Lung Cancer Kenneth Albert, MD Lung cancer is not the most common cancer in either men or women.

Prostate cancer is certainly number one in men and breast cancer is number one in women. It cuts lung
cancer at approximately half; so you can see breast cancer is much more common than lung cancer.
However, if you look at the deaths from cancer, lung cancer, it is by far the biggest killer in both men
and women. If you look at the changing incidence of lung cancer in men, the United Kingdom is actually
decreasing quite substantially from the earlier 1960s and '70s. In the United States, it actually leveled off
in the 1980s, and it has started to decline in the last couple of years, and in France it is still rising. So it
really just depends on where you are and on your habits. In women, the United States is still going up. It
hasn't showed any sign of leveling off. The United Kingdom has already leveled off and started to decline
a little bit. In France, it is has always been low. Types of lung cancer. There are two major types: non-
small cell and small cell. Approximately 75-80% of the tumors that we see are non-small cell, while only
20-25% are small cell itself. If we look at the small cell subtypes, previously the vast majority of those
particularly with the disease found in males was squamous cell cancer, but more recently the majority of
them are adenocarcinomas, and 40% of all lung cancers are adenocarcinomas. So this has really shot up
and changed the nature of the disease as well. Squamous cell is only 17% of all lung cancers. In smokers,
particularly males, squamous cell is a fairly predominant tumor type. But if we look at nonsmokers,
adenocarcinoma is by far the most common subtype. The same is true of females, even to a greater
extent. In smokers, adenocarcinoma is more common in females. LUNG CANCER Page 2 2 Staging. The T-
stage is based on the size, the location, the amount of atelectasis and a few other things. The N-stage is
fairly simple. N1 is intrapulmonary lymph nodes, N2 is outside and N3 is outside the chest and M1 is self-
explanatory. Stage 1 and 2 are localized to the lung itself. Stage 3A is more advanced with metastases in
general or chest wall invasion and 3B is your unresectable tumors. T3N0 is tumors that involve the
parietal pleura either on the chest wall, the diaphragm or the mediastinum, now it is considered to be
stage 2 as well since the survival is actually better. In these two groups up here, TI and T2, each one has
been divided into A and B. Now, there is 1A, 1B, 2A, 2B and then T3 can be observed in 2B as well.
Stage1 tumors have to be less than 3 cm and it can't involve a major lobar bronchus and create lobar
atelectasis or consolidation, and it can't have any lymph node involvement either in the lung or outside.
T2, they are just bigger lesions. Either greater than 3 cm or those that involve the visceral pleura and
that cause lobar atelectasis. Segmental atelectasis is the T1 finding. Stage 2 is the same two groups
except for there is intrapulmonary lymph node involvement so that the criteria are the same. This is 2A,
this is 2B but there is intrapulmonary lymph nodes either along the segmental bronchi or either the
lobar bronchi that are involved. Also, again, 2B consists of T3, which is tumors that are involved in the
parietal pleura or 2 cm with carina. 3A is locally advanced. T3N0 again goes to the 2B now but T3N1 and
2, T3 involves basically anything that has parietal pleura. if you see something with complete collapse of
the lung, by definition they have to have a T3 disease. The other component of a 3A is N2 disease and
that means now lymph nodes up in this area that are involved. So you can kind of get a feeling from the
number of different subgroups in this phase that there are a lot of different patient populations in here.
N2 disease is a lot different from T3 disease so implications in terms of survival and treatment are also
different