• Lung cancer is the leading cancer killer in the United States.
• Every year, it accounts for 30% of all cancer deaths—
• more than cancers of the breast, prostate, and ovary combined.
• It is the third most frequently diagnosed cancer in the United States, behind prostate cancer in men and breast cancer in women
• Most patients are diagnosed at an advanced stage of disease, so therapy is rarely curative.
• The overall 5-year survival for all patients with lung cancer is 15%, making lung cancer the most lethal of the leading four cancers
Positive survival factors
• Female sex (5-year survival of 18.3% for women versus 13.8% for men),
• Younger age (5-year survival of 22.8% for those less than 45 years versus 13.7% for those over 65 years)
• White race (5-year survival of 16.1% for whites versus 12.2% for blacks).
Epidemiology• Cigarette smoking is the primary cause of lung
cancer.
• Secondhand (or passive) smoke exposure (an excess risk of 24% )
• Preexisting lung disease (13% )
• Exposure to a number of industrial compounds, including asbestos, arsenic, and chromium compounds
• Chronic obstructive pulmonary disease (COPD)
Field cancerization
• Risk is increased for cancers of the oral cavity, pharynx, larynx, tracheobronchial tree and lung, and esophagus
Preinvasive Lesions• Squamous Dysplasia and Carcinoma In
Situ
• Atypical Adenomatous Hyperplasia
• Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia
Invasive or Malignant Lesions• Non-Small-Cell Lung Carcinoma
Squamous Cell Carcinoma
Adenocarcinoma
Bronchoalveolar Carcinoma
Large-Cell Carcinoma• Neuroendocrine Neoplasms
Grade I NEC Classic or typical carcinoid
Grade II NEC Atypical carcinoid
Grade III NEC Large-cell type
Small-cell type• Salivary Gland–Type Neoplasms
Metastatic Symptoms• CNS metastases : headache, nausea and vomiting,
seizures, hemiplegia, and speech difficulty.
• Bone metastases : lytic, producing localized pain
• Spinal cord compression :
• Liver metastases : incidental finding on CT scan
• Adrenal metastases : asymptomatic
• Skin and soft tissue metastases : painless subcutaneous or intramuscular masses
Treatment• Early-Stage Disease :
The current standard of treatment is surgical resection
• Pancoast tumor (apical tumor) :
an induction radiation dose of 30 to 35 Gy followed by surgery 4 to 5 weeks later
• Stage III disease :
a combination of chemotherapy and radiation
Small-Cell Lung Carcinoma• Small-cell lung carcinoma (SCLC)
accounts for about 20% of primary lung cancers
• is not generally treated surgically. • These aggressive neoplasms have early
widespread metastases• limited" SCLC : Patients present without
evidence of distant metastatic disease, but often have bulky locoregional disease