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INTRODUCTION

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Lung cancer remains the leading cause of cancer mortality in the United States and worldwide by a large margin. In 2016, there was an estimated 243,820 new lung cancer cases in the United States, and there were over 162,510 deaths attributable to lung cancer.1 Despite a very clear and well-established link between tobacco use and lung cancer, lung cancer mortality results in more deaths in the United States per year than breast, colon, prostate, and pancreas combined. One of the many hurdles in the successful treatment of lung cancer relates to the difficulty in early detection. Only 10% to 15% of all lung cancer patients have localized disease (clinical stage I or II) at the time of diagnosis. Conversely, close to two-thirds of newly diagnosed lung cancer patients have metastatic disease (stage IV) at their initial time of diagnosis.1 The delay in identifying early-stage lung cancer poses a significant challenge in the treatment of this disease. This chapter focuses on the workup and treatment of stage I and II lung cancers, and the expected long-term outcomes for this group of patients.

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EPIDEMIOLOGY

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Although the incidence of breast and prostate cancer remains much higher than that of lung cancer, the mortality from lung cancer for years has exceeded that of breast, prostate, and colon cancer combined.2 As of yet, no single intervention or treatment has resulted in a significant reduction in the number of lung cancer cases or long-term survival. There is a modest improvement in survival in a select group of patients with stage IV lung cancer utilizing targeted molecular therapies. Unfortunately, the patients who are responsive to this type of treatment represent a minority of all lung cancer cases diagnosed. The modest success achieved reducing the number of lung cancer deaths is likely attributable to a slow decline in the use of tobacco in the United States. Although the primary cure for lung cancer remains surgical resection for early stage lung cancer, the percentage of patients who are cured (as defined by disease-free 5-year survival) remains poor.

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The primary cause of lung cancer remains the ongoing use of tobacco, specifically cigarette smoking. Despite a modest reduction in the use of tobacco through a number of initiatives here in the United States, smoking rates continue to remain above targeted goals for reduction.3 It is estimated that 85% to 90% of all lung cancers are directly attributable to smoking. The remaining 10% to 15% of lung cancer cases may be attributable to radon gas, occupational exposures (arsenic, nickel), air pollution, radiation exposure, and sporadic genetic changes. Although asbestos exposure is most commonly associated with the development of mesothelioma, it is also well recognized that asbestos significantly contributes to the development of lung cancer as well, and the combination of asbestos exposure and cigarette smoke has a synergistic effect in lung cancer development. Since the early 2000s, there have been ...

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