Disease Facts:

Lung cancer is the second most common malignancy in the United States behind breast cancer in women, and prostate cancer in men. Lung cancer accounts for 28% of cancer deaths, more than breast, colon and prostate cancers combined. This high death rate is influenced by the fact that the majority of patients present with locally advanced or distant stage disease where five-year survival rates are poor. West Virginia's mortality rate for lung cancer is higher than the national average - ranking 7th highest among men and 6th highest among women in age - adjusted mortality among the fifty states and the District of Columbia in 1993-1994.

Smoking is associated with 90% of lung cancers. In 1997, West Virginia had a smoking prevalence of 27.4% in comparison to 22.3% for the United States as a whole, higher than all but four other states. Passive smoking is felt to be associated with an increase risk for lung cancer. Other risk factors include exposure to asbestos, radon, radiation, arsenic and certain organic chemicals.

Primary lung cancers are divided into two main subgroups. Small cell lung cancer and non-small cell lung cancer account for 20% and 80% of lung cancer cases respectively. Small cell lung cancer generally has a rapid course with early systemic spread requiring treatment with chemotherapy supplemented by radiation therapy and occasionally surgery. Non-small cell lung cancer maybe further divided into three main groups; squamous cell carcinoma, adenocarcinoma and large cell carcinoma. Surgery is considered first in non-small cell lung cancer with chemotherapy and radiation playing important roles.

Lung tumors first grow locally, then invade lymphatic and vascular channels resulting in regional and distal spread. Lymphatic drainage allows for spread within the lung area, to the mediastinum (area between the lungs), and up into the supraclavicular region in the lower neck. Tumor invasion into blood vessels leads to spread to distal sites such as bone, liver, adrenals and brain.

The TMN staging system is widely accepted in the management of lung cancer. The primary tumor is subdivided into four T categories (T1-T4) depending upon the tumor size, site and local involvement. Lymph node spread is subcategorized into bronchio/pulmonary within the lung (N1), mediastinal spread on the same side as the primary tumor (N2) and mediastinal spread to the side opposite the primary lung tumor or supraclavicular involvement (N3). Distal or metastatic spread is either absent or present (M0 or M1). The TMN stage is relevant to prognosis and assists in treatment decisions, particularly whether surgery is indicated.

Symptoms & Diagnosis:

Persistent cough is frequent presenting symptom in patients with lung cancer. Pressure on large airways may cause wheezing. Streaks of blood may occur in the sputum. Patients may complain of chest pain or discomfort. Collapse of a portion of the lung or pneumonia may occur with airway obstruction. Hoarseness or swelling in the face and neck may occasionally occur. Weight loss and fatigue and a sense of being unwell are common.

Patients with symptoms suggesting lung cancer should have a chest x-ray and usually a CT scan of the chest. Recent studies raise the possibility that screening with spiral CT may identify lung cancer at an early, asymptomatic stage when treatment may be more effective. If there are abnormal x-ray findings, a tissue sample needs to be obtained to establish the diagnosis. This can be obtained through a bronchoscopy where a doctor will pass a special tube into the lung through the bronchi or breathing tubes. Also, a needle may be passed through the chest wall directly into the tumor to obtain a small tissue sample. It may be necessary for a surgeon to obtain a diagnosis by passing a special scope behind the sternum in the neck to sample enlarged lymph nodes in the area between the lungs (mediastinum) or into the chest using another scope or by direct surgical incision. Once the diagnosis of lung cancer is confirmed, it is necessary to determine how far it has spread. Again, a CT scan of the chest and abdomen are useful. A bone scan and CT scan or MRI of the brain may be considered. Positive Emission Tomography (PET) scanning has increasingly become the diagnostic test of choice in staging patients with lung cancer. It is a highly sensitive and specific test that aids physicians to more accurately diagnose and stage patients with lung cancer. Accuracy is further enhanced with the use of a combined PET/CT scanner.

Treatment Information:

Small cell lung cancer is generally divided into two groups based on the extent of the disease. Disease limited to the chest is generally approached with chemotherapy plus local radiation and occasionally surgery. Seventy percent of patients present with extensive small cell lung cancer that has spread outside of the chest. This is treated with chemotherapy and occasionally radiation therapy.

Non-small cell lung cancer may be divided into three groups based on the extent of disease and treatment approach. The first group includes stage I and II disease cancers that are considered to be surgically respectable with reasonable chance of cure. Radiotherapy should be considered for patients with medical contraindications for surgery. The benefits of adding chemotherapy after surgery for stage II and selected stage IB cancers has been established. The second treatment group includes locally (T3-T4) or regionally (N2-N3) advanced stage III cancers. Surgery or radiation may be considered. Post-operative chemotherapy is beneficial in stage IIIA cancers. Recent studies have demonstrated doubling of survival with addition of chemotherapy to radiation in stage III cancers. Pre-operative chemotherapy or pre-operative chemotherapy plus radiation therapy increases survival over surgery alone in these patients. The third treatment group includes patients with distant metastasis (M1). Such patients may be treated for relief of symptoms and increase survival with chemotherapy. The addition of an murine antibody (bevazizumub) inhibiting tumor blood vessel growth has improved survival when added to chemotherapy in selected stage IV patients. Erlotinib and other targeted agents offer promise. Focal symptoms may be treated with radiotherapy. Longer survival has been noted in patients with good performance status, females and patients with a single distance metastatic site. A patient with locally advanced or metastatic lung cancer should be considered for clinical trials exploring new therapeutic options.

To Refer a Patient:

To refer a patient call 304-598-4552. For more information call the Lung Cancer Program at (304) 293-4980. If after 4:30 PM, call (304) 293-4500. If after 5:00 PM, call (304) 598-6000 or 1-800-WVA-MARS (982-6277). Patients may also call the Cancer Center triage nurse at 304-598-4513.

Directions:

From I-68: Take Exit 7, Pierpont Road. Turn west onto WV 857. At the second traffic light, turn left onto US 119 South. You will drive up a steep hill. At the top of the hill there will be a traffic light. Keep going straight. At the next light, turn right onto WV 705. Go straight through first traffic light. At second light, turn left onto Willowdale Road. At the light turn right. Near the end of the road, take the first right and continue up the hill. There will be a guardhouse on the left, they will show you where to park and give you a parking permit.

From I-79: Take Exit 155, Star City. A sign at the end of the exit ramp will direct you toward West Virginia University. At the first traffic light, turn right onto US 19 South. You will cross the Star City Bridge and go straight through the next light. At the top of the hill, there will be a stop light (WVU Coliseum will be on your right), make a left onto Patterson Drive (WV 705). Go straight through the next two stop lights. Go approximately 1 block and turn right onto Elmer Prince Drive. Bare to the right and proceed up the hill. There will be a guardhouse on the left. They will tell you where to park and give you a parking permit.

Support Groups:

For ALL cancer patients, their families and friends:

Look Good/Feel Better - For women who have or will undergo chemotherapy