According to the latest statistics, more than 8,000 Belgians are diagnosed with lung cancer every year. Two in three are male, but the percentage of females is rising every year. Four in five of these patients die within five years of diagnosis. Early diagnosis is essential in order to reduce the death rate and improve quality of life. Early and accurate diagnosis leads to more effective treatment, better quality of life and a more favourable prognosis. In the pursuit of a better prognosis, VITO doctoral student Eline Berghmans is cooperating with Prof.  Dr. Patrick Pauwels (Head of the Pathological Anatomy Clinic at Antwerp University Hospital).

What exactly is lung cancer?

Prof.  Dr. Pauwels: Lung cancer occurs when something goes wrong with the division of the cells in the respiratory tract and they start to divide uncontrollably, forming a lump or tumour. These cells can then invade the surrounding tissue and cause a lot of damage. There are two types of lung cancer: small cell and non-small cell lung cancer.

What are the symptoms of lung cancer?

Lung cancer patients experience a persistent cough, which often produces a mixture of blood and mucus. They also commonly have pain around the chest area, particularly on coughing, laughing and breathing in deeply. They complain of shortness of breath. Regular respiratory tract infections can also be a sign of lung cancer. Other symptoms are also common in other types of cancer. They can include loss of appetite, weight loss and feelings of fatigue and weakness.

Is lung cancer difficult to detect, and how is it diagnosed?

Lung cancer produces almost no symptoms at an early stage of tumour development, which means that the diagnosis is not usually made until a later stage. By this time the cancer has often spread. In many cases, small lung tumours are discovered as a chance finding on an X-ray or CT scan.

Is lung cancer a common type of cancer?

With around two million diagnoses every year worldwide, lung cancer is one of the most common cancers along with breast cancer. Lung cancer occurs more frequently in men: in Belgium there are more than 8,000 new cases of lung cancer every year, of which 5,439 are men and 2,835 women.

Has science already identified  possible causes? Is there a hereditary element?

Smoking is still the main cause of lung cancer. Cigarette smoke is responsible for 85 % of lung cancers. Smokers need to be aware that around 17 % of smokers eventually develop lung cancer. It’s not just active smokers who are at risk. Passive smoking also increases the risk of developing lung cancer by 30 %. Long-term exposure to fine particulate matter is the second biggest cause, followed by exposure to asbestos, radon and other substances. Smokers with a family member who has, or has had, lung cancer are three times more likely to develop lung cancer themselves.

What treatments are available and how invasive are they?

If the lung tumour is still relatively small, is not embedded and has not yet spread, the tumour is often surgically removed. Chemotherapy and radiotherapy, alone or in combination with other therapies, are also widely used in the treatment of lung cancer patients. Depending on the type of cancer, some patients are eligible for targeted treatment.  This treatment affects the cancer cells much more specifically, with a much lower impact on healthy cells. As a result, patients experience much fewer side effects. Unfortunately, a downside is that the therapy is only suitable for a small percentage of all lung cancer patients. Immunotherapy is a recent but promising treatment for lung cancer patients. It strengthens the immune system so that it attacks and eliminates the tumour cells.

What is the prognosis for someone diagnosed with lung cancer?

Around 85 % of lung cancer patients worldwide eventually die as a result of this cancer because it is a disease that is not usually detected until a late stage, after the cancer has already spread.  

VITO is currently carrying out research into lung cancer in cooperation with the Antwerp University Hospital. What exactly does this involve?

Eline Berghmans (VITO): We analyse tissue from the lung tumour.  If a lung tumour is surgically removed, we can examine the lung tissue. Although the lung tissue removed during a lung biopsy – in which doctors collect a small amount of lung tissue using a needle – is sufficient for the lung cancer tests the hospital carries out, it is not enough for the tests that we want to perform. That is why, at present, we only work with tissue that has been removed during a surgical procedure. These tissue samples are bigger for the purpose of testing.

What exactly are you testing for?

Some non-small cell lung cancer patients are eligible for treatment with PD-1 and PD-L1 inhibitor immunotherapy drugs (Nivolumab, Pembrolizumab or Atezolizumab). One in four patients who receive immunotherapy respond well to the treatment and sometimes have a significantly longer survival rate. Even if the cancer has spread, they survive for a number of years with a relatively good quality of life. However, three in four patients treated do not benefit from the treatment. Worse still: they experience serious side effects that reduce their quality of life to below pre-treatment levels. We want to avoid this as much as possible. 

That is why we want to be able to predict more accurately which patients will respond well to the treatment and which patients will not benefit from it. As part of this research, we are using mass spectrometry imaging to try to predict more accurately how each individual patient will respond to immunotherapy. Mass spectrometry imaging enables us to visualise proteins and their distribution directly from the tissue. We can then determine which proteins are present and which are absent in new lung cancer patients based on a biopsy or lung tumour tissue removed during surgery using mass spectrometry imaging. The results can then be used to identify those patients who will benefit from immunotherapy.

What volume of samples/data has already been collected?

We have currently collected around 10 test samples from different lung cancer patients, and have used this tissue to optimise our technique (mass spectrometry imaging). None of these patients had previously received immunotherapy. At the same time, we have also started to study lung tumour tissue from 30 lung cancer patients who had already received immunotherapy. This includes patients who responded well and those who did not respond well to the therapy.

How does the cooperation between Antwerp University Hospital and VITO work?

We are able to contact both the Pathology Department (via co-promotor Prof. Dr. Pauwels) and Biobank to obtain tissue samples for this research. Antwerp University Hospital’s Multidisciplinary Oncology Centre Antwerp (MOCA) provides us with the information we need about patients who have received immunotherapy and whether or not the patient responded positively to the treatment.

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