SeminarLung cancer
Section snippets
Clinical and pathological features
Features visible on light microscopy classify lung cancers into two major groups: small-cell and non-small-cell cancers. The latter include squamous-cell (epidermoid) carcinoma, adenocarcinoma, and large-cell carcinoma; bronchoalveolar carcinoma is generally subclassified under adenocarcinoma. This division is sufficient for most clinical needs.
The proportion of squamous-cell carcinomas has decreased from about 40% of lung cancers to 20–25% in North America in the past 15–20 years. In European
Clinical features
Patients may present for medical attention because of symptoms related to the primary tumour, mediastinal spread of tumour, distant metastatic spread, or paraneoplastic syndrome. Symptoms related to the primary tumour include cough, dyspnoea, haemoptysis, and postobstructive pneumonia. Chest pain suggests parietal pleural involvement or other extension beyond the lung. Superior sulcus tumours may produce shoulder pain, arm pain or brachial plexopathy, or Horner's syndrome.
Symptoms related to
Diagnosis
As with any cancer, accurate tissue diagnosis is essential, with the main differentiation being small-cell or non-small-cell carcinoma. In patients with unresectable tumours, thoracotomy for tissue diagnosis is almost never necessary. Sputum cytology may give a high yield for typically endobronchial tumours (eg, small-cell and squamous-cell carcinoma) but the yield is poor for adenocarcinomas. Overall, because of the changing histological patterns, the yield is probably less than 50%.
Staging of lung cancer
The main aim of staging is to identify candidates for surgical resection, since this approach offers the highest potential for cure lung cancer. Careful staging is also warranted to identify candidates for new aggressive multimodal treatments for locally advanced disease. The staging assessment covers three major issues: distant metastases; the state of the chest and mediastinum; and the condition of the patient.
In the assessment for metastatic spread, the history and physical examination are
Treatment of non-small-cell lung cancer
Stage I (T1N0, T2N0) cancers are treated whenever possible by surgical resection. 5-year survival is in the range of 40–67%, with the better results in patients with T1N0 staging.11, 12 Many presumed recurrences are second primary cancers. No role for adjuvant therapy has been established, although a trial comparing adjuvant chemotherapy with observation alone is underway for patients with T2N0 cancers. In this group chemoprevention trials are of great interest, in an effort to prevent the
Treatment of small-cell lung cancer
Chemotherapy is the mainstay of treatment for small-cell lung cancer, and adjuvant radiotherapy is commonly used in patients with limited disease. Surgical resection is reserved for patients with pathologically documented stage I or II disease, or as part of a combined-modality clinical trial. Active drugs include cisplatin, carboplatin, etoposide, cyclophosphamide, doxorubicin, vincristine, lomustine, and ifosfamide. Newer drugs of interest include altretamine, paclitaxel, docetaxel, topotecan
The future
Therapy for lung cancer has made progress in recent years. Chemotherapy is now firmly established as a useful therapeutic modality for both small-cell and advanced non-small-cell lung cancer (stages III and IV). Nevertheless, most patients will die of disease progression, and current treatments, in particular concomitant chemoradiotherapy for stage III disease, are very toxic. Therefore, the investigation of novel agents remains a high priority. Current interest is focused on agents that may
References (50)
- et al.
International differences in epidemiology of lung adenocarcinoma
Lung Cancer
(1997) - et al.
Regional accuracy of computed tomography of the mediastinum in staging of lung cancer
J Thorac Cardiovasc Surg
(1986) - et al.
Evaluation of fluorine-18-fluorodeoxyglucose whole body positron emission tomography imaging in the staging of lung cancer
Ann Thorac Surg
(1999) - et al.
Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung
J Thorac Cardiovasc Surg
(1986) - et al.
Mediastinoscopy, thoracoscopy, and video-assisted thoracic surgery in the diagnosis and staging of lung cancer
Chest
(1997) - et al.
Optimizing selection of patients for major lung resection
Ann Thorac Surg
(1995) Revisions in the international system for staging lung cancer
Chest
(1997)- et al.
Incidence of local recurrence and secondary primary tumors in resected stage I lung cancer
J Thorac Cardiovasc Surg
(1995) - et al.
Radiotherapy as an alternative to surgery in elderly patients with resectable lung cancer
Radiother Oncol
(1988) - et al.
Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: a randomised multicentre trial
Lancet
(1997)
Survival after resection of stage II non-small cell lung cancer
Ann Thorac Surg
Induction cisplatin/vinblastine and irradiation versus irradiation in unresectable squamous cell lung cancer: failure patterns by cell type in RTOG 88–08/ECOG 4588
Int J Radiat Oncol Biol Phys
Neurotoxicity in long-term survivors of small cell lung cancer
Int J Radiat Oncol Biol Phys
Global cancer statistics
CA Cancer J Clin
Emerging tobacco hazards in China; 1: retrospective proportional mortality study of one million deaths
BMJ
Transcarinal needle aspiration biopsy in the staging of lung cancer
Eur Respir J
Phase-III intergroup trial of 13-cis-retinoic acid to prevent second primary tumors in stage-1 non-small cell lung cancer (NSCLC): interim report of NCI#191-0001
Proc Am Soc Clin Oncol
Effects of postoperative mediastinal radiation on completely resected stage II and stage III epidermoid cancer of the lung
N Engl J Med
Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials
Lancet
The benefit of adjuvant treatment for resected locally advanced non-small cell lung cancer
J Clin Oncol
Prospective randomized trial of postoperative adjuvant therapy in patients with completely resected stages II and IIIa non-small cell lung cancer: an intergroup trial
Proc Am Soc Clin Oncol
Significant effect of adjuvant chemotherapy on survival in locally advancd non-small cell lung carcinoma
J Natl Cancer Inst
Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials
BMJ
Improved survival in stage III non-small cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial
J Natl Cancer Inst
Cited by (689)
Junctional adhesion molecule-like protein as a novel target for kaempferol to ameliorate lung adenocarcinoma
2023, Journal of Integrative MedicineBilateral Iris Metastasis in a Patient with Small Cell Lung Carcinoma: A Case Report
2024, Beyoglu Eye JournalPD-L2 overexpression on tumor-associated macrophages is one of the predictors for better prognosis in lung adenocarcinoma
2023, Medical Molecular Morphology