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Chapter 22: Lung Cancer

Enriqueta Felip; Rafael Rosell

INTRODUCTION

Epidemiology

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Epidemiology
Incidence:

224,210 (male: 116,000; female: 108,210. Estimated new cases for 2014 in the United States)

61.4 per 100,000 male and female per year (74.3 per 100,000 men, 51.9 per 100,000 women)
Deaths: Estimated 159,260 in 2014 (male: 86,930; female: 72,330)
Median age: 61.4 years
Male-to-female ratio: ~1:1

 

Stage at Presentation

Localized (confined to primary site): 15%

Regional (spread to regional lymph nodes): 22%

Distant (cancer has metastasized): 57%

 

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

Weir HK et al. J Natl Cancer Inst 2003;95:1276–1299

Pathology

Lung cancer is divided into 2 major classes:

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1. Non–small cell lung cancer (NSCLC):

  • Squamous cell carcinoma

  • Adenocarcinoma

  • Large-cell carcinoma

 75–85%

2. Small cell lung cancer (SCLC)

 15–25%

Brambilla E et al. Eur Respir J 2001;18:1059–1068

NON–SMALL CELL LUNG CANCER (NSCLC)

Work-up

  1. History and physical examination including performance status and weight loss

  2. Chest x-ray, PA and lateral

  3. CT scan of chest and upper abdomen including adrenals

  4. CBC, serum electrolytes, BUN, creatinine, calcium, magnesium, and LFTs

  5. CT scan and/or MRI of brain if neurologic history or examination is abnormal

  6. Bone scan if there is bone pain, elevated calcium level, or elevated alkaline phosphatase level

  7. Assessment of perioperative risks for potential candidates for surgery, including pulmonary function tests (PFTs)

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Stages I-II

  1. Bronchoscopy

  2. FDG-PET scan
Stages IIIA-IIIB

  1. Bronchoscopy

  2. FDG-PET scan

  3. MRI of the chest in superior sulcus tumors

  4. MRI of brain

  5. Bone scan

  6. Mediastinal lymph node biopsy if CT scan shows nodes >1 cm

  Invasive tests: Mediastinoscopy, thoracoscopy, transbronchial needle aspiration, and endoscopic ultrasound and needle aspiration
Stage IV Biopsy for otherwise potentially resectable patient with isolated adrenal mass or liver lesion

Staging

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Staging

Primary Tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Tis Carcinoma in situ
T1 Tumor ≤3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (ie, not in the main bronchus)✫
T1a Tumor ≤2 cm in greatest dimension
T1b Tumor >2 cm but ≤3 cm in greatest dimension
T2

Tumor >3 cm but ≤7 cm or tumor with any of the following features (T2 tumors with these features are classified T2a if ≤5 cm)

Involves main bronchus, ≥2 cm distal to the carina

Invades visceral pleura (PL1 or PL2)

Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
T2a Tumor >3 cm but ≤5 cm in greatest dimension
T2b Tumor >5 cm but ≤7 cm in greatest dimension
T3 Tumor >7 cm or one that ...

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