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Upon completion of the chapter, the reader will be able to:

  1. Identify major risk factors for the development of lung cancer.

  2. Explain the pathologic progression of lung cancer and its relationship with signs and symptoms of the disease.

  3. Make appropriate recommendations for screening or preventive measures in high-risk patients.

  4. Understand staging of lung cancer patients and how it influences treatment decisions.

  5. List the rationale, advantages, disadvantages, and place in therapy for adjuvant and neoadjuvant chemotherapy.

  6. Identify the chemotherapeutic regimens of choice for limited and extensive small cell lung carcinoma, as well as local, locally advanced, and advanced non–small cell lung carcinoma.

  7. Monitor patients for chemotherapy-associated toxicity and recommend appropriate management.

  8. Distinguish the treatment goals of palliative care versus those of first-line treatment.




  • Image not available. The most important risk factor for the development of lung cancer is smoking, and the most effective way for high-risk patients to reduce their risk is to stop smoking. Additional recommendations should include an increase in dietary intake of fruits and vegetables.

  • Image not available. The signs and symptoms of lung cancer can be classified as pulmonary, extrapulmonary, and paraneoplastic. These classifications relate to disease progression.

  • Image not available. The treatment goals in lung cancer are cure (early-stage disease), prolongation of survival, and maintenance or improvement of quality of life through alleviation of symptoms.

  • Image not available. The performance status (PS) of the patient represents an important aspect of chemotherapy treatment decisions. Patients with a PS of 0 to 1 may be treated with chemotherapy. Patients with a PS of 2 may be treated with less aggressive regimens that have a decreased risk of major toxicities.

  • Image not available. Surgical resection of the tumor is the mainstay of treatment in early-stage non–small cell lung cancer and produces the longest survival rates.

  • Image not available. Doublet chemotherapy regimens offer superior response rates compared to single-agent regimens and should be used when the patient can tolerate the associated toxicity. Platinum-containing doublets are first-line treatment in most cases.

  • Image not available. Knowing when and how to treat adverse events from chemotherapy is an important aspect of patient care. Unmanaged events may cause delays in chemotherapy administration and reduced chemotherapy doses and may contribute to treatment failure.

  • Image not available. Although some evidence suggest that the use of a colony-stimulating factor reduces the number of neutropenic fever episodes, hospital stay, and antibiotic administration in certain subsets of lung cancer patients, routine front-line (prophylactic) use of a colony-stimulating factor is not recommended owing to lack of a survival benefit.


Lung cancer has a major health impact both in the United States and worldwide. Before 1930, lung cancer was a relatively rare disease, but a sharp incline in industrialization and smoking in the early 1900s has bred an epidemic. Lung cancer has a high mortality rate, and although treatment can cure selected patients, most therapies only prolong survival for months. Recent advances in lung cancer research provide good reason for optimism. However, despite the emergence of new therapies, antismoking campaigns still ...

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