Lung Cancer Information

Lung Cancer Overview
Lung cancer is the leading cause of cancer-related death in the U.S. More people die from lung cancer each year than die from breast cancer, prostate cancer, and colon cancer combined. Lung cancer is the number one cancer-killer in women as well as men. Nearly twice as many women will die from lung cancer this year than will die from breast cancer (the 2nd leading cause of cancer-related death in women). Approximately 170,000 people are diagnosed with lung cancer in the U.S. every year and nearly 160,000 will die from this disease. Globally, over 1 million people are diagnosed with lung cancer each year. Lung cancer is generally divided into two sub-types- small cell and non-small cell. 

Small Cell Lung Cancer
Small cell lung cancer comprises approximately 15% of all cases (25,000 persons/year) and is thought of as an aggressive tumor with a propensity for early spread outside the chest. Common sites of spread (metastasis) include the brain, liver, adrenal glands, bone and bone marrow. There are two stages to small cell lung cancer-limited and extensive stage. The stage refers to the extent of disease present and allow the physician to plan for the best treatment and provide a prognosis to the patient. Limited stage refers to disease confined to the chest (lung and local lymph nodes). Extensive stage generally refers to disease that has already spread to distant sites (brain, liver, bone, adrenal glands, bone marrow). While limited stage disease is potentially curable, extensive stage disease is nearly universally incurable.
Standard treatment for patients with limited stage small cell lung cancer comprises chemotherapy and radiation, usually given simultaneously. Surgery is usually not part of standard treatment, with rare exception. Standard chemotherapy includes cisplatin and etoposide given over 3 days every 3 weeks for 4 "cycles" concurrently with once or twice daily radiation for the first 3-5 weeks of treatment. Approximately 50% of patients achieve a complete response and about 30-50% of those achieving a complete response will be expected to maintain the remission. Therefore, approximately 20% of patients can be cured. Because small cell lung cancer has a high propensity for spreading to the brain, patients who achieve a complete remission with chemo and radiation may be offered radiation to the brain as well (prophylactic), thus reducing the chances that the cancer will appear in the brain and also improving the cure rate by about 5%.
Standard treatment for patients with extensive stage small cell lung cancer comprises the use of combination chemotherapy, ususally a platinum agent (cisplatin or carboplatin) combined with a second drug (ususally etoposide). Small cell lung cancer is very sensitive to chemotherapy (and radiation); therefore, most patients do initially respond to chemotherapy with an improvement in their symptoms and disease state. Unfortunately, relapse is also nearly universal and treatment of relapsed disease results in far inferior results to initial treatment. Other agents may be used, including irinotecan, topotecan, paclitaxel, docetaxel, and gemcitabine and may result ina subsequent response (usually of shorter duration than the initial response).

Non-Small Cell Lung Cancer
Non-small cell lung cancer comprises approximately 85% of all cases of lung cancer. There are 4 general subtypes of non-small cell lung cancer-adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and bronchioalveolar carcinoma. There are 4 stages to non-small lung cancer. Stage I disease generally refers to lung cancer confined to one lobe of one lung without lymph node involvement or metastatic spread. Stage II disease refers to cancer confined to the lung and lymph nodes within the lung. Stage III disease refers to cancer that has spread into the mediastinum (the compartment in the mid-chest between the lungs) either by direct tumor spread or lymph node involvement and State IV refers to cancer that has spread to a distant site (brain, liver, bone, adrenal gland, other lung).
Treatment for stage I non-small cell lung cancer involves surgical resection, provided that one is considered medically operable. The average age of someone with lung cancer is 70 and most patients have a lifelong history of smoking and smoking-related illnesses such as emphysema or heart disease. Therefore, surgical resection may not be possible in some patients. For patients who do undergo surgery and are found to have stage IA disease (tumor less than 3cm), surgery alone remains the standard of care. If the tumor is greater than 3cm (stage IB), surgery followed by chemotherapy may be considered a standard option. If one is medically inoperable with stage I disease, radiation treatment is standard.
Treatment for stage II disease consists of surgical resection followed by chemotherapy (4 cycles). Cure rates are improved by about5-10% with the addition of chemotherapy. No standard regimen has been defined.
The optimal treatment of patients with stage III disease is not well defined. Treatment options range from surgery followed by chemotherapy (and/or radiation), chemotherapy and radiation followed by surgery, chemotherapy followed by surgery, or chemotherapy and radiation alone. Decisions on the optimal treatment for an individual must be made in consultation with your treating oncologist.

Links for more information

National Center for Chronic Disease Prevention and Health Promotion - Tobacco Information and Prevention Source (TIPS)
American Society of Clinical Oncology
Morbidity and Mortality Weekly Report
Americans for Nonsmoker's Rights - Smokefree Lists, Maps and Data
Smokefree List of Municipalities