The Low Down on Lung Cancer

Just over five years ago, my 46 year old aunt who had never smoked was diagnosed with Stage IV lung cancer. I was in the midst of my biomedical engineering Ph.D. working on cancer therapeutics and diagnostics so when I received word of the diagnosis, I immediately knew her chances of 1-year survival were just around 10%. Today in memory of my aunt on her birthday, I hope to increase awareness about this devastating disease by sharing what I’ve learnt through my experiences working with oncologists, working in research, and simply as a family member who has lost a loved one.

What’s the deal with lung cancer?

It’s the deadliest cancer — the majority of patients do not show symptoms. A such, their cancer is only detected in the latest stage of the disease where they have a ~1% chance to live 5 years after diagnosis. Despite this fact it is the least funded cancer.

Why is it killing so many people?

It’s a cancer that’s near impossible to detect until it’s too late. Our tools for detection and early diagnosis are subpar. There is no established cure once the cancer is detected in late stages.

We now know that this is not just a smoker’s disease. It happens in healthy non-smokers and young patients as well. Patients have been diagnosed as young as 21, and patients of all ages face dismal chances for survival.

Why isn’t there a cure yet?

Cancers differ from patient to patient. Each case is unique, and each person’s cancer responds differently to treatment. Hundreds of years ago, doctor’s first began identifying cancers by which organ they originated from (thus, the term “lung” cancer). Today, by sequencing and decoding the DNA of cancer cells, we know that lung cancer can actually be viewed as many different diseases that happened to originate in the lung. Sometimes, lung cancers could even appear more similar to breast cancer cells than other lung cancer cells.

So what makes something cancer then?

Cancer is a disease where your normal cells start growing out of control. Normal cells in our body are smart — they stop dividing, stop growing or sometimes even kill themselves (“cell suicide”) before they become a cancer. Sometimes normal cells get “mutations” where the DNA of the cell is changed. If too many mutations occur, the cell can become cancerous and will begin growing without any checks.

Why do we still group cancers by organ?

Because just like most of biology it’s a mix of genetics and environment. The location of the cancer still matters because these cells are exposed to different conditions. Biologists call this the “microenvironment’ of the cancer. When a cell metastasizes or spreads to other regions of the body, the same cancer can behave differently at different sites because it is in a different microenvironment and responds differently.

You make it sound like cancers are smart…

Kind of. Cancers are just responding to the environment around them. Because cancer cells don’t have any checks on them, they not only divide uncontrollably but also in a messy way. Normal cells duplicate themselves — make an exact copy. Cancer cells have lost many “safety checks”, so when they attempt to make a duplicate, they may be making a cell that actually has another “mutation” or change. By pure randomness, a new cancer cell type may come up that happens to be resistant to a drug, or is able to grow in a different part of the body (metastasize). It’s “survival of the fittest” for cancer cells.

Will we ever be smarter than cancer?

We’ve been getting smarter. In lung cancer we can now screen each person’s cancer to learn about it and pick better drugs that target each mutation. Some examples of this have been drugs to target the proteins EGFR, or the recently discovered lung-cancer driver, ALK, which is often present in non-smokers. Unfortunately, within 9 months to 2 years, cancer often returns. This is because over time, a “resistant” cancer cell will eventually arise.

Using combination therapies or other mechanisms (boosting the immune system), scientists, clinicians and engineers are working together to discover better ways to keep cancer in check.

theLoDown

Increased funding for cancer research has been correlated to improved survival rates in colon, breast, and prostate cancer patients. Lung cancer is severely underfunded as it is stigmatized as a “smoker’s disease.” Increased funding can galvanize advances in genomics and new detection technologies that are paving the way to a future with early diagnosis and smarter treatments.

About Me

I completed my Ph.D. in Biomedical Engineering from Harvard-MIT where I developed better diagnostics to monitor cancer treatment at Massachusetts General Hospital. I now work at Apple and continue to support lung cancer research as Director of Science & Research at Jill’s Legacy, a youth advisory board to the Bonnie J. Addario Lung Cancer Foundation . BJALCF is an inspiring organization that has helped guide many families including mine through medical care for lung cancer. Contact me with your questions, feedback, your stories or simply if you’d like to help at adeeti.ullal@gmail.com.

Learn More

The Basics: National Cancer Institute Page on Lung Cancer

Don’t Guess, Test: Guide to Genetic Testing for Lung Cancer

Cancer Specimen Bank: Advance Research and Contribute your Sample

Patient Support: Meet other patients and talk to top doctors weekly