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 and preventive measures in high-risk patients.
Understand staging of lung cancer patients and how it influences treatment decisions.
Explain how histology, biomarkers, and genetic mutational testing are used to select therapy.
List the rationale, advantages, and disadvantages for neoadjuvant and adjuvant chemotherapy in non–small cell lung cancer (NSCLC).
Identify the treatment of choice and treatment goals for limited and extensive small-cell lung carcinoma.
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 are aimed at prolonging survival and reducing symptoms. Recent advances in lung cancer research have provided a number of new targeted therapies that provide significant benefit for some populations of patients; however, prevention and risk-reduction still appear to be the best strategies for reducing lung cancer incidence and mortality.
EPIDEMIOLOGY AND ETIOLOGY
Lung cancer, including cancer of the bronchus, is the second most common cancer diagnosis in the United States behind breast cancer1 and 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 patients with lung cancer ultimately die of the disease.1
The most important risk factor for the development of lung cancer is tobacco smoke. 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 while the remaining 85% of cases occur in current or former smokers.2 The correlation between smoking and lung cancer continues to drive anti-smoking and clean indoor air campaigns. Both total smoke exposure (reported as pack-years where one pack-year is the equivalent of smoking one pack per day for 1 year) and current use correlate with the individual’s risk of developing malignancy. The risk of lung cancer decreases over time after a patient stops smoking, with at least 5 years needed to see appreciable decreases in cancer risk.3 However, a former smoker will never see their risk return to that of a nonsmoker. Therefore, smoking cessation plays an important role in reducing lung cancer risk, making this a critical element of lung cancer prevention and treatment in at-risk patients. In addition to ...