Preface

The readers of Lung Cancer: Standards of Care will not be surprised to hear—again—that lung cancer is still the deadliest cancer in absolute numbers worldwide. And yet, it’s a cancer that is mostly due to behavioral and environmental factors. One hundred years ago, lung cancer was among the rarest seen. It took decades to realize its main cause—tobacco—and still, decades later, tobacco’s addictiveness is the major challenge for its users. It’s a major roadblock for countries and global organizations trying to control the use and sale of tobacco and reduce the addiction to it.

For the longest time, lung cancer patients were shamed, and their physicians dealt them fatalism and not hope. In that same era, many other cancers became success stories. Lung cancer was labeled a treatment-refractory disease when other common cancers became curable, preventable, or turned into chronic conditions with well-preserved quality of life.

The new standards of care for lung cancer are never to accept it as an inevitable part of life or to expect that diagnosis leads only to a grave prognosis. Public health measures over the last decades have bent the curve in mortality rate for both men and women. The decrease in lung cancer mortality in the last decade, in the economically more advanced nations, is a tribute to the science of epidemiology and to modern medicine, advocacy groups, and prudent policy.

Our understanding of lung cancer’s etiology and biology, of its molecular machinery, and of its dependence on host-related and environmental factors has led to breakthroughs in survival that were not imaginable a few years ago. A cancer that was until very recently simplified as either “small or non–small cell” histology has become a cancer with many genomic variants, dynamic in its molecular and histologic evolution and staged to its anatomical extent. We track it by new imaging modalities and new techniques of tissue sampling, using interventional radiology and interventional pulmonary techniques. New surgical modalities that are minimally invasive, and new radiation modalities, allow curative intent with minimal risk and side effects. Inhibiting oncogenes and activating hosts’ immune defenses have both added a new dimension in cancer care, with the promise of more breakthroughs to come.

This book is intended for a broad audience and is meant to highlight the most important points and new principles of lung cancer management, still allowing the reader to go into more detail, especially in terms of etiology, diagnosis, and therapy.

In a field that is rapidly evolving, the organization of the book and the intent of the authors are to give the readers a practical and efficient way to familiarize themselves with the newest developments in the field. The bibliography will allow the interested reader to see the data of numerous studies and trials that are behind the new developments, such as immunotherapy and oncogene inhibition, and newer concepts, such as the stem cell concept of lung cancer.

The rapidly changing landscape, with ever-increasing options available in diagnostics and therapeutics, makes any attempt to capture in print the oncoming waves of recommendations a Sisyphean task.

The hope and intent of the authors are to give the readers a solid foundation of the new principles approaching this disease. Many contributors from a wide range of disciplines provide the reader with practice-changing information that can be applied in patient care today.

Moreover, this book may give the readers a glimpse of a future where lung cancer will no longer be accepted as a common and natural cause of death.