Glória Maria: why cancer like the one that killed a journalist is so difficult to treat

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Journalist Glória Maria died this Thursday (2), after spending the last four years treating lung cancer.

According to information released by Rede Globo, Glória Maria had been treated, at first, with immunotherapy, an alternative that focuses on fighting cancer through changes in the patient’s own immune system, which is done with medications injected into a vein.

At the time, the treatment was successful, but later the cancer returned and spread to the brain, creating so-called metastases. The brain tumors were surgically removed, but new foci of the disease appeared.

In 2022, according to Globo, “the journalist began a new phase of treatment to combat new brain metastases, which, unfortunately, has stopped working in recent days”.

Lung cancer and brain metastases

Metastasis happens when cancer cells spread through the bloodstream or lymphatics.

The lungs are highly vascularized organs, which favors the spread of cancer cells to other parts of the body.

In addition, the anatomy of the lung also contributes to brain metastases.

“The pulmonary veins send oxygenated blood to the heart, which distributes it throughout the body through the arteries. If there are cancer cells in the area, it is easier, compared to other types of cancer, for them to reach the central nervous system”, explains Gustavo Prado, pulmonologist and coordinator of the Scientific Commission on Lung Cancer of the SBPT (Brazilian Society of Pneumology and Phthisiology).

In cases of metastatic lung cancer, a study published in the scientific journal Current Oncology estimates that between 20 to 40% are brain metastases.

“Historically, the survival of patients with metastases has been considered very poor, with a high risk of death and significant impairment in quality of life. The average survival of patients with untreated brain metastases is between 1 and 3 months”, describes the study .

Why is it so difficult to treat metastatic cancer?

The presence of metastases, points out Prado, already indicates that the disease is not controlled.

“It is also worth mentioning that the central nervous system is a particularly difficult region to treat with medication, since not all of them reach a good distribution”, he says.

“There is a barrier, called the hematoencephalic barrier, which normally works as a protection that hinders the passage of substances from the blood to the central nervous system, but in this case, it hinders the absorption of medicines.”

Another factor, according to the doctor, is the possibility of lesions that imaging tests do not capture.

“Microlesions may be present, they just haven’t reached a sufficient size for the exams to be able to detect.”

Lung cancer is among the most common types in Brazil

According to Inca (National Cancer Institute), lung cancer is the second most common in men and women in Brazil, representing 4.6% of cases of malignant tumors and second only to non-melanoma skin cancer.

Lung cancer is a disease that does not show signs in its early stages.

“When the symptoms appear, it is common for the disease to have already reached an advanced stage, which reduces the chances of cure and compromises the patient’s quality of life”, indicates Clarissa Mathias, oncologist at Grupo Oncoclínicas and coordinator of the oncology league at UFBA (Federal University of Bahia).

The doctor also comments that there are two main types of lung cancer: small cell and non-small cell carcinoma.

“Non-small cell carcinoma corresponds to 85% of cases and is subdivided into squamous cell carcinoma, adenocarcinoma and large cell carcinoma. The most common type in Brazil and in the world is adenocarcinoma and affects 40% of patients.”

Gustavo Prado, SBPT pulmonologist, recalls that there are many subtypes among lung cancers, but that although they may present different characteristics between them, there is an important message that applies to all.

“The earlier the diagnosis, the greater the chance of cure for the patient. However, at any time the disease is diagnosed there is benefit in being accompanied by specialists, because we have important resources to improve the quality of life even in patients with advanced disease.”

What are the early signs of this type of cancer?

According to Mathias, most patients with lung cancer have symptoms linked to the respiratory system. Among the most common signs, the oncologist cites:

  • Persistent cough and hoarseness
  • Shortness of breathe
  • Fadriga
  • Bloody sputum;
  • Chest pain;
  • bone pain
  • Headache;
  • Loss of weight and appetite;
  • Recurrent pneumonia or bronchitis;
  • Pleural effusion (abnormal accumulation of fluid in the pleura);

If symptoms appear late, how to protect yourself and diagnose lung cancer early?

Only about 25% of cases are diagnosed early. For most, lung cancer is discovered when it is already large, has spread to the chest, or has metastasized to other organs.

“Therefore, one of the most effective measures we have is to control the main risk factor, smoking, by supporting those who need to stop smoking and public measures to make it difficult for other people to start the habit, such as raising taxes and fees for cigarettes and prohibition of smoking in public places”, says the SBPT physician.

Being a passive smoker (inhaling other people’s cigarette smoke), living in the midst of large amounts of environmental pollution and exposure to substances such as asbestos, arsenic, asbestos and radon are also factors that increase the risk of the disease.

For early diagnosis, the doctor points out that the referral of incidental findings contribute a lot to starting a follow-up in the early stages of the disease.

“Tomograms ordered for reasons other than the specific investigation of lung cancer, for example, can point to the presence of nodules, and thus a timely investigation begins.”

In addition, Prado points out that it is essential to maintain an active screening of people considered within the risk group, especially after the age of 50.

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