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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 and preventive measures in high-risk patients.

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

  5. Explain how histology, biomarkers, and genetic mutational testing are used to select therapy.

  6. List the rationale, advantages, and disadvantages for neoadjuvant and adjuvant chemotherapy in non–small cell lung cancer (NSCLC).

  7. Identify the treatment of choice and treatment goals for limited and extensive small cell lung carcinoma.

  8. Identify the treatment of choice and treatment goals for local, locally advanced, and advanced non–small cell lung carcinoma.


Lung cancer continues to be one of the most commonly diagnosed cancers and the leading cause of cancer-related mortality. Although treatment can cure some patients, most therapies only prolong survival and improve symptoms. Recent advances in lung cancer research has provided a number of new therapies that provide significant benefit for some populations of patients; however, antismoking campaigns still appear to offer the best opportunity to reduce lung cancer incidence and mortality.


Incidence and Mortality

Cancers of the lung and bronchus remain to be the second most common cancer diagnosis in the United States in 2018 (behind breast cancer). Lung cancer is the number one cause of cancer-related mortality, comprising more than 25% of cancer-related deaths in the United States. A close correlation exists between incidence and mortality of lung cancer, reflecting the reality that approximately 80% of lung cancer patients ultimately die of the disease.1

Clinical Risk Factors


image The most important risk factor for the development of lung cancer is smoking. One of the most predictive factors of lung cancer incidence is cigarette smoking prevalence. Although rates of lung cancer have nearly doubled in never smokers over the past 25 years, this population still only represents about 15% of all cases and ∼85% of cases occur in current or former smokers.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 of preventing lung cancer in at-risk patients. Both total smoke exposure and current use correlate with the individual’s risk of developing malignancy. The risk of lung cancer decreases to near-normal levels 10 to 15 years following successful smoking cessation. Total smoke exposure is reported as ...

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