LUNG CANCER Dr.Mohammadzadeh

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