Lung Cancer.pdf

22 J.B. Putnam, Jr., F.V. Fossella, and R. Komaki
KEY PRACTICE POINTS
• Chest radiography, sputum cytology, and fiber-optic bronchoscopy have
shown only limited effectiveness in lung cancer screening.
• Most patients with advanced lung cancer have symptoms at the time of
diagnosis; common symptoms include cough, dyspnea, chest pain, and
hemoptysis.
• In patients with lung cancer, a thorough pretreatment evaluation, including
clinical staging based on chest radiography, CT of the chest and upper abdomen,
and other examinations plus evaluation of the patient’s performance
status, is essential for effective treatment planning.
• SCLC is more aggressive than NSCLC and is often extensive-stage at diagnosis.
• Clinical trials offer access to the best available treatment ideas, and enrollment
of eligible patients in such trials is encouraged.
• In patients with localized NSCLC, lobectomy with intrathoracic mediastinal
lymph node dissection should be performed.
• In patients with NSCLC with histologically positive mediastinal lymph nodes
or unresectable local disease, various combinations of surgery, chemotherapy,
and radiation therapy are recommended.
• Patients with SCLC are usually treated with combination chemotherapy.
of treatment. Radiation therapy may be used for palliation of symptoms or
treatment of metastasis.
In rare situations in which SCLC is suspected but not confirmed after
fine-needle aspiration and radiographic staging, surgical techniques
(e.g., bronchoscopy) may be helpful for staging or diagnosis (Lassen and
Hansen, 1999). In patients who present with a solitary pulmonary nodule
characterized as early stage ( 3 cm), pulmonary resection (e.g.,
wedge resection or lobectomy and mediastinal lymph node dissection)
may be viewed as “treatment” after the fact in those cases in which
SCLC is confirmed. Postoperative chemotherapy may be considered in
these cases.
Suggested Readings
American Cancer Society. Cancer Facts and Figures—2002. Atlanta, Ga: American
Cancer Society; 2002;3.
Dillman RO, Herndon J, Seagren SL, et al. Improved survival in stage III nonsmall-cell
lung cancer: seven-year follow-up of Cancer and Leukemia Group B
(CALGB) 8433 trial. J Natl Cancer Inst 1996;88:1210–1215.