Squamous Lung Cancer: Questions and Concerns for Patients and Families

Many questions?

Hello, doctor.
My family members do not smoke or drink alcohol.
During the day, they work in an office, and at night, they cook.
One family member was diagnosed with bone metastasis from squamous lung cancer after suffering from a persistent cough that would not improve.
There were no genetic mutations found, and no effective targeted therapies were available.
After receiving two immunotherapy treatments, they passed away.
Later, the hospital provided an opportunity for the deceased's sister to undergo a low-dose computed tomography (LDCT) scan, which came back normal.
A few months after I131 treatment, I also went to a nearby clinic for an LDCT scan, which showed no abnormalities.

Meanwhile, an older male relative who had smoked, drank, and chewed betel nut for decades eventually passed away.
After that, we no longer lived together.
I would like to ask the doctor how often LDCT scans should be done as a self-paid health check for peace of mind.
I am very afraid that another family member might fall ill and we would have to say goodbye again.
Would having an LDCT scan every two to three years be too frequent? Is LDCT similar to SPECT in terms of radiation exposure, and does the background radiation return to normal within a week? Isn't squamous carcinoma often associated with secondhand smoke exposure? Why did that relative, who smoked for decades, remain healthy for so long? Is this really related to gender? Shouldn't non-smoking women have a higher incidence of adenocarcinoma? Adults often say that cooking oil fumes can cause lung cancer, but should I accept this explanation? According to adults, the incense used in temples for worship might also contribute to lung cancer.
I feel so angry and sad, but the lives that have been lost can never come back.

Niming, 20~29 year old female. Ask Date: 2020/12/22

Dr. Chen Sirong reply Oncology

Anonymous / 25 years old / Female
1.
How often should I get an LDCT scan? Is it too frequent to have one every two to three years?
A: 1.1 Please confirm if you meet the criteria for the "Taiwan Low-Dose Computed Tomography Lung Cancer Screening Consensus Statement" regarding the recommended screening population.

1.1.1 Individuals aged 50 to 80 years with a smoking history of over 30 pack-years, who are currently smoking or have quit for less than 15 years, are advised to undergo low-dose computed tomography (LDCT) for lung cancer screening.
This is particularly cost-effective for those aged 60 to 75.

1.1.2 Individuals with a family history of lung cancer are also recommended to undergo LDCT for screening.

1.2 I believe you are too young to require frequent LDCT scans.

1.2.1 Regular thyroid monitoring by your physician should suffice.

1.2.2 An annual chest X-ray, followed by LDCT every 2-3 years starting at age 45-50, is also acceptable.
2.
Is LDCT similar to SPECT in terms of radiation exposure? Does the body recover from radiation in a week?
A: During a CT scan, the equipment exposes the body to a certain amount of radiation, which can affect ovulation and its quality.
To ensure a successful pregnancy without complications, it is advisable to wait until the effects of the CT scan have fully resolved before attempting to conceive.
Typically, the body requires about 7-10 days to recover to a normal state after a CT scan, so it is generally safe to conceive about two weeks post-scan.
However, individual circumstances may vary, and adjustments should be made based on personal health conditions.
3.
Isn't squamous carcinoma primarily caused by secondhand smoke? Why do some people smoke for decades without issues? Is this really related to gender? Shouldn't non-smoking women have more adenocarcinoma cells? Adults often say cooking oil fumes are a cause; should I believe this? According to adults, does incense used in temples also increase the risk of lung cancer?
A: These are probabilities; for the general population, it is a matter of risk.
For an individual, it is either a 100% chance of developing cancer or a 0% chance.
4.
I am very upset and sad; however, lost lives can never return.
A: If you believe in reincarnation, you will meet again in the future.
Wishing you peace and joy.

Taoyuan Hospital, Chen Si-Rong

Reply Date: 2020/12/22

More Info

Understanding squamous lung cancer can be a daunting experience for patients and their families, especially when faced with the complexities of diagnosis, treatment options, and the emotional toll of the disease. Squamous cell carcinoma (SCC) of the lung is a subtype of non-small cell lung cancer (NSCLC) that is often associated with smoking, but it can also occur in non-smokers. Here, I will address your concerns and provide insights based on current medical knowledge.

Risk Factors and Causes
While smoking is the most significant risk factor for lung cancer, particularly squamous cell carcinoma, it is not the only one. Other factors include exposure to secondhand smoke, environmental pollutants, occupational hazards (such as asbestos or radon), and even genetic predispositions. It is important to note that lung cancer can develop in individuals without any of these risk factors, as seen in your family member. The absence of a clear cause in some cases can be frustrating and confusing.

Screening and Monitoring
Low-Dose Computed Tomography (LDCT) is a valuable tool for lung cancer screening, especially in high-risk populations, such as long-term smokers. For individuals with a history of lung cancer or significant risk factors, regular screening can help detect any recurrence or new lung cancers early. The frequency of LDCT screenings can vary based on individual risk factors and physician recommendations, but generally, it is suggested to have screenings annually for high-risk individuals.

In your case, since you have undergone LDCT and found no abnormalities, it may be reasonable to continue with annual screenings, especially given your family history. However, the decision should always be made in consultation with your healthcare provider, who can tailor recommendations based on your specific circumstances.

Understanding the Role of Radiation
Both LDCT and SPECT (Single Photon Emission Computed Tomography) involve exposure to radiation, but the levels are typically low and considered safe for diagnostic purposes. The body can generally recover from this radiation exposure quickly, and the benefits of early detection often outweigh the risks. It is essential to discuss any concerns about radiation exposure with your doctor, who can provide reassurance and information about the safety of these procedures.

Emotional Impact and Support
The emotional burden of having a family member with cancer can be overwhelming. Feelings of fear, anger, and sadness are common. It is crucial to seek support, whether through counseling, support groups, or talking with friends and family. Sharing your feelings and experiences can help alleviate some of the emotional stress.

Lifestyle Factors
You mentioned concerns about cooking fumes and incense exposure. While there is some evidence that indoor air pollution, including cooking fumes, can contribute to lung cancer risk, the relationship is complex and not fully understood. It is essential to maintain good ventilation while cooking and consider using exhaust fans to minimize exposure to smoke and fumes.

Conclusion
In summary, squamous lung cancer can affect anyone, regardless of smoking history. Regular screenings like LDCT are essential for early detection, especially for those with a family history of lung cancer. While the emotional toll is significant, seeking support and maintaining a healthy lifestyle can help manage anxiety and promote overall well-being. Always consult with your healthcare provider for personalized advice and recommendations tailored to your situation. Remember, you are not alone in this journey, and there are resources available to help you navigate these challenges.

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