($ 10,000 or more)If the tumor is inoperable, radiation therapy can stop the growth of the neoplasm and even lead to full recovery in the very early stages of the disease.
Radiation therapy is also used before surgery (neoadjuvant radiotherapy) or after tumor removal (adjuvant radiotherapy), as well as in combination with chemotherapy (chemoradiotherapy).
In the later stages of lung cancer, when brain metastases have already formed, radiation therapy can slow the growth of metastases and alleviate neurological symptoms. In patients with bone metastases, radiation therapy relieves pain and prevents fractures.
Radiation therapy locally destroys tumors and lung metastases with high-energy radiation. Irradiation is performed either through the skin (external radiation therapy) or from the inside using an implanted radiation source (brachytherapy). Thanks to advanced methods, radiation therapy for lung cancer in America is very accurate and safe today. However, side effects are possible.
In some patients, mild skin irritation occurs. Other patients complain of weakness and fatigue, nausea, vomiting, diarrhea and headache. However, these symptoms usually go away quickly. The long-term side effects of radiation therapy, such as skin ulcers, are rare.
Targeted therapy (up to $ 25,000 per month)Targeted therapy selectively acts on tumor cells, and therefore it is relatively safe for healthy cells. Modern targeted drugs are well tolerated.
They inhibit different molecular factors that support tumor growth, disrupt the blood supply to the tumors, or interfere with the transmission of chemical signals between cancer cells.
Targeted therapy drugs for NSCLC include:
An important therapeutic principle is the inhibition of the receptor for epidermal growth factor EGFR, which is overexpressed in many cases of non-small cell lung cancer.
The so-called EGFR tyrosine kinase inhibitors (EGFR-TKI) specifically block EGFR signaling in tumor cells and thus stop tumor growth. These medicines can be taken in pill form.
Patients with progressive NSCLC who have EGFR mutation can receive this targeted therapy as the first treatment option (first line therapy) or as the second treatment option (second line therapy) after systemic chemotherapy with cytostatics.
Unfortunately, after 8–16 months, 60% of patients develop another specific EGFR mutation (called T790M), and TKI EGFRs of the first and second generation are no longer effective. The tumor has developed resistance to these TKIs due to the T790M mutation.
Until now, chemotherapy has been the treatment of choice in such cases. But today, the third generation TKI EGFR osimertinib is used in the United States. This drug, after confirming a T790M mutation, may delay the progression of the disease.
Inhibition of other messenger substances for cancer cell growth:Random shifts in the cancer genome, the so-called translocations, can lead to the activation of other tyrosine kinases, anaplastic lymphoma kinase (ALK) or ROS1 tyrosine kinases.
Such ALK-positive or ROS1-positive lung cancer cells are rare, but American doctors have learned how to slow their growth with targeted drugs.
Every year, scientists discover more and more genetic changes. For some of them, however, there are no treatments available. The function of others is not yet fully known.
Inhibition of tumor blood vessel growth:Tumors need their own blood vessels that supply them with nutrients and oxygen. Cancer uses various growth signals, such as vascular endothelial growth factor (VEGF), to form its own vascular network.
There are drugs that target VEGF or its receptor. Since they disable growth signals to form blood vessels, they are also called angiogenesis inhibitors. They prevent the emergence of new blood vessels supplying the tumor. Nutrients no longer enter the tumor, which stops growing and dies.
Targeted therapy is generally better tolerated than chemotherapy, but side effects also occur. For example, typical side effects of EGFR-TKI include diarrhea and skin rashes on the face.
Lung cancer immunotherapy (over $ 100,000 per year)American scientists were the pioneers of lung cancer immunotherapy, and today local clinics and hospitals remain among the best in the world.
A promising approach is immunotherapy with antibodies that target immune checkpoints. These points are used by tumor cells to protect against the immune system. A healthy body is able to recognize foreign substances, such as bacteria, viruses and cancer cells, and effectively counteract them.
Cancer cells, however, are able to “hide” from the attacking cells of the immune system.
If the immune system cannot recognize tumor cells, the cancer gets a chance.
So-called “checkpoint inhibitors” make tumor cells visible to the immune system. This new treatment option is usually given to patients with advanced lung cancer who have already received other treatments.
The effect is observed only after a few weeks, and not all patients respond to it. Analysis of the expression of PD-L1 can give an idea of whether this is the best treatment option for a particular patient.
Typical side effects of immunotherapy are associated with excessive activation of the immune system. If these immune-mediated side effects are detected early, they can be successfully controlled.
Is lung cancer always fatal?This disease is very dangerous, but not always fatal. The earlier lung cancer is diagnosed, the higher the probability of recovery and the higher the life expectancy.
The likelihood of recovery in a particular case depends on several factors:
• Type of tumor.
• Stage of the disease.
• Tumor localization.
• Patient's condition.
• Age of patient.
Women have a slightly better prognosis than men. Small cell lung cancer usually grows and spreads beyond the lung very quickly, so the overall prognosis for this disease is worse than for NSCLC.
Thanks to the innovative treatment of lung cancer in America, the survival rate and quality of patient’s life here are much higher compared to the most countries of the world.