Ask the Expert

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Professor Stephen Spiro is an Honorary Consultant Physician to University College London Hospitals and the Royal Brompton Hospital, London.
He has conducted clinical trials in the treatment of lung cancer in the UK for more than 30 years and is currently heading a national screening study for high-risk individuals. He is a former President of the British Thoracic Society and of the European Respiratory Society. He was Chair of the Lung Cancer Board in the NE Thames NHS Region between 1997 and 2005, and has sat on several National and International Boards involved with policy for the management of lung cancer.
Q: Why if daddys chemotherapy can reduce his cancer tumours, can it not get rid of them and cure him?
A: When someone gets cancer is it is a combination of cells that grow rapidly to create a lump or bump. Within that lump is some good tissue as well as the abnormal cancer ones. When we give chemo we aim to kill the abnormal ones but we are aware that some of the cells are so abnormal that the chemo we have at present will not work. Therefore we can reduce the lump and the growth but we cannot eradicate it. Also in some cancers we use combinations of drugs as this gives us a multi action approach killing as many different abnormal cells as we can. We unfortunately can only work with what we have which is why we do lots of trials and research to try and find cures.
Q: When I was little, my parents chain-smoked in the house, and even in the car it was horrible. Have they increased my chances of getting lung cancer?
A: Almost certainly not. Being subjected to passive smoking as a child is equivalent to assault as it is against your will, and it will increase your chances of, as a child, getting chest and ear infections and increase the chances of getting asthma. However, there is no good evidence that it will increase your chances of getting lung cancer.
Q: I've been told that if I stop smoking my lungs will repair themselves. Does this mean that if I quit smoking for a few months each year to allow them to do so, I'll significantly reduce my chances of getting cancer? Or, that even if I don't give up until I'm in my 60s, my lungs will recover and I won't get cancer?
A: All the evidence indicates that 60 is late to give up in the hope of avoiding lung cancer. Ideally smokers should quit before they reach their 40th birthday. If you smoke more than the equivalent of 20 cigarettes a day for 20 years, your risk of getting lung cancer after quitting never quite returns to that of a never-smoker, but after 13 years will remain at twice the risk from normal. However, if you were to continue to smoke your risk would inexorably rise to 20 or more times that of a never-smoker. Lung cancers, like many cancers take years, often 10-15 years, to become large enough to cause symptoms within the body. This is why risk of getting lung cancer takes 13 or so years to fall back after quitting smoking.
Q: I understand that if you remove part ofthe liver it grows back - will my lung growback if I have to have it removed?
A: No it won't. Fortunately, most lung cancersoccur in the upper lobe of the lungs which wedon't need so much for breathing,and they are the smallest lobes.However, as the lungs don'tregenerate, removal of a lobecontaining a cancer, will, especiallyif it's the lower lobes (which arelarge), reduce your breathingcapacity. In some cases, becausesmoking causes COPD, somepatients may have technicallyremovable tumours, but their lungfunction has become too poor forthe risk of surgery.
Q: Both my father and his father died of lung cancer. My grandfather smoked but my father didn't. Does this mean it's likely to be hereditary, and if so are there any tests I can have to see if I'm at an increased risk?
A: The hereditary risk for lung cancer if one orboth parents had it, is small. However, thereare case studies of such families. There areno satisfactory screening tests as yet forlung cancer, although this is an area of muchresearch. There is little point in having aprecautionary chest X-ray, as its likely tobe normal if you are well, and no-one knowshow often this should be repeated. In fact,studies looking at the use of chest X-rays todetect lung cancers early, before they causesymptoms, have failed to show that this saveslives. Clearly the most important thing in yourcase is never to smoke.