Book contents
- Frontmatter
- Contents
- List of contributors
- Preface to the first edition
- Preface to the second edition
- Acknowledgements
- Abbreviations
- 1 Practical issues in the use of systemic anti-cancer therapy drugs
- 2 Biological treatments in cancer
- 3 Hormones in cancer
- 4 Pathology in cancer
- 5 Radiotherapy planning 1: fundamentals of external beam and brachytherapy
- 6 Radiotherapy planning 2: advanced external beam radiotherapy techniques
- 7 Research in cancer
- 8 Acute oncology 1: oncological emergencies
- 9 Acute oncology 2: cancer of unknown primary
- 10 Palliative|care
- 11 Management of cancer of the head and neck
- 12 Management of cancer of the oesophagus
- 13 Management of cancer of the stomach
- 14 Management of cancer of the liver, gallbladder and biliary tract
- 15 Management of cancer of the exocrine pancreas
- 16 Management of cancer of the colon and rectum
- 17 Management of cancer of the anus
- 18 Management of gastrointestinal stromal tumours
- 19 Management of cancer of the breast
- 20 Management of cancer of the kidney
- 21 Management of cancer of the bladder
- 22 Management of cancer of the prostate
- 23 Management of cancer of the testis
- 24 Management of cancer of the penis
- 25 Management of cancer of the ovary
- 26 Management of cancer of the body of the uterus
- 27 Management of cancer of the cervix
- 28 Management of cancer of the vagina
- 29 Management of cancer of the vulva
- 30 Management of gestational trophoblast tumours
- 31 Management of cancer of the lung
- 32 Management of mesothelioma
- 33 Management of soft tissue and bone tumours in adults
- 34 Management of the lymphomas and myeloma
- 35 Management of cancers of the central nervous system
- 36 Management of skin cancer other than melanoma
- 37 Management of melanoma
- 38 Management of cancer of the thyroid
- 39 Management of neuroendocrine tumours
- 40 Management of cancer in children
- Multiple choice questions
- Multiple choice answers
- Index
- References
31 - Management of cancer of the lung
Published online by Cambridge University Press: 05 November 2015
- Frontmatter
- Contents
- List of contributors
- Preface to the first edition
- Preface to the second edition
- Acknowledgements
- Abbreviations
- 1 Practical issues in the use of systemic anti-cancer therapy drugs
- 2 Biological treatments in cancer
- 3 Hormones in cancer
- 4 Pathology in cancer
- 5 Radiotherapy planning 1: fundamentals of external beam and brachytherapy
- 6 Radiotherapy planning 2: advanced external beam radiotherapy techniques
- 7 Research in cancer
- 8 Acute oncology 1: oncological emergencies
- 9 Acute oncology 2: cancer of unknown primary
- 10 Palliative|care
- 11 Management of cancer of the head and neck
- 12 Management of cancer of the oesophagus
- 13 Management of cancer of the stomach
- 14 Management of cancer of the liver, gallbladder and biliary tract
- 15 Management of cancer of the exocrine pancreas
- 16 Management of cancer of the colon and rectum
- 17 Management of cancer of the anus
- 18 Management of gastrointestinal stromal tumours
- 19 Management of cancer of the breast
- 20 Management of cancer of the kidney
- 21 Management of cancer of the bladder
- 22 Management of cancer of the prostate
- 23 Management of cancer of the testis
- 24 Management of cancer of the penis
- 25 Management of cancer of the ovary
- 26 Management of cancer of the body of the uterus
- 27 Management of cancer of the cervix
- 28 Management of cancer of the vagina
- 29 Management of cancer of the vulva
- 30 Management of gestational trophoblast tumours
- 31 Management of cancer of the lung
- 32 Management of mesothelioma
- 33 Management of soft tissue and bone tumours in adults
- 34 Management of the lymphomas and myeloma
- 35 Management of cancers of the central nervous system
- 36 Management of skin cancer other than melanoma
- 37 Management of melanoma
- 38 Management of cancer of the thyroid
- 39 Management of neuroendocrine tumours
- 40 Management of cancer in children
- Multiple choice questions
- Multiple choice answers
- Index
- References
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 - 426Publisher: Cambridge University PressPrint publication year: 2015