Upon completion of the chapter, the reader will be able to:
Identify major risk factors for the development of lung cancer.
Explain the pathologic progression of lung cancer and its relationship with signs and symptoms of the disease.
Make appropriate recommendations for screening or preventive measures in high-risk patients.
Understand staging of lung cancer patients and how it influences treatment decisions.
List the rationale, advantages, disadvantages, and place in therapy for adjuvant and neoadjuvant chemotherapy.
Identify the chemotherapeutic or molecularly targeted regimens of choice for limited and extensive small cell lung carcinoma, as well as local, locally advanced, and advanced non–small cell lung carcinoma.
Monitor patients for treatment-associated toxicity and recommend appropriate management.
Distinguish the treatment goals of palliative care versus those of first-line treatment.
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 some patients, most therapies only prolong survival for months. Recent advances in lung cancer research provide good reason for optimism but antismoking campaigns still appear to offer the best opportunity to reduce lung cancer incidence and mortality.
EPIDEMIOLOGY AND ETIOLOGY
Cancers of the lung and bronchus rank first in cancer-related mortality, comprising more than 28% of cancer-related deaths.1 In 2015, more than 1,500 new cases of lung cancer are expected. A close correlation exists between incidence and mortality of lung cancer, reflecting the reality that approximately 70% of lung cancer patients ultimately die of the disease.
KEY CONCEPT The most important risk factor for the development of lung cancer is smoking. One of the most predictive factors on lung cancer epidemiology is prevalence of cigarette smoking. Because lung cancer is a fatal disease in most cases, both incidence and mortality strongly reflect the smoking prevalence of the population on a 20- to 30-year lag. In other words, decreases in tobacco use now would be expected to affect lung cancer incidence in 2040. With this knowledge, the current expectation is that lung cancer incidence and mortality will decrease steadily until 2020, reflecting decreases in cigarette smoking between 1970 and 1990. Because smoking prevalence has been constant since 1990, lung cancer incidence is expected to plateau.2 Correlation between smoking and lung cancer continues to drive antismoking and clean indoor air campaigns and should be considered an investment in the future health care of the nation. Furthermore, smoking cessation plays an important role in reducing lung cancer risk on a patient-to-patient basis, and appropriately guiding such therapy is a crucial part ...