Dr Robert Gin of Arizona Oncology On The 5 Things Everyone Needs To Know About Cancer

An Interview With Savio P. Clemente

The majority of lung cancers can be prevented by not smoking. I encourage any smokers to stop smoking and those in the high-risk category to get an annual low-dose CT of the chest.

Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?

In this interview series called, “5 Things Everyone Needs To Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Dr. Robert Gin — Arizona Oncology.

Dr. Gin practices radiation oncology with a special interest in breast and head and neck malignancies. He is experienced in the diagnosis and treatment of all soft tissue cancers such as breast, prostate, and lung cancer. Dr. Gin is also active in the use of intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT) of adult cancers.

While earning his Bachelor of Science degrees in Chemistry and Molecular and Cellular Biology from the University of Arizona, Dr. Gin also earned membership in the academic honors society, Phi Beta Kappa. He served as chief resident while completing his residency in radiation oncology at the University of Arizona.

What or who inspired you to pursue your career? We’d love to hear the story.

My parents came to the United States from China. They opened a grocery store in Chandler, Arizona on the south side of town. I was born and raised in Chandler, Arizona as well. My siblings and I grew up working in the grocery store along with our aunts and uncles.

I saw my parents’ hard work at the grocery store. The store was open for 7 days a week, from 9 a.m. to 9 p.m. I worked Fridays after school and on the weekends. I was also able to see my parents’ compassion for others. At that time, it was routine for my mom to give credit to customers that did not have enough money. In some cases, their credit was signed with just an “X” next to the amount. Somehow, my mom and the customers knew which “X” belonged to them. My dad would also take customers home in his personal truck and even bring meals to neighbors behind the grocery store. They taught me that anything is possible with hard work and kindness toward others.

In my senior year of high school, I had swollen lymph nodes under my chin and neck. My primary care doctor thought it could be related to a malignancy. It was then I became interested in cancer. I went to college as a pre-med, but my decision to become a radiation oncologist started as a volunteer in the department of radiation oncology during my first year of undergrad. My duties included transporting patients to their treatments, running X-ray films for the therapists, and assisting the radiation residents with errands. I noticed the courage exhibited by the patients, compassion from the clinical staff, and the respect the residents and staff showed to me as an undergraduate student.

This is not easy work. What is your primary motivation and drive behind the work that you do?

When anyone hears I am a radiation oncologist, they always tell me that it is a tough profession. When people hear the word “cancer,” they think it’s a death sentence. However, there have been significant improvements in radiation oncology. Radiation techniques have improved so that we can use pinpoint radiation to target tumors. Additionally, radiation doses can be shaped around the tumor, avoiding critical nearby structures. Planning systems have also improved in calculating more accurate doses to a tumor. Consequently, there is less toxicity compared to 25 years ago when I trained. My primary motivation and drive are to cure the patient with the least amount of side effects, but also in cases where a cure is not possible, to give them relief from the symptoms of their cancer.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

I am excited about SBRT. This stands for stereotactic body radiation therapy. This is a technique of delivering radiation at a high dose with pinpoint accuracy. The purpose is to treat in five or fewer treatments instead of weeks. We have been doing this for brain tumors, lung cancers, metastases, and currently we’re evaluating for prostate cancer. Additionally, there are studies looking at dose de-escalation. These studies are looking at using lower doses for a variety of cancers that can lead to less acute and long-term side effects.

For the benefit of our readers, can you briefly let us know why you are an authority about the topic of Lung Cancer?

Lung cancer is the second most common cancer for both men and women. In 2022, approximately 240,000 men and women will be diagnosed with lung cancer. Of that, 130,000, or 54% will die from lung cancer. Radiation oncologists approach lung cancer as a team consisting of a pulmonologist, a thoracic surgeon, and a medical oncologist. For early-stage lung cancer, surgery or radiation alone can be used for a cure. For locally advanced cancers, chemotherapy and radiation are commonly used together.

Ok, thank you for all of that. Let’s now shift to the main focus of our interview. Let’s start with some basic definitions so that we are all on the same page. What exactly is lung cancer?

Lung cancer is essentially cells in the lung that have become abnormal and now have properties of uncontrolled growth and the ability to leave their primary location and travel to other parts of the body.

What causes lung cancer?

Smoking is the primary cause of lung cancer. Approximately 85% of lung cancers are caused by smoking. People who are exposed to secondhand smoke are also at risk of developing lung cancer. Exposure to heavy metals such as chromium and arsenic, as well as insulation such as asbestos, can also increase risk. Radon, which is a radioactive gas, is the number one cause of lung cancer in nonsmokers.

What is the difference between the different forms of lung cancer?

There are essentially two types of lung cancer — non-small cell, and small cell. These are differentiated under the microscope based upon their size. Non-small cell are larger cells compared to their small cell cohorts. However, it is their characteristics that are more important than their size. Small cell tends to be very fast-growing with a high tendency to metastasize to other parts of the body, including the brain. As a result, the primary treatment is chemotherapy to treat systemically. With non-small cell lung cancer, they tend to be slower growing. As a result, if it is localized, surgery or focal radiation such as SBRT is an option for cure. If there is nodal involvement, chemoradiation is a more common approach. Metastatic lung cancer is primarily treated with systemic agents such as chemotherapy or immunotherapy.

I know that the next few questions are huge topics, but we’d love to hear your thoughts regardless. How can lung cancer be prevented?

Smoking cessation is the primary way to prevent lung cancer. Additionally, reducing exposure to environmental carcinogens such as secondhand smoke, heavy metals, and radon testing can also further reduce the risk for lung cancer.

How can one detect the main forms of lung cancer?

Symptoms of lung cancer include persistent or worsening cough, chest pain, shortness of breath, coughing up blood, unexplained weight loss, loss of appetite, feeling of unwellness, or fatigue. If you have unexplained symptoms, I recommend you follow up with your primary care doctor for additional work-up. In most cases, for respiratory symptoms, your doctor may order a chest x-ray or a CT scan of the chest. High-risk patients between the ages of 55 and 77 with a 30+ pack per year smoking history (number of packs smoked per day times years of smoking), who are currently smoking or stopped smoking over the past 15 years, may benefit from an annual low-dose CT scan of the chest. Studies have shown that early detection can lead to a better prognosis and a higher rate of cure.

Lung Cancer used to almost be a death sentence, but it seems that it has changed today. What are the odds of surviving cancer today?

The mortality rate for lung cancer has come down. This is most likely due to a decrease in smoking. In the past, surgery was the main treatment for localized lung cancer. Currently, patients who are not operable candidates are being effectively treated with SBRT for a cure. For locally advanced non-small cell lung cancer, improvement in survival has been seen with the use of immunotherapy after completion of chemoradiation.

Can you share some of the new cutting-edge treatments for cancer that have recently emerged? What new cancer treatment innovations are you most excited to see come to fruition in the near future?

Researchers are currently looking at a phenomenon known as the abscopal effect. With the recent uses of immunotherapy, which enhances the body’s immune system to go after tumor cells, radiation is being studied to enhance that effect. Some studies have shown that treating a single tumor in a patient with metastatic disease can cause regression of metastatic sites. I find it exciting that a local treatment can work with a systemic agent to enhance its effect. Again, this reinforces the teamwork approach needed to treat this aggressive cancer.

Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?

I find that being accessible to patients helps with healing. When patients are actively treated, they may have a sense of safety that they are aggressively attacking their cancer. They can access their doctors or nurses during their treatments. However, once treatments are over, they may lose that sense of security. Being available after their treatments for questions or problems can help in both their physical and emotional recovery.

From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?

From my experience, most patients don’t want to bother family or friends and try to do it on their own. However, patients have told me how grateful they were when a family member, neighbor, or friend stopped over with some food, offered a car ride to the doctor’s office, or just simply called to ask how they were doing.

What are a few of the biggest misconceptions and myths out there about fighting cancer that you would like to dispel?

One of the biggest misconceptions and myths out there about fighting cancer is when a patient has researched their cancer on their own on the Internet and applied those findings to themselves. Unfortunately, some of the information on the Internet may not be correct and patients may decide against treatment based on inaccurate information.

Thank you so much for all of that. Here is the main question of our interview. Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Lung Cancer? Please share a story or example for each.

#1 — The majority of lung cancers can be prevented by not smoking. I encourage any smokers to stop smoking and those in the high-risk category to get an annual low-dose CT of the chest.

#2 — Because small cell lung cancer has a high risk of spreading to the brain, approximately 10% of small cell lung cancers can be present in the brain at the time of diagnosis. Approximately 40 to 50% can develop brain metastases during the course of disease. As a result, preventative whole-brain radiation may be recommended for small cell lung cancer.

#3 — Non-small cell lung cancer is more likely curable when diagnosed early. I have seen an increase in early localized lung cancer since low-dose CT screening started.

#4 -Treatment for lung cancer involves a multidisciplinary team including pulmonary medicine, cardiothoracic surgery, radiation oncology, and medical oncology. At Arizona Oncology, we participate in a lung cancer tumor board to determine the best treatment for our patients.

#5 — Lung cancer has a high mortality rate. However, modern therapy has improved survival for patients diagnosed with lung cancer. Talk with your multidisciplinary team regarding your treatment options.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

If I were to start a movement that would bring the most amount of good to the most amount of people, it would be to show respect and kindness to each other.

How can our readers further follow your work online?

arizonaoncology.com

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.