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31 - Management of cancer of the lung

Published online by Cambridge University Press:  05 November 2015

By
Alison Brewster  and
Fergus MacBeth
Edited by
Louise Hanna ,
Tom Crosby  and
Fergus Macbeth
Alison Brewster
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Fergus MacBeth
Affiliation:
Cardiff University, Cardiff, UK
Louise Hanna
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
Tom Crosby
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
Fergus Macbeth
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
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Summary

Introduction

Lung cancer has a significant impact on mortality in the UK, accounting for 6% of all deaths and 22% of deaths from cancer. It has one of the lowest survival outcomes of any cancer, with a 5-year survival of 7% in men and 9% in women which has changed little over the past 30 years. The last 10 years has seen a significant improvement in one-year survival, probably due to more widespread use of palliative therapies. One-year survival in the period 1990–1991 was 20.4% for men and women compared with 30.4% for men and 35.1% for women in the period 2010–2011 (http://www.cancerresearchuk.org/, accessed January 2015).

The lung cancer pathway is complex. Up to 38% of patients present as an acute medical admission compared to 23% of cancer presentations overall and this is known to be associated with a poorer outcome. Non-acute patients are assessed in rapid access clinics by chest physicians following a diagnostic CT scan. Informed of the high suspicion of lung cancer, they then undergo a series of tests to stage, establish histology and assess fitness. Specialist nurses play a key role in supporting the patient and their carers while they wait to discuss treatment options. The mean rate for surgery in England and Wales is 21.9% (range 15.1–30.8%) and for Scotland, 20.5% (Health and Social Care Information Centre, 2013). For those unfit or unwilling to undergo surgery, radiotherapy offers a possibility of cure, and high local control rates are now reported with stereotactic ablative radiotherapy (SABR) (Takeda et al., 2013). Adjuvant chemotherapy can increase absolute survival rates by up to 4%, but with 70% of patients presenting with stage IIIB and IV disease, most patients are offered palliative interventions. Chemotherapy can improve symptom control, in particular systemic symptoms, and offer modest improvements in median survival. Palliative radiotherapy is highly effective in improving symptoms such as cough, haemoptysis and pain. More recently, targeted therapies such as gefitinib offer improvements in median survival for those with EGFR mutations, and as more molecular targets are identified, there is optimism that survival outcomes in lung cancer, which has lagged far behind other malignancies such as breast cancer, may start to improve.

Type
Chapter
Information
Practical Clinical Oncology , pp. 413 - 426
Publisher: Cambridge University Press
Print publication year: 2015

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