Cancer.Net Q&A forums are month-long events on a specific topic. During the month, guests may submit questions to leading cancer experts by emailing them to contactus@cancer.net . Each week, answers are posted on Cancer.Net (www.cancer.net). Cancer.Net Q&A forums are free of charge, anonymous, and preregistration is not required.

Please keep in mind that Dr. Kris is unable to give individual medical advice in this setting, nor is he able to address questions that include information specific to one person's medical profile. The information presented here is for informational and educational purposes only and is not intended to substitute the professional medical advice or treatment recommendations provided by your doctor.

This forum is neither intended nor appropriate to serve as a means of obtaining a second opinion on cancer diagnosis or treatment. In response to questions about specific drugs, comments will focus only on the state of current research and clinical trials. It is advised that you do not delay seeking professional medical advice based on any information contained in this Q&A forum.

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Mark Kris, MD, is Chief of the Thoracic Oncology Service, Division of Solid Tumor Oncology and Associate Chairman – Clinical Trials, Department of Medicine, at Memorial Sloan-kettering Cancer Center and Attending Physician at Memorial Hospital for Cancer and Allied Diseases, New York, NY. He is Professor of Medicine at the Weill Medical College of Cornell University and serves as Co-Leader of Memorial Sloan-Kettering's Multidisciplinary Thoracic Disease Management Team.

Dr. Kris is a specialist in thoracic malignancies and a clinical investigator. His research includes the evaluation of new anticancer agents, the development of treatments targeting lung cancer, multimodality therapy, the testing of antiemetics, and identifying better ways to manage the physical symptoms caused by cancer.

Question 1: I underwent radiation therapy for lung cancer about four years ago and have had a constant cough since then. Is this common, and are their ways to manage it?

Dr. Kris: It is unusual for a cough to persist for this many years after radiation. I urge you to contact your doctor and have a thorough evaluation for the many different possible causes of this cough.

Question 2: What are some of the long-term side effects of radiation therapy for lung cancer treatment, and are there any ways to manage/treat long-term side effects?

Dr. Kris: Thoracic radiation can accelerate atherosclerosis (hardening of the coronary arteries). It is essential that your internist know you received radiation. Your cardiac care must be precisely managed with exquisite control of cardiac risk factors, specifically blood pressure, LDL cholesterol, and diabetes. Smoking is absolutely forbidden. You may also need a stress test. Osteoporosis can be accelerated in those bones that receive radiation. Once again, discuss this with your doctor.

Question 3: Are there any vaccines under study to prevent a recurrence of lung cancer? If so, when will it be available to patients?

Dr. Kris: There is no vaccine that has been proven to prevent recurrence of lung cancer. However, many vaccines are being tested in clinical trials. Discuss this with your doctor, and also visit Cancer.Net's clinical trialsection to find searchable listings of open clinical trials if you are interested.

Question 4: Are there any new lung cancer drug treatments recently approved by the Food and Drug Administration (FDA) or currently in clinical trials?

Dr. Kris: Bevacizumab (Avastin) was approved for the treatment of non-small cell lung cancer (NSCLC) just two weeks ago. However, this drug has several unique side effects and is not the right drug for every patient with lung cancer. Your oncologist can advise if it is right for you.

Question 5: What screening is currently recommended -- especially for someone at relatively high risk (former smoker, emphysema, history of breast cancer)?

Dr. Kris: There is no screening test recommended for lung cancer today. Helical (spiral) CT scans can find tiny lung cancers at a curable stage. This was recently heavily covered by the media. Unfortunately, doctors have not yet been able to decide which persons should have screening CT scans. Clinical trials are underway to help answer this question.  In the meantime, you should speak with your doctor to see if a screening CT scan is right for you.

People who have been cured of lung cancer are those at the highest risk for a second lung cancer. While there is disagreement in screening general populations of smokers, there is full agreement that, if you have had one lung cancer, you require a helical CT scan at least once a year.

Question 6: Is it possible that lung cancer could be hereditary?

Dr. Kris: Unlike other forms of cancer, there is no conclusive link of lung cancer to family history. It is likely that the smoking habit is something that runs in families, and indeed, whether or not you become addicted to smoking may have something to do with your genetic background. Also, people often learn to smoke from watching their parents smoke, and in that sense, lung cancer is familial. In this case, however, genetics is not destiny, and by never smoking, that chain can be broken.

Question 1: Is the risk of lung cancer lower for people that only smoke occasionally?

Dr. Kris: There is no safe amount of cigarette smoking. Any degree of cigarette smoking can potentially cause lung cancer.

Question 2: I have lung cancer and have developed fluid around my lungs. Is this common? What treatments are available?

Dr. Kris: Fluid commonly collects in the chest cavity in people with lung cancer. For many people, receiving chemotherapy can make this go away. In addition, there are many procedures that can remove the fluid and provide immediate relief of the shortness of breath and cough it can cause. In addition, medicine can be placed inside the chest cavity to prevent fluid from reaccumulating. Your doctor will know what to recommend if you have developed this complication.

Question 3: What is being done to find new treatments for small cell lung cancer? I feel like there is no hope for people diagnosed with that type of lung cancer.

Dr. Kris: There is a large amount of research underway to find better treatments for small cell lung cancer. Unfortunately, there have been few breakthroughs in the last decade.

One other problem that has developed is that successful treatments are often not offered to all patients. For example, there is good information to show that receiving radiation twice a day improves survival over receiving it just once a day. Despite this, not every patient who receives radiation receives it twice a day. By applying the information we currently have, we can help people live longer and cure more patients. There are also many clinical trials to test drugs specifically for small cell lung cancer, and I urge you to investigate open clinical trials with your doctor and through Cancer.Net.

Question 4: I was diagnosed last October with stage 1 lung cancer. After treatment with erlotinib (Tarceva), the tumor shrank by 50%. Now the tumor in my right lung is growing again. My doctors want me to try a new drug called HKI? What can you tell me about it?

Dr. Kris: HKI is one of many drugs that is being investigated for people like you. Your doctor can give you more specific information about this drug and other options that are right for you.

Question 5: My husband's doctor is recommending an open lung biopsy. How long does it take to recover from this surgery? What should we expect?

Dr. Kris: Recovery depends on an individual person's health and the type and extent of surgery performed. Only your surgeon can accurately advise you on these questions, and I urge you to speak with him or her.

Question 6: My mom was diagnosed a few months ago with NSCLC that has spread to her brain and possibly the liver. We've been told it's an incurable situation. I'm not sure what to expect at this point. She is pretty much in bed all day.

Dr. Kris: While lung cancer is too often incurable, that does not mean that treatment cannot make individuals feel better and live longer. Effective treatment is available both for lung cancer that has spread to the brain and to the liver, and I urge you to speak with her oncologist about these options.

Question 1: I'm baffled as to how I got lung cancer when I never smoked. What are the other major risk factors? I'm getting tired of not having an answer for those people who assume I smoked.

Dr. Kris: We still do not know what causes lung cancer in many patients. Some specific occupational exposures, such as radiation or asbestos, and exposure to radon can cause lung cancer even in the absence of cigarette smoking.

Many patients have been frustrated by the persistence of often well-meaning people in asking whether or not they smoked, when they learn someone has lung cancer. You are right to be concerned by this. The fact of the matter is that today, three-quarters of persons with lung cancer have either never smoked or have heeded health warnings and stopped smoking many years ago. All who have joined the fight against lung cancer need to get this message out.

Question 2: Dana Reeve's death seems to have raised public awareness about lung cancer and that it can strike anyone. Will this new attention really help fight this disease?

Dr. Kris: Despite the tremendous burden of lung cancer to persons diagnosed with it and our country, the public still does not appreciate the magnitude of this problem. Everyone fighting lung cancer needs to get this message out more often.

Question 3: Are there any areas of research regarding lung cancer that seem particularly promising for developing new treatments?

Dr. Kris: There are likely 100 new treatments being tested today to attack lung cancer. Only research will define which of these new medicines will help persons with this illness. Everyone facing lung cancer should consider participating in clinical trials. For many individuals, a clinical trial is their best option; for others, it provides yet another option beyond those open to them with the available treatments we have. To learn more, visit Cancer.Net's Clinical Trials section and speak with your oncologist.

Question 4: I was a pack-a-day smoker, but quit about 18 years ago. Should I be having any special screening for lung cancer, or is my risk the same as anyone else's at this point?

Dr. Kris: Screening is not recommended for any patient with a history of smoking, at this time.

Question 5: I'm in treatment and holding steady physically, but I'm having a hard time emotionally. So many people seem to stop caring the second they hear I smoked, like I deserved to get lung cancer. Any recommendations for me?

Dr. Kris: Many people fighting lung cancer feel exactly as you do. I urge you to connect with others fighting this illness through support groups, which can be found throughout the country and online. Visit CancerCare's website to learn more.

Question 6: How much of a risk is lung cancer to bones? My mother just started taking one of those osteoporosis drugs, but I'm not sure why her oncologist recommended it.

Dr. Kris: Often, drugs that help strengthen bones are prescribed to persons with lung cancer. For some, it is part of their general healthcare. For others, they are given specifically because the cancer has spread to the bone. For the latter group, these drugs can help strengthen bone and prevent fractures. Her oncologist can explain why this drug was prescribed for your mother.

Question 1: My brother smokes, and I've nagged him for years to stop. (Most people in our family have died from one type of cancer or another). What are the most effective ways for a person to quit smoking?

Dr. Kris: There is no one single way to stop smoking. We now have many different approaches available. It is important for a person who wants to quit smoking to know the various options available, and choose the one that best suits them. I urge your brother to speak with his doctor to make that decision.

Question 2: What is stereotactic radiotherapy? I'm facing early stage lung cancer.

Dr. Kris: The technology of radiation therapy has advanced dramatically in the last decade. New equipment can precisely direct the radiation beam to the cancer, avoiding normal structures around it and permitting a higher dose of radiation (more likely to eradicate the cancer) to be directed to the tumor. Stereotactic radiotherapy is one example of this new technology.

Question 3: Why is lung cancer so hard to treat?

Dr. Kris: This question has perplexed researchers for decades. Cancer is a disease of the genes. In the case of lung cancer, lifelong smoking allows genetic damage to accumulate to the point that cancer develops. Many feel that there are multiple steps from turning a normal cell into a malignant one. The exact number of steps, as well as the sequence of these steps, is not known, but these are the likely reasons lung cancer is so hard to figure out. People smoke for decades before developing the illness, and others often develop lung cancer decades after smoking has stopped.

Question 4: I am nervous for my cousin who's recently been diagnosed with lung cancer. How effective are the current treatments?

Dr. Kris: Lung cancer treatment can almost always lessen the symptoms caused by the disease and lengthen life. Some patients are cured. Almost everyone diagnosed with lung cancer does benefit from treatment.

Question 5: Do you think the public smoking bans that are popping up around the country are going to help lower the risk of lung cancer?

Dr. Kris: Any efforts that make it harder to smoke decrease the numbers of cigarettes smoked by individuals and the number of individuals that smoke at all. Everyone interested in fighting lung cancer should support bans on smoking everywhere. If smoking is curtailed, lung cancer will be curtailed as well.