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Contents
Contents 2
Overview 3
Section 1: Lung Cancer 4
i. Types of lung cancer 4
ii. Causes and risk factors 5
iii. Symptoms and diagnosis 6
iv. Staging 7
v. Prognosis 8
Section 2: Epidemiology 9
i. Incidence & mortality 10
Section 2: Treatment 11
i. Surgery 11
ii. Radiotherapy 11
iii. Chemotherapy 11
iv. Biological (targeted) therapy 11
References 12
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
Overview
Lung cancer is the leading cause of cancer death Five year survival rates for lung cancer
are poor when compared to other high
diagnosed at an advanced stage, making
successful treatment more difficult and
globally. It kills more people than breast, colorectal and incidence cancers. For example, the five survival outcomes poor.5
year survival rate for patients with breast
prostate cancers combined.1 Each year 1.38 million cancer is up to 89%;3 for lung cancer Traditionally, treatment options have
people die as a result of the disease, equating to more patients, that figure is only around 15%.4 included surgery (for patients with earlier
stage disease), radiation therapy and
than 3,000 deaths a day worldwide, or two deaths There are two main types of lung cancer; chemotherapy, alone or in combination.
non-small cell lung cancer (NSCLC) and More recently, new treatment options,
every minute.1,2 small cell lung cancer (SCLC). NSCLC is including biological therapies, have become
the most commonly diagnosed type of lung available and are helping to improve
cancer, accounting for approximately 85% outcomes and survival for patients.
of all cases.5
This guide provides an overview of lung
The early signs and symptoms of lung cancer, including its incidence, risk factors,
cancer are non-specific and as a symptoms, diagnosis and treatment options.
consequence the majority of cases are
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
Section 1
Lung cancer
i. Types of lung cancer? Figure 1 Typical location of the most common types of non small cell lung cancer
Lung cancer arises from the uncontrolled
Squamous Cell Carcinoma
growth (proliferation) of abnormal cells
inside the lung. There are two main forms Develops from cells that line the airways
Often found near the centre of the lung in one
of the disease, non-small cell lung cancer of the main airways (the left or right bronchus)
(NSCLC) and small cell lung cancer (SCLC). TRACHEA Associated with smoking
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
ii. Causes and risk factors Ionising radiation Exposure to ionising Environment Extensive evidence suggests Diseases as risk factors for lung cancer
radiation increases the risk of lung cancer. 10
that lung cancer rates are higher in cities Patients with pulmonary tuberculosis are at
Smoking The most common cause of
Atomic bomb survivors and patients treated than in rural settings. This is likely to be increased risk of lung cancer, as are those
lung cancer is cigarette smoking which
with radiotherapy for some rheumatic caused by urban air pollution, although with chronic bronchitis and emphysema.11
is associated with at least 80% of all
diagnoses.8 The risk of lung cancer diseases or Hodgkins lymphoma are at it may also involve other factors, such
amongst smokers is at least ten times moderately increased risk of developing as tobacco smoking and occupational
higher than that of non-smokers. This lung cancer.8 exposures.8
risk is reduced among ex-smokers, but Occupational risks There is an increased Indoor air pollution Indoor air pollution
a small excess risk may remain for ex- risk of lung cancer amongst workers may be responsible for the increased risk
smokers throughout their lives.8 There is of lung cancer that exists for non-smoking
employed in certain industries and
also a causal link between lung cancer and women in certain regions of China and
occupations which involve high-risk agents.
use of cigars, tobacco pipes, water pipes other Asian countries. This risk is highest
The most significant of these are asbestos
and smoking of other tobacco products.9 for women living in poorly ventilated
and combustion fumes. In industrialised
Evidence also exists of a link between lung homes where coal, wood or other solid
countries, occupational risks account for
cancer risk and passive smoking (estimated fuels are regularly burnt. Fumes from
approximately 5-10% of lung cancers.9
to be 20%).9 high-temperature cooking using unrefined
Underground miners exposed to radioactive
vegetable oils such as rapeseed oil have
radon and its decay products have also
Whilst smoking is the single biggest cause also been associated with an increased risk
of lung cancer, people who have never been found to be at an increased risk of
of developing lung cancer.8 There is also a
smoked also develop the disease. Risk developing lung cancer.12
link between high concentrations of radon
factors include: gas decay particles and lung cancer in
some countries.8 This gas is emitted from
natural sources and can accumulate in
buildings, especially in confined areas such
as attics and basements.10
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
iii. Symptoms and diagnosis Persistent cough Diagnosis allows confirmation of the Cytology: A sample of sputum is taken
disease. Analysis of cancerous cell tissue to confirm the diagnosis and type of
Common symptoms of NSCLC are A change in a persistent cough
(histology) is particularly important in lung cancer.
mostly non-specific and may initially Shortness of breath
obtaining an accurate diagnosis. There are
be disregarded by the patient. As a Coughing up phlegm (sputum) with Bronchoscopy: A visual examination
a variety of tests available to diagnose lung
consequence many patients go to their signs of blood of the trachea and internal parts of
cancer.5
doctor when the disease is at an advanced Aches or pains when breathing or the lungs. Specimens of tissue may be
stage when symptoms become more coughing taken from inside the lungs to gather
troublesome and persist. Symptoms to Loss of appetite cells for analysis.
watch out for include: Fatigue Needle biopsy: Alongside a CT scan
this procedure is used to obtain cells
Loss of weight
for analysis.
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
Prognosis Figure 2 Lung cancer average 5 year survival rates depending on stage at diagnosis
Cancer statistics often use an overall
5-year survival rate to give a better idea of
the longer term outlook for people with a
particular cancer. Five year survival rates
for lung cancer are poor when compared to
other high incidence cancers. For example,
the five year survival rate for patients with
breast cancer is up to 89%.3 For lung cancer
patients that figure is only around 15%.4
Average 5 year survival rates at Stage I NSCLC: 58% Average 5 year survival rates at Stage IV NSCLC: 7.5%
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
Section 2
Epidemiology
i. Incidence & mortality Figure 3 Lung cancer incidence by region
2000 where it accounts for an average of
20.3% of all cancer deaths.8
Lung cancer is the most common type of North America Central & South America Europe Asia Africa Australia & New Zealand
2007.8
from lung cancer worldwide, equal to two Parkin MD et al. Global Cancer Statistics, 2002. CA Cancer J Clin 2005; 55:74-108
Allen J et al. Neoadjuvant Chemotherapy in Stage III NSCLC J Natl Compr Canc Netw. 2008 6 (3):285-93
Garcia M, et al. Global Cancer Facts & Figures 2007. Atlanta, GA: American Cancer Society, 2007
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
478 217
among South Central Asian populations
(accounting for 8.2% of all cancer deaths).8 899
Prostate
China and Japan in particular have a high 258
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
Section 3
Treatment
Treatment options vary depending on the In general the treatment options for these cases chemotherapy is often used iv. Biological (targeted)
type and stage of the cancer in addition to NSCLC are: to treat patients. The most common therapy
its size, position in the lung, whether it has chemotherapies used in NSCLC are based
This is a relatively a new approach to
spread to other parts of the body and the i. Surgery on a platinum-containing regimen in
cancer treatment that target specific
overall physical health of the patient. combination with a second therapeutic
Patients with early stage, localised NSCLC biological processes often essential to
agent. Patients usually receive treatment
may be successfully treated using surgery. tumour growth. Biological therapy can
in a number of defined cycles as the
Up to 70% of patients survive for at least include monoclonal antibodies, vaccines
incremental benefit of giving continuous
five years after diagnosis if treated at this and gene therapies. As biological therapies
chemotherapy does not outweigh the
stage, with a proportion of these patients precisely target cancer-specific processes,
cumulative toxicities experienced.
being cured. they may potentially be more effective
than other types of treatment (such as
First-line treatment refers to the initial
ii. Radiotherapy therapy a patient receives for advanced
chemotherapy and radiotherapy) and less
toxic to non-cancerous, healthy cells.12
For patients whose cancer cannot be disease.
Several types of biological therapy exist
operated on, radiotherapy may be offered
Treatment until progression/ for the treatment of advanced non-small
alone or in combination with chemotherapy.
maintenance therapy describes treatment cell lung cancer. These are either given as
In addition, radiotherapy also has a well
given immediately following first-line monotherapy or in conjunction with other
established role in providing control and therapies at various stages of advanced
treatment, when the tumour has not
relief of the symptoms of lung cancer. disease (in accordance with their approved
progressed.
label).
Second line treatment that patients
iii. Chemotherapy
receive after a first-line treatment, following
The majority of cases of NSCLC cases disease progression.
diagnosed at an advanced stage1 when
the cancer has already spread to another
part of the body and can no longer be
successfully removed by surgery. In
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Contents Overview Section 1 Lung Cancer Section 2 Epidemiology Section 3 Treatment References
References
1 GLOBOCAN 2008 facts about lung cancer mortality rate at http://globocan.iarc.fr/factsheet.asp. 9 I ARC (2004). Tobacco smoke. In: IARC Monographs on the Evaluation of Carcinogenic Risks to
Accessed 15.05.12 13. Humans, Volume 83, Tobacco smoke and involuntary smoking Lyon, France: International
Agency for Research on Cancer. 51-1187
2 1.38 million deaths per year / 365 days 3,771 deaths per day / 24 hours = 157 deaths per hour / 60
minutes = 2.61 deaths per minute 10 US Environmental Protection Agency. A Citizens Guide to Radon. http://www.epa.gov/radon/pdfs/
citizensguide.pdf Accessed 22.02.10
3 American Cancer Society. Breast Cancer Facts and Figures 2009-2010. Atlanta. American Cancer
Society Inc. 11 Boffetta P and Trichopoulos D (2008). Biomarkers in cancer epidemiology. In: Adami HO, Hunter
DJ, 17. Trichopoulos D, eds., Textbook of cancer epidemiology. Oxford: Oxford University Press
4 Lung cancer 5 year survival rates at http://lung-cancer.emedtv.com/lung-cancer/lung-cancer-surviv
109 126
al-rate-p2.html. Accessed 11.05.11
12 National Cancer Institute. Targeted cancer therapies. Last accessed April 2011 at http://www.
5 Barzi A and Pennell NA. Targeting angiogenesis in non-small cell lung cancer: agents in practice
cancer.gov/cancertopics/factsheet/Therapy/targeted
and clinical development. EJCMO (2010). 2(1):31-42
6 Schiller JH, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung
cancer. NEJM (2002). 346(2):92-98
8 WHO World Cancer Report 2008. Edited by Peter Boyle and Bernard Levin. Lung cancer, 12.
Chapter 5.10
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