OVERVIEW

Lung cancer is now the most common cause of cancer related death among both men and women, accounting for 28% of all cancer deaths in the U.S. Last year more than 170,000 Americans will be diagnosed with lung cancer. Among men the incidence of lung cancer has been declining, but it continues to increase among women. Since 1987 more women have died from lung cancer than from breast cancer.

There are two major types of lung cancer; small cell and nonsmall cell. They each affect different types of cells in the lung and grow and Spread in different ways. Accordingly, doctors treat them differently. A diagnosis will  include not only the type of lung cancer but also the stage. Stage describes the extent and spread of the disease at the time of diagnosis.

Nonsmall lung cancer, the most common type of lung cancer, can be further divided into three categories based on their actual call type. These are squamous cell carcinoma, adenocarcinoma, and large cell Carcinoma. Nonsmall cell lung cancer is described using four stages.  In stage I the cancer is confined to the lung. In stages II and III the cancer is confined to the chest. In stage IV the cancer has spread from the chest.

Small cell lung cancer, also called oat call lung cancer, accounts for one quarter of all lung Cancer cases. The extent of this disease is described using a two stage system. A case can be limited, meaning the cancer  is confined to a portion of the chest, or extensive meaning the cancer has spread from the chest.

Tumors are also sometimes found in the lungs which originate in cancer elsewhere in the body, these are not classified as lung cancers but rather as Cancer which has metastasized to the lung. Treatment of these tumors will be different from that of primary lung cancers,

RISK FACTORS

Lung cancer occurs most frequently among people over 50 years of age who have smoked for many years. UP to 90% Of all lung cancers are associated with smoking. Exposure to second hand smoke is also a risk factor for lung cancer among nonsmokers. Cigarette smoke contains thousands of chemicals, many of them known to be carcinogens, These chemicals initiate changes in the cells in the lungs which may turn into cancer cells. Male smoker, are at the highest risk of developing lung cancer. Their risk is more often 20 times that of nonsmoking men. Female smokers have a risk which is 12 times that of nonsmoking women. The previously mentioned increase in lung cancer  deaths among women is directly tied to an increase in the number of women in the U.S. who now smoke.

Besides cigarette smoke there are other industrial and environmental exposures which increase one's risk for developing lung cancer. These include asbestos, certain organic chemicals, arsenic, radiation, and radon gas. The risk of these exposures Contributing to the development of lung cancer are multiplied when they occur in cigarette smokers.

Research has demonstrated that changes at the cellular level can he detected soon after lungs are exposed to carcinogens. With continued exposure, more abnormal cells appear. Lung cancer may take many years to develop. Precancerous changes in lung tissue may be reversed to some extent when a person stops smoking.

DIAGNOSIS

Lung cancer is difficult to detect because symptoms do not usually appear until the disease is advanced. Not surprisingly the best outcomes in lung cancer treatment are obtained when the cancer is discovered incidentally on a routine chest x-ray Symptoms depend on the location and size of the tumor. These may include cough, hoarseness, wheezing, shortness of breath, blood streaked sputum, pneumonia, weight loss, or chest pain.

Several techniques are useful for diagnosing lung cancer. Chest x-rays and chest CT scans help cc locate abnormal areas in the lung. A sample of sputum can often be shown to contain cancerous cells. Physicians may perform a bronchoscopy to examine the bronchial airways. This is done by inserting a small fibroptic instrument through the patient's note or mouth. During bronchoscopy tissue can be removed for analysis. Areas of the long which are not accessible by bronchoscopy may often be reached by needle biopsy.

TREATMENT

Long cancer can be treated with surgery, radiation, chemotherapy, or a combination of these modalities, depending on the type and stage of the disease. For non-small cell lung cancers that have not spread beyond the lung, surgery is the most common treatment. When the disease has spread, treatment will often include radiation therapy and/or chemotherapy. or small cell lung cancer, chemotherapy, which is sometimes combined with radiation therapy, is the most common treatment.

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Last Updated: Tuesday, November 20, 2001 Rev A

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