Dear Dr. Roach: Why does non-small cell lung cancer have such an unwieldy name? Why not call it “large cell lung cancer” instead?
P.R.
There are four main types of lung cancer, as well as a few rare types. Small cell cancer is a specific type of lung cancer that behaves differently from the others and represents only about 10% to 15% of lung cancers. The others — adenocarcinoma, squamous cell carcinoma and large cell carcinoma — are grouped together as non-small cell lung cancer, because they tend to have similar prognoses and tumour behaviour.
Surgery remains the best hope for cure in people with non-small cell lung cancer; unfortunately, it’s only an option for a minority. At the time of diagnosis, most people have a tumour that cannot be treated with surgery, and they are generally treated with medication. In the past, therapy was guided by visual examination of the tissue, and this is still a useful way of choosing the type of medication treatment.
Increasingly, treatments are based on understanding of the types of mutations on a molecular level. The tumour cells are sampled from the patient, and the DNA is sequenced to find what mutations the tumour has. There is an ever-growing number of new medications to target tumours with those specific mutations. Traditional chemotherapy typically targets cancer cells by their tendency to grow faster than healthier cells, but it has well-known toxicities. Newer treatments have the potential not only for more success, but for much less toxicity. This can lead to a longer and better-quality life for a person with lung cancer that cannot be removed surgically.
Dear Dr. Roach: My wife gets really annoyed when I ask her to repeat a request or comment. She thinks I need a hearing aid. Although my hearing isn’t what it used to be (one too many power plants and rock music shows) and I do have mild to moderate tinnitus, I sometimes have to ask her to turn down the audio on the TV when the chatter starts to bother me. Part of the problem is that she doesn’t seem to grasp the communication concept of “signal to noise ratio.” If she’s trying to tell me something when I’m standing near a noisy appliance, or if the TV is blathering away, whatever she’s saying is drowned out by the ambient noise. Should I be seeing an audiologist, or do we need a TV that turns down the volume when someone in the room is speaking?
R.L.D.
You are quite right that hearing a person is much more difficult when there is a lot of ambient noise. However, I do think it would be wise to see an audiologist. The exposure to loud noise you have had and your tinnitus are both signs that you should have a visit with your regular doctor, who will do an exam and make sure there isn’t an obvious cause, like an earwax impaction, and will otherwise refer you to an audiologist for a formal hearing evaluation.
Once the evaluation is complete, you can get specific advice about your options, which may include hearing aids, but you might not be ready for those yet. Getting more information is the first step.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
