Seminars in respiratory and critical care medicine
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The diagnosis, treatment, and management of lung tumors represent a complex set of decision algorithms and require the cooperation and interaction of a team of experts and support systems. The surgical pathologist, an early, important member of the diagnostic team, uses clinical and radiological evidence to differentiate benign from malignant tumors and renders a unique diagnosis that provides both prognostic and treatment information. Using routine histopathologic criteria, histochemical and immunohistochemical stains, and molecular and genetic testing, surgical pathologists and cytopathologists may distinguish between small cell and other bronchogenic carcinomas, separate adenocarcinomas from squamous cell carcinomas, differentiate between pleural carcinomas and diffuse malignant mesotheliomas, and discriminate among the varieties of neuroendocrine carcinomas. ⋯ The team approach also enables the optimal use of tumor tissue for diagnostic purposes as well as molecular genetic testing and the discovery of targetable sites for therapeutic management. Though low-stage tumors tend to be initially treated with surgical resection, more advanced stages will be approached with limited tissue acquisition, necessitating a strategy for best practices of scarce tissue resources. The awareness of diagnostic modalities and tissue handling by all members of the team ensures the best patient-centered care.
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Semin Respir Crit Care Med · Dec 2013
ReviewImmunotherapy in lung cancer: "b7-bombers" and other new developments.
Several recent immunotherapy agents have exhibited exceptional activity, and their eventual approval for use in lung cancer appears plausible. The immune checkpoint proteins, such as the B7 superfamily, are becoming increasingly relevant targets for therapeutic inhibition. ⋯ Several vaccine trials are accruing more patients than any previous lung cancer trials and are designed to select a specific population based on a predefined, scientifically justified biomarker. These emerging immune treatments may hold great potential for the systemic treatment of lung cancers.
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Semin Respir Crit Care Med · Dec 2013
ReviewAdvances in surgical techniques in non-small cell lung cancer.
Thoracic surgery is a dynamic field, and many scientific, technological, technical, and organizational changes are occurring. A prominent example is the use of less invasive approaches to major resection of non-small cell lung cancer (NSCLC), both thoracoscopic and robotic. Sophisticated technology corroborated by clinical data has led to these approaches becoming accepted additions to the armamentarium. ⋯ Lung cancer is being detected more often at an early stage. At the same time, advances in techniques, patient care, clinical science, and multidisciplinary treatment support an increased role for aggressive resection in the face of larger locally advanced tumors or for those with limited metastatic disease. These advances, conducted in the setting of multidisciplinary decision making, have resulted in real and palpable advancements for patients with lung cancer.
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Lung cancer screening with low dose computed tomography (CT) is the only method ever proven to reduce lung cancer-specific mortality in high-risk current and former cigarette smokers. Radiation exposure from annual screening CT examinations and subsequent CT and nuclear medicine testing to further evaluate positive screening CTs is sometimes raised as a reason to avoid screening and is often misunderstood. With all testing, there are potential benefits and risks. As we sit on the brink of widespread adoption of lung cancer screening CT, we aim to explain why the risks associated with radiation exposure from lung cancer screening are very low and should not be used to avoid screening or dissuade individuals who qualify for screening CT to participate in a lung cancer screening program.
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Semin Respir Crit Care Med · Dec 2013
ReviewLung cancer in women: differences in epidemiology, biology, histology, and treatment outcomes.
Lung cancer is a major health problem for both men and women, not only because of the high incidence rate but, more alarming, the high mortality rate. The prevalence of lung cancer in women has been increasing worldwide. In the United States, lung cancer is currently the leading cause of cancer death in women, and this may well be the case in European countries in just a few years. ⋯ Smoking among women has increased significantly since the 1960s, and, unfortunately, the risk of death from cigarette smoking continues to increase among women. Although epidemiological data remain controversial regarding the increased risk of lung cancer from tobacco exposure in women, there is little controversy surrounding the fact that the biology of lung cancer differs between the sexes. This paper summarizes the explanations for the sex differences in lung cancer, including differences in molecular abnormalities, growth factor receptors, hormonal influences, cytochrome P-450 enzymes, and DNA repair capacity, as well as differences in the histology of lung cancer and treatment outcomes in women.