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Key Concepts

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  • Epidemiology

    • Lung cancer is a leading cause of preventable death attributed to smoking and environmental exposure. Its highest incidence is in men but recent trends have shown a significant increase in women paralleling the trend of smoking prevalence in different genders.

  • Pathophysiology

    • Most of lung cancer is the result of a series of genetic changes caused by environmental factors that allow cells to grow, proliferate, and metastasize.

  • Clinical features

    • Most lung cancer patients present with late-stage disease. Patients’ clinical symptoms depend on the location and size of the tumor and the presence of metastasis.

  • Diagnostics

    • Lung cancer diagnosis is accomplished through the pathologic examination of a biopsied specimen of the mass. Clinical staging is based on a combination of patient history, physical exam, and radiographic information along with pathologic examination of the primary tumor, mediastinal lymph nodes, and any suspected sites of metastasis.

  • Treatment

    • Lung cancer patients are treated with surgery, radiotherapy, and/or chemotherapy. Surgery and radiotherapy are used for local and regional lung cancer; surgery is the primary therapy, and radiotherapy is used in patients who cannot tolerate surgery. Chemotherapy is used to treat patients with regional or metastatic lung cancer.

  • Prognosis

    • Overall, the prognosis for lung cancer is poor. The estimated overall 5-year survival rate for all of the patients with lung cancer is about 16 percent; however, patients with resected pathologic early-stage lung cancer can achieve a 5-year survival rate of 70 to 80 percent. The type and pathologic stage of lung cancer is the best predictor for prognosis.

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Introduction

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Historical Highlights

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Lung cancer, once considered rare at the beginning of the 20th century, became a frequently diagnosed disease by the mid-1930s. Oschner and Debakey attributed the increased incidence to the rise in smoking, a link that was later supported by the findings of a case-control study in 1939.1 The surgical treatment of lung cancer has evolved over time. The first successful single-stage pneumonectomy was performed by Graham and Singer in 1933,2 and the modern technique of ligating individual pulmonary vessels and suturing the bronchus was first described by Reinhoff in 1947.3

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Pathology

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Lung cancer originates from epithelial cells. The two broad categories of lung cancer are nonsmall cell lung cancer (NSCLC), which constitutes about 80 percent of lung cancers, and small cell lung cancer (SCLC).

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Nonsmall Cell Lung Cancer

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Adenocarcinoma
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Adenocarcinoma, the most common type of NSCLC, is a malignant epithelial tumor with glandular differentiation or mucin production. Adenocarcinomas are white, fleshy solid tumors that are usually located in the periphery of the lung and involve the pleura and chest wall in 15 percent of patients. There are five macroscopic growth patterns of adenocarcinoma; the most common pattern is peripheral tumor with desmoplastic fibrosis retracting the overlying pleura. Other patterns include central or endobronchial adenocarcinoma, ...

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