[医药卫生]06nsclc.pdf

CHAPTER 6 Non–small-cell lung cancer Benjamin Movsas, MD, Fadlo R. Khuri, MD and Kemp Kernstine, MD, PhD Lung cancer has been the leading cause of cancer death among men in the United States for years, and since 1988, it has become the number-one cause of cancer death among women. An estimated 172,570 new cases of lung cancer are expected in 2005, and 163,510 deaths due to this disease are expected to occur. This exceeds the combined number of deaths from the leading causes of cancer (breast, prostate, and colon cancer). It accounts for 6% of all deaths in the United States. Lung cancer develops from pulmonary parenchymal or bronchial supportive tissues. Although multiple cell types are often found within a single lung tumor, one type usually predominates. Based on therapeutic approach, there are two major subdivisions of lung cancer: small-cell lung cancer (SCLC), for which chemotherapy is the primary treatment, and non–small-cell lung cancer (NSCLC), which in its early stages (I and II) is treated primarily with surgery. Nearly all cures in NSCLC involve surgery. This chapter provides basic information on the epidemiology, etiology, screen- ing, prevention, and signs and symptoms of lung cancer in general, and then focuses specifically on the diagnosis, staging, pathology, and treatment of NSCLC and carcinoid tumors of the lungs, as well as the pulmonary evalua- tion of lung cancer patients and follow-up of long-term survivors. Chapter 7 provides information on the staging, pathology and pathophysiol- ogy, and treatment of the far less common SCLC and concludes with brief discussions of mesothelioma and thymoma. Epidemiology Gender From 1995 to 1999, there were 86 cases of lung cancer per 100,000 men and 57 cases of lung cancer per 100,000 women. Although the incidence of lung cancer had been rising in women, the rate of increase has begun to slow recently. Age The age at which lung cancer patients