SYMPOSIUM ON SOLID TUMORSNon-Small Cell Lung Cancer: Epidemiology, Risk Factors, Treatment, and Survivorship
Section snippets
Cigarette Smoking
The emergence of the lung cancer epidemic in the 20th century has no doubt been caused by cigarette smoking. The effect of pipe and cigar use on the risk of lung cancer is similar to that of light cigarette smoking.6, 7 In the United States and the United Kingdom, the decline in lung cancer rates is projected to level off in 2 decades because of the slow progress in smoking cessation at present. Lung cancer will remain among the top killers for decades unless radical reductions in smoking
STAGING OF LUNG CANCER
After the initial diagnosis of NSCLC, accurate TNM staging of lung cancer is crucial for determining appropriate therapy. Most patients with stages I to II NSCLC benefit from surgical resection, whereas patients with more advanced disease are candidates for nonsurgical treatment. Conventional clinical staging is most often performed with computed tomography (CT) of the thorax and upper abdomen. Nevertheless, CT imaging has limited sensitivity for microscopic metastatic disease and is frequently
LUNG CANCER SCREENING
Lung cancer has a dismal 5-year survival rate of 15%. Timely detection in individuals at risk could prevent, interrupt, or delay lung cancer progression. The first hurdle to overcome in achieving the goal of timely detection is precise identification of individuals at risk. After initial inconclusive studies during the 1970s, a seminal article by Henschke et al42 in 1999 ignited a controversy about lung cancer screening by means of radiographic techniques. In a recent article, Henschke, writing
Surgery
Surgical resection remains the single most consistent and successful option for cure for patients diagnosed as having lung cancer. For this option to be feasible, the cancer must be completely resectable, and the patient must be able to tolerate the proposed surgical intervention. Issues of resectability refer to preoperative staging including imaging studies and biopsy, whereas issues of operability pertain to the evaluation of patient factors and operative approaches that minimize surgical
DETERMINANTS OF SURVIVAL
Factors that have emerged as prognostic indicators of survivorship in lung cancer include tumor cell grade of differentiation, smoking cessation, dietary supplements, tumor molecular markers, and pharmacogenomics and treatment outcomes.
LONG-TERM SURVIVORS
Outcome varies among patients with NSCLC, even within groups that have the same stage at the time of diagnosis and that are treated in similar ways. People who are alive 5 years after a diagnosis of primary lung cancer are referred to as long-term lung cancer (LTLC) survivors.108 Although the chance is only 15%, more than 25,000 persons become LTLC survivors every year in the United States.109, 110 Most LTLC survivors have undergone invasive treatment such as lung resection, RT, or
CONCLUSION
Lung cancer is the leading cause of cancer-related mortality in the United States. Non-small cell lung cancer accounts for most lung cancer and carries a 5-year survival rate of 15%. Lung cancer incidence has peaked and declined in several regions of the world but has yet to peak in many other parts of the world, particularly China. With the decline in smoking in most Western countries, NSCLC is now predominant among former rather than current smokers. The treatment of NSCLC is surgery for
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