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Alert Number 180

CLL and Risk of Lung Cancer

Date: July 31, 2006

By now I hope every single one of our readers is very aware of the risk of aggressive skin cancer as a sequel to CLL. Episodic squamous cell or basal cell carcinoma that are easily controlled in “normal” people can become much more aggressive and life-threatening in CLL patients, and there is some research suggesting therapy with immune suppressive drugs can further increase the risk. Below are some articles that may be of interest, if you wish to explore the connections between CLL and secondary cancers:
Dying to Get a Tan?;
Secondary Cancers;
Winning the Battle but Losing the War.

Did you think squamous cell carcinoma occurs only on parts of your body that are exposed to the sun? Not so. Squamous cells are present in many other places besides your skin. For example, this particular cell type is found in your mouth, in your lungs, in your gut and reproductive systems. One of the most common types of lung cancer, the non-small-cell lung cancer, can be squamous cell carcinoma of the lungs. As the abstract below points out, CLL patients are significantly at higher risk of lung cancer, compared to the general population.

  • Memorial Sloan-Kettering studied 1329 CLL patients that were registered at MSKK, over two decades.
  • 26 of these CLL patients developed lung cancer, an incidence of 2%.
  • For comparison, in the general population without CLL, the expected number of lung cancer cases would be less than one person, an incidence rate of 0.06%. That means CLL patients are 33 times more at risk of developing lung cancer, compared to the general public.
  • As you would expect, the bulk of the CLL patients who developed lung cancer were also smokers.
  • If you develop a dangerous second cancer such as lung cancer, CLL is going to be the lesser of your worries. You are more likely to die from the shorter fuse lung cancer. Chances are good that you will also develop a third cancer along the way.

Possible signs of non-small cell lung cancer could be as simple as a cough that doesn't go away and shortness of breath. If you cough up traces of blood in the sputum, it is important to get yourself checked out, especially if you are/were a smoker and therefore at much higher risk of lung cancer. For most patients with non-small cell lung cancer, current treatments are not curative. CLL is indeed the “the good cancer to have” when you compare it against secondary cancers such as lung cancer, aggressive skin cancer, etc.

The first chart below gives the incidence of lung cancer in the general U.S public. The second chart shows the influence of radiation and therapy using alkylating agents. As you can see, the combination of smoking, radiation therapy and treatment with alkylating agents can ratchet up the risks dramatically. This chart is with reference to Hodgkins disease. But since chlorambucil and cyclophosphamide (both alkylating agents) are pretty common in CLL therapy, and as we saw with the MSKK work, CLL patients are inherently more at risk of lung cancer, I think this is information worth noting. Fortunately, radiation is not used very often in CLL, with the exception of people getting ready for stem cell transplants.

I do not mean to scare you with these facts. This issue became very personal and real to me when I heard from a good friend and long time member and supporter of CLL Topics that she has been diagnosed with lung cancer. She has one of the most indolent varieties of CLL and I had her pegged as one of the lucky ones at very low risk. She did everything right, took very good care of herself. On the other hand, I do know several CLL patients who continue to smoke, make no effort to control their sun exposure, and that is just plain silly.

People, take care of yourselves!

Be well,

Chaya
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Abstract:

Cancer. 1999 Nov 1;86(9):1720-3.

The clinical course of lung carcinoma in patients with chronic lymphocytic leukemia.

Parekh K, Rusch V, Kris M.

Thoracic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

BACKGROUND: Although patients with chronic lymphocytic leukemia (CLL) have an increased risk of developing second primary malignancies, including lung carcinoma, there is virtually no information about their clinical outcomes. To evaluate this, the authors reviewed their 20-year institutional experience with CLL patients who also had lung carcinoma.
METHODS: The records of patients with diagnoses of both CLL and lung carcinoma seen between January 1977 and July 1998 were reviewed. The data collected included patient demographics, the tumor histology and stage, the type of treatment for both CLL and lung carcinoma, the presence of a third malignancy, the disease status at last follow-up, and the first site of relapse. Survival was calculated by the Kaplan-Meier method.
RESULTS: From January 1977 to July 1998, 1329 patients with CLL were seen at Memorial Sloan-Kettering Cancer Center. Twenty-six (1.9%) also had lung carcinoma (19 males and 7 females). The median age of patients at the time CLL was diagnosed was 61 years, and for patients with lung carcinoma it was 68 years. Twenty-two patients (85%) were current or former smokers. Histologically, the lung carcinomas included 6 squamous cell carcinomas, 19 nonsquamous carcinomas, and 1 small cell carcinoma. Ten patients (38%) had a third malignancy; these malignancies included melanoma, basal cell carcinoma, laryngeal carcinoma, and colon carcinoma. Thirteen patients underwent surgical resection and 13 were treated nonsurgically for lung carcinoma. A poor performance status precluded surgery for 3 patients with Stage I tumors and limited chemotherapy for all patients with advanced disease. The median survival following the diagnosis of lung carcinoma for patients treated surgically was 25 months, and for those treated nonsurgically it was 6 months.
CONCLUSIONS: Approximately 2% of patients with CLL develop lung carcinoma. In this study, 85% of the patients were smokers. These patients had a high risk of a third primary malignancy. Lung carcinoma was diagnosed a decade after CLL. Patients who develop both diseases die of lung carcinoma and not CLL or other solid tumors. CLL and poor performance status limit treatment, particularly for patients with unresectable lung carcinoma.

Copyright 1999 American Cancer Society.

PMID: 10547544
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http://planning.cancer.gov/disease/Lung-Snapshot.pdf

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