Selected Podcast

Lung Cancer

Is smoking the only way to get lung cancer?

Learn more about this disease and the available treatment options from a UVA surgeon who specializes in lung cancer.
Lung Cancer
Featured Speaker:
Dr. Christine Lau
Dr. Christine Lau is a board-certified thoracic surgeon who specializes in treating lung and esophageal cancer.


Melanie Cole (Host): Is smoking the only way to get lung cancer? Learning more about this disease and the available treatment options will help you get the answers that you need. My guest is Dr. Christine Lau. She’s board-certified thoracic surgeon who specializes in treating lung and esophageal cancers at UVA Cancer Center. Welcome to the show, Dr. Lau. Most people associate lung cancer with smoking. Is that the only cause of lung cancer? Are there other causes?

ChristineLau: It’s really great to be on the show. Smoking is by far the leading risk factor for lung cancer. In the early 20th century, lung cancer was much less common than it is today, because of the manufacturing of cigarettes. At least 80% of lung cancer deaths are thought to be a result of smoking. But other things can cause lung cancer. Cigar smoking, pipe smoking – that’s obvious. That’s very similar to cigarette smoking. Second-hand exposure smoke can cause lung cancer. Radon which is in very small levels outdoors, but inside, higher levels of radon have been associated with lung cancer. Asbestos exposure in the workplace has been associated with lung cancer, and other types including mesothelioma with asbestos aren’t just the standard types of lung cancer that we see. There are other things that are more, you know, rare. Diesel exhaust has also been somewhat associated with it. Radioactive ores, such as uranium, other types of chemicals and minerals have been associated with it. More commonly now, we’re seeing cities with air pollution have higher risks of lung cancer. People who have been exposed to radiation to their lungs, and then a personal or family history of lung cancer have a higher risk of developing a second lung cancer, or developing lung cancer.

Melanie: So what are some of the best steps? You mentioned smoking as one of the main causes, but what are some of the best other steps that we can do to prevent lung cancer? Exercise, for example, Dr. Lau, does that help to reverse some of the effects that smoking or radon or any of these other pollutants might have had on our systems? Are there ways to actually prevent it?

ChristineLau: There have been a couple of studies looking at various minerals and vitamins to prevent lung cancer. None of them have panned out. Exercise and a healthy kind of lifestyle is always good for any person, but really the big thing is to avoid smoking and then to get your health tested for radon. Asbestos is much less common in the workforce today, but we still see it in patients who were exposed to it even 30 or 40 years ago. So, there really isn’t good prevention other than avoidance of the risk factors.

Melanie: So what are some of the common symptoms? People always think of the coughing and they vision people with oxygen. What are some symptoms that might send someone to the doctor to even get that lung cancer found?

ChristineLau: That’s a great question. Usually, symptoms of lung cancer don’t appear until the disease is quite advanced and usually non-curable by the time patients present with symptoms. Symptoms such as weight loss, even hemoptysis, bone pain – these can be signs that the tumor is quite advanced. Even something like an infection, where they come in, they have had a chronic infection, they may have a lung cancer that’s actually been the cause of that. It’s unfortunate, but those patients are often quite advanced by the time they present. When we see cancer that’s curable, it’s often found by just a routine chest X-ray for another reason. They come in for a hernia surgery and they get a chest X-ray. There is new evidence that lung cancer screening in patients who meet very specific criteria that does help detect it early. I think the best thing to do is, if you have smoked or you are currently smoking, that you let your doctor know and you talk with them about lung cancer screening, because that’s relatively new. It’s a CT scan and it’s relatively new on the horizon. I think it has been shown to decrease deaths from lung cancer.

Melanie: What’s involved in the screening?

ChristineLau: The screening is done in most centers. UVA has a lung cancer screening program. You basically call our number and if you fit in a certain criteria, they will get you in for a CT, a low-dose CT scan. That scan will scan your lungs and look for any small nodule. So patients who have smoked for 30 packs a year and they’re over 55, they still smoke or has smoked, they should really be contacting their primary care doctor to arrange to get a lung cancer screening study.

Melanie: That’s really great advice, because if you’ve been a smoker, even if you’re a reformed smoker, it’s something to ask your doctor about getting lung cancer screening, because it could help you to find it early enough. You mentioned the word “cure,” Dr. Lau. At what point and stage, if lung cancer is found early enough, can it be treated successfully?

ChristineLau: It sure can. I mean that’s the goal, if we can find lung cancer as early. There are four stages of lung cancer. Stage four is the most advanced. It is considered not really curable but we can palliate patients with stage four lung cancer. Stage 1, 2 and some 3, we can still go after cures for the patient. And if it’s found early, if it’s a very small nodule, with no lymph nodes spread and no other spread, we often will be able to treat them with surgery.

Melanie: Wow. That’s amazing. So tell us some of the treatment options you mentioned. Surgery – does this usually also involve chemotherapy radiation? When it’s the lungs, people, you know, get a little bit more wary of these types of treatments. Tell us how these treatments affect the lungs.

ChristineLau: Well, there are several options for patients who are diagnosed with lung cancer, and that’s the big thing. I always tell my patients, “The first thing we need to figure out is: What are we dealing with? How advanced is it?” And then, we can really sit down and go through all the options that they have. I know it’s very hard to hear. I’ve had my own family members diagnosed with cancer and the first thing you hear is that word and it’s really hard to focus on anything else. The best thing you can do when you get a diagnosis is to really figure out, where do you fit in and what are your treatment options? There are several options for patients with lung cancer. Surgery is for relatively early stage lung cancer: Stage 1, stage 2 and some stage 3-A lung cancers. There are other new options: the radiofrequency ablation, also called stereotactic radiation. It’s a type of very focused beam radiation treatment, and that’s been very successful and is relatively new in the armamentarium of what we can use to treat lung cancer with. There’s also standard radiation and chemotherapy. Then finally, there’s targeted therapies that are very specific for the type of cancer you have. I think the big thing is to get in with a group that’s multidisciplinary and can really approach you based on what is the best plan, individualized plan for you if you have lung cancer, because it can really vary based on: 1) what you want; 2) what your health is, how good your health is; and 3) what options are available at the institution that you’re being seen at.

Melanie: Give us a little advice about some of the lifestyle things if somebody is diagnosed with lung cancer, Dr. Lau. Coping with some of the symptoms, like shortness of breath, can be very scary. Give us some of your best advice on dealing with some of those things at home.

ChristineLau: Yeah. I think that is really hard. It’s a very difficult time and often they are still smokers and then everyone tells them, “You know, you really need to quit smoking.” It’s a very stressful time. I will tell you that my own father smoked until the day he died, and I’m a thoracic surgeon. So I do understand what a habit and how addictive tobacco is to my patients and to people, in general. I think the first thing is to recognize a lot of these patients are already short of breath and some of them are on oxygen. But to really just take a step back and know that it’s not always that this lung cancer stuff is causing additional symptoms. It’s really just the stress of knowing you have this diagnosis and how it’s going to be treated. So, the thing I really tell patients is it’s going to take some time to put together your treatment plan and we need to just be very thoughtful about that.

Melanie: So, in just the last minute, tell the listeners why patients should choose UVA for their lung cancer treatment.

ChristineLau: Well, I think UVA has a lot of options that other places also do have, but they’re a fairly unique one. We are a big multidisciplinary group. There are three thoracic surgeons at University of Virginia, which is a very large group of thoracic surgeons, and we all communicate with each other. We discuss cases together. We have conferences where we meet and discuss various options. What would you do? How would you handle this? We also have three thoracic oncologists, that all they do is thoracic surgery. That’s the only type of chemotherapy that they actually provide. They’re experts specifically in lung and esophageal cancer. We also have a radiation oncology program that is very specific to lung cancer. We have nurses that all they work on are patients who have lung cancer. And so, I think the thing that we have that’s very unique is that we have a multidisciplinary group. I actually go over to Augusta. We also have collaborations with the community hospitals, as well. So we have the option to do some things over at Augusta Hospital and also over at UVA. I think we have an outreach, a pretty big, broad group or area that we can cover. I think the biggest thing is that we’re also affiliated with a major cancer center and so we all the resources that are offered from the cancer center. So, big clinical trials – there’s a lot of clinical trials that are coming out that we can offer, that other centers just don’t have the ability to, because we are affiliated with such a topnotch cancer center.

Melanie: Thank you so much, Dr. Christine Lau. For more information, you can go to That’s You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.