Lung cancer is the leading cause of cancer related death in the U.S. and world wide. The number of deaths from lung cancer continues to rise and is more frequent than the next four most common sites combined - colon, breast, prostate and pancreas.
Clearly, tobacco exposure receives the most blame for development of lung cancer. Even if we improve smoking cessation intervention, tobacco abuse will continue to be a major health problem for several decades. Additionally, women who smoke seem to be more susceptible to lung cancer than men. It is expected that by 2030 the incidence of lung cancer in women will surpass that in men.
Screening for lung cancer primarily involves chest radiography, sputum cytology and clinical assessment. Data suggests that screening of high-risk individuals may result in detection of many lung cancers at an early stage, which will improve survival. Current recommendations include at least annual chest X-ray and physical assessment for high-risk individuals.
The diagnosis of lung cancer is usually suspected based on an abnormal chest radiograph or CT scan. It is important to differentiate between small cell and non-small cell lung cancer. A multidisciplinary team approach is necessary to evaluate the patient with lung cancer and plan therapy. Needle aspiration or biopsy along with bronchoscopy and biopsy are the mainstays of initial diagnostic evaluation. Metastatic workup is tailored to the individual patient but may involve CT scan, PET scan, MRI, bone scan and clinical evaluation.
Staging of lung cancer is based on the TNM (tumor; nodes; metastases) system as described by the American Joint Commission for Cancer. If no distant metastatic disease is found, then further diagnosis and staging are accomplished most efficiently with mediastinoscopy. Further staging techniques include percutaneous or endoscopic biopsy, supraclavicular lymph node biopsy, parasternal mediastinotomy and also video-assisted thoracoscopy. Accurate diagnosis and staging are critical in order to devise an appropriate treatment plan for the individual patient. It is particularly important to differentiate between small cell (SC) and non-small cell (NSC) cancer. NSC comprises about 80% of lung cancer. Functional status of the patient will also help determine the best treatment the patient will be able to tolerate.