Lung cancer

Lung cancer is a malignant tumour of the lungs. Most commonly it is bronchogenic carcinoma (about 90%). Lung cancer is the most lethal malignant tumour worldwide, causing up to 3 million deaths annually.

Treatment

Treatment for lung cancer depends on the cancer's specific form, how far it has spread, and other factors such as the patient's age and general medical state. Common treatments include surgery, chemotherapy, and radiation therapy.

Related Topics:
Spread - Surgery - Chemotherapy - Radiation therapy

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Surgery

Surgery is only an option in NSCLC and if the disease is limited to one lobe and has not spread beyond its confines. This is assessed with medical imaging (computed tomography, positron emission tomography). Furthermore, as stated, a sufficient respiratory reserve needs to be present to allow for the removal of large amounts of lung tissue. Procedures performed include lobectomy (removal of one lobe), bilobectomy (two lobes) or pneumonectomy (removal of a whole lung).

Related Topics:
Computed tomography - Positron emission tomography - Lobectomy - Pneumonectomy

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After surgery, adjuvant chemotherapy is usually recommended to decrease the risk of recurrence. Five-year prognosis is often as good as 70% in limited disease with clear resection margins.

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Chemotherapy

Small-cell lung cancer is treated primarily with chemotherapy, as surgery has no demonstrable influence on survival. Primary chemotherapy is also given in metastatic NSCLC.

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The combination regimens depend on the tumour type:

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• NSCLC: cisplatin or carboplatin, in combination with gemcitabine, paclitaxel, docetaxel, etoposide or vinorelbine
• SCLC: cisplatin or carboplatin, in combination etoposide or ifosfamide; combinations with gemcitabine, paclitaxel, vinorelbine, topotecan and irinotecan are being studied

Radiotherapy

Radiotherapy is often given together with chemotherapy, and may be used with curative intent in patients who are not elegible for surgery. A radiation dose of 40 or more Gy in many fractions is commonly used with curative intent in non-small cell lung cancer; typically in North America, the dose prescribed is 60 or 66 Gy in 30 to 33 fractions given once daily, 5 days a week, for 6 to 6 1/2 weeks. For small cell lung cancer cases that are potentially curable, in addition to chemotherapy, chest radiation is often recommended. For these small cell lung cancer cases, chest radiation doses of 40 Gy or more in many fractions are commonly given; typically in North America, the dose prescribed is 45 to 50 Gy and can be given in either once daily treatments for 5 weeks or twice daily treatments for 3 weeks.

Related Topics:
Radiotherapy - Gy

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For both non-small cell lung cancer and small cell lung cancer patients, radiation of disease in the chest to smaller doses (typically 20 Gy in 5 fractions) may be used for symptom control.

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Interventional radiology

Radiofrequency ablation is increasing in popularity for this condition as it is nontoxic and causes very little pain. It seems especially effective when combined with chemotherapy as it catches the cells inside a tumor—the ones difficult to get with chemotherapy due to reduced blood supply to the inside of the tumor. It is done by inserting a small heat probe into the tumor to cook the tumor cells. The body then disposes of the cooked cells through its normal eliminative processes.

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Targeted therapy

In recent years, various molecular targeted therapies have been developed for the treatment of advanced lung cancer. Gefitinib (Iressa®) is one such drug, which targets the epidermal growth factor receptor (EGF-R) which is expressed in many cases of NSCLC. however despite an exciting start it was not shown to increase survival, although younger females without a smoking history appear to be deriving most benefit from gefitinib.

Related Topics:
Gefitinib - Epidermal growth factor receptor

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A newer drug called erlotinib (Tarceva®) has been shown to increase survival in lung cancer patients and has recently been approved by the FDA for second-line treatment of advanced non-small cell lung cancer.http://medicineworld.org/cancer/lead/tarceva-approved.html

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Treatment of non-small cell lung cancer is evolving and the next few years could present exciting developments and new targeted therapies for lung cancer.

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