Features of Lung Cancer

% of lung cancers

13–15%

35–40%

25–30%

10–15%

Location

Submucosa of airways, perihilar mass

Peripheral nodule or mass

Central, endobronchial

Peripheral nodule or mass

Risk factors

Smoking

Smoking (for 80‒85% of patients; 15‒20% never smoked or smoked only minimally); patients particularly those who never smoked often have oncogenic driver mutations

Environmental and occupational exposures (mainly to radon, asbestos, radiation, secondhand smoke, polycyclic aromatic hydrocarbons, arsenic, chromates, or nickel)

Treatment

Immunotherapy for extensive stage SCLC

Concurrent radiation therapy in limited-stage disease

No role for surgery unless patient presented with a solitary pulmonary nodule without apparent lymph node or distant spread

Stage I and II: Surgery with or without neoadjuvant or adjuvant chemotherapy; many trials are examining neoadjuvant (chemotherapy +/- immunotherapy) followed by definitive surgical resection

Stage IIIA: Choice of therapy depends on the extent and localization of disease and may include: surgery with adjuvant therapy (chemotherapy and/or radiation therapy); neoadjuvant therapy (chemotherapy and/or radiation therapy) followed by surgery if there is a response; chemotherapy plus radiation therapy without surgery; immunotherapy is typically added to these regimens

Stage IIIB: Radiation therapy and/or chemotherapy; immunotherapy may be added

Stage IV: Systemic targeted therapy, chemotherapy, or immunotherapy —each with or without palliative radiation therapy

Factors that influence the treatment modality and sequence of therapies include histology (adenocarcinoma vs squamous vs other), presence of driver mutations, PD-L1 expression (for immunotherapy), and patient-specific factors (age, co-morbid diseases, treatment preferences)

Advanced NSCLC generally requires the sequential use of multiple systemic therapies (chemotherapy, radiation therapy, immunotherapy, targeted (biologic) therapy to improve overall survival

Complications

SVC syndrome

Paraneoplastic syndromes

Hemoptysis, airway obstruction, pneumonia, pleuritic involvement with pain, pleural effusion, SVC syndrome, Pancoast tumor (causing shoulder or arm pain), hoarseness due to laryngeal nerve involvement, neurologic symptoms due to brain metastasis, pathologic fractures due to bone metastasis, jaundice due to liver metastasis

5-year survival with treatment

Limited: 20%

Extensive: < 1%

Stage I: 68–92%

Stage II: 53–65%

Stage III: 12–41%

Stage IV: 0–10%