What are some of the tests done in lung cancer?

Read lung cancer and How do those with lung cancer present first.

• The most important examination at the early stage is plain chest x-ray.
• Other tests include the endoscopic studies
• CT scan of the chest
• MRI of the chest
• Tissue biopsy ( done during the endoscopy)
• Flexible fiberoptic bronchoscopy
• A transbronchial needle aspiration: done via a special needle passed through the bronchoscope. This technique can be used to sample out mediastinal masses or paratracheal lymph nodes
• Transthoracic fine-needle aspiration biopsy with fluoroscopic or CT scan guidance
• Mediastinoscopy
• Pleural biopsy in patients with pleural effusion
• Thoracentesis of pleural effusion and cytologic evaluation of the obtained fluid

Preventing lung cancer

Stop smoking. Smoking cessation can minimize one’s subsequent risk of lung cancer. If you stop smoking way before reaching middle age, you avoid more than 90% of the risks attributable to tobacco. The use of drugs such as varenicline has been shown to be significantly more efficacious than bupropion alone for smoking cessation programs.

How to treat lung cancer

• The mode of therapy depends on the cell type and clinical extent of the disease (Tumor staging), the patient’s general condition and compliance to treatment.
• The primary treatment for a cancer that has not spread such as non-small cell lung carcinoma is surgical resection of a lung lobe or an entire lung. Radical surgery is possible only in 25% of patients.
• In cases of local regional involvement where the cancer has spread, the patient is given new combined modality regimes such as
  1. chemotherapy before surgery
  2. Chemotherapy with radiotherapy
  • The primary treatment for small cell lung cancer limited to the thoracic area is chemotherapy in combination with radiotherapy.
  • Patients with disseminated disease are given chemotherapy. Prophylactic radiotherapy to the brain may be given to patients in whom an almost complete response to primary treatment has been obtained.
  • Chemotherapy: various combination regimens are available such as
    1. Paclitaxel plus either carboplatin or cisplatin;
    2. cisplatin plus vinorelbine;
    3. Gemcitabine plus cisplatin;
    4. Carboplatin or cisplatin plus docetaxel.

Prognostic Factors

• Several pretreatment factors are reported to have prognostic significance in Small cell lung cancer (SCLC) including the stage and performance status.
• Female gender has been shown consistently to be a favorable prognostic factor in SCLC.
• A  significant weight loss of ≥10% of body weight is an independent adverse prognostic factor
• High serum lactate dehydrogenase in persons with extensive-stage disease is a sign of poor prognosis
• The 5-yr survival of patients with non–small cell carcinoma when the disease is resectable is approximately 30%.

References

1. The Prophylactic Cranial Irradiation Overview Collaborative Group: Cranial irradiation for preventing brain metastases of small cell lung cancer in patients in complete remission.  Cochrane Database Syst Rev  2000; 4:
   
2. Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized trials. BMJ 1995; 311:899–909.
   
3. The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.: DARE-952726. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software.
   
4. Marino P, Preatoni A, Cantoni A, Buccheri G. Single-agent chemotherapy versus combination chemotherapy in advanced non-small cell lung cancer: a quality and meta-analysis study. Lung Cancer 1995; 13:1–12.
   
5. The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.: DARE-952578. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software.
   
6. Keller SM, et al: A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or stage IIIA non-small cell lung cancer.  N Engl J Med 2000; 343:1217.