Lung Cancer
What is it?
The incidence of carcinoma of the lung has
risen greatly in all economically developed
countries of the world. It now stands as one the
most common causes of death from cancer in both
men and women.
Who gets it?
Although carcinoma of the lung is still more
common in men than women, the frequency of
disease in both sexes has been associated with
the introduction of certain environmental factors
prevalent such as cigarette smoking, urban air
pollution and specific industrial exposure.
What are the symptoms?
Symptoms indicative of a diagnosis of lung
cancer may be cough, pneumonia, hemoptysis
(coughing up blood), or weight loss. Diagnosis is
initially made by a chest x-ray with a follow-up
computer tomography scan. The decision-making
process for determining surgery is very dependent
on preoperative clinical staging. Additionally,
this may include bronchoscopy; mediastinoscopy to
evaluate mediastinal nodes when indicated, and
physiologic assessment of the patient's ability
to tolerate a major pulmonary resection. Once
clinical staging is accomplished treatment can be
defined. Prior to surgery it may be necessary for
the patient to undergo pulmonary function testing
to assess lung capacity. This is done to
determine that there will be enough reserve
following the removal of the tumor and a portion
of the lung itself. Careful preoperative
evaluation assures maximum safety.
Diagnosis
When the diagnosis is established there are
several treatment options available to the
patient depending upon the stage of the disease.
Surgical resection, radiation therapy,
chemotherapy, immunotherapy, and supportive care
all have roles alone or in combination.
In some instances resection is not an option
to the patient due to findings unrelated to the
tumor. Ventilatory studies must be done to
evaluate at what level impaired function makes
resection too hazardous. In addition the
patient's cardiac status must be evaluated.
Cardiac contraindications include recent
myocardial infarct, uncontrolled heart failure or
an uncontrollable arrhythmia.
Treatment
Once the patient is cleared for surgical
resection, and if the tumor's location permits
clear margins, surgery will be performed. Because
of the advantages and disadvantages of the
various procedures, the selection of the
operative procedure for a given patient is not
blind adherence to any one operation as the only
procedure of choice, but should be determined by
the physiologic status of the patient and the
topographic extent of the tumor at operation.1
At present, a lobectomy is done more often
than is a pneumonectomy. Lobectomy is indicated
in carcinoma of the bronchus if:
- the growth is relatively peripheral and
confined to one lobe (or middle and right lower
lobe) - in the case of an upper lobe growth,
especially on the right, it is possible to
obtain almost as good a clearance of lymphatic
glands as by pneumonectomy.
- The patient is considered unfit of
pneumonectomy because of age or impaired lung
function.
The final decision whether to carry out a
lobectomy or pneumonectomy must remain until the
operation because the growth may be more
extensive than anticipated.
Lobectomy is also carried out for
bronchiectasis, lung abscess, benign tumors and
other miscellaneous conditions.2
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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