Lung cancer Classification and external resources
Cross section of a human lung. The white area in the upper lobe is cancer; the black areas indicate that the patient was a smoker. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette.
ICD-10	C33.-C34.
ICD-9	162
DiseasesDB	7616
MedlinePlus	007194
eMedicine	med/1333  med/1336 emerg/335 radio/807 radio/405 radio/406
MeSH	D002283

Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly The term cell growth is used in two different ways in Biology. Tissue is a cellular organizational level intermediate between cells and a complete organism lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive This growth may lead to metastasis, invasion of adjacent tissue and infiltration beyond the lungs. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, The vast majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells. In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body Lung cancer, the most common cause of cancer-related death in men and the second most common in women,^[1][2] is responsible for 1.3 million deaths worldwide annually. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled ^[3] In the UK, it is the most common site of fatal cancer in both men and women. The most common symptoms are shortness of breath, coughing (including coughing up blood), and weight loss. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Hemoptysis or haemoptysis (see American and British spelling differences) is the expectoration ( Coughing up of Blood or of blood-stained ^[4]

The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma. This distinction is important because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation. Lung cancer surgery describes the use of surgical operations in the treatment of Lung cancer. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. ^[5] The most common cause of lung cancer is long term exposure to tobacco smoke. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. ^[6] The occurrence of lung cancer in non-smokers, who account for fewer than 10% of cases, appears to be due to a combination of genetic factors,^[7][8] radon gas,^[9] asbestos,^[10] and air pollution,^[11][12][13] including second-hand smoke. Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is Radon (ˈreɪdɒn is the Chemical element that has the symbol Rn and Atomic number 86 Asbestos is a group of Minerals with long thin fibrous Crystals The word "asbestos" (῾ἀσβεστος is derived from a Greek adjective Air pollution is the human introduction into the atmosphere of Chemicals Particulate matter, or Biological materials that cause harm or discomfort ^[14][15]

Lung cancer may be seen on chest x-ray and computed tomography (CT scan). A chest X-ray, commonly abbreviated CXR, is a projection radiograph ( X-ray) taken by a Radiographer, of the Thorax which is used Computed tomography (CT is a Medical imaging method employing Tomography. The diagnosis is confirmed with a biopsy. Diagnosis is the identification by Process of elimination, of the nature of anything A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues This is usually performed via bronchoscopy or CT-guided biopsy. Bronchoscopy is a technique of visualising the inside of the Airways An instrument Bronchoscope is inserted into the Airways usually through Treatment and prognosis depend upon the histological type of cancer, the stage (degree of spread), and the patient's performance status. Prognosis (older Greek πρόγνωσις modern Greek πρόγνωση - literally fore-knowing foreseeing) is a medical term denoting the Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread In Medicine ( Oncology and other fields performance status is an attempt to quantify Cancer patients' general wellbeing Possible treatments include surgery, chemotherapy, and radiotherapy. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant With treatment, the five-year survival rate is 14%. In Biostatistics, survival rate is a part of Survival analysis, indicating the percentage of people in a study or treatment group who are alive for a given period ^[4]

Contents 1 Classification 1.1 Non-small cell lung carcinoma (NSCLC) 1.2 Small cell lung carcinoma (SCLC) 1.3 Metastatic cancers 1.4 Staging 2 Signs and symptoms 2.1 Causes 2.2 Smoking 2.3 Radon gas 2.4 Asbestos 2.5 Viruses 3 Pathophysiology 4 Diagnosis 5 Prevention 6 Screening 7 Treatment 7.1 Surgery 7.2 Chemotherapy 7.2.1 Adjuvant chemotherapy for NSCLC 7.3 Radiotherapy 7.4 Interventional radiology 7.5 Targeted therapy 8 Prognosis 9 Epidemiology 10 History 10.1 Treatment 11 References 12 External links

Classification

Frequency of histological types of lung cancer^[16]

Histological type	Frequency (%)
Non-small cell lung carcinoma	80. 4
Small cell lung carcinoma	16. 8
Carcinoid[17]	0. Carcinoid (also carcinoid tumour or carcinoid tumor) is a slow-growing but Malignant type of Neuroendocrine tumour, originating in the cells 8
Sarcoma[18]	0. A sarcoma (from the Greek 'sarx' meaning "flesh" is a Cancer of the connective or supportive tissue ( Bone, Cartilage, Fat 1
Unspecified lung cancer	1. 9

The vast majority of lung cancers are carcinomas—malignancies that arise from epithelial cells. A carcinoma is any Malignant Cancer that arises from epithelial cells. In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body There are two main types of lung carcinoma, categorized by the size and appearance of the malignant cells seen by a histopathologist under a microscope: non-small cell (80. Histopathology (from the Greek histos (tissue and pathos (suffering refers to the microscopic examination of tissue in order to study the manifestations A microscope ( Greek: ( micron) = small + ( skopein) = to look or see is an instrument for viewing objects that are 4%) and small-cell (16. 8%) lung carcinoma. ^[16] This classification, based on histological criteria, has important implications for clinical management and prognosis of the disease. Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and

Non-small cell lung carcinoma (NSCLC)

The non-small cell lung carcinomas are grouped together because their prognosis and management are similar. There are three main sub-types: squamous cell lung carcinoma, adenocarcinoma and large cell lung carcinoma. In Medicine, squamous cell carcinoma (SCC is a form of Cancer of the Carcinoma type that may occur in many different organs including the Skin Adenocarcinoma is a cancer that originates in Glandular tissue

Sub-types of non-small cell lung cancer^[16]

Histological sub-type		Frequency of all lung cancers (%)
Squamous cell lung carcinoma		31. 1
Adenocarcinoma	Adenocarcinoma (not otherwise specified)	23. 2
	Bronchioloalveolar carcinoma	3. Bronchioloalveolar carcinoma (BAC is a rare type of Lung cancer. 0
	Adenosquamous carcinoma	1. 2
	Papillary adenocarcinoma	0. 7
	Mucoepidermoid carcinoma[19]	0. 1
	Adenoid cystic carcinoma[20]	0. 04
	Other specified adenocarcinoma	1. 1
Large cell carcinoma		10. 7
Giant cell and spindle cell carcinoma		0. 4
Other/unspecified non-small cell lung carcinoma		8. 9

Accounting for 31. 1% of lung cancers,^[16] squamous cell lung carcinoma usually starts near a central bronchus. A bronchus (plural bronchi, adjective bronchial) is a caliber of airway in the Respiratory tract that conducts air into the Lungs No Gas Cavitation and necrosis within the center of the cancer is a common finding. Cavitation is defined as the phenomenon of formation of vapour bubbles of a flowing liquid in a region where the pressure of the liquid falls below its vapour pressure Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. Well-differentiated squamous cell lung cancers often grow more slowly than other cancer types. ^[5]

Adenocarcinoma accounts for 29. 4% of lung cancers. ^[16] It usually originates in peripheral lung tissue. Most cases of adenocarcinoma are associated with smoking. However, among people who have never smoked ("never-smokers"), adenocarcinoma is the most common form of lung cancer. ^[21] A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have different responses to treatment. Bronchioloalveolar carcinoma (BAC is a rare type of Lung cancer. ^[22]

Accounting for 10. 7% of lung cancers,^[16] large cell lung carcinoma is a fast-growing form that develops near the surface of the lung. ^[23] It is often poorly differentiated and tends to metastasize early. In Developmental biology, cellular differentiation is the process by which a less specialized cell becomes a more specialized Cell type. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, ^[5]

Small cell lung carcinoma (SCLC)

Small cell lung carcinoma (SCLC, also called "oat cell carcinoma") is less common. Small cell carcinoma is a type of Carcinoma usually associated with the Lung, though it can be associated with other topographies such as in Cervical cancer It tends to arise in the larger airways (primary and secondary bronchi) and grows rapidly, becoming quite large. A bronchus (plural bronchi, adjective bronchial) is a caliber of airway in the Respiratory tract that conducts air into the Lungs No Gas ^[24] The "oat" cell contains dense neurosecretory granules (vesicles containing neuroendocrine hormones) which give this an endocrine/paraneoplastic syndrome association. A vesicle is a small bubble of liquid within a cell A more formal definition in Cell biology, would be that a vesicle is a relatively small intracellular membrane-enclosed Neuroendocrine nʊəroʊˈɛndəkrɪn cells are cells that release a hormone into the circulating blood in response to a neural stimulus Hormones (from Greek ὁρμή - "impetus" are chemicals released by cells that affect cells in other parts of the body ^[25] While initially more sensitive to chemotherapy, it ultimately carries a worse prognosis and is often metastatic at presentation. Small cell lung cancers are divided into Limited stage and Extensive stage disease. This type of lung cancer is strongly associated with smoking. ^[26]

Metastatic cancers

The lung is a common place for metastasis from tumors in other parts of the body. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, These cancers are identified by the site of origin, thus a breast cancer metastasis to the lung is still known as breast cancer. They often have a characteristic round appearance on chest x-ray. ^[27] Primary lung cancers themselves most commonly metastasize to the adrenal glands, liver, brain, and bone. In Mammals the adrenal glands (also known as suprarenal glands) are the triangle-shaped Endocrine glands that sit on top of the Kidneys their ^[5]

Staging

See also: Non-small cell lung carcinoma staging and lung cancer staging with EUS

Lung cancer staging is an assessment of the degree of spread of the cancer from its original source. Non-small cell lung carcinoma staging is an important part of the assessment of patients with non-small cell lung carcinoma (a type of Lung cancer) This article is about lung cancer staging methods emphasizing the use of EUS (endoscopic ultrasound whereas the companion article Non-small cell The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread It is an important factor affecting the prognosis and potential treatment of lung cancer. Prognosis (older Greek πρόγνωσις modern Greek πρόγνωση - literally fore-knowing foreseeing) is a medical term denoting the Non-small cell lung carcinoma is staged from IA ("one A", best prognosis) to IV ("four", worst prognosis). ^[28] Small cell lung carcinoma is classified as limited stage if it is confined to one half of the chest and within the scope of a single radiotherapy field. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Otherwise it is extensive stage. ^[24]

Signs and symptoms

Symptoms that suggest lung cancer include:^[29]

• dyspnea (shortness of breath)
• hemoptysis (coughing up blood)
• chronic coughing or change in regular coughing pattern
• wheezing
• chest pain or pain in the abdomen
• cachexia (weight loss), fatigue and loss of appetite
• dysphonia (hoarse voice)
• clubbing of the fingernails (uncommon)
• dysphagia (difficulty swallowing). A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Dyspnea or dyspnoea (pronounced disp-nee-ah, IPA /dɪsp'niə/ from Latin dyspnoea, from Greek dyspnoia from Hemoptysis or haemoptysis (see American and British spelling differences) is the expectoration ( Coughing up of Blood or of blood-stained In Medicine, a cough ( Latin: tussis) is a sudden and often repetitively occurring defence Reflex which helps to clear the large breathing passages In Medicine, chest pain is a Symptom of a number of serious conditions and is generally considered a Medical emergency. Cachexia (kəˈkɛksiə is loss of weight, Muscle atrophy, fatigue weakness and significant loss of appetite in someone who is not actively trying to In Medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the Fingers and fingernails that is associated with a Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder

If the cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. The airways are those parts of the Respiratory system through which air flows to get from the external environment to the Alveoli. Dyspnea or dyspnoea (pronounced disp-nee-ah, IPA /dɪsp'niə/ from Latin dyspnoea, from Greek dyspnoia from This can lead to accumulation of secretions behind the blockage, predisposing the patient to pneumonia. Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Many lung cancers have a rich blood supply. The surface of the cancer may be fragile, leading to bleeding from the cancer into the airway. This blood may subsequently be coughed up.

Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to the disease. A paraneoplastic syndrome is a Disease or Symptom that is the consequence of the presence of Cancer in the body but is not due to the local presence ^[30] In lung cancer, these phenomena may include Lambert-Eaton myasthenic syndrome (muscle weakness due to auto-antibodies), hypercalcemia or syndrome of inappropriate antidiuretic hormone (SIADH). Lambert-Eaton myasthenic syndrome (LEMS is a rare Autoimmune disorder which affects calcium channels of the nerve-muscle ( neuromuscular) junction Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues Hypercalcaemia (in American English '''Hypercalcemia''' is an elevated calcium level in the Blood. The syndrome of inappropriate antidiuretic hormone (SIADH is a condition commonly found in the hospital population especially in patients being hospitalized for Central nervous system Tumors in the top (apex) of the lung, known as Pancoast tumors,^[31] may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner's syndrome), as well as muscle weakness in the hands due to invasion of the brachial plexus. A pancoast tumor or superior sulcus tumor, is a tumor of the pulmonary apex i The Sympathetic Nervous System ( SNS) is a branch of the Autonomic nervous system along with the Enteric nervous system and Parasympathetic nervous Horner's syndrome is a clinical Syndrome caused by damage to the Sympathetic nervous system. The brachial Plexus is an arrangement of nerve fibers running from the spine formed by the Ventral rami of the lower cervical and upper thoracic nerve roots specifically

Many of the symptoms of lung cancer (bone pain, fever, weight loss) are nonspecific; in the elderly, these may be attributed to comorbid illness. The term ' Bone pain' (or Ostealgia, or Osteodynia) generally is used to refer to Pain felt within a bone Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to ^[5] In many patients, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Common sites of metastasis include the bone, such as the spine (causing back pain and occasionally spinal cord compression), the liver and the brain. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral Spinal cord compression develops when the Spinal cord is compressed by bone fragments from a vertebral fracture a Tumor, Abscess, ruptured Intervertebral About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are incidentally found on routine chest x-rays. ^[4]

Causes

The main causes of lung cancer (and cancer in general) include carcinogens (such as those in tobacco smoke), ionizing radiation, and viral infection. The term carcinogen refers to any substance Radionuclide or radiation that is an agent directly involved in the promotion of Cancer or in the fatation of its propagation Image talkNew_radiation_symbol_ISO_21482svg for details --> Ionizing radiation A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable This exposure causes cumulative changes to the DNA in the tissue lining the bronchi of the lungs (the bronchial epithelium). Deoxyribonucleic acid ( DNA) is a Nucleic acid that contains the genetic instructions used in the development and functioning of all known A bronchus (plural bronchi, adjective bronchial) is a caliber of airway in the Respiratory tract that conducts air into the Lungs No Gas In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body As more tissue becomes damaged, eventually a cancer develops. ^[5]

Smoking

Smoking, particularly of cigarettes, is by far the main contributor to lung cancer. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. A cigarette ( French "small Cigar " from cigar + -ette) is a product consumed through Smoking and manufactured ^[32] Across the developed world, almost 90% of lung cancer deaths are caused by smoking. ^[33] In the United States, smoking is estimated to account for 87% of lung cancer cases (90% in men and 85% in women). ^[34] Among male smokers, the lifetime risk of developing lung cancer is 17. 2%. Among female smokers, the risk is 11. 6%. This risk is significantly lower in non-smokers: 1. 3% in men and 1. 4% in women. ^[35] Cigarette smoke contains over 60 known carcinogens^[36] including radioisotopes from the radon decay sequence, nitrosamine, and benzopyrene. A radionuclide is an Atom with an unstable nucleus, which is a nucleus characterized by excess energy which is available to be imparted either to a newly-created Radon (ˈreɪdɒn is the Chemical element that has the symbol Rn and Atomic number 86 Nitrosamines are Chemical compounds of the Chemical structure R1N(-R2-N=O some of which are carcinogenic. Benzopyrene, C20H12 is a five-ring Polycyclic aromatic hydrocarbon that is Mutagenic and highly Carcinogenic It is a crystalline Additionally, nicotine appears to depress the immune response to malignant growths in exposed tissue. ^[37]

The length of time a person smokes as well as the amount smoked increases the person's chance of developing lung cancer. If a person stops smoking, this chance steadily decreases as damage to the lungs is repaired and contaminant particles are gradually removed. ^[38] In addition, there is evidence that lung cancer in never-smokers has a better prognosis than in smokers,^[39] and that patients who smoke at the time of diagnosis have shorter survival than those who have quit. ^[40]

Passive smoking—the inhalation of smoke from another's smoking—is a cause of lung cancer in non-smokers. Studies from the U. S. ,^[41] Europe,^[42] the UK,^[43] and Australia^[44] have consistently shown a significant increase in relative risk among those exposed to passive smoke. In Statistics and mathematical Epidemiology, relative risk (RR is the risk of an event (or of developing a disease relative to exposure Recent investigation of sidestream smoke suggests it is more dangerous than direct smoke inhalation. Sidestream smoke is Smoke coming from the lit end of a smoldering Cigarette. ^[45]

Radon gas

Radon is a colorless and odorless gas generated by the breakdown of radioactive radium, which in turn is the decay product of uranium, found in the earth's crust. Radon (ˈreɪdɒn is the Chemical element that has the symbol Rn and Atomic number 86 This page is about the physical properties of gas as a state of matter Radium (ˈreɪdiəm is a radioactive Chemical element which has the symbol Ra and Atomic number 88 Uranium (jʊˈreɪniəm is a silvery-gray Metallic Chemical element in the In Geology, a crust is the outermost solid shell of a planet or moon The radiation decay products ionize genetic material, causing mutations that sometimes turn cancerous. An ion is an Atom or Molecule which has lost or gained one or more Valence electrons giving it a positive or negative electrical charge Radon exposure is the second major cause of lung cancer after smoking. ^[9] Radon gas levels vary by locality and the composition of the underlying soil and rocks. For example, in areas such as Cornwall in the UK (which has granite as substrata), radon gas is a major problem, and buildings have to be force-ventilated with fans to lower radon gas concentrations. Cornwall ( Kernow ˈkɛɹnɔʊ is the most southwesterly county of England, on the Peninsula that lies to the west of the River Tamar Granite (ˈɡrænɪt is a common and widely occurring type of intrusive, Felsic, igneous rock. The United States Environmental Protection Agency (EPA) estimates that one in 15 homes in the U. S. has radon levels above the recommended guideline of 4 picocuries per liter (pCi/L) (148 Bq/m³). A CURIE (short for Compact URI) is an abbreviated URI expressed in CURIE syntax and may be found in both XML and non-XML grammars The becquerel (symbol Bq) is the SI derived unit of radioactivity. CM3 redirects here If you were looking for the 3rd game in the Cooking Mama series abbreviated as CM3 see here. ^[46] Iowa has the highest average radon concentration in the United States; studies performed there have demonstrated a 50% increased lung cancer risk with prolonged radon exposure above the EPA's action level of 4 pCi/L. The State of Iowa ( is a state in the Midwestern region of the United States of America. ^[47][48]

Asbestos

Asbestos can cause a variety of lung diseases, including lung cancer. Asbestos is a group of Minerals with long thin fibrous Crystals The word "asbestos" (῾ἀσβεστος is derived from a Greek adjective There is a synergistic effect between tobacco smoking and asbestos in the formation of lung cancer. Synergy (from the Greek el-Latn syn-ergo, el συνεργός meaning working together is the term used to describe a situation where the final outcome ^[10] In the UK, asbestos accounts for 2–3% of male lung cancer deaths. ^[49] Asbestos can also cause cancer of the pleura, called mesothelioma (which is different from lung cancer). Mesothelioma is a form of Cancer that is almost always caused by previous exposure to Asbestos.

Viruses

Viruses are known to cause lung cancer in animals^[50][51] and recent evidence suggests similar potential in humans. A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable Implicated viruses include human papillomavirus,^[52] JC virus,^[53] simian virus 40 (SV40), BK virus and cytomegalovirus. A human papillomavirus ( HPV) is a Papillomavirus that infects the skin and Mucous membranes of Humans Approximately 130 HPV types have been The JC virus or John Cunningham virus (JCV is a type of human Polyomavirus (formerly known as papovavirus and is genetically similar to BK virus and SV40 SV40 is an abbreviation for Simian vacuolating virus 40 or Simian virus 40, a Polyomavirus that is found in both Monkeys and The BK virus is a member of the Polyomavirus family Past infection with the BK virus is widespread but significant consequences of infection are uncommon with the exception Cytomegalovirus (CMV (from the Greek cyto-, "cell" and -megalo-, "large" is a viral ^[54] These viruses may affect the cell cycle and inhibit apoptosis, allowing uncontrolled cell division. The cell cycle, or cell-division cycle, is the series of events that take place in a eukaryotic cell leading to its replication

Pathophysiology

Main article: Carcinogenesis

Similar to many other cancers, lung cancer is initiated by activation of oncogenes or inactivation of tumor suppressor genes. Carcinogenesis (meaning literally the creation of Cancer) is the process by which normal cells are transformed into cancer cells An oncogene is a protein encoding Gene, which — when deregulated — participates in the onset and development of Cancer. A tumor suppressor gene, or antioncogene is a Gene that protects a cell from one step on the path to cancer ^[55] Oncogenes are genes that are believed to make people more susceptible to cancer. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance Proto-oncogenes are believed to turn into oncogenes when exposed to particular carcinogens. An oncogene is a protein encoding Gene, which — when deregulated — participates in the onset and development of Cancer. ^[56] Mutations in the K-ras proto-oncogene are responsible for 20–30% of non-small cell lung cancers. In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism ^[57] Chromosomal damage can lead to loss of heterozygosity. A chromosome is an organized structure of DNA and Protein that is found in cells. Loss of heterozygosity (LOH in a cell represents the loss of normal function of one allele of a gene in which the other allele was already inactivated This can cause inactivation of tumor suppressor genes. Damage to chromosomes 3p, 5q, 13q and 17p are particularly common in small cell lung carcinoma. The TP53 tumor suppressor gene, located on chromosome 17p, is often affected. ^[58]

Several genetic polymorphisms are associated with lung cancer. Polymorphism in biology occurs when two or more clearly different Phenotypes exist in the same population of a species — in other words the occurrence of more than one These include polymorphisms in genes coding for interleukin-1,^[59] cytochrome P450,^[60] apoptosis promoters such as caspase-8,^[61] and DNA repair molecules such as XRCC1. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance Interleukins are a group of Cytokines (secreted Signaling molecules) that were first seen to be expressed by White blood cells ( Leukocytes hence Cytochrome P450 (abbreviated CYP, P450, infrequently CYP450) is a very large and diverse superfamily of Hemoproteins found in all Domains Caspases, or c ysteine- asp artic acid prote ases, are a family of Cysteine proteases which play essential roles in Apoptosis (programmed XRCC1 is a DNA repair Protein. It complexes with DNA ligase III ^[62] People with these polymorphisms are more likely to develop lung cancer after exposure to carcinogens. The term carcinogen refers to any substance Radionuclide or radiation that is an agent directly involved in the promotion of Cancer or in the fatation of its propagation

Diagnosis

Performing a chest x-ray is the first step if a patient reports symptoms that may be suggestive of lung cancer. A chest X-ray, commonly abbreviated CXR, is a projection radiograph ( X-ray) taken by a Radiographer, of the Thorax which is used This may reveal an obvious mass, widening of the mediastinum (suggestive of spread to lymph nodes there), atelectasis (collapse), consolidation (pneumonia), or pleural effusion. The mediastinum is a non-delineated group of structures in the Thorax (chest surrounded by Loose connective tissue. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. Atelectasis is a collapse of lung tissue affecting part or all of one lung Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Pleural effusion is excess fluid that accumulates in the Pleural cavity, the fluid-filled space that surrounds the Lungs Excessive amounts of such fluid can impair If there are no x-ray findings but the suspicion is high (such as a heavy smoker with blood-stained sputum), bronchoscopy and/or a CT scan may provide the necessary information. Bronchoscopy is a technique of visualising the inside of the Airways An instrument Bronchoscope is inserted into the Airways usually through Computed tomography (CT is a Medical imaging method employing Tomography. Bronchoscopy or CT-guided biopsy is often used to identify the tumor type. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues ^[4]

The differential diagnosis for patients who present with abnormalities on chest x-ray includes lung cancer, as well as nonmalignant diseases. A differential diagnosis (sometimes abbreviated DDx, ddx These include infectious causes such as tuberculosis or pneumonia, or inflammatory conditions such as sarcoidosis. Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized These diseases can result in mediastinal lymphadenopathy or lung nodules, and sometimes mimic lung cancers. The mediastinum is a non-delineated group of structures in the Thorax (chest surrounded by Loose connective tissue. Lymphadenopathy is a term meaning "disease of the Lymph nodes. In Medicine, a nodule refers to a relatively hard roughly spherical abnormal structure ^[5]

Prevention

See also: Smoking ban and List of smoking bans

Prevention is the most cost-effective means of fighting lung cancer. Smoking bans are public policies including Criminal laws and Occupational safety and health Regulations which prohibit Tobacco smoking This is a list of Smoking bans by country A 2006 smoking ban in Buenos Aires city prohibits smoking in public areas including bars and restaurants While in most countries industrial and domestic carcinogens have been identified and banned, tobacco smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of lung cancer, and smoking cessation is an important preventative tool in this process. Smoking cessation is the effort to stop smoking Tobacco products ^[63]

Policy interventions to decrease passive smoking in public areas such as restaurants and workplaces have become more common in many Western countries, with California taking a lead in banning smoking in public establishments in 1998. Ireland played a similar role in Europe in 2004, followed by Italy and Norway in 2005, Scotland as well as several others in 2006, England in 2007, and France in 2008. New Zealand has banned smoking in public places as of 2004. The state of Bhutan has had a complete smoking ban since 2005. The Kingdom of Bhutan (buːˈtɑːn is a Landlocked nation in South Asia. ^[64] In many countries, pressure groups are campaigning for similar bans. In 2007, Chandigarh became the first city in India to become 'smoke-free'. Chandigarh ( ਚੰਡੀਗੜ੍ਹ, चंडीगढ़) also called The City Beautiful India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country

Arguments cited against such bans are criminalisation of smoking, increased risk of smuggling and the risk that such a ban cannot be enforced. In Criminology, criminalization or criminalisation is "the process by which behaviors and individuals are transformed into Crime and criminals" Smuggling, also known as trafficking, is the clandestine transportation of goods or persons past a point where prohibited such as out of a building into a Prison ^[65]

A 2008 study performed in over 75,000 middle-aged and elderly people demonstrated that the long-term use of supplemental multivitamins, such as vitamin C, vitamin E, and folate did not reduce the risk of lung cancer. To the contrary, the study indicates that the long term intake of high doses of vitamin E supplements may even increase the risk of lung cancer. ^[66]

The World Health Organization has called for governments to institute a total ban on tobacco advertising in order to prevent young people from taking up smoking. They assess that such bans have reduced tobacco consumption by sixteen percent where already instituted. ^[67]

Screening

Main article: Lung cancer screening

Screening refers to the use of medical tests to detect disease in asymptomatic people. Lung cancer screening refers to strategies used to identify early Lung cancers before they cause symptoms at a point where they are more likely to be curable Screening, in medicine is a strategy used in a Population to detect a Disease in individuals without signs or Symptoms of that disease A medical test is a kind of Medical procedure performed to detect, diagnose, or evaluate Disease, disease processes susceptibility and determine Possible screening tests for lung cancer include chest x-ray or computed tomography (CT) of the chest. A chest X-ray, commonly abbreviated CXR, is a projection radiograph ( X-ray) taken by a Radiographer, of the Thorax which is used Computed tomography (CT is a Medical imaging method employing Tomography. So far, screening programs for lung cancer have not demonstrated any clear benefit. Randomized controlled trials are underway in this area to see if decreased long-term mortality can be directly observed from CT screening. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare ^[68]

Treatment

Treatment for lung cancer depends on the cancer's specific cell type, how far it has spread, and the patient's performance status. The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread In Medicine ( Oncology and other fields performance status is an attempt to quantify Cancer patients' general wellbeing Common treatments include surgery, chemotherapy, and radiation therapy. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant ^[4]

Surgery

Main article: Lung cancer surgery

If investigations confirm lung cancer, CT scan and often positron emission tomography (PET) are used to determine whether the disease is localised and amenable to surgery or whether it has spread to the point where it cannot be cured surgically. Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the

Blood tests and spirometry (lung function testing) are also necessary to assess whether the patient is well enough to be operated on. A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via Spirometry (meaning the measuring of breath) is the most common of the Pulmonary Function Tests (PFTs measuring Lung function specifically the measurement If spirometry reveals poor respiratory reserve (often due to chronic obstructive pulmonary disease), surgery may be contraindicated. Chronic obstructive pulmonary disease ( COPD) is a Disease of the lungs in which the Airways become narrowed

Surgery itself has an operative death rate of about 4. 4%, depending on the patient's lung function and other risk factors. ^[69] Surgery is usually only an option in non-small cell lung carcinoma limited to one lung, up to stage IIIA. This is assessed with medical imaging (computed tomography, positron emission tomography). Computed tomography (CT is a Medical imaging method employing Tomography. Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the A sufficient pre-operative respiratory reserve must be present to allow adequate lung function after the tissue is removed.

Procedures include wedge resection (removal of part of a lobe), segmentectomy (removal of an anatomic division of a particular lobe of the lung), lobectomy (one lobe), bilobectomy (two lobes) or pneumonectomy (whole lung). Wedge resection of the lung is a surgical operation where a part of a Lung is removed Lobectomy of the lung is a surgical operation where a lobe of the Lung is removed A pneumonectomy (or pneumectomy) is a surgical procedure to remove a Lung. In patients with adequate respiratory reserve, lobectomy is the preferred option, as this minimizes the chance of local recurrence. If the patient does not have enough functional lung for this, wedge resection may be performed. ^[70] Radioactive iodine brachytherapy at the margins of wedge excision may reduce recurrence to that of lobectomy. Iodine (ˈaɪədaɪn ˈaɪədɪn or /ˈaɪədiːn/ from ιώδης iodes "violet" is a Chemical element that has the symbol I and Atomic Brachytherapy (from the Greek brachy, meaning "short" also known as sealed source radiotherapy or endocurietherapy, is a form of ^[71]

Chemotherapy

Small cell lung carcinoma is treated primarily with chemotherapy and radiation, as surgery has no demonstrable influence on survival. Primary chemotherapy is also given in metastatic non-small cell lung carcinoma.

The combination regimen depends on the tumor type. Non-small cell lung carcinoma is often treated with cisplatin or carboplatin, in combination with gemcitabine, paclitaxel, docetaxel, etoposide or vinorelbine. Cisplatin, cisplatinum or cis -diamminedichloridoplatinum(II (CDDP is a Platinum -based Chemotherapy drug used to treat CARBOplatin is a Chemotherapy drug used against some forms of Cancer (mainly ovarian carcinoma lung head and neck cancers Gemcitabine is a Nucleoside analog used as Chemotherapy. It is marketed as Gemzar by Eli Lilly and Company. Paclitaxel is a Mitotic inhibitor used in Cancer Chemotherapy. Docetaxel is a clinically well established anti-mitotic Chemotherapy Etoposide phosphate (brand names Eposin, Etopophos, Vepesid, VP-16) is an inhibitor of the Enzyme Topoisomerase II. Vinorelbine (Navelbine is an anti-mitotic Chemotherapy drug that is given as a treatment for some types of cancer including Breast cancer and non-small ^[72] In small cell lung carcinoma, cisplatin and etoposide are most commonly used. ^[73] Combinations with carboplatin, gemcitabine, paclitaxel, vinorelbine, topotecan and irinotecan are also used. Topotecan hydrochloride (trade name Hycamtin) is a chemotherapy agent that is a topoisomerase 1 inhibitor. Irinotecan is a chemotherapy agent that is a topoisomerase 1 inhibitor. ^[74][75]

Adjuvant chemotherapy for NSCLC

Adjuvant chemotherapy refers to the use of chemotherapy after surgery to improve the outcome. Adjuvant chemotherapy is a term used to describe the role of Chemotherapy relative to other cancer treatments During surgery, samples are taken from the lymph nodes. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. If these samples contain cancer, then the patient has stage II or III disease. In this situation, adjuvant chemotherapy may improve survival by up to 15%. ^[76][77] Standard practice is to offer platinum-based chemotherapy (including either cisplatin or carboplatin). ^[78]

Adjuvant chemotherapy for patients with stage IB cancer is controversial as clinical trials have not clearly demonstrated a survival benefit. ^[79][80] Trials of preoperative chemotherapy (neoadjuvant chemotherapy) in resectable non-small cell lung carcinoma have been inconclusive. Neoadjuvant chemotherapy refers to Drug treatment given to people with Cancer prior to surgery ^[81]

Radiotherapy

Radiotherapy is often given together with chemotherapy, and may be used with curative intent in patients with non-small cell lung carcinoma who are not eligible for surgery. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant This form of high intensity radiotherapy is called radical radiotherapy. A refinement of this technique is continuous hyperfractionated accelerated radiotherapy (CHART), where a high dose of radiotherapy is given in a short time period. ^[82] For small cell lung carcinoma cases that are potentially curable, in addition to chemotherapy, chest radiation is often recommended. ^[83] The use of adjuvant thoracic radiotherapy following curative intent surgery for non-small cell lung carcinoma is not well established and controversial. Benefits, if any, may only be limited to those in whom the tumor has spread to the mediastinal lymph nodes. The mediastinum is a non-delineated group of structures in the Thorax (chest surrounded by Loose connective tissue. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. ^[84][85]

For both non-small cell lung carcinoma and small cell lung carcinoma patients, smaller doses of radiation to the chest may be used for symptom control (palliative radiotherapy). Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms Unlike other treatments, it is possible to deliver palliative radiotherapy without confirming the histological diagnosis of lung cancer. Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and

Patients with limited stage small cell lung carcinoma are usually given prophylactic cranial irradiation (PCI). This is a type of radiotherapy to the brain, used to reduce the risk of metastasis. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, ^[86] More recently, PCI has also been shown to be beneficial in those with extensive small cell lung cancer. In patients whose cancer has improved following a course of chemotherapy, PCI has been shown to reduce the cumulative risk of brain metastases within one year from 40. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, 4% to 14. 6%. ^[87]

Recent improvements in targeting and imaging have led to the development of extracranial stereotactic radiation in the treatment of early-stage lung cancer. In this form of radiation therapy, very high doses are delivered in a small number of sessions using stereotactic targeting techniques. Its use is primarily in patients who are not surgical candidates due to medical comorbidities. In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to

Interventional radiology

Radiofrequency ablation should currently be considered an investigational technique in the treatment of bronchogenic carcinoma. Radio Frequency Ablation ( RFA) of Lung kidney breast bone and Liver tumors RFA is performed to cure tumors in lung liver kidney bone and rarely in other It is done by inserting a small heat probe into the tumor to kill the tumor cells. ^[88]

Targeted therapy

In recent years, various molecular targeted therapies have been developed for the treatment of advanced lung cancer. Gefitinib (Iressa) is one such drug, which targets the tyrosine kinase domain of the epidermal growth factor receptor (EGF-R) which is expressed in many cases of non-small cell lung carcinoma. Gefitinib ( INN) (gɛˈfɪtɨnɪb (originally coded ZD1839 is a drug used in the treatment of certain types of Cancer. A tyrosine kinase is an Enzyme that can transfer a Phosphate group from ATP to a Tyrosine residue in a Protein. The epidermal growth factor receptor (EGFR ErbB-1 HER1 in humans is the cell-surface receptor for members of the Epidermal growth factor family (EGF-family It was not shown to increase survival, although females, Asians, non-smokers and those with bronchioloalveolar carcinoma appear to derive the most benefit from gefitinib. Bronchioloalveolar carcinoma (BAC is a rare type of Lung cancer. ^[22]

Erlotinib (Tarceva), another tyrosine kinase inhibitor, has been shown to increase survival in lung cancer patients^[89] and has recently been approved by the FDA for second-line treatment of advanced non-small cell lung carcinoma. Erlotinib hydrochloride (originally coded as OSI-774) is a drug used to treat non-small cell Lung cancer, Pancreatic cancer and several other Similar to gefitinib, it appeared to work best in females, Asians, non-smokers and those with bronchioloalveolar carcinoma. ^[90]

The angiogenesis inhibitor bevacizumab (in combination with paclitaxel and carboplatin) improves the survival of patients with advanced non-small cell lung carcinoma. An angiogenesis inhibitor is a substance that inhibits Angiogenesis (the growth of new blood vessels Bevacizumab (Avastin Genentech/Roche is a Monoclonal antibody against Vascular endothelial growth factor (VEGF Paclitaxel is a Mitotic inhibitor used in Cancer Chemotherapy. CARBOplatin is a Chemotherapy drug used against some forms of Cancer (mainly ovarian carcinoma lung head and neck cancers ^[91] However this increases the risk of lung bleeding, particularly in patients with squamous cell carcinoma. In Medicine, squamous cell carcinoma (SCC is a form of Cancer of the Carcinoma type that may occur in many different organs including the Skin

Advances in cytotoxic drugs,^[92] pharmacogenetics^[93] and targeted drug design^[94] show promise. The terms Pharmacogenomics and pharmacogenetics tend to be used interchangeably and a precise consensus definition of either remains elusive A number of targeted agents are at the early stages of clinical research, such as cyclo-oxygenase-2 inhibitors,^[95] the apoptosis promoter exisulind,^[96] proteasome inhibitors,^[97] bexarotene^[98] and vaccines. COX-2 selective inhibitor is a form of Non-steroidal anti-inflammatory drug (NSAID that directly targets COX-2, an Enzyme responsible for Inflammation Exisulind is a Drug used to treat Cancer. It acts by inhibiting the Enzyme Cyclic guanosine monophosphate Phosphodiesterase. Proteasome inhibitors are drugs that block the action of Proteasomes cellular complexes that break down Proteins like the P53 protein Bexarotene ( Targretin) is an oral Antineoplastic agent indicated by the FDA for Cutaneous T cell lymphoma. ^[99] Future areas of research include ras proto-oncogene inhibition, phosphoinositide 3-kinase inhibition, histone deacetylase inhibition, and tumor suppressor gene replacement. An oncogene is a protein encoding Gene, which — when deregulated — participates in the onset and development of Cancer. Phosphoinositide 3-kinases (PI 3-kinases or PI3Ks are a family of related enzymes that are capable of phosphorylating the 3 position Hydroxyl group of the Inositol Histone deacetylases (HDAC ( EC number 351 are a class of Enzymes that remove Acetyl groups from an ε-N-acetyl Lysine Amino acid A tumor suppressor gene, or antioncogene is a Gene that protects a cell from one step on the path to cancer ^[100]

Prognosis

Main articles: Non-small cell lung carcinoma staging and Manchester score

Prognostic factors in non- small-cell lung cancer include presence or absence of pulmonary symptoms, tumor size, cell type (histology), degree of spread (stage) and metastases to multiple lymph nodes, and vascular invasion. Non-small cell lung carcinoma staging is an important part of the assessment of patients with non-small cell lung carcinoma (a type of Lung cancer) Manchester score is an indicator of Prognosis in small cell Lung cancer. See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. For patients with inoperable disease, prognosis is adversely affected by poor performance status and weight loss of more than 10%. In Medicine ( Oncology and other fields performance status is an attempt to quantify Cancer patients' general wellbeing ^[101] Prognostic factors in small-cell lung cancer include performance status, gender, stage of disease, and involvement of the central nervous system or liver at the time of diagnosis. In Medicine ( Oncology and other fields performance status is an attempt to quantify Cancer patients' general wellbeing Gender comprises a range of differences between men and women extending from the biological to the social In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. The liver is a vital organ in the human body and is present in Vertebrates and some other animals Diagnosis is the identification by Process of elimination, of the nature of anything ^[102]

For non-small cell lung carcinoma, prognosis is generally poor. Following complete surgical resection of stage IA disease, five-year survival is 67%. With stage IB disease, five-year survival is 57%. ^[103] The 5-year survival rate of patients with stage IV NSCLC is about 1%. ^[6]

For small cell lung carcinoma, prognosis is also generally poor. The overall five-year survival for patients with SCLC is about 5%. ^[4] Patients with extensive-stage SCLC have an average five-year survival rate of less than 1%. The median survival time for limited-stage disease is 20 months, with a five-year survival rate of 20%. In Probability theory and Statistics, a median is described as the number separating the higher half of a sample a population or a Probability distribution ^[6]

According to data provided by the National Cancer Institute, the median age of incidence of lung cancer is 70 years, and the median age of death by lung cancer 71 years. The National Cancer Institute (NCI is part of the United States Federal government's National Institutes of Health. ^[104]

Epidemiology

Worldwide, lung cancer is the most common cancer in terms of both incidence and mortality with 1. The United States of America —commonly referred to as the 35 million new cases per year and 1. 18 million deaths, with the highest rates in Europe and North America. ^[105] The population segment most likely to develop lung cancer is over-fifties who have a history of smoking. Lung cancer is the second most commonly occurring form of cancer in most western countries, and it is the leading cancer-related cause of death. Although the rate of men dying from lung cancer is declining in western countries, it is actually increasing for women due to the increased takeup of smoking by this group. Among lifetime non-smokers, men have higher age-standardized lung cancer death rates than women.

Not all cases of lung cancer are due to smoking, but the role of passive smoking is increasingly being recognized as a risk factor for lung cancer, leading to policy interventions to decrease undesired exposure of non-smokers to others' tobacco smoke. Emissions from automobiles, factories and power plants also pose potential risks. ^{[11][13][106]}

Eastern Europe has the highest lung cancer mortality among men, while northern Europe and the U. Eastern Europe is a general term that refers to the Geopolitical region encompassing the easternmost part of the European continent. S. have the highest mortality among women. Lung cancer incidence is currently less common in developing countries. ^[107] With increased smoking in developing countries, the incidence is expected to increase in the next few years, notably in China^[108] and India. ^[109]

Lung cancer incidence (by country) has an inverse correlation with sunlight and UVB exposure. Sunlight, in the broad sense is the total spectrum of the Electromagnetic radiation given off by the Sun. Ultraviolet ( UV) light is Electromagnetic radiation with a Wavelength shorter than that of Visible light, but longer than X-rays One possible explanation is a preventative effect of vitamin D (which is produced in the skin on exposure to sunlight). Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or ^[110]

History

Lung cancer was extremely rare before the advent of cigarette smoking; it was not even recognized as a distinct disease until 1761. ^[111] Different aspects of lung cancer were described further in 1810. ^[112] Malignant lung tumors made up only 1% of all cancers seen at autopsy in 1878, but had risen to 10–15% by the early 1900s. ^[113] Case reports in the medical literature numbered only 374 worldwide in 1912,^[114] but a review of autopsies showed that the incidence of lung cancer had increased from 0. 3% in 1852 to 5. 66% in 1952. ^[115] In Germany, in 1929 physician Fritz Lickint recognized the link between smoking and lung cancer,^[113] which led to an aggressive anti-smoking campaign. Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. ^[116] The British Doctors Study, published in the 1950s, was the first solid epidemiological evidence of the link between lung cancer and smoking. The British doctors study is the generally accepted name of a Prospective Cohort study which has been running from 1951 to 2001 and in 1956 provided convincing statistical Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the ^[117] As a result, in 1964 the Surgeon General of the United States recommended that smokers should stop smoking. Overview The Surgeon General is nominated by the US President and confirmed via majority vote by the Senate. ^[118]

The connection with radon gas was first recognized among miners in the Ore Mountains near Schneeberg, Saxony. Radon (ˈreɪdɒn is the Chemical element that has the symbol Rn and Atomic number 86 Schneeberg is a town in Saxony ’s district of Erzgebirgskreis. Silver has been mined there since 1470, and these mines are rich in uranium, with accompanying radium and radon gas. Silver (ˈsɪlvɚ is a Chemical element with the symbol " Ag " (argentum from the Ancient Greek: ἀργήντος - argēntos gen Uranium (jʊˈreɪniəm is a silvery-gray Metallic Chemical element in the Radium (ˈreɪdiəm is a radioactive Chemical element which has the symbol Ra and Atomic number 88 Miners developed a disproportionate amount of lung disease, eventually recognized as lung cancer in the 1870s and an estimated 75% of former miners died from lung cancer. Despite this discovery, mining continued into the 1950s due to the USSR's demand for uranium. The Union of Soviet Socialist Republics (USSR was a constitutionally Socialist state that existed in Eurasia from 1922 to 1991 ^[119]

Treatment

The first successful pneumonectomy for lung cancer was carried out in 1933 ^[120] and initially, pneumonectomy was the surgical treatment of choice. A pneumonectomy (or pneumectomy) is a surgical procedure to remove a Lung. ^[121] However, with improvements in cancer staging and surgical techniques, lobectomy with lymph node dissection has now become the treatment of choice. The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread Lobectomy of the lung is a surgical operation where a lobe of the Lung is removed A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. ^[122][123]

Palliative radiotherapy has been used since the 1940s. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant ^[121] Radical radiotherapy, initially used in the 1950s, was an attempt to use larger radiation doses in patients with relatively early stage lung cancer, but who were otherwise unfit for surgery. ^[124] In 1997, continuous hyperfractionated accelerated radiotherapy (CHART) was seen as an improvement over conventional radical radiotherapy. ^[82]

With small cell lung carcinoma, initial attempts in the 1960s at surgical resection^[125] and radical radiotherapy^[126] were unsuccessful. In the 1970s, successful chemotherapy regimens were developed. ^[127]

References

External links

• Chest Radiology Lung cancer tutorial
• Lung cancer at the Open Directory Project
• LungCancer.org - free resources and support services
• OutWithCancer LGBT Cancer Support - free cancer support services
• National Cancer Insitute
• Tobacco Smoke and Involuntary Smoking, Summary of Data Reported and Evaluation 2004 by the IARC
• Lung Cancer Articles & Information Stop Smoking Articles & Information at National Institutes of Health

The Open Directory Project ( ODP) also known as dmoz (from directory The International Agency for Research on Cancer ( IARC, or CIRC in its French Acronym) is an intergovernmental agency forming part of the World Health "NIH" redirects here For other meanings of NIH see NIH (disambiguation.

© 2009 citizendia.org; parts available under the terms of GNU Free Documentation License, from http://en.wikipedia.org
Dapyx Software network: MP3 Explorer | Ebook Manager | Zenithic