The deadliest form of cancer in the U.S., involving cells that originate in the bronchi or lung. The term includes four cell types: squamous cell (epidermoid) carcinoma, adenocarcinoma, large cell (anaplastic) cancer, and small cell (oat cell) cancer.
In 2013, the National Cancer Institute (NCI) estimated that more than 228,000 people would be diagnosed with lung cancer and that about 159,500 would die of the disease. It is the second most common cancer in both men and women.
The vast majority are caused by carcinogens in tobacco smoke, including secondhand smoke. Other risks include exposure to carcinogenic industrial and air pollutants (asbestos, uranium, arsenic, nickel, chromium, iron oxides, coal dust, and radioactive dusts), concentrations of radon gas, and familial susceptibility.
SYMPTOMS AND SIGNS
Symptoms may include persistent cough, chest pain, dyspnea, weight loss, or hemoptysis. Changes in normal respiratory patterns or hoarseness, as well as pneumonia, bronchitis, epigastric pain, symptoms of brain metastasis, arm or shoulder pain, or swelling of the upper body are other possible signs.
Diagnostic tests include a chest x-ray, computed tomography (CT) scan, cytological sputum analysis, and bronchoscopy. Other tests include needle biopsy, magnetic resonance imaging (MRI), thoracentesis, thoracotomy, mediastinoscopy, or pulmonary function tests.
Treatment includes lung surgery, radiation therapy, and chemotherapy (including epidermal growth factor receptor blockers) often provided serially or in combination.
People with localized lung cancer have an approx. 5-year survival of 50%. People with widely metastatic lung cancer have a 5-year survival of less than 5%.
Staging determines the extent of the disease and aids in planning treatment and predicting the prognosis. Lung cancer is relatively difficult to cure but much easier to prevent. Children and adolescents should be discouraged from smoking tobacco products, and current smokers should be assisted in their efforts to quit, e.g., through referrals to local branches of the American Cancer Society (ACS), smoking-cessation programs, individual counseling, or group therapy.
SCREENING AND PUBLIC HEALTH
Chest x-rays do not show small, early cancers, but computed tomography (CT) scanning can be used to screen people who have a long history of smoking and evidence of emphysema. In this high-risk group, screening detects the disease in its early stages when it is most likely to be curable. Smokers over the age of 55 who undergo annual lung cancer screening with low-dose CT scans have improved survival relative to those who do not. However, the public health costs of mass screening are high compared with the cost of encouraging smokers to quit or teaching teenagers not to start smoking.
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