Lung cancer.

Susan was not her usual cheerful self. I could tell that something was not right in her world. When I asked her how things were going, tears came to her eyes, "My dad has just been diagnosed with lung cancer. He's not a candidate for surgery, but he starts radiation treatments next week, and we're hoping for the best."

Each time I saw Susan over the next several months, she reported on her dad's condition. Initially, he seemed to do well - the size of his tumor decreased in response to the radiation and he generally felt pretty good. But his reprieve was short-lived. Soon he began to experience progressive pain and weakness as the tumor resumed its growth. Less than nine months from the time of his diagnosis he died.

Lung cancer is the leading cause of cancer death for both men and women and is a major cause of death around the world. Almost two million people worldwide are diagnosed with lung cancer each year. Only about 250,000 of them (less than one in six) will remain alive five years later. More men than women contract the disease, by a ratio of three to two.

The simple rectangular box entitled "SURGEON GENERAL'S WARNING" highlights a lonely element of truth in every cigarette advertisement:" Smoking Causes Lung Cancer." Cigarette smoking is responsible for 85 percent of lung cancer deaths.

And it is now abundantly clear that "passive smoking" (ongoing, persistent exposure to other's smoke) is a significant health hazard.

There are other, well-documented, but less frequent, causes of lung cancer, including exposure to asbestos, radon, beryllium, and various other chemicals. But the combination of chemical exposure with cigarette smoking is particularly ominous, raising the risk of contracting the disease by ten to 50 times.

Increasing evidence suggests a genetic susceptibility to lung cancer. And data indicates that a deficiency of vitamin A may also be a risk factor. However, current dietary recommendations for prevention of lung cancer simply call for a well-balanced diet, including an abundance of fruits and vegetables.

Lung cancer is not easily discovered in the early stages. It often goes undetected until it is moderately advanced. By the time it is visible on a routine chest X-ray, it has often spread to nearby tissues or to organs outside the lung.

Depending on the specific tumor type and its degree of spread, treatment recommendations may include surgery, radiation, chemotherapy, or some combination of the three. Unfortunately, the potential benefits of treatment may be outweighed by the associated side effects.

Lung cancer is one of the most preventable and least curable of cancers. Therein lies the poignant paradox of this devastating disease. You can help prevent the tragedy of lung cancer by refusing to smoke and encouraging your family and friends to do the same.

Cancer

Warning

Signals

The American Cancer Society stresses C-A-U-T-I-O-N. Although these signs do not necessarily indicate the presence of cancer, they should be checked by your personal physician.

C - Change in bowel or bladder habits

A - A sore that doesn't heal

U - Unusual bleeding or discharge

T - thickening or lump in breast or elsewhere

I - Indigestion or difficulty in swallowing

O - Obvious changes in a wart or mole

N - Nagging cough or horseness

As many as 80 percent of cancer cases may be related to lifestyle and/or environment.

Ted Hamilton, M. D., is medical director of Florida Hospital Centra Care in Orlando, Florida.