well hello and welcome to night too.

>> I was gonna say Nightline HealthLine it is night but it's HealthLine.

I'm so glad you joined us this evening.

I'm Jennifer Blomquist.

I have the privilege of hosting the program and if you are new to our show, welcome and you will enjoy it and I guarantee you will learn something.

I learn something every week I am doing a show for 18 years and never ceases to amaze me all the information you can get out of this program so there are two things that I want to tell you about.

We are live in the studio right now and we keep the phone number up at the bottom of your screen.

The reason we do that is because we welcome any calls you may want to put into any questions you may want to ask our doctor tonight where we have a surgical oncologist.

We're going to be talking about lung cancer.

Maybe you have a question about yourself or somebody you care about.

So free advice you can't be that give us a call at any time.

It's (969) 27 two zero if you're outside of Fort Wayne it's still a toll free call.

Just dial 866- in front of that and when you call in you have two choices.

You can either ask your question why they don't just throw you on the air.

By the way, you'll talk to a very nice call screener.

They will tell you just to wait and then we'll get your question answered live the other way you can do it is you can just give the call screener your question and I'll ask the doctor for you.

>> I like the live option because sometimes the doctor may want to ask you some questions to better answer give you a better answer so do whatever makes more sense for you but just want to make sure you are aware of that.

We have a familiar guest joining us.

>> He has been on our program before.

Doctor Alexander, thank you so much.

Thank you for having me.

Great to have you back.

As I mentioned before, you are a surgical oncologist, correct.

And so and just came back to the area about a year and a half ago.

So we were so incredibly fortunate to have him here.

>> I didn't realize this but November is lung cancer awareness.

That's correct.

So we think you know I think everyone knows October is cancer awareness.

I feel like that's pretty established but lung cancer is is very prevalent as well.

>> Oh, very much so in both men and women it's the second most common cancer in men behind prostate cancer and in women behind cancer.

So it is a very prevalent cancer in both men and women and you know, you don't hear much about it.

>> You know, I guess people probably always assume that if you have lung cancer it's because you were a smoker.

Right.

But in my own family we my aunt passed away.

She never smoked a day in her life and she ended up dying from lung cancer when she was just forty five and it was a horrible ordeal so that opened up my eyes then to I met more people after that that that knew of people who had lung cancer but had never smoked.

>> Right.

So I mean obviously smoking's not good.

That's right.

I mean certainly smoking is associated with the vast majority of lung cancers.

Yeah.

Probably about 80 to 90 percent of all lung cancers can be traced to smoking.

But for those that didn't smoke or had had no history smoking probably in the next most common cause of lung cancer is radon exposure.

>> Oh so for those who don't know, radon is a colorless, odorless gas that is found naturally in the ground.

Yeah, it is a breakdown product of uranium and it just leaks up through the ground.

>> So there at any time well for example in a house any time there is a break or a crack within the foundation of the house, radon can leak through a very common place for it to leak through is an assumption because that is really a break in the foundation and radon is heavier than air so it tends to accumulate in the lowest part of the house.

>> It also happens to be that that Fort Wayne is in one of the highest zones for radon.

>> So the EPA divides it up into zones one through three zone.

The one is the highest and Fort Wayne is right in the middle of the zone one area.

>> So you have a very high rate of rate of radon here.

And so again that is probably one of the one of the main causes of lung cancer in nonsmokers.

>> I feel like in Fort Wayne the basement is a big deal like people are really into finished basements here in some parts of the country and like Florida they can't do basements because it's such a high water table but basements are huge here and I mean I grew up in northern Illinois and it wasn't really a thing then I came here and everyone said oh no, you got to have a basement and it's funny you bring that up because I remember my father in law when he went to sell his house years ago that was an issue was the raid on my home.

So is that something you should that you can have check or should you like I don't even know who you call to do but you can get raid on testing kits on low self like yourself.

>> But but also you could there are companies that will do that for you.

OK, if you do get a high radon level detected you'll need to get a professional involved to do what's called abatement.

>> So it's essentially a venting system where they'll it's a fan of venting fan that will vent that air out and then they expel it out the roof of the house.

>> I'm glad you're telling us this because I never thought about I never really thought about it and yeah, we you know, I think a lot of people spend time especially with teenagers and stuff they like to hang out in the basement.

>> So good good advice.

You know, I was going to ask you besides the radon, how how prevalent would secondhand smoke be that's also known to be a cause of lung cancer?

Yes.

So much that really smoke related smoking related cancers are are directly correlated with the the length of time that a person is smoked or is exposed to smoke.

>> Yeah.

And the amount right.

So if you were inhaling secondhand smoke from a you know, a very heavy smoker.

Yeah.

Even though you didn't smoke yourself that is a that is a big risk factor.

>> What about just living with somebody who smokes like maybe or not because I know there are some people where it's a couple and one smokes one doesn't and the agreement is the person who smokes goes outside but they still smell smoke and the home smells smoke.

>> Does that have an impact problem a little bit.

It's really mostly the inhalation of the actual smoke combusted tobacco product.

>> Yeah, right.

Definitely interesting things things to think about for sure.

Um, I just wanna remind everybody because our callers sometimes tend to call in later in the show and I would hate to miss your question tonight.

So that's why again we keep that phone number up at the bottom of the screen.

I just want to remind you that we'd love to hear from you.

We have great things to talk about but please feel free to call any time it's (969) 27 two zero and again if you want to make it a toll free call if you're outside of Fort Wayne, just put 866- in front of their oh.

>> So what would you suggest to people especially during this month you're focusing on lung cancer.

Are there things that if you even if you're a non smoker things that you should be thinking about or symptoms to look for ?

I don't I'm not even sure except maybe I've heard some people say it hurts when you have the little that that's the first symptom as well.

>> Unfortunately the lung cancers don't often give symptoms until they're fairly advanced and so that's that's the need that's the reason for screening is to try to find them before they become symptomatic and that's going a little side here and that's actually sort of one of the fallacies of of why people think they don't need screening.

They'll say well I don't have any symptoms, why do I need to get screened?

But in fact they're the exact people we want to screen because they aren't having symptoms.

>> And so because of that we could probably catch a cancer earlier if it's there .

That's not something you know, we hear all about the cancer screenings and prostate and so forth.

But what what are the guidelines for lung cancer screening?

And I don't know if it's by age or depends on your lifestyle.

>> Yes.

So it's by age and also by by small amount of smoke.

So depending on what what guidelines you're following, the ones we most often follow those related to Medicare, what the government pays or some Medicare guidelines or anybody between the age of 50 and 77 you also have to have had a history of smoking of what's called twenty pack years and the way you calculate pack years is by taking the number of packs smoked per day and multiplying it by the number of years that you've smoked.

So for example, if you smoke one pack a day for twenty years that's a 20 pack your history of smoking so again 20 pack year history smoking or greater or have had a history of smoking that amount but quit within the past 15 years.

So also related to that is that you don't have any symptoms related to lung cancer and to answer your previous question about what are the symptoms yeah, common symptoms would be shortness of breath, cough, a persistent cough not just occasional cough.

OK, blood tinged sputum or phlegm when you have sort of chest pain but that would be a fairly late sign and then and then really unexplained weight loss as well.

So those but if you don't have any of those symptoms then you would qualify for a lung screening cat scans so again age 50 to 77 20 pack year history of smoking or greater or quit within the past 15 years and then no symptoms of lung cancer and and you're a great candidate get screened and just nobody wants to do screening that's inconvenient or painful.

>> But I've heard it's just it's just like a CT scan.

It's very straightforward like a colonoscopy.

>> Absolutely like that.

It's much easier.

Yes.

It's it's a very pretty quick it's about ten fifteen minutes absolutely pain free noninvasive so you don't need an I.V.

put in so you don't need contrast material so it's just lying on the CT scanner getting scanned get up and you're on your way afterwards so it's very quick painless you know it's I there is inconvenience having to go to the center to get a scan but that's really about it.

>> Yeah well what I guess what is that I don't know if you can measure it by percentage but how how good are the screenings like how early could you possibly catch is it just looking for like spots on your lung.

>> Exactly so so the way of lung cancer will first present is as a small little dot in the lung tissue because it'll show up as a dot on an X-ray.

So an X-ray looks at relative densities of tissue so the cancer is denser than the surrounding lung tissue and so it looks like a just a dot as we call a large nodule.

>> OK, right.

So it will show up is that over time if nothing is done about to grow bigger and bigger and bigger and then will likely cause symptoms which will then prompt the person to go to their physician and get a scan.

But if we can do it earlier, catch it earlier when it's just this little dot.

>> Yeah.

Then we have a much better chance of curing it with treatment.

I was going to ask what what are the treatment options and with a nodule how can I mean are they automatically cancerous?

>> I don't know.

In fact the vast majority of nodules are benign so they're either scarring or perhaps an old infection or something of that sort but only about four percent of all lung nodules will end up being cancerous.

OK, but if you take all the lung nodules that we find on CAT scans for whatever reason it's a large number of nodules that we find.

>> But luckily again not the minority of those will be worrisome.

So one, if you went for the scan and they noticed these spots, what would be the next step then?

Do they all hands on on several things that depends on the size of the of the nodule that they see.

So if it's really small so less than a half an inch in size or so then probably can just be watched and followed.

If it's larger than that it probably needs some kind of further investigation with another scan or perhaps a bronchoscopy or look down into the lungs with a scope I don't know can they buy I don't know if they do biopsy just looking OK they can so it all depends on the size in the character to some nodules are very, very dense or what are called calcified nodules and those are almost always benign.

>> So if you see a calcified nodule we can just probably we can usually just let those go and not do anything further about them not to have any other scans at all.

>> Yeah, I was going to ask you know, I think most people know the colonoscopy if it looks good you've got ten years you have to go back.

So if everything does look OK, how often a year?

>> Oh, just one year and OK.

All right.

And you in part of the reason for that is that lung cancers we we are usually think of cancer as being fairly slow growing so but lung cancers can be very aggressive and can grow very quickly and so we may not have seen a nodule this year but within a year you can you can get a you know, fairly good sized nodule.

>> So that's why we need to follow them up every year.

>> Well, I remember doing this program years ago and there was somebody from a local health center was a nonprofit agency and she brought I mean I don't know what they had done to these it was actual lungs but they had been preserved and she brought a set from somebody, you know, that hadn't smoked and then she brought a pair from somebody who had and it was just frightening to see they were shriveled.

They looked shriveled up and she said that she said because they primarily work with kids and she said I always tell the kids just think about if you took your lungs out and put them in the oven for like ten years.

This is that's kind of the same thing as smoking every day, you know?

And it but it was just unbelievable how unhealthy the smokers lungs, the lungs, black blotches of black are in there.

>> Yes.

It's it's not a good looking lung.

Yeah.

And I'm I am surprised that I still see so many people smoking.

>> Oh I am too.

I mean there's been a huge campaign for gosh I mean I'm old and it's been around since I was in high school.

I remember you know, the pretty strong about you know, don't smoke and yeah yeah it was you know I think in general smoking anti smoking campaigns have done a good job and we could we know that the incidence of lung cancer is dropping and it's been dropping over the past two to three decades and I think it definitely coincides with when a lot of the anti smoking campaigns were going into effect and then decreasing smoking in public places and such.

So definitely incidence is going down and so is mortality.

So I think the the anti-smoking movement is is working.

We just have a lot more to do especially in the state of Indiana.

>> Yeah, I've heard that we have a pretty high school so we have about sixteen percent of the adult population in the state of Indiana are smokers.

Yeah.

And that we rank seventh worst in the United States as far as as far as no smoking.

>> So and I don't want to get too far off track but I do see a lot of people vaping and I think they feel like that's quote unquote the safe way to smoke.

I don't know what your thoughts are on that.

>> Well, you know, vaping has not been around for that long.

Yeah.

I mean or very popular for that I feel like yeah.

>> Like so we don't have a lot of a lot of follow time on these.

Remember I was saying that it's a matter of amount and time it gets to the get developed lung cancers so I think we'll know a lot more in the next several years but right now we don't have a whole lot of data to directly implicate vaping with cancer.

There's some preliminary data suggesting it but I think there's a really interesting study that really puts vaping in a bad light and that is that there was there was a study looking at about 5000 people with lung cancers and they then looked at those who smoke and those who smoked and vaped OK and those people who smoked and vaped were about four times at higher risk for getting lung cancer than those who just smoked alone.

>> So that has suggests that there's some bad effects, some negative effect on the lung that vaping has that either somehow accentuates the effect of smoking or makes it worse conditions for or better conditions I guess for lung cancer to form.

>> And I think that probably all has to do with inflammation.

And as we know that inflammation is a is you know, very much associated with the start of or the incidence of cancer.

So I think it's the inflammation in the lung plus the smoking that really is makes it a great environment for lung cancer form.

>> I mean it's just I've never seen anybody like right next to me do it but I've seen people from a distance and there's been I don't know what there's just it's like you don't see their head like it's a plume of smoke.

>> Yes.

I don't know why people thought that was a good idea but I and I'm not trying to be discriminatory against people but you know, it does seem like there would be some negative side effect of doing that every day.

So probably the most common injury or problem we see bad problem in the lungs with vaping is is an entity called Evolve which is e cigaret and vape associated lung injury and it's it's a horrible problem in the lung.

It's severe inflammation.

>> Oh patient people often need to be on ventilators or breathing machines until all that inflammation dies down and then they can breathe better again.

But it's it's it's a bad thing and does cause a lot of injury to the lung.

>> Wow.

Yeah.

Just just don't do it just don't do it and encourage if there's somebody in your family I would I would just highly suggest you know try and have a conversation with them about that probably two or three minutes ago they showed me the card to say that we're down to ten minutes so we're probably down to seven minutes or so right now.

We could still squeeze in a few questions.

So I just remind you one last time to please call if you have any questions about lung cancer or lung cancer awareness month ,there might be some local organizations maybe doing screenings or programs so you know, look that up or maybe want to go online and find out more information about that.

Make a priority just to put in a plug for that November 8th.

>> So this coming Saturday is national Lung Cancer Screening Day.

OK, so now of health care health care organizations around this area are doing scans or screenings gambol oh no just at the hospital and hospitals and so they're open for business to scan people on Saturday.

>> So I would encourage you to first of all talk to your primary care to make sure that you are eligible for screening and that you do satisfy those criteria I talked about before and then if you do, then I would encourage you to go on on Saturday or whatever days convenient for you but to get your screening scan done.

Yeah.

All right.

Make it a make it a priority for sure.

What you know if somebody does have the diagnosis of of lung cancer is surgery usually the next step or their more conservative steps you can take before that?

>> Well, it all depends on the stage of the cancer how likely it is though that it's localized.

Yeah.

So if it's very much localized so just confined to the lung itself then surgery is usually the first route of the therapy if it's spread further to the lymph nodes then it might be a combination of surgery plus chemotherapy or radiation therapy.

But if it's spread elsewhere to other organs then it's usually just chemotherapy and immunotherapy that would be used.

>> What in general what is the survival rate or does it depend on what your stages I imagine very much in general is it a is improving the number or it is you know I said that the mortality rate is improving and likely because of decreased amount of smoking.

But also it's I think it's very much due to improvements in our treatment and we've had some really tremendous advances in treatment over the past ten years or so and that's using immunotherapy and we've been having some very amazing results with that.

But to answer your other your previous question about survival rates.

Yeah, so yes, it all depends on on the stage for the cancer.

So if it's it's localized still isolated just to the lung this the five survival rates are in the 60 to 70 percent range.

>> Right.

Once it spreads to the lymph nodes it's now down to in the thirty thirty five percent range and then if it's metastatic spread elsewhere then we're we're in the single digit numbers.

Yeah.

So again that just speaks to how important it is to catch these as early as possible and why screening is so important and we need to get everybody out there to get screened.

>> Yeah maybe they get the word out because like I said, you know, I think the whole you know, I had a doctor one time tell me that there was so much going on with the cancer awareness campaign that a lot of other cancers took a back seat.

Right.

So you know, he was you trying to work with you know, for other cancers that that had very high rates affecting both men and women to try and get the word out right.

>> So well, I think it's it's well deserved to try to put more attention on lung cancer and lung cancer screening.

>> If you look at the compliance rates with screening meaning those who are eligible for screening based on those criteria and those who actually get screened in the state of Indiana we're only at about sixteen percent.

OK, in some of our local data we're think we're seeing that it's more around four to six percent so so few people are getting screened that really should get screened.

>> I did I did notice that a call came in.

Sure.

Well, just if it was somebody that wanted me to ask it for them.

So let's see how does Brian cause lung cancer?

Well, it sounds like this person has a personal connection like something has happened within their family.

>> Sure.

So radon as I said, it's a it's a gas is a breakdown product of uranium but radon itself is radioactive.

>> OK, so I believe it's most likely that is this the chronic exposure to a low level of radioactivity that's causing damage to the lung and damage to the lung cells which then cause the the lung cancer OK and that's a yeah.

>> Something again most people probably don't even think about that.

I think my the only reason they call it that my father loses because it was part of the deal when they were selling it they wanted to test or had to test for it.

>> So I realize if you're a smoker that predisposes you to getting cancer but what if you had a relative who didn't smoke and who had lung cancer?

>> Does it tend to be to worry about a hereditary factor than others?

Good question and lung cancer is not often related to an inherited syndrome.

OK, but there are now more and more data that there are some genes that are associated with lung cancer.

One of them is a fairly common mutation in a gene called p53 which is a but most often that's associated with cancers of the of the colon lymphoma is a rare tumor called a sarcoma but they are found in the lung cancer can be associated with that.

There's also some mutations in the the inherited mutations in EGFR gene which is the epidermal growth factor receptor gene but really hereditary lung cancer probably represents less than 10 percent of all cancers.

>> So it's it's not as common as other cancers might be.

>> All right.

Interesting.

Yeah, well our time is up and they told me to wrap up the show believe it or not is so fascinating, such a wonderful guest.

I really appreciate all that you share with us.

Thank you.

I appreciate you having me.

I've got to get you on the list again for later this year for this coming year.

So thank you Doctor Allen, your Honda.

And I'm Jennifer Blomquist.

Thank you so much for tuning in tonight.

Really appreciate it.

Hey, I won't see you again until December so have a happy Thanksgiving and Happy Veterans Day to all the events next week.

>> Thank you for your service.

Have a good night.

Bye bye.