Cancer of the Lung
Non–Small Cell Lung Cancer and Small Cell Lung Cancer
Leora Horn, Rosana Eisenberg, David Gius, Katherine N. Kimmelshue, Pierre P. Massion, Joe Bill Putnam, Clifford G. Robinson and David P. Carbone
Summary of Key Points
Non–Small Cell Lung Cancer
Incidence and Epidemiology
• Constitutes 80% to 85% of new cases of lung cancer in North America.
• Most frequent histologies: adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.
• Leading cause of cancer-related death in the United States for both men and women; represents one of the most preventable forms of cancer death.
Staging Evaluation
• History and physical examination, routine hematologic and biochemical testing.
CT scan (with contrast) evaluating lungs, mediastinum, liver, and adrenals
Positron emission tomography (PET) scan
If patient has locally advanced or metastatic disease, add magnetic resonance imaging (MRI) of brain
• Bronchoscopy and/or CT-guided and/or ultrasound-guided biopsy.
• If disease is clinically more advanced, use the least invasive biopsy procedure and sample to confirm advanced disease.
Primary Therapy
Role of preoperative or postoperative chemotherapy is unclear. Often recommended in patients with stage IB tumors ≥4 cm.
Postoperative chemotherapy useful in resected IIIA in patients with a good performance status.
Role of preoperative chemotherapy ± radiotherapy for stage IIIA is unknown except for Pancoast tumors where it is recommended.
Concurrent chemotherapy combined with radiation therapy in patients with a good performance status.