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 There are approximately 180,000 new cases each year. The development of lung cancer has been associated with tobacco use, as well as radon and asbestos exposure although some patients may have none of these risk factors.
Lung cancer is generally divided into two major types, nonsmall cell and small cell depending on the cell type seen under the microscope. Although the general workup (diagnostic procedures ) for patients is similar, treatment recommendations vary greatly depending largely on the type (small cell vs. nonsmall cell) and the stage (extent of spread) of the disease.
Nonsmall cell is more common and is further subdivided into adenocarcinoma, squamous cell carcinoma and large cell type. These subdivisions generally do not alter therapy recommendations. Treatment depends on a number of factors including the size, location and extent of the tumor as well as the general health of the patient. Therefore many combinations of all three modalities: surgery, chemotherapy and radiation therapy may be used to treat nonsmall cell lung cancer.
Surgery and radiation therapy are local modalities which are used to control disease within the lung and chest cavity. Surgery to remove the lung lesion is preferable if the lesion can safely be resected. Several operations which may remove a small portion (wedge resection) , a single lobe (lobectomy) or the entire lung (pnemonectomy) are used. Unfortunately many lesions because of their size, location or the medical condition of the patient are not amenable to surgical removal.
For lung cancers that are not surgically resectable, a combination of radiation therapy and chemotherapy may be recommended. Radiation therapy is usually directed to the lung lesion and the surrounding lymph node regions within the chest. The newest form of radiation therapy for lung cancer is 3D conformal therapy Conformal therapy utilizes CT based treatment planning to determine the radiation field. This approach allows higher doses of radiation therapy to be delivered with greater accuracy and fewer side effects.
Small cell lung cancers tend to be rapidly growing tumors. For those that are limited to the thoracic region a combination of chemotherapy and radiation therapy is usually recommended. These tumors are usually very sensitive to both chemotherapy and radiation treatments. Surgical resection is only rarely performed. Like patients with nonsmall cell lung cancer, 3D conformal radiation therapy offers the benefit of more accurate dose delivery. A new approach which has shown promise in small cell lung cancer is twice daily (hyperfractionated) treatment. A recent study in the New England Journal of Medicine demonstrated a benefit to twice daily radiation therapy at the expense of increased toxicity (side effects) and the inconvenience of having to receive treatment twice a day. At present this remains a controversial issue which you should discuss with your doctors.
Although great progress has been achieved in the treatment of lung cancer in recent years, further improvements are needed. For this reason there are several clinical investigations underway to test if new agents or combinations of therapy will improve the survival of patients with lung cancer. Many of these are available within the Saint Barnabas Health Care System and patients are encouraged to discuss these options with their doctors.
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