Worldwide lung cancer is the leading cause of cancer-related death. Approximately 85 %– 90% of lung cancer cases are caused by cigarette smoking. There are 2 main types of lung cancer; Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). These 2 types have different prognosis and management approach.
22.6.1 Non-small cell lung Cancer
Accounts for approximately 85% of all lung cancer cases
Diagnostic Criteria
- Chronic chest symptoms in a smoker
- Haemoptysis
- May present with superior vena cava obstruction (SVCO) syndrome
- cough in patient exposed to asbestos
- Findings of chest symptoms, weight loss, poor karnofsky performance scale (KPS)
Investigations:
- FBC, LFTs, urea, creatinine
- CXR PA & lateral views or CT scan of thorax and abdomen
- Abdominal USS
- Bronchoscopy and Biopsy for histopathology
- Cytology of sputum or bronchial aspirate examination
Staging: TNM
Management: Surgery (pneumonectomy or lobectomy) is curative for stage I and some stage II disease.
Pharmacological Treatment:
Several active chemotherapy drugs like carboplatine, cisplatin, paclitaxel, docetaxel, gemcitabine, Capecitabine and targeted therapy (bevacizumab) are available; to administered as single or in combination for adjuvant, unresectable or recurrent and metastatic disease. Below is an example of the commonly used combination regimen.
S: Carboplatin IV AUC 6 Day1 +Paclitaxel IV 175 mg/m2 Day 1 every 3 weeks for 6 cycles
Radiotherapy
With advanced radiotherapy machine and treatment technic, RT may be given for neo– adjuvant or adjuvant to surgery. Palliative Radiotherapy is frequently used in metastatic disease to bone, spinal cord compression,brain, liver and in case of superior vena cava obstruction (SVCO), atelectasis, obstructive pneumonitis and fungating masses. Dose of 30GY/10fr/2weeks gives good symptom relief.
22.6.2 Small cell lung cancer
SCLC is characterized by early development of widespread of metastases. It is highly sensitive to initial chemotherapy and radiotherapy; however, most patients eventually die of recurrent disease.
Diagnostic criteria and investigations: As in non – small cell lung cancer (NSCLC) however brain scan and bone marrow aspirate are necessary
Staging: Limited disease versus extensive disease
Pharmacological Treatment
Aim is for local control and palliation. Cure rate is low
Platinum + Etoposide are the major drugs for which the tumor is sensitive.
S: Cisplatin IV 60 mg/m2 Day 1 + Etoposide IV 100 mg/m2 Day1–3 , Every 3 weeks for 4 –6 cycles
OR
S: Carboplatin IV AUC 5 Day 1 + Etoposide IV 100 mg/m2 Day1–3, every 3 weeks for 4–6 cycles
Other available active drugs include irinotecan and gemcitab
Radiotherapy:
Consolidation to primary site and mediastinum: 50Gy/25F/5weeeks
- Prophylactic brain irradiation in complete responders
- Temporary relief of respiratory, bone or CNS symptoms: 30Gy/10F/2wks