Overview of the initial evaluation, treatment and prognosis of lung cancer
- David E Midthun, MD
David E Midthun, MD
- Section Editor — Lung Cancer
- Professor of Medicine, Mayo Clinic College of Medicine
- Section Editors
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
Worldwide, lung cancer occurred in approximately 1.8 million patients in 2012 and caused an estimated 1.6 million deaths . In the United States, there will be approximately 225,000 new cases of lung cancer and over 160,000 deaths annually .
Both the absolute and relative frequencies of lung cancer have risen dramatically. Around 1953, lung cancer became the most common cause of cancer deaths in men. In 1985 it became the leading cause of cancer deaths in women, and now causes approximately twice as many deaths as breast cancer. Lung cancer deaths are declining in men, and the death rate in women has plateaued secondary to decreases in smoking. Now however, almost one-half of all lung cancer deaths occur in women. (See "Women and lung cancer".)
The term lung cancer, or bronchogenic carcinoma, refers to malignancies that originate in the airways or pulmonary parenchyma. Approximately 95 percent of all lung cancers are classified as either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC). This distinction is required for proper staging, treatment, and prognosis. Other cell types comprise about 5 percent of malignancies arising in the lung.
This discussion will present an overview of the initial diagnosis, treatment, and prognosis of patients with both NSCLC and SCLC. An overview of the risk factors, pathology, and clinical manifestations of lung cancer is presented separately, as is an overview of the management of patients with advanced NSCLC, and a discussion of issues concerning lung cancer survivors. (See "Overview of the risk factors, pathology, and clinical manifestations of lung cancer" and "Overview of the treatment of advanced non-small cell lung cancer" and "Overview of approach to lung cancer survivors".)
The main issues to assess in a patient with a suspected lung cancer are to confirm that the lesion is malignant, determine whether the cell type non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC), assess the stage of disease, and the functional status of the patient. These parameters are essential for appropriate patient management. The initial evaluation of a patient with suspected lung cancer is discussed in detail separately. (See "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer".)
- Brambilla E, Travis WD. Lung cancer. In: World Cancer Report, Stewart BW, Wild CP (Eds), World Health Organization, Lyon 2014.
- Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
- Silvestri GA, Tanoue LT, Margolis ML, et al. The noninvasive staging of non-small cell lung cancer: the guidelines. Chest 2003; 123:147S.
- Havemann K, Hirsch FR, Ihde DC, et al. Staging and prognostic factors in small cell lung cancer: a consensus report. Lung Cancer 1989; 5:119.
- Karnofsky D, Abelmann W, Craver L, Burchenal J. The use of nitrogen mustard in the palliative treatment of cancer. Cancer 1948; 1:634.
- Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 1996; 32A:1135.
- Tanvetyanon T, Robinson LA, Schell MJ, et al. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol 2008; 26:1142.
- Kvale PA, Simoff M, Prakash UB, American College of Chest Physicians. Lung cancer. Palliative care. Chest 2003; 123:284S.
- Hoang T, Xu R, Schiller JH, et al. Clinical model to predict survival in chemonaive patients with advanced non-small-cell lung cancer treated with third-generation chemotherapy regimens based on eastern cooperative oncology group data. J Clin Oncol 2005; 23:175.
- Blackstock AW, Herndon JE 2nd, Paskett ED, et al. Outcomes among African-American/non-African-American patients with advanced non-small-cell lung carcinoma: report from the Cancer and Leukemia Group B. J Natl Cancer Inst 2002; 94:284.
- Stanley KE. Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst 1980; 65:25.
- FEINSTEIN AR. SYMPTOMATIC PATTERNS, BIOLOGIC BEHAVIOR, AND PROGNOSIS IN CANCER OF THE LUNG. PRACTICAL APPLICATION OF BOOLEAN ALGEBRA AND CLINICAL TAXONOMY. Ann Intern Med 1964; 61:27.
- Kawaguchi T, Takada M, Kubo A, et al. Performance status and smoking status are independent favorable prognostic factors for survival in non-small cell lung cancer: a comprehensive analysis of 26,957 patients with NSCLC. J Thorac Oncol 2010; 5:620.
- Sculier JP, Chansky K, Crowley JJ, et al. The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th Edition of the TNM Classification of Malignant Tumors and the proposals for the 7th Edition. J Thorac Oncol 2008; 3:457.
- Gail MH, Eagan RT, Feld R, et al. Prognostic factors in patients with resected stage I non-small cell lung cancer. A report from the Lung Cancer Study Group. Cancer 1984; 54:1802.
- Postoperative T1 N0 non-small cell lung cancer. Squamous versus nonsquamous recurrences. The Lung Cancer Study Group. J Thorac Cardiovasc Surg 1987; 94:349.
- Harpole DH Jr, Herndon JE 2nd, Young WG Jr, et al. Stage I nonsmall cell lung cancer. A multivariate analysis of treatment methods and patterns of recurrence. Cancer 1995; 76:787.
- Pairolero PC, Williams DE, Bergstralh EJ, et al. Postsurgical stage I bronchogenic carcinoma: morbid implications of recurrent disease. Ann Thorac Surg 1984; 38:331.
- Martini N, Bains MS, Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 1995; 109:120.
- Lipford EH 3rd, Eggleston JC, Lillemoe KD, et al. Prognostic factors in surgically resected limited-stage, nonsmall cell carcinoma of the lung. Am J Surg Pathol 1984; 8:357.
- Takise A, Kodama T, Shimosato Y, et al. Histopathologic prognostic factors in adenocarcinomas of the peripheral lung less than 2 cm in diameter. Cancer 1988; 61:2083.
- Cagini L, Monacelli M, Giustozzi G, et al. Biological prognostic factors for early stage completely resected non-small cell lung cancer. J Surg Oncol 2000; 74:53.
- Kwiatkowski DJ, Harpole DH Jr, Godleski J, et al. Molecular pathologic substaging in 244 stage I non-small-cell lung cancer patients: clinical implications. J Clin Oncol 1998; 16:2468.
- Shields TW. Prognostic significance of parenchymal lymphatic vessel and blood vessel invasion in carcinoma of the lung. Surg Gynecol Obstet 1983; 157:185.
- Macchiarini P, Fontanini G, Hardin MJ, et al. Blood vessel invasion by tumor cells predicts recurrence in completely resected T1 N0 M0 non-small-cell lung cancer. J Thorac Cardiovasc Surg 1993; 106:80.
- Rusch VW, Hawes D, Decker PA, et al. Occult metastases in lymph nodes predict survival in resectable non-small-cell lung cancer: report of the ACOSOG Z0040 trial. J Clin Oncol 2011; 29:4313.
- Brambilla E, Le Teuff G, Marguet S, et al. Prognostic Effect of Tumor Lymphocytic Infiltration in Resectable Non-Small-Cell Lung Cancer. J Clin Oncol 2016; 34:1223.
- Shimada Y, Saji H, Kato Y, et al. The Frequency and Prognostic Impact of Pathological Microscopic Vascular Invasion According to Tumor Size in Non-Small Cell Lung Cancer. Chest 2016; 149:775.
- Ruffini E, Asioli S, Filosso PL, et al. Significance of the presence of microscopic vascular invasion after complete resection of Stage I-II pT1-T2N0 non-small cell lung cancer and its relation with T-Size categories: did the 2009 7th edition of the TNM staging system miss something? J Thorac Oncol 2011; 6:319.
- Naito Y, Goto K, Nagai K, et al. Vascular invasion is a strong prognostic factor after complete resection of node-negative non-small cell lung cancer. Chest 2010; 138:1411.
- Xi L, Coello MC, Litle VR, et al. A combination of molecular markers accurately detects lymph node metastasis in non-small cell lung cancer patients. Clin Cancer Res 2006; 12:2484.
- D'Angelo SP, Janjigian YY, Ahye N, et al. Distinct clinical course of EGFR-mutant resected lung cancers: results of testing of 1118 surgical specimens and effects of adjuvant gefitinib and erlotinib. J Thorac Oncol 2012; 7:1815.
- De Wever W, Ceyssens S, Mortelmans L, et al. Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT. Eur Radiol 2007; 17:23.
- Paesmans M, Berghmans T, Dusart M, et al. Primary tumor standardized uptake value measured on fluorodeoxyglucose positron emission tomography is of prognostic value for survival in non-small cell lung cancer: update of a systematic review and meta-analysis by the European Lung Cancer Working Party for the International Association for the Study of Lung Cancer Staging Project. J Thorac Oncol 2010; 5:612.
- Paesmans M, Garcia C, Wong CY, et al. Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data. Eur Respir J 2015; 46:1751.
- Nair VS, Krupitskaya Y, Gould MK. Positron emission tomography 18F-fluorodeoxyglucose uptake and prognosis in patients with surgically treated, stage I non-small cell lung cancer: a systematic review. J Thorac Oncol 2009; 4:1473.
- Lowe VJ, Hoffman JM, DeLong DM, et al. Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities. J Nucl Med 1994; 35:1771.
- Pöttgen C, Levegrün S, Theegarten D, et al. Value of 18F-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography in non-small-cell lung cancer for prediction of pathologic response and times to relapse after neoadjuvant chemoradiotherapy. Clin Cancer Res 2006; 12:97.
- Hoekstra CJ, Stroobants SG, Smit EF, et al. Prognostic relevance of response evaluation using [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography in patients with locally advanced non-small-cell lung cancer. J Clin Oncol 2005; 23:8362.
- Sugimura H, Nichols FC, Yang P, et al. Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection. Ann Thorac Surg 2007; 83:409.