TITLE: LUNG CANCER
AUTHORS: PETER MAZZONE, MD -- Department of Pulmonary Disease
REVISED: MAY 6, 2003
    
Table 1:
Lung Cancer Risk Factors
Tobacco Smoke Exposure

 • Active (mainstream)

  

      Cigarette

  

      Cigar

  

 • Passive (sidestream)

  

Occupational and Environmental Exposures
 • Arsenic  • Chromium
 • Asbestos  • Nickel
 • Beryllium  • Polycyclic aromatic    hydrocarbons
 • Bis(chloromethyl)ether  • Radon
 • Cadmium  • Vinyl chloride
Genetic Predisposition
Gender
Dietary Factors
Chronic Obstructive Pulmonary Disease

 

Table 2:
Lung Cancer Manifestations
 
Paraneoplastic
Local
Growth
Regional
Growth
Metastatic
Disease
Cutaneous/
Skeletal
Endocrine
Hematologic
Neurologic
Renal
Cough Dysphagia/
Dyspnea		 Headache Acanthosis nigricans Cushing's syndrome Anemia/ polycythemia Cancer-associated retinopathy Glomerulonephritis
Dyspnea Hoarseness Hepatomegaly Clubbing Humoral hypercalcemia DIC Encephalomyelitis Nephrotic
syndrome
Hemoptysis Horner's syndrome Mental status change Dermatomyositis SIADH Eosinophilia Lambert-eaton syndrome  
Pain Hypoxia Pain Hypertrophic osteoarthropathy Tumor necrosis factor (cachexia) Granulocytosis Neuropathies  
   Pancoast syndrome Papilledema       Thrombophlebitis Cerebellar degeneration  
   Pericardial/ pleural effusions Seizures              
   Superior
vena cava syndrome		 Skin/ soft tissue mass              
      Syncope              
      Weakness           

 

Table 3:
TNM Descriptors and Non-Small Cell Lung Cancer Staging
Primary
Tumor (T)
Description
T1

A small tumor that is not locally advanced or invasive
Criteria: <3 cm in size; surrounded by lung or visceral pleura; not extending into the
main bronchus
T2

A larger tumor that is minimally advanced or invasive
Criteria: >3 cm in size; may invade the visceral pleura; may extend into the main bronchus but remains >2 cm from the main carina; may cause segmental or lobar atelectasis
T3

Any size tumor that is locally advanced or invasive up to but not including the
major intrathoracic structures
Criteria: any size; may involve the chest wall, diaphragm, mediastinal pleura, parietal pericardium; main bronchus within 2 cm of the main carina (not involving the main carina); may cause atelectasis of the entire lung
T4
 Any size tumor that is advanced or invasive into the major intrathoracic structures
Criteria: any size; invades the mediastinum, heart, great vessels, trachea, esophagus, vertebral body, main carina; malignant pericardial or pleural effusion; presence of satellite tumor nodule(s) within the primary tumor lobe
Regional
Lymph Node
Involvement (N)
Description
N1
 Metastatic disease to nodes within the ipsilateral lung
Criteria: direct extension to intrapulmonary nodes; metastasis to ipsilateral peribronchial and/or hilar nodes (nodal stations 10 through 14)
N2
 Metastatic disease to nodes beyond the ipsilateral lung but not contralateral to the
primary tumor
Criteria: metastasis to the ipsilateral mediastinal and/or subcarinal nodes
(nodal stations 1 through 9)
N3
 Metastatic disease to nodes distant to those included in N2
Criteria: metastasis to contralateral mediastinal and/or hilar nodes, ipsilateral or contralateral scalene and/or supraclavicular nodes
Metastases (M)
Description
MO
 Local or regional disease, no distant metastases
M1
 Disseminated disease, distant metastases present
Staging
Description
IA
 T1N0M0
IB
 T2N0M0
IIA
 T1N1M0
IIB
 T2N1M0, T3N0M0
IIIA
 T3N1M0, T(1-3)N2M0
IIIB
 T4N(0-3)M0, T(1-4)N3M0
IV
 T(any)N(any)M1
Adapted from reference 7

 

Table 4:
Options for the Treatment of Lung Cancer
Non-Small Cell

     Stage IA, IB, IIA, IIB
  • Surgical resection is the standard of care if patient deemed able to tolerate
  • Limited resection if patient is unable to tolerate larger resection
  • Radiotherapy if patient is unable to tolerate or chooses not to undergo resection
  • Adjuvant radiotherapy possibly of use if incomplete resection has occurred
  • Consider adjuvant chemotherapy

     Stage IIIA
  • Concurrent chemoradiotherapy using a platinum-based regimen if performance status is reasonable
  • Induction chemoradiotherapy followed by resection in selected patients, ideally as part of a study protocol

     Stage IIIB
  • Concurrent chemoradiotherapy using a platinum-based regimen if performance status is reasonable
  • Induction chemoradiotherapy followed by resection in highly selected patients, only as part of a study protocol

     Stage IV
  • Platinum-based chemotherapy regimen in patients with adequate performance status
Small Cell

     Limited-Stage
  • Combination chemotherapy with concurrent hyperfractionated radiotherapy if performance status is adequate
  • Prophylactic cranial radiation for those with a complete response to chemoradiotherapy

     Extensive-Stage
  • Combination chemotherapy if performance status is adequate


Table 5:
Non-Small Cell Lung Cancer:
5-year Survival (%) by Stage7
Stage
Clinical
Pathologic
IA
61
67
IB
38
57
IIA
34
55
IIB
22-24
38-39
IIIA
9-13
23-25
IIIB
3-7
  
IV
1
–
  

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