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Chapter 11 Lung Cancer PDF
Chapter 11 Lung Cancer PDF
Lung Cancer
Lung cancer is the deadliest of all cancers in the United States and the world. It
kills more Americans than the next four most common cancers combined. Lung
cancer is largely preventable; inroads in reducing cigarette smoking are having
a positive influence, though other environmental exposures also put people at
risk. Advances in understanding this disease are leading to new means of diag-
nosis and treatment.
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WA
3,090 NH
MT 750 ME
ND VT
550 MN 350 980
OR 370
2,380
2,140 MA
ID WI
SD 2,910 3,610
630 MI NY
WY 450 8,780 RI
260 5,840
560
IA PA CT 1,810
NV NE 1,760
OH 8,090
1,340 890 NJ 4,190
IL
4,000
UT 7,300
IN
CA 480 CO 6,460 DE 590
1,5 V
00
KS VA MD 2,880
W
12,750 12,750 MO
1,620 KY 4,250
4,100 DC 240
3,430
NC
TN 5,630
AZ OK 4,520
2,820 NM 2,390 AR SC
710 2,160 2,880
GA
2,030 AL
MS
4,660
3,140
TX
LA
9,780
2,700
AK
12,
220
FL 0
US 21
159,390
PR
HI N/A
570
Lung cancer is the leading cause of cancer death in the United States. Its low survival rates are due in
part to the lack of a method to detect it early. American Cancer Society. Cancer Facts and Figures 2009.
Atlanta: American Cancer Society; 2009.
In the early decades of the 1900s, a steeply rising incidence of lung cancer in
men led to speculation implicating a variety of etiologies, including tuberculosis,
influenza, industrial pollution, and chronic bronchitis, among others. In that
period, tobacco tar liberated from burning tobacco was found to be carcinogenic,
and clinical observations suggested a link between cigarette smoking and lung
cancer. In 1950, landmark epidemiologic studies published in the United States
and in the United Kingdom demonstrated that an association between cigarette
smoking and lung cancer existed, that intensity of smoking was a factor in the
development of lung cancer, and that a lag time of years between exposure to
cigarette smoking and diagnosis of lung cancer was typical. In 1964, the United
States Surgeon General issued a landmark report on the health consequences
of smoking that acknowledged the causative role of cigarette smoking in the
development of lung cancer.
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CASE STUDY
A 65-year-old man had a dry cough for several months. He had smoked
one pack of cigarettes a day for 35 years and quit five years earlier. He
had a history of chronic obstructive pulmonary disease (COPD). A chest
radiograph showed a mass in the left lower lobe with lymph node
enlargement. A chest computed tomography (CT) scan confirmed these
findings. A positron emission tomography (PET) scan showed
abnormalities in the mass and lymph nodes, but no other areas. Magnetic
resonance imaging (MRI) of the brain was normal. A bronchoscopy with
endobronchial ultrasound confirmed lung cancer, with adenocarcinoma
histology. The cancer was staged by its size and spread as T2aN2M0,
clinical stage IIIA. (T is for tumor size and location; N is for lymph node
spread; and M is for distant metastasis.)
Comment
Lung cancer symptoms typically include persistent cough, difficulty
breathing, coughing up blood, and chest discomfort, though many patients
are asymptomatic. Patients with advanced disease often have weight loss,
fatigue, or pain outside the chest. This patient’s evaluation included
diagnostic studies generally performed in a lung cancer evaluation, the
purpose of which is to determine the cancer stage. Staging predicts
prognosis and influences treatment.
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Most lung cancer risk factors are modifiable and, therefore, can be minimized or
eliminated. Cigarette smoking, occupational exposures, radon exposure, and
environmental tobacco smoke all can be reduced. Cigarette smoking cessation
at any age will decrease lung cancer risk. Though it never reaches the level of a
never-smoker, the risk of lung cancer in an individual who quits smoking
decreases with longer duration of abstinence. Community and public health ini-
tiatives increasingly limit exposure to second-hand smoke. Government regula-
tion has reduced occupational exposure to most carcinogens.
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There is unfortunately no reliable screening tool for early lung cancer detec-
tion. Screening studies have failed to show a clear increase in survival in high-
risk patients. The National Lung Screening Trial is an ongoing, large, prospective
study comparing yearly screening chest radiographs versus yearly screening
computed tomography scans in persons at risk for lung cancer because of smok-
ing. This study should increase our understanding of whether either of these
means of early detection will decrease lung cancer mortality.
The ability to study the entire genome now makes it possible to understand
genetic variation not only between those with and without the disease, but also
among those with different severities of illness. These studies also may give
insight into the mechanism of disease and lead to potential therapeutic targets.
For example, several studies have reported an association between lung cancer
and a single genetic variant on chromosome 15. This site includes genes that
code nicotinic acetylcholine receptors that are strongly associated with smoking
behavior. Although the genetic risk alone for lung cancer is relatively small
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gene products will predict patient outcomes. This may help identify individuals
who would benefit from more aggressive treatment, and which genes might be
targets for new therapies.
All of these investigative efforts will enhance our understanding of the
molecular mechanisms governing carcinogenesis and tumor behavior. Transla-
tion of this knowledge to the development of biomarkers predicting risk, clinical
models that can more accurately predict patient outcomes, and novel therapies
targeted to molecular pathways of carcinogenesis will facilitate the goal of per-
sonalized treatment for individual patients with lung cancer.
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references
1. World Health Organization Web site. Projections of mortality and burden of disease,
2002–2030. Available at: http://www.who.int/healthinfo/global_burden_disease/
projections2002/en/. Accessed January 30, 2010.
2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin
2009;59:225–249.
3. National Cancer Institute Web site. Cancer trends progress report - 2007 update. Available
at: http://progressreport.cancer.gov. Accessed January 30, 2010.
4. Yabroff KR, Bradley CJ, Mariotto AB, Brown ML, Feuer EJ. Estimates and projections of
value of life lost from cancer deaths in the United States. J Natl Cancer Inst 2008;100:
1755–1762.
5. Alberg AJ, Ford JG, Samet JM. 2007. Epidemiology of lung cancer: ACCP evidence-based
clinical practice guidelines (2nd edition). Chest 132(3 Suppl):29S-55S.
6. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, Postmus PE,
Rusch V, Sobin L. 2007. The IASLC Lung Cancer Staging Project: proposals for the revision
of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of
malignant tumours. J Thorac Oncol 2(8):706–714.
Medline Plus
Lung Cancer
www.nlm.nih.gov/medlineplus/lungcancer.html
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