The Medical Minute: Lung cancer, a global health problem

By Chandra P. Belani and Henry Wagner Jr.

More than 1.2 million cases of lung cancer are diagnosed worldwide each year. It is estimated that approximately 215,020 new cases of lung cancer will be diagnosed in 2008 in the United States, with nearly 161,840 resultant deaths accounting for around 29 percent of all cancer deaths. More people will die of lung cancer than from colon, breast and prostate cancers combined.

While the majority of cases of lung cancer are related to tobacco smoke, lung cancer in nonsmokers (approximately 10 percent), particularly women, also is a major problem. Recent epidemiologic and genetic studies are clearly showing that there are significant molecular and clinical differences between lung cancer in smokers and nonsmokers.

Lung cancer usually occurs in the elderly. Approximately two out of three people diagnosed with lung cancer are older than 65 years and less than 3 percent of all cases are found in people younger than 45 years of age.

Symptoms of lung cancer usually do not appear until the disease is in an advanced stage. Some lung cancers are found early but they are usually detected as a result of testing for other medical conditions. The most common symptoms of lung cancer are:

  • A cough that does not go away
  • Chest pain that is often worse with deep breathing, coughing or laughing
  • Hoarseness
  • Weight loss and loss of appetite
  • Bloody or rust-colored sputum (spit or phlegm)
  • Shortness of breath
  • Recurring infections such as bronchitis and pneumonia
  • New onset of wheezing

Several methods of detecting lung cancer early have been studied as a screening tool, and can identify small lung cancers in asymptomatic individuals, but to date there is no valid lung cancer screening test that has been shown to decrease overall mortality from the disease.

Approximately 13 percent of lung cancers comprise small-cell lung cancer (SCLC), characterized by rapid growth and strongly related to cigarette smoking. SCLC is responsive to chemotherapy and radiotherapy but also has a tendency to recur quickly. It metastasizes to other parts of the body, such as bone, brain, liver and adrenal glands.

Non-small cell lung cancer (NSCLC) — which includes squamous cell, adenocarcinoma and large cell carcinoma — comprises the remaining 87 percent of lung cancers and if detected early is amenable to surgical resection. Multimodality therapy with a multidisciplinary approach is necessary for patients with locally advanced disease. Systemic therapy is now indicated in almost all stages of NSCLC.

Patients who have been treated successfully for lung cancer are at high risk for the development of a second tobacco-related malignancy, another lung cancer or a tumor of the head and neck, esophagus or bladder. Similarly, patients with treated head and neck cancer are at risk for lung cancer. Close follow-up of these individuals is important for their long-term health.

Recent insight gained into the molecular mechanisms of lung cancer development and progression has led to modest therapeutic improvements. The outcome for patients with all stages of lung cancer has improved with a true multidisciplinary approach utilizing navigation bronchoscopic evaluation, incorporation of novel cytotoxic and molecularly targeted agents, minimally invasive surgery, lung sparing radiation techniques, and improved supportive care measures. Identification of clinical characteristics, genomic alterations and mutations that play a role in lung cancer development and progression will lead to tailored and individualized therapy.

These clinical and translational research initiatives are under way currently at Penn State Hershey Cancer Institute of the Penn State Milton S. Hershey Medical Center. For more information, please visit our Penn State Hershey Cancer Institute at http://web1.hmc.psu.edu/psci/ online.

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Chandra Belani is deputy director of Penn State Hershey Cancer Institute, Penn State Milton S. Hershey Medical Center. Henry Wagner Jr. is a professor of radiology and chairman Division of Radiation Oncology at Penn State Milton S. Hershey Medical Center.

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Last Updated March 19, 2009