Amanda Nerstad talks about her need not to let her battle with cancer define her, at her home in West Knoxville on Tuesday, May 9, 2017.

Esa There must be stress in her chest when she returns to Knoxville after 15 years in Chicago, thought Amanda Nerstad.

When it did not disappear, "I thought maybe I had walking pneumonia," Nerstad said.

But after 10 days in the hospital, Nerstad – then 39 years old – ended up with a diagnosis he never expected: stage 4 lung cancer.

Nerstad was young, healthy, active with two small daughters. She had never smoked. She had no family history of cancer.

I was stunned.

"At that time, I did not realize that, clearly, any lung can get lung cancer," said Nerstad.

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Among the US states. UU., Tennessee has the fourth highest lung cancer rate, according to a new report from the "Lung Cancer Status" of the American Lung Association, and the Tennessee Cancer Consortium reported last year that lung cancer rates incidence for black and white men in all regions of Tennessee are between 50 and 100 percent higher than the national rate.

Lung cancer is the main reason the cancer mortality rate in Tennessee is so high compared to national rates, the consortium said.

"He's just a killer terri ble," said Dr. J. Francis Turner, a pneumologist at the University of Tennessee Medical Center. "Every day in the United States, it's the same as a fully loaded jet airplane 737 – 433 people die every day from lung cancer."

Smoking remains the most common cause of lung cancer, and more than 20 percent of Tennessee adults smoke, also higher than the national average. The Tobacco Control State Report of the American Lung Association of 2018 gave "F" grades to Tennessee for financing the tobacco prevention program; tobacco taxes; access to treatments to stop smoking; and tobacco 21 laws. Rated Tennessee "C" for smoke-free air.

Tennessee – and eastern Tennessee, in particular – also has higher levels of radon, a colorless, odorless gas that can seep into homes and buildings from the ground. Some studies have established that radon is the second leading cause of lung cancer, behind smoking. In houses where there is radon, systems can be installed to reduce gas levels. The Tennessee Department of Environment and Conservation also offers a radon program with information and home test kits.

In addition, Turner said that environmental exposure has an effect, including air pollution and exposure of workers to carcinogenic dust in the mining industry, or to asbestos or even a large amount of cigarette smoke used in other jobs.

Unused Screening

Part of the reason lung cancer has a lower survival rate is that it is usually diagnosed in later stages, often after it has spread to other organs.

In Tennessee, less than 20 percent of cases are detected early when survival can be more than 50 percent. More than 46 percent of cases of lung cancer in Tennessee are not detected until a late stage, when national survival rates are 4.5 percent.

In its early stages, lung cancer can sometimes be treated with surgery before it spreads. In Tennessee, about 20 percent of patients with lung cancer are treated surgically.

Screening for lung cancer with low-dose annual CT scans among high-risk lungs could reduce the lung cancer death rate by up to 20 percent, simply by finding it earlier.

But it's not that common, in some rural places, because access to screening is lacking, but in most places, because awareness is low, said oncologist Dr. Richard Grapski, who practices in hospitals in the United States. Covenant Health system, [19659010] "It has been very slow to catch up," Grapski said. "Screening for lung cancer saves more lives than mammography."

Screening for lung cancer with low-dose annual CT scans among those at high risk could reduce the mortality rate by up to 20 percent simply by finding it earlier. (Photo: photo courtesy)

Grapski has been actively examining patients for more than two years.

"We see about two or three abnormal CT scans a month," he said.

Catching an injury when it is smaller than 1 inch means it could be surgically removed, with a cure rate of 90 percent, he said. A 2-centimeter tumor could be successfully exploited in five radiation treatments.

"But half of lung cancers present with the disease of Stage 4" and once the cancer spreads, the person begins to show symptoms such as weight loss and the chances of survival are bleak, said Grapski. "We are getting better medications for this, but we want to catch people when the tumor measures one centimeter instead of 10 centimeters."

Targeted therapy

Nerstad's lung cancer turned out to be caused by a genetic mutation: its anaplastic lymphoma kinase gene breaks down and binds to another gene, called "ALK-positive". Before starting traditional chemotherapy, your oncologist requested genetic tests, which have become increasingly common in the last decade.

ALK positive cancer modified Nerstad's treatment plan and survival rate.

"I went to the surgeon saying that I could have from two weeks to nine months of life, until, suddenly, the doctor calls and says:" You have reached the lottery ", he said.

Now, 18 months after his diagnosis, Nerstad takes a therapy twice a day that points to his specific genetic mutation. He responded well to the treatment, he said.

Radiation oncologist Dr. Nilesh Patel of Tennova Healthcare said that such targeted therapy is one of the many recent advances in the treatment of advanced lung cancer.

More focused radiation systems allow the treatment of the tumor while sparing the surrounding tissue.

Immunotherapy drugs can stimulate the body's own immune system to recognize certain types of cancer cells, based on markers, as invaders and fight them.

And doctors can match the "blueprint" of a tumor to certain types of medications to improve the chances of a good response.

"In essence, we can customize the treatment based on a person's cancer," Patel said.

Such treatments lengthen patients' chances of long-term survival and increase their quality of life, leading doctors to hope that lung cancer can one day be treated as a survivable chronic disease.

But do not increase "cure" rate. Over time, cancer can evolve and "be smarter" than treatments designed to eradicate it.

"The number one goal of a tumor is to grow, grow, grow, grow," said Dr. Christine Lovly, assistant professor of medicine and co-leader of translational research and interventional oncology at Vanderbilt University Medical Center in Nashville. . Eventually, "the tumor will find a way to avoid the drug."

A research need

Nerstad takes the second-generation formulation of the drug that targets his ALK positive cancer.

"Eventually I will gain resistance to this type of medication, and then I will move on to the next generation pill, that's how these mutations work," Nerstad said.

So she has a great interest in making sure that researchers are creating future generations of their medicine. Although among the most deadly cancers, lung cancer receives significantly less funding than breast, prostate or colorectal cancer.

And the type of Nerstad's lung cancer is quite rare. That's why she and other members of a supportive community 900 ALK have positive online, through the non-profit group focused on lung cancer LUNGevity, collectively raised $ 400,000 to fund two one-year grants for a researcher who works on ALK positive cancers and are now taking applications. Nerstad's husband, Gary, and his daughters, ages 5 and 8, raised money through a lemonade stand and a dance party.

"We realized that we have to change these statistics," he said.

Lovly is one of those researchers working to learn why 15 percent of people develop lung cancer, despite never having smoked.

"We really do not have a good explanation," Lovly said.

Nerstad, for example, was not born with the mutation; "It developed while I was alive," Lovly said. "The overwhelming number of cancers is not due to mutations that you are born with." Most of these mutations are found only in the tumor, and only in the last decade have doctors been able to detect them.

Lovly's job is to see what causes the mutations, as well as how to better focus on them.

Still, "there is such a stigma about lung cancer," Lovly said. "The first question that people with lung cancer ask is: How much do you smoke? & # 39;

The research that led doctors to not treat all lung cancers in the same way is "exciting," said Turner of UT Medical Center.

"It's still a terrible disease, and it's not something I want to have, I do not want to sweeten it," Turner said. "But we have real hope for the first time, not only in terms of treatment, but detection, if we find it early."

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