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Lungcancer
FromWikipedia,thefreeencyclopedia
Lungcancer,alsoknownaslungcarcinoma,[1]isa
malignantlungtumorcharacterizedbyuncontrolledcell
growthintissuesofthelung.[2]Ifleftuntreated,thisgrowth
canspreadbeyondthelungbytheprocessofmetastasisinto
nearbytissueorotherpartsofthebody.[3]Mostcancersthat
startinthelung,knownasprimarylungcancers,are
carcinomas.[4]Thetwomaintypesaresmallcelllung
carcinoma(SCLC)andnonsmallcelllungcarcinoma
(NSCLC).[5]Themostcommonsymptomsarecoughing
(includingcoughingupblood),weightloss,shortnessof
breath,andchestpains.[6]
Thevastmajority(85%)ofcasesoflungcanceraredueto
longtermtobaccosmoking.[7]About1015%ofcasesoccur
inpeoplewhohaveneversmoked.[8]Thesecasesareoften
causedbyacombinationofgeneticfactorsandexposureto
radongas,asbestos,secondhandsmoke,orotherformsof
airpollution.[7][9][10][11]Lungcancermaybeseenonchest
radiographsandcomputedtomography(CT)scans.[1]The
diagnosisisconfirmedbybiopsywhichisusuallyperformed
bybronchoscopyorCTguidance.[12][13]
Preventionisbyavoidingriskfactorsincludingsmokingand
airpollution.[14]Treatmentandlongtermoutcomesdepend
onthetypeofcancer,thestage(degreeofspread),andthe
person'soverallhealth.[1]Mostcasesarenotcurable.[5]
Commontreatmentsincludesurgery,chemotherapy,and
radiotherapy.[1]NSCLCissometimestreatedwithsurgery,
whereasSCLCusuallyrespondsbettertochemotherapyand
radiotherapy.[15]
Worldwidein2012,lungcanceroccurredin1.8million
peopleandresultedin1.6milliondeaths.[4]Thismakesitthe
mostcommoncauseofcancerrelateddeathinmenand
secondmostcommoninwomenafterbreastcancer.[16]The
mostcommonageatdiagnosisis70years.Overall,17.4%of
peopleintheUnitedStatesdiagnosedwithlungcancer
survivefiveyearsafterthediagnosis,[17]whileoutcomeson
averageareworseinthedevelopingworld.[18]
Contents
1 Signsandsymptoms
2 Causes
https://en.wikipedia.org/wiki/Lung_cancer
LungcancerWikipedia
Lungcancer
AchestXrayshowingatumorinthelung(marked
byarrow)
Classificationandexternalresources
Specialty Oncology
ICD10 C33(http://apps.who.int/classification
s/icd10/browse/2016/en#/C33)C34
(http://apps.who.int/classifications/icd
10/browse/2016/en#/C34)
ICD9CM 162(http://www.icd9data.com/getIC
D9Code.ashx?icd9=162)
OMIM 211980(https://omim.org/entry/2119
80)
DiseasesDB 7616(http://www.diseasesdatabase.co
m/ddb7616.htm)
MedlinePlus 007194(https://medlineplus.gov/enc
y/article/007194.htm)
eMedicine med/1333(http://www.emedicine.co
m/med/topic1333.htm)med/1336(htt
p://www.emedicine.com/med/topic13
36.htm#)emerg/335(http://www.eme
dicine.com/emerg/topic335.htm#)
radio/807(http://www.emedicine.co
m/radio/topic807.htm#)radio/405(ht
tp://www.emedicine.com/radio/topic4
05.htm#)radio/406(http://www.eme
dicine.com/radio/topic406.htm#)
PatientUK Lungcancer(http://patient.info/docto
r/lungcancerpro)
MeSH D002283(https://www.nlm.nih.gov/c
1/25
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2.1 Smoking gi/mesh/2017/MB_cgi?field=uid&ter

2.2 Radongas m=D002283)
2.3 Asbestos
2.4 Airpollution
2.5 Genetics
2.6 Othercauses
3 Pathogenesis
4 Diagnosis
4.1 Classification
4.2 Metastasis
4.3 Staging
5 Prevention
5.1 Smokingban
5.2 Screening
5.3 Otherpreventionstrategies
6 Management
6.1 Surgery
6.2 Radiotherapy
6.3 Chemotherapy
6.4 Bronchoscopy
6.5 Palliativecare
7 Prognosis
8 Epidemiology
9 History
10 Researchdirections
11 References
12 Externallinks

Signsandsymptoms
Signsandsymptomswhichmaysuggestlungcancerinclude:[6]

Respiratorysymptoms:coughing,coughingupblood,wheezing,orshortnessofbreath
Systemicsymptoms:weightloss,weakness,fever,orclubbingofthefingernails
Symptomsduetothecancermasspressingonadjacentstructures:chestpain,bonepain,superiorvena
cavaobstruction,ordifficultyswallowing

Ifthecancergrowsintheairways,itmayobstructairflow,causingbreathingdifficulties.Theobstructioncan
leadtoaccumulationofsecretionsbehindtheblockage,andpredisposetopneumonia.[6]

Dependingonthetypeoftumor,paraneoplasticphenomenasymptomsnotduetothelocalpresenceofcancer
mayinitiallyattractattentiontothedisease.[19]Inlungcancer,thesephenomenamayincludehypercalcemia,
syndromeofinappropriateantidiuretichormone(SIADH,abnormallyconcentratedurineanddilutedblood),
ectopicACTHproduction,orLambertEatonmyasthenicsyndrome(muscleweaknessduetoautoantibodies).
Tumorsinthetopofthelung,knownasPancoasttumors,mayinvadethelocalpartofthesympatheticnervous
system,leadingtoHorner'ssyndrome(droppingoftheeyelidandasmallpupilonthatside),aswellasdamage
tothebrachialplexus.[6]

Manyofthesymptomsoflungcancer(poorappetite,weightloss,fever,fatigue)arenotspecific.[12]Inmany
people,thecancerhasalreadyspreadbeyondtheoriginalsitebythetimetheyhavesymptomsandseek
medicalattention.[20]Symptomsthatsuggestthepresenceofmetastaticdiseaseincludeweightloss,bonepain
andneurologicalsymptoms(headaches,fainting,convulsions,orlimbweakness).[6]Commonsitesofspread

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includethebrain,bone,adrenalglands,oppositelung,liver,pericardium,andkidneys.[20]About10%ofpeople
withlungcancerdonothavesymptomsatdiagnosisthesecancersareincidentallyfoundonroutinechest
radiography.[13]

Causes
CancerdevelopsfollowinggeneticdamagetoDNAand
epigeneticchanges.Thesechangesaffectthenormalfunctionsof
thecell,includingcellproliferation,programmedcelldeath
(apoptosis)andDNArepair.Asmoredamageaccumulates,the
riskofcancerincreases.[21]

Smoking

Smoking,particularlyofcigarettes,isbyfarthemaincontributor
tolungcancer.[22]Cigarettesmokecontainsatleast73known
carcinogens,[23]includingbenzo[a]pyrene,[24]NNK,1,3
butadieneandaradioactiveisotopeofpolonium,polonium
210.[23]Acrossthedevelopedworld,90%oflungcancerdeaths
inmenduringtheyear2000wereattributedtosmoking(70%for Graphshowinghowageneralincreasein
women).[25]Smokingaccountsforabout85%oflungcancer salesoftobaccoproductsintheUSAinthe
cases.[1] firstfourdecadesofthe20thcentury
(cigarettesperpersonperyear)ledtoa
Passivesmokingtheinhalationofsmokefromanother's correspondingrapidincreaseintherateof
smokingisacauseoflungcancerinnonsmokers.Apassive lungcancerduringthe1930s,'40sand'50s
smokercanbedefinedassomeonelivingorworkingwitha (lungcancerdeathsper100,000male
smoker.StudiesfromtheUS,[26][27][28]Europe[29]andtheUK[30] populationperyear)
haveconsistentlyshownasignificantlyincreasedriskamong
thoseexposedtopassivesmoke.[31]Thosewholivewithsomeone
whosmokeshavea2030%increaseinriskwhilethosewho
workinanenvironmentwithsecondhandsmokehavea1619%
increaseinrisk.[32]Investigationsofsidestreamsmokesuggestit
ismoredangerousthandirectsmoke.[33]Passivesmokingcauses
about3,400deathsfromlungcancereachyearintheUSA.[28]

Marijuanasmokecontainsmanyofthesamecarcinogensasthose
intobaccosmoke.[34]However,theeffectofsmokingcannabison
lungcancerriskisnotclear.[35][36]A2013reviewdidnotfindan
increasedriskfromlighttomoderateuse.[37]A2014review Riskofdeathfromlungcancerisstrongly
correlatedwithsmoking
foundthatsmokingcannabisdoubledtheriskoflungcancer.[38]

Radongas

Radonisacolourlessandodorlessgasgeneratedbythebreakdownofradioactiveradium,whichinturnisthe
decayproductofuranium,foundintheEarth'scrust.Theradiationdecayproductsionizegeneticmaterial,
causingmutationsthatsometimesturncancerous.Radonisthesecondmostcommoncauseoflungcancerin
theUSA,[39]causingabout21,000deathseachyear.[40]Theriskincreases816%forevery100Bq/mincrease
intheradonconcentration.[41]Radongaslevelsvarybylocalityandthecompositionoftheunderlyingsoiland
rocks.Aboutonein15homesintheUShasradonlevelsabovetherecommendedguidelineof4picocuriesper
liter(pCi/l)(148Bq/m).[42]
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Asbestos

Asbestoscancauseavarietyoflungdiseases,includinglungcancer.Tobaccosmokingandasbestoshavea
synergisticeffectontheformationoflungcancer.[10]Insmokerswhoworkwithasbestos,theriskoflung
cancerisincreased45foldcomparedtothegeneralpopulation.[43]Asbestoscanalsocausecancerofthe
pleura,calledmesothelioma(whichisdifferentfromlungcancer).[44]

Airpollution

Outdoorairpollutants,especiallychemicalsreleasedfromtheburningoffossilfuels,increasetheriskoflung
cancer.[7]Fineparticulates(PM2.5)andsulfateaerosols,whichmaybereleasedintrafficexhaustfumes,are
associatedwithslightlyincreasedrisk.[7][45]Fornitrogendioxide,anincrementalincreaseof10partsper
billionincreasestheriskoflungcancerby14%.[46]Outdoorairpollutionisestimatedtoaccountfor12%of
lungcancers.[7]

Tentativeevidencesupportsanincreasedriskoflungcancerfromindoorairpollutionrelatedtotheburningof
wood,charcoal,dungorcropresidueforcookingandheating.[47]Womenwhoareexposedtoindoorcoal
smokehaveabouttwicetheriskandanumberofthebyproductsofburningbiomassareknownorsuspected
carcinogens.[48]Thisriskaffectsabout2.4billionpeopleglobally,[47]andisbelievedtoaccountfor1.5%of
lungcancerdeaths.[48]

Genetics

About8%oflungcancerisduetoinheritedfactors.[49]Inrelativesofpeoplewithlungcancer,theriskis
doubled.Thisislikelyduetoacombinationofgenes.[50]Polymorphismsonchromosomes5,6and15are
knowntoaffecttheriskoflungcancer.[51]

Othercauses

Numerousothersubstances,occupations,andenvironmentalexposureshavebeenlinkedtolungcancer.The
InternationalAgencyforResearchonCancer(IARC)statesthereis"sufficientevidence"toshowthefollowing
arecarcinogenicinthelungs:[52]

Somemetals(aluminumproduction,cadmiumandcadmiumcompounds,chromium(VI)compounds,
berylliumandberylliumcompounds,ironandsteelfounding,nickelcompounds,arsenicandinorganic
arseniccompounds,undergroundhematitemining)
Someproductsofcombustion(incompletecombustion,coal(indooremissionsfromhouseholdcoal
burning),coalgasification,coaltarpitch,cokeproduction,soot,dieselengineexhaust)
Ionizingradiation(Xradiation,gammaradiation,plutonium)
Sometoxicgases(methylether(technicalgrade),Bis(chloromethyl)ether,sulfurmustard,MOPP
(vincristineprednisonenitrogenmustardprocarbazinemixture),fumesfrompainting)
Rubberproductionandcrystallinesilicadust

Pathogenesis
Similartomanyothercancers,lungcancerisinitiatedbyactivationofoncogenesorinactivationoftumor
suppressorgenes.[53]Carcinogenscausemutationsinthesegeneswhichinducethedevelopmentofcancer.[54]

MutationsintheKrasprotooncogeneareresponsiblefor1030%oflungadenocarcinomas.[55][56]About4%
ofnonsmallcelllungcarcinomasinvolveanEML4ALKtyrosinekinasefusiongene.[57]

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EpigeneticchangessuchasalterationofDNAmethylation,histone
tailmodification,ormicroRNAregulationmayleadtoinactivationof
tumorsuppressorgenes.[58]

Theepidermalgrowthfactorreceptor(EGFR)regulatescell
proliferation,apoptosis,angiogenesis,andtumorinvasion.[55]Mutations
andamplificationofEGFRarecommoninnonsmallcelllung
carcinomaandprovidethebasisfortreatmentwithEGFRinhibitors.
Her2/neuisaffectedlessfrequently.[55]Othergenesthatareoften
Falsecolorscanningelectron mutatedoramplifiedarecMET,NKX21,LKB1,PIK3CA,and
micrographofalungcancercell BRAF.[55]
dividing
Thecelllinesoforiginarenotfullyunderstood.[6]Themechanismmay
involveabnormalactivationofstemcells.Intheproximalairways,stem
cellsthatexpresskeratin5aremorelikelytobeaffected,typicallyleadingtosquamouscelllungcarcinoma.In
themiddleairways,implicatedstemcellsincludeclubcellsandneuroepithelialcellsthatexpressclubcell
secretoryprotein.Smallcelllungcarcinomamaybederivedfromthesecelllines[59]orneuroendocrinecells,[6]
andmayexpressCD44.[59]

Metastasisoflungcancerrequirestransitionfromepithelialtomesenchymalcelltype.Thismayoccurthrough
activationofsignalingpathwayssuchasAkt/GSK3Beta,MEKERK,Fas,andPar6.[60]

Diagnosis
Performingachestradiographisoneofthefirstinvestigativestepsifa
personreportssymptomsthatmaysuggestlungcancer.Thismayreveal
anobviousmass,wideningofthemediastinum(suggestiveofspreadto
lymphnodesthere),atelectasis(collapse),consolidation(pneumonia)or
pleuraleffusion.[1]CTimagingistypicallyusedtoprovidemore
informationaboutthetypeandextentofdisease.BronchoscopyorCT
guidedbiopsyisoftenusedtosamplethetumorforhistopathology.[13]

Lungcanceroftenappearsasasolitarypulmonarynoduleonachest
radiograph.However,thedifferentialdiagnosisiswide.Manyother CTscanshowingacanceroustumor
diseasescanalsogivethisappearance,includingmetastaticcancer, intheleftlung
hamartomas,andinfectiousgranulomassuchastuberculosis,
histoplasmosisandcoccidioidomycosis.[61]Lungcancercanalsobean
incidentalfinding,asasolitarypulmonarynoduleonachestradiographorCTscandoneforanunrelated
reason.[62]Thedefinitivediagnosisoflungcancerisbasedonhistologicalexaminationofthesuspicious
tissue[6]inthecontextoftheclinicalandradiologicalfeatures.[12]

Clinicalpracticeguidelinesrecommendfrequenciesforpulmonarynodulesurveillance.[63]CTimagingshould
notbeusedforlongerormorefrequentlythanindicatedasextendedsurveillanceexposespeopletoincreased
radiation.[63]

Classification

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Ageadjustedincidenceof
lungcancerbyhistological
type[7]
Incidence
Histologicaltype per100,000
peryear
Alltypes 66.9
Adenocarcinoma 22.1
Squamouscell
14.4
carcinoma
Smallcell
9.8
carcinoma
Piechartshowingincidencesofnonsmall
celllungcancersascomparedtosmallcell
Lungcancersareclassifiedaccordingtohistologicaltype.[12]This carcinomashownatright,withfractionsof
classificationisimportantfordeterminingmanagementand smokersversusnonsmokersshownforeach
predictingoutcomesofthedisease.Lungcancersarecarcinomas
type. [64]
malignanciesthatarisefromepithelialcells.Lungcarcinomas
arecategorizedbythesizeandappearanceofthemalignantcells
seenbyahistopathologistunderamicroscope.Fortherapeuticpurposes,twobroadclassesaredistinguished:
nonsmallcelllungcarcinomaandsmallcelllungcarcinoma.[65]

Nonsmallcelllungcarcinoma

ThethreemainsubtypesofNSCLCareadenocarcinoma,squamouscell
carcinomaandlargecellcarcinoma.[6]

Micrographofsquamouscell
carcinoma,atypeofnonsmallcell
carcinoma,FNAspecimen,Papstain
Nearly40%oflungcancersareadenocarcinoma,whichusually
originatesinperipherallungtissue.[12]Althoughmostcasesof
adenocarcinomaareassociatedwithsmoking,adenocarcinomaisalso
themostcommonformoflungcanceramongpeoplewhohavesmoked
fewerthan100cigarettesintheirlifetimes("neversmokers")[6][66]and
exsmokerswithamodestsmokinghistory.[6]Asubtypeof
adenocarcinoma,thebronchioloalveolarcarcinoma,ismorecommonin
femaleneversmokers,andmayhaveabetterlongtermsurvival.[67]

Squamouscellcarcinomaaccountsforabout30%oflungcancers.Theytypicallyoccurclosetolargeairways.
Ahollowcavityandassociatedcelldeatharecommonlyfoundatthecenterofthetumor.[12]About9%oflung
cancersarelargecellcarcinoma.Thesearesonamedbecausethecancercellsarelarge,withexcesscytoplasm,
largenucleiandconspicuousnucleoli.[12]

Smallcelllungcarcinoma

Insmallcelllungcarcinoma(SCLC),thecellscontaindenseneurosecretorygranules(vesiclescontaining
neuroendocrinehormones),whichgivethistumoranendocrine/paraneoplasticsyndromeassociation.[68]Most
casesariseinthelargerairways(primaryandsecondarybronchi).[13]Sixtytoseventypercenthaveextensive
disease(whichcannotbetargetedwithinasingleradiationtherapyfield)atpresentation.[6]

Others

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Fourmainhistologicalsubtypesarerecognised,althoughsomecancers
maycontainacombinationofdifferentsubtypes,[65]suchas
adenosquamouscarcinoma.[12]Raresubtypesincludecarcinoidtumors,
bronchialglandcarcinomasandsarcomatoidcarcinomas.[12]

Metastasis
TypicalNapsinAandTTF1
immunostaininginprimarylung
Smallcelllungcarcinoma carcinoma[6]
(microscopicviewofacoreneedle Histologicaltype NapsinA TTF1
biopsy) Squamouscell
Negative Negative
carcinoma
Adenocarcinoma Positive Positive
Smallcell
Negative Positive
carcinoma

Thelungisacommonplaceforthespreadoftumorsfromotherpartsofthebody.Secondarycancersare
classifiedbythesiteoforigine.g.,breastcancerthathasspreadtothelungiscalledmetastaticbreastcancer.
Metastasesoftenhaveacharacteristicroundappearanceonchestradiograph.[69]

Primarylungcancersthemselvesmostcommonlymetastasizetothebrain,bones,liverandadrenalglands.[12]
Immunostainingofabiopsyisoftenhelpfultodeterminetheoriginalsource.[70]ThepresenceofNapsinA,
TTF1,CK7andCK20arehelpfulinconfirmingthesubtypeoflungcarcinoma.SCLCderivedfrom
neuroendocrinecellsmayexpressCD56,neuralcelladhesionmolecule,synaptophysinorchromogranin.[6]

Staging

Lungcancerstagingisanassessmentofthedegreeofspreadofthecancerfromitsoriginalsource.[71]Itisone
ofthefactorsaffectingtheprognosisandpotentialtreatmentoflungcancer.[6][71]

Theevaluationofnonsmallcelllungcarcinoma(NSCLC)stagingusestheTNMclassification.Thisisbased
onthesizeoftheprimarytumor,lymphnodeinvolvement,anddistantmetastasis.[6]

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TNMclassificationinlungcancer[6][72]

T:Primarytumor N:Lymphnodes M:Metastasis

Primarytumorcannotbeassessed Regionallymphnodes Distantmetastasis
NX
Any Tumorcellspresentinsputumorbronchial cannotbeassessed MX cannotbe
TX assessed
of: washing,buttumornotseenwithimagingor Noregionallymphnode
N0
bronchoscopy metastasis Nodistant
M0
T0 Noevidenceofprimarytumor Metastasistoipsilateral metastasis
Tis Carcinomainsitu N1 peribronchialand/orhilar Separate
lymphnodes tumor
Tumorsizelessthanorequalto3cmacross, noduleinthe
T1 surroundedbylungorvisceralpleura,withoutinvasion Metastasistoipsilateral
N2 mediastinaland/or otherlung
proximaltothelobarbronchus
subcarinallymphnodes Tumorwith
T1a Tumorsizelessthanorequalto2cmacross Any
Metastasistoscalene M1a pleural
Tumorsizemorethan2cmbutlessthanorequalto of:
T1b orsupraclavicular nodules
3cmacross lymphnodes Malignant
Tumorsizemorethan3cmbutlessthanorequal Any pleuralor
N3 Metastasisto
to7cmacross of: pericardial
contralateralhilaror
Involvementofthemainbronchusatleast2cm mediastinallymph effusion
Any distaltothecarina
T2 nodes M1b Distantmetastasis
of:
Invasionofvisceralpleura
Atelectasis/obstructivepneumonitisextendingto
thehilumbutnotinvolvingthewholelung
Tumorsizemorethan3cmbutlessthanorequalto
T2a
5cmacross
Tumorsizemorethan5cmbutlessthanorequalto
T2b
7cmacross
Tumorsizemorethan7cmacross
Invasionintothechestwall,diaphragm,phrenic
nerve,mediastinalpleuraorparietalpericardium
Any Tumorlessthan2cmdistaltothecarina,butnot
T3
of: involvingthecarina
Atelectasis/obstructivepneumonitisofthewhole
lung
Separatetumornoduleinthesamelobe
Invasionofthemediastinum,heart,greatvessels,
trachea,carina,recurrentlaryngealnerve,
Any esophagus,orvertebra
T4
of:
Separatetumornoduleinadifferentlobeofthe
samelung

UsingtheTNMdescriptors,agroupisassigned,rangingfromoccultcancer,throughstages0,IA(oneA),IB,
IIA,IIB,IIIA,IIIBandIV(four).Thisstagegroupassistswiththechoiceoftreatmentandestimationof
prognosis.[73]

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Stagegroupaccordingto
TNMclassificationinlung
cancer[6]
TNM Stagegroup
T1aT1bN0M0 IA
T2aN0M0 IB
T1aT2aN1M0
IIA
T2bN0M0
T2bN1M0
IIB
T3N0M0
T1aT3N2M0
T3N1M0 IIIA
T4N0N1M0
N3M0
IIIB
T4N2M0
M1 IV

Smallcelllungcarcinoma(SCLC)hastraditionallybeenclassifiedas"limitedstage"(confinedtoonehalfof
thechestandwithinthescopeofasingletolerableradiotherapyfield)or"extensivestage"(morewidespread
disease).[6]However,theTNMclassificationandgroupingareusefulinestimatingprognosis.[73]

ForbothNSCLCandSCLC,thetwogeneraltypesofstagingevaluationsareclinicalstagingandsurgical
staging.Clinicalstagingisperformedpriortodefinitivesurgery.Itisbasedontheresultsofimagingstudies
(suchasCTscansandPETscans)andbiopsyresults.Surgicalstagingisevaluatedeitherduringorafterthe
operationandisbasedonthecombinedresultsofsurgicalandclinicalfindings,includingsurgicalsamplingof
thoraciclymphnodes.[12]

Diagramsofmainfeaturesofstaging

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StageIAandIBlungcancer StageIIAlungcancer

StageIIBlungcancer OneoptionforstageIIBlung
cancer,withT2bbutiftumoris
within2cmofthecarina,thisis
stage3

StageIIIAlungcancer StageIIIAlungcancer,ifthereis
onefeaturefromthelistoneach
side

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StageIIIAlungcancer StageIIIBlungcancer

StageIIIBlungcancer StageIVlungcancer

Prevention
Smokingpreventionandsmokingcessationareeffectivewaysofpreventingthedevelopmentoflung
cancer.[74]

Smokingban

Whileinmostcountriesindustrialanddomesticcarcinogenshavebeenidentifiedandbanned,tobaccosmoking
isstillwidespread.Eliminatingtobaccosmokingisaprimarygoalinthepreventionoflungcancer,and
smokingcessationisanimportantpreventivetoolinthisprocess.[75]

Policyinterventionstodecreasepassivesmokinginpublicareassuchasrestaurantsandworkplaceshave
becomemorecommoninmanyWesterncountries.[76]Bhutanhashadacompletesmokingbansince2005[77]
whileIndiaintroducedabanonsmokinginpublicinOctober2008.[78]TheWorldHealthOrganizationhas
calledforgovernmentstoinstituteatotalbanontobaccoadvertisingtopreventyoungpeoplefromtakingup
smoking.Theyassessthatsuchbanshavereducedtobaccoconsumptionby16%whereinstituted.[79]

Screening

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Cancerscreeningusesmedicalteststodetectdiseaseinlargegroupsof
peoplewhohavenosymptoms.[80]Forindividualswithhighriskof
developinglungcancer,computedtomography(CT)screeningcan
detectcancerandgiveapersonoptionstorespondtoitinawaythat
prolongslife.[63][81]Thisformofscreeningreducesthechanceofdeath
fromlungcancerbyanabsoluteamountof0.3%(relativeamountof
20%).[82][83]Highriskpeoplearethoseage5574whohavesmoked
equivalentamountofapackofcigarettesdailyfor30yearsincluding
timewithinthepast15years.[63]

CTscreeningisassociatedwithahighrateoffalselypositivetests
whichmayresultinunneededtreatment.[84]Foreachtruepositivescan
thereareabout19falselypositivesscans.[85]Otherconcernsinclude
radiationexposure[84]andthecostoftestingalongwithfollowup.[63]
Researchhasnotfoundtwootheravailabletestssputumcytologyor
chestradiograph(CXR)screeningteststohaveanybenefit.[81][86]

TheUnitedStatesPreventiveServicesTaskForce(USPSTF) Crosssectionofahumanlung:The
recommendsyearlyscreeningusinglowdosecomputedtomographyin whiteareaintheupperlobeiscancer
thosewhohaveatotalsmokinghistoryof30packyearsandare theblackareasarediscolorationdue
between55and80yearsolduntilapersonhasnotbeensmokingfor tosmoking.
[87]
morethan15years. Screeningshouldnotbedoneinthosewithother
healthproblemsthatwouldmaketreatmentoflungcanceriffoundnot
anoption.[87]TheEnglishNationalHealthServicewasin2014reexaminingtheevidenceforscreening.[88]

Otherpreventionstrategies

ThelongtermuseofsupplementalvitaminA,[89][90]vitaminC,[89]vitaminD[91]orvitaminE[89]doesnot
reducetheriskoflungcancer.Somestudiessuggestthatpeoplewhoeatdietswithahigherproportionof
vegetablesandfruittendtohavealowerrisk,[28][92]butthismaybeduetoconfoundingwiththelowerrisk
actuallyduetotheassociationofahighfruit/vegetablesdietwithlesssmoking.[93]Morerigorousstudieshave
notdemonstratedaclearassociationbetweendietandlungcancerrisk.[6][92]

Management
Treatmentforlungcancerdependsonthecancer'sspecificcelltype,howfarithasspread,andtheperson's
performancestatus.Commontreatmentsincludepalliativecare,[94]surgery,chemotherapy,andradiation
therapy.[6]Targetedtherapyoflungcancerisgrowinginimportanceforadvancedlungcancer.

Surgery

IfinvestigationsconfirmNSCLC,thestageisassessedtodeterminewhetherthediseaseislocalizedand
amenabletosurgeryorifithasspreadtothepointwhereitcannotbecuredsurgically.CTscanandpositron
emissiontomographyareusedforthisdetermination.[6]Ifmediastinallymphnodeinvolvementissuspected,
thenodesmaybesampledtoassiststaging.Techniquesusedforthisincludetransthoracicneedleaspiration,
transbronchialneedleaspiration(withorwithoutendobronchialultrasound),endoscopicultrasoundwithneedle
aspiration,mediastinoscopy,andthoracoscopy.[95]Bloodtestsandpulmonaryfunctiontestingareusedto
assesswhetherapersoniswellenoughforsurgery.[13]Ifpulmonaryfunctiontestsrevealpoorrespiratory
reserve,surgerymaynotbepossible.[6]

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InmostcasesofearlystageNSCLC,removalofalobeoflung
(lobectomy)isthesurgicaltreatmentofchoice.Inpeoplewhoareunfit
forafulllobectomy,asmallersublobarexcision(wedgeresection)may
beperformed.However,wedgeresectionhasahigherriskofrecurrence
thanlobectomy.Radioactiveiodinebrachytherapyatthemarginsof
wedgeexcisionmayreducetheriskofrecurrence.Rarely,removalofa
wholelung(pneumonectomy)isperformed.[96]Videoassisted
thoracoscopicsurgery(VATS)andVATSlobectomyuseaminimally
invasiveapproachtolungcancersurgery.[97]VATSlobectomyisequally
effectivecomparedtoconventionalopenlobectomy,withless
postoperativeillness.[98]

InSCLC,chemotherapyand/orradiotherapyistypicallyused.[99]
HowevertheroleofsurgeryinSCLCisbeingreconsidered.Surgery
mightimproveoutcomeswhenaddedtochemotherapyandradiationin
earlystageSCLC.[100]

Radiotherapy

Radiotherapyisoftengiventogetherwithchemotherapy,andmaybe
usedwithcurativeintentinpeoplewithNSCLCwhoarenoteligiblefor
surgery.Thisformofhighintensityradiotherapyiscalledradical Pneumonectomyspecimencontaining
radiotherapy.[101]Arefinementofthistechniqueiscontinuous asquamouscellcarcinoma,seenasa
hyperfractionatedacceleratedradiotherapy(CHART),inwhichahigh whiteareanearthebronchi

doseofradiotherapyisgiveninashorttimeperiod.[102]Postoperative
thoracicradiotherapygenerallyshouldnotbeusedaftercurativeintentsurgeryforNSCLC.[103]Somepeople
withmediastinalN2lymphnodeinvolvementmightbenefitfrompostoperativeradiotherapy.[104]

ForpotentiallycurableSCLCcases,chestradiotherapyisoftenrecommendedinadditiontochemotherapy.[12]

Ifcancergrowthblocksashortsectionofbronchus,brachytherapy
(localizedradiotherapy)maybegivendirectlyinsidetheairwaytoopen
thepassage.Comparedtoexternalbeamradiotherapy,brachytherapy
allowsareductionintreatmenttimeandreducedradiationexposureto
healthcarestaff.[105]Evidenceforbrachytherapy,however,islessthan
thatforexternalbeamradiotherapy.[106]

Prophylacticcranialirradiation(PCI)isatypeofradiotherapytothe
brain,usedtoreducetheriskofmetastasis.PCIismostusefulinSCLC.
Inlimitedstagedisease,PCIincreasesthreeyearsurvivalfrom15%to
20%inextensivedisease,oneyearsurvivalincreasesfrom13%to
27%.[107]

Internalradiotherapyforlungcancer Recentimprovementsintargetingandimaginghaveledtothe
givenviatheairway. developmentofstereotacticradiationinthetreatmentofearlystage
lungcancer.Inthisformofradiotherapy,highdosesaredeliveredovera
numberofsessionsusingstereotactictargetingtechniques.Itsuseis
primarilyinpatientswhoarenotsurgicalcandidatesduetomedicalcomorbidities.[108]

ForbothNSCLCandSCLCpatients,smallerdosesofradiationtothechestmaybeusedforsymptomcontrol
(palliativeradiotherapy).[109]

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Chemotherapy

Thechemotherapyregimendependsonthetumortype.[12]Smallcelllungcarcinoma(SCLC),evenrelatively
earlystagedisease,istreatedprimarilywithchemotherapyandradiation.[110]InSCLC,cisplatinandetoposide
aremostcommonlyused.[111]Combinationswithcarboplatin,gemcitabine,paclitaxel,vinorelbine,topotecan,
andirinotecanarealsoused.[112][113]Inadvancednonsmallcelllungcarcinoma(NSCLC),chemotherapy
improvessurvivalandisusedasfirstlinetreatment,providedthepersoniswellenoughforthetreatment.[114]
Typically,twodrugsareused,ofwhichoneisoftenplatinumbased(eithercisplatinorcarboplatin).Other
commonlyuseddrugsaregemcitabine,paclitaxel,docetaxel,[115][116]pemetrexed,[117]etoposideor
vinorelbine.[116]

Adjuvantchemotherapyreferstotheuseofchemotherapyafterapparentlycurativesurgerytoimprovethe
outcome.InNSCLC,samplesaretakenofnearbylymphnodesduringsurgerytoassiststaging.IfstageIIorIII
diseaseisconfirmed,adjuvantchemotherapyimprovessurvivalby5%atfiveyears.[118][119]Thecombination
ofvinorelbineandcisplatinismoreeffectivethanolderregimens.[119]Adjuvantchemotherapyforpeoplewith
stageIBcanceriscontroversial,asclinicaltrialshavenotclearlydemonstratedasurvivalbenefit.[120][121]
ChemotherapybeforesurgeryinNSCLCthatcanberemovedsurgicallyalsoappearstoimproveoutcomes.[122]

ChemotherapymaybecombinedwithpalliativecareinthetreatmentoftheNSCLC.Inadvancedcases,
appropriatechemotherapyimprovesaveragesurvivaloversupportivecarealone,aswellasimprovingquality
oflife.[123]Withadequatephysicalfitnessmaintainingchemotherapyduringlungcancerpalliationoffers1.5to
3monthsofprolongationofsurvival,symptomaticrelief,andanimprovementinqualityoflife,withbetter
resultsseenwithmodernagents.[124][125]TheNSCLCMetaAnalysesCollaborativeGrouprecommendsifthe
recipientwantsandcantoleratetreatment,thenchemotherapyshouldbeconsideredinadvanced
NSCLC.[114][126]

Targetedtherapy

Severaldrugsthattargetmolecularpathwaysinlungcancerareavailable,especiallyforthetreatmentof
advanceddisease.Erlotinib,gefitinibandafatinibinhibittyrosinekinaseattheepidermalgrowthfactor
receptor.DenosumabisamonoclonalantibodydirectedagainstreceptoractivatorofnuclearfactorkappaB
ligand.Itmaybeusefulinthetreatmentofbonemetastases.[127]

Bronchoscopy

Severaltreatmentscanbeadministeredviabronchoscopyforthemanagementofairwayobstructionor
bleeding.Ifanairwaybecomesobstructedbycancergrowth,optionsincluderigidbronchoscopy,balloon
bronchoplasty,stenting,andmicrodebridement.[128]Laserphotosectioninvolvesthedeliveryoflaserlight
insidetheairwayviaabronchoscopetoremovetheobstructingtumor.[129]

Palliativecare

Palliativecarewhenaddedtousualcancercarebenefitspeopleevenwhentheyarestillreceiving
chemotherapy.[130]Theseapproachesallowadditionaldiscussionoftreatmentoptionsandprovide
opportunitiestoarriveatwellconsidereddecisions.[131][132]Palliativecaremayavoidunhelpfulbutexpensive
carenotonlyattheendoflife,butalsothroughoutthecourseoftheillness.Forindividualswhohavemore
advanceddisease,hospicecaremayalsobeappropriate.[13][132]

Prognosis
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Outcomesinlungcanceraccordingto
clinicalstage[73]
Fiveyearsurvival(%)
Clinical
stage Nonsmallcell Smallcelllung
lungcarcinoma carcinoma
IA 50 38
IB 47 21
IIA 36 38
IIB 26 18
IIIA 19 13
IIIB 7 9
IV 2 1

OfallpeoplewithlungcancerintheUS,16.8%surviveforatleastfiveyearsafterdiagnosis.[17][133]In
EnglandandWales,between2010and2011,overallfiveyearsurvivalforlungcancerwasestimatedat
9.5%.[134]Outcomesaregenerallyworseinthedevelopingworld.[18]Stageisoftenadvancedatthetimeof
diagnosis.Atpresentation,3040%ofcasesofNSCLCarestageIV,and60%ofSCLCarestageIV.[12]
Survivalforlungcancerfallsasthestageatdiagnosisbecomesmoreadvanced:theEnglishdatasuggestthat
around70%ofpatientssurviveatleastayearwhendiagnosedattheearlieststage,butthisfallstojust14%for
thosediagnosedwiththemostadvanceddisease.[135]

PrognosticfactorsinNSCLCincludepresenceofpulmonarysymptoms,largetumorsize(>3cm),
nonsquamouscelltype(histology),degreeofspread(stage)andmetastasestomultiplelymphnodes,and
vascularinvasion.Forpeoplewithinoperabledisease,outcomesareworseinthosewithpoorperformance
statusandweightlossofmorethan10%.[136]Prognosticfactorsinsmallcelllungcancerincludeperformance
status,gender,stageofdisease,andinvolvementofthecentralnervoussystemorliveratthetimeof
diagnosis.[137]

ForNSCLC,thebestprognosisisachievedwithcompletesurgicalresectionofstageIAdisease,withupto
70%fiveyearsurvival.[138]PeoplewithextensivestageSCLChaveanaveragefiveyearsurvivalrateofless
than1%.Theaveragesurvivaltimeforlimitedstagediseaseis20months,withafiveyearsurvivalrateof
20%.[1]

AccordingtodataprovidedbytheNationalCancerInstitute,themedianageatdiagnosisoflungcancerinthe
UnitedStatesis70years,[139]andthemedianageatdeathis72years.[140]IntheUS,peoplewithmedical
insurancearemorelikelytohaveabetteroutcome.[141]

Epidemiology
Worldwide,lungcanceristhemostcommoncanceramongmenintermsofbothincidenceandmortality,and
amongwomenhasthethirdhighestincidence,andissecondafterbreastcancerinmortality.In2012,there
were1.82millionnewcasesglobally,and1.56milliondeathsduetolungcancer,representing19.4%ofall
deathsfromcancer.[16]ThehighestratesareinNorthAmerica,EuropeandEastAsia,withoverathirdofnew
casesin2012inChina.RatesinAfricaandSouthAsiaaremuchlower.[142]

Thepopulationsegmentmostlikelytodeveloplungcancerispeopleagedover50whohaveahistoryof
smoking.Incontrasttothemortalityrateinmen,whichbegandecliningmorethan20yearsago,women'slung
cancermortalityrateshavebeenrisingoverthelastdecades,andarejustrecentlybeginningtostabilize.[143]In
theUSA,thelifetimeriskofdevelopinglungcanceris8%inmenand6%inwomen.[6]

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Forevery34millioncigarettessmoked,onelungcancer
deathoccurs.[144]Theinfluenceof"BigTobacco"playsa
significantroleinthesmokingculture.[145]Young
nonsmokerswhoseetobaccoadvertisementsaremorelikely
totakeupsmoking.[146]Theroleofpassivesmokingis
increasinglybeingrecognizedasariskfactorforlung
cancer,[31]leadingtopolicyinterventionstodecrease
undesiredexposureofnonsmokerstoothers'tobacco Trachea,bronchus,andlungcancersdeathsper
millionpersonin2012
smoke.[147]
07 82125
IntheUnitedStates,blackmenandwomenhaveahigher 812 126286
incidence.[148]Lungcancerratesarecurrentlylowerin 1332 287398
developingcountries.[149]Withincreasedsmokingin 3353 399527
developingcountries,theratesareexpectedtoincreaseinthe 5481 528889
nextfewyears,notablyinChina[150]andIndia.[151]

IntheUnitedStatesmilitaryveteranshavea2550%higherrateoflung
cancerprimarilyduetohigherratesofsmoking.[152]DuringWorldWar
TwoandtheKoreanWarasbestosalsoplayedapartandAgentOrange
mayhavecausedsomeproblemsduringtheVietnamWar.[153]

LungcanceristhethirdmostcommoncancerintheUK(around46,400
peoplewerediagnosedwiththediseasein2014),[154]anditisthemost
commoncauseofcancerdeath(around35,900peoplediedin
2014).[155] Lungcancerdistributionforwhite
malesintheUnitedStates
Fromthe1960s,theratesoflungadenocarcinomastartedtoriserelative
toothertypesoflungcancer.Thisispartlyduetotheintroductionof
filtercigarettes.Theuseoffiltersremoveslargerparticlesfromtobaccosmoke,thusreducingdepositionin
largerairways.However,thesmokerhastoinhalemoredeeplytoreceivethesameamountofnicotine,
increasingparticledepositioninsmallairwayswhereadenocarcinomatendstoarise.[156]Theincidenceoflung
adenocarcinomacontinuestorise.[157]

History
Lungcancerwasuncommonbeforetheadventofcigarettesmokingitwasnotevenrecognizedasadistinct
diseaseuntil1761.[158]Differentaspectsoflungcancerweredescribedfurtherin1810.[159]Malignantlung
tumorsmadeuponly1%ofallcancersseenatautopsyin1878,buthadrisento1015%bytheearly
1900s.[160]Casereportsinthemedicalliteraturenumberedonly374worldwidein1912,[161]butareviewof
autopsiesshowedtheincidenceoflungcancerhadincreasedfrom0.3%in1852to5.66%in1952.[162]In
Germanyin1929,physicianFritzLickintrecognizedthelinkbetweensmokingandlungcancer,[160]whichled
toanaggressiveantismokingcampaign.[163]TheBritishDoctors'Study,publishedinthe1950s,wasthefirst
solidepidemiologicalevidenceofthelinkbetweenlungcancerandsmoking.[164]Asaresult,in1964the
SurgeonGeneraloftheUnitedStatesrecommendedsmokersshouldstopsmoking.[165]

TheconnectionwithradongaswasfirstrecognizedamongminersintheOreMountainsnearSchneeberg,
Saxony.Silverhasbeenminedtheresince1470,andtheseminesarerichinuranium,withitsaccompanying
radiumandradongas.[166]Minersdevelopedadisproportionateamountoflungdisease,eventuallyrecognized
aslungcancerinthe1870s.[167]Despitethisdiscovery,miningcontinuedintothe1950s,duetotheUSSR's
demandforuranium.[166]Radonwasconfirmedasacauseoflungcancerinthe1960s.[168]
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Thefirstsuccessfulpneumonectomyforlungcancerwasperformedin
1933.[169]Palliativeradiotherapyhasbeenusedsincethe1940s.[170]
Radicalradiotherapy,initiallyusedinthe1950s,wasanattempttouse
largerradiationdosesinpatientswithrelativelyearlystagelungcancer,
butwhowereotherwiseunfitforsurgery.[171]In1997,continuous
hyperfractionatedacceleratedradiotherapywasseenasanimprovement
overconventionalradicalradiotherapy.[172]Withsmallcelllung
carcinoma,initialattemptsinthe1960satsurgicalresection[173]and
radicalradiotherapy[174]wereunsuccessful.Inthe1970s,successful
chemotherapyregimensweredeveloped.[175]

Researchdirections
Currentresearchdirectionsforlungcancertreatmentinclude
immunotherapy,[176]whichencouragesthebody'simmunesystemto
attackthetumorcells,epigenetics,andnewcombinationsof
chemotherapyandradiotherapy,bothontheirownandtogether.Many
ofthesenewtreatmentsworkthroughimmunecheckpointblockade,
disruptingcancer'sabilitytoevadetheimmunesystem.[176]

IpilimumabblockssignalingthroughareceptoronTcellsknownas
CTLA4whichdampensdowntheimmunesystem.Ithasbeen
approvedbytheU.S.FoodandDrugAdministration(FDA)for
treatmentofmelanomaandisundergoingclinicaltrialsforbothnon
smallcelllungcancer(NSCLC)andsmallcelllungcancer(SCLC).[176]

Otherimmunotherapytreatmentsinterferewiththebindingof
programmedcelldeath1(PD1)proteinwithitsligandPD1ligand1
(PDL1).SignalingthroughPD1inactivatesTcells.Somecancercells
appeartoexploitthisbyexpressingPDL1inordertoswitchoffTcells
thatmightrecognisethemasathreat.Monoclonalantibodiestargeting Lungcancer,incidence,mortalityand
bothPD1andPDL1,suchaspembrolizumabandnivolumab[177]are survival,England19712011

currentlyinclinicaltrialsfortreatmentforlungcancer.[176]

Epigeneticsisthestudyofsmall,usuallyheritable,molecularmodificationsor"tags"thatbindDNAand
modifygeneexpressionlevels.Targetingthesetagswithdrugscankillcancercells.Earlystageresearchin
NSCLCusingdrugsaimedatepigeneticmodificationsshowsthatblockingmorethanoneofthesetagscankill
cancercellswithfewersideeffects.[178]Studiesalsoshowthatgivingpatientsthesedrugsbeforestandard
treatmentcanimproveitseffectiveness.Clinicaltrialsareunderwaytoevaluatehowwellthesedrugskilllung
cancercellsinhumans.[178]Severaldrugsthattargetepigeneticmechanismsareindevelopment.Histone
deacetylaseinhibitorsindevelopmentincludevalproicacid,vorinostat,belinostat,panobinostat,entinostat,and
romidepsin.DNAmethyltransferaseinhibitorsindevelopmentincludedecitabine,azacytidine,and
hydralazine.[58]

TheTRACERxprojectislookingathowNSCLCdevelopsandevolves,andhowthesetumorsbecome
resistanttotreatment.[179]Theprojectwilllookattumorsamplesfrom850NSCLCpatientsatvariousstages
includingdiagnosis,afterfirsttreatment,posttreatment,andrelapse.[180]Bystudyingsamplesatdifferent
pointsoftumordevelopment,theresearchershopetoidentifythechangesthatdrivetumorgrowthand
resistancetotreatment.Theresultsofthisprojectwillhelpscientistsanddoctorsgainabetterunderstandingof
NSCLCandpotentiallyleadtothedevelopmentofnewtreatmentsforthedisease.[179]

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Forlungcancercasesthatdevelopresistancetoepidermalgrowthfactorreceptor(EGFR)andanaplastic
lymphomakinase(ALK)tyrosinekinaseinhibitors,newdrugsareindevelopment.NewEGFRinhibitors
includeafatinibanddacomitinib.Analternativesignalingpathway,cMet,canbeinhibitedbytivantiniband
onartuzumab.NewALKinhibitorsincludecrizotinibandceritinib.[181]

References
1."LungCarcinoma:TumorsoftheLungs".MerckManualProfessionalEdition,Onlineedition.Retrieved15August
2007.
2."NonSmallCellLungCancerTreatmentPatientVersion(PDQ)".NCI.May12,2015.Retrieved5March2016.
3.Falk,SWilliams,C(2010)."Chapter1".LungCancerthefacts(3rded.).OxfordUniversityPress.pp.34.
ISBN9780199569335.
4.WorldCancerReport2014.WorldHealthOrganization.2014.pp.Chapter5.1.ISBN9283204298.
5."LungCancerPatientVersion".NCI.Retrieved5March2016.
6.Horn,LLovly,CMJohnson,DH(2015)."Chapter107:Neoplasmsofthelung".InKasper,DLHauser,SL
Jameson,JLFauci,ASLongo,DLLoscalzo,J.Harrison'sPrinciplesofInternalMedicine(19thed.).McGraw
Hill.ISBN9780071802161.
7.Alberg,AJBrock,MVSamet,JM(2016)."52:Epidemiologyoflungcancer".Murray&Nadel'sTextbookof
RespiratoryMedicine(6thed.).SaundersElsevier.ISBN9781455733835.
8.ThunMJ,HannanLM,AdamsCampbellLL,etal.(September2008)."Lungcanceroccurrenceinneversmokers:an
analysisof13cohortsand22cancerregistrystudies".PLoSMedicine.5(9):e185.
doi:10.1371/journal.pmed.0050185.PMC2531137 .PMID18788891.
9.Carmona,RH(27June2006)."TheHealthConsequencesofInvoluntaryExposuretoTobaccoSmoke:AReportof
theSurgeonGeneral".U.S.DepartmentofHealthandHumanServices."Secondhandsmokeexposurecausesdisease
andprematuredeathinchildrenandadultswhodonotsmoke."Retrieved20140616
10.O'Reilly,KMMclaughlinAMBeckettWSSimePJ(March2007)."Asbestosrelatedlungdisease".American
FamilyPhysician.75(5):683688.PMID17375514.
11."TobaccoSmokeandInvoluntarySmoking"(PDF).IARCMonographsontheEvaluationofCarcinogenicRisksto
Humans.WHOInternationalAgencyforResearchonCancer.83.2004."Thereissufficientevidencethatinvoluntary
smoking(exposuretosecondhandor'environmental'tobaccosmoke)causeslungcancerinhumans....Involuntary
smoking(exposuretosecondhandor'environmental'tobaccosmoke)iscarcinogenictohumans(Group1)."
12.LuC,OnnA,VaporciyanAA,etal.(2010)."78:CanceroftheLung".HollandFreiCancerMedicine(8thed.).
People'sMedicalPublishingHouse.ISBN9781607950141.
13.Collins,LGHainesCPerkelREnckRE(January2007)."Lungcancer:diagnosisandmanagement".American
FamilyPhysician.AmericanAcademyofFamilyPhysicians.75(1):5663.PMID17225705.
14."LungCancerPreventionPatientVersion(PDQ)".NCI.November4,2015.Retrieved5March2016.
15.Chapman,SRobinsonGStradlingJWestS(2009)."Chapter31".OxfordHandbookofRespiratoryMedicine(2nd
ed.).OxfordUniversityPress.ISBN9780199545162.
16.WorldCancerReport2014.WorldHealthOrganization.2014.pp.Chapter1.1.ISBN9283204298.
17."Surveillance,EpidemiologyandEndResultsProgram".NationalCancerInstitute.Retrieved5Mar2016.
18.Majumder,editedbySadhan(2009).Stemcellsandcancer(OnlineAusg.ed.).NewYork:Springer.p.193.
ISBN9780387896113.
19.Honnorat,JAntoineJC(May2007)."Paraneoplasticneurologicalsyndromes".OrphanetJournalofRareDiseases.
BioMedCentral.2(1):22.doi:10.1186/17501172222.PMC1868710 .PMID17480225.
20.Greene,FrederickL.(2002).AJCCcancerstagingmanual.Berlin:SpringerVerlag.ISBN0387952713.
21.BrownKM,KeatsJJ,SekulicA,etal.(2010)."Chapter8".HollandFreiCancerMedicine(8thed.).People's
MedicalPublishingHouseUSA.ISBN9781607950141.
22.BiesalskiHK,BuenodeMesquitaB,ChessonA,etal.(1998)."EuropeanConsensusStatementonLungCancer:
riskfactorsandprevention.LungCancerPanel".CACancerJClin.Smokingisthemajorriskfactor,accountingfor
about90%oflungcancerincidence.48(3):167176discussion164166.doi:10.3322/canjclin.48.3.167.
PMID9594919.
23.Hecht,SS(2012)."Lungcarcinogenesisbytobaccosmoke".InternationalJournalofCancer.131(12):27242732.
doi:10.1002/ijc.27816.PMC3479369 .PMID22945513.
24.Kumar,VAbbasAKAsterJC(2013)."Chapter5".RobbinsBasicPathology(9thed.).ElsevierSaunders.p.199.
ISBN9781437717815.
25.PetoR,LopezAD,BorehamJ,etal.(2006).Mortalityfromsmokingindevelopedcountries19502000:Indirect
estimatesfromNationalVitalStatistics.OxfordUniversityPress.ISBN0192625357.

https://en.wikipedia.org/wiki/Lung_cancer 18/25
14/02/2017 LungcancerWikipedia

26.CaliforniaEnvironmentalProtectionAgency(1997)."Healtheffectsofexposuretoenvironmentaltobaccosmoke.
CaliforniaEnvironmentalProtectionAgency".TobaccoControl.6(4):346353.doi:10.1136/tc.6.4.346.
PMC1759599 .PMID9583639.
27.CentersforDiseaseControlandPrevention(CDC)(December2001)."Statespecificprevalenceofcurrentcigarette
smokingamongadults,andpoliciesandattitudesaboutsecondhandsmokeUnitedStates,2000".Morbidityand
MortalityWeeklyReport.Atlanta,Georgia:CDC.50(49):11011106.PMID11794619.
28.Alberg,AJSametJM(September2007)."Epidemiologyoflungcancer".Chest.AmericanCollegeofChest
Physicians.132(S3):29S55S.doi:10.1378/chest.071347.PMID17873159.
29.Jaakkola,MSJaakkolaJJ(August2006)."Impactofsmokefreeworkplacelegislationonexposuresandhealth:
possibilitiesforprevention".EuropeanRespiratoryJournal.28(2):397408.doi:10.1183/09031936.06.00001306.
PMID16880370.
30.Parkin,DM(December2011)."TobaccoattributablecancerburdenintheUKin2010".BritishJournalofCancer.
105(Suppl.2):S6S13.doi:10.1038/bjc.2011.475.PMC3252064 .PMID22158323.
31.Taylor,RNajafiFDobsonA(October2007)."Metaanalysisofstudiesofpassivesmokingandlungcancer:effects
ofstudytypeandcontinent".InternationalJournalofEpidemiology.36(5):10481059.doi:10.1093/ije/dym158.
PMID17690135.
32."Frequentlyaskedquestionsaboutsecondhandsmoke".WorldHealthOrganization.Retrieved25July2012.
33.Schick,SGlantzS(December2005)."PhilipMorristoxicologicalexperimentswithfreshsidestreamsmoke:more
toxicthanmainstreamsmoke".TobaccoControl.14(6):396404.doi:10.1136/tc.2005.011288.PMC1748121 .
PMID16319363.
34.Greydanus,DEHawverEKGreydanusMM(October2013)."Marijuana:currentconcepts".FrontiersinPublic
Health.1(42).doi:10.3389/fpubh.2013.00042.PMC3859982 .PMID24350211.
35.Owen,KPSutter,MEAlbertson,TE(February2014)."Marijuana:respiratorytracteffects.".Clinicalreviewsin
allergy&immunology.46(1):6581.doi:10.1007/s120160138374y.PMID23715638.
36.Joshi,MJoshi,ABartter,T(March2014)."Marijuanaandlungdiseases.".CurrentOpinioninPulmonary
Medicine.20(2):173179.doi:10.1097/mcp.0000000000000026.PMID24384575.
37.Tashkin,DP(June2013)."Effectsofmarijuanasmokingonthelung.".AnnalsoftheAmericanThoracicSociety.10
(3):23947.doi:10.1513/annalsats.201212127fr.PMID23802821.
38.Underner,MUrbanTPerriotJ(June2014)."Cannabissmokingandlungcancer".RevuedesMaladies
Respiratoires.31(6):488498.doi:10.1016/j.rmr.2013.12.002.PMID25012035.
39.Choi,HMazzone,P(September2014)."Radonandlungcancer:assessingandmitigatingtherisk".ClevelandClinic
JournalofMedicine.81(9):567575.doi:10.3949/ccjm.81a.14046.PMID25183848.
40."Radon(Rn)HealthRisks".EPA.
41.SchmidK,KuwertT,DrexlerH(March2010)."RadoninIndoorSpaces:AnUnderestimatedRiskFactorforLung
CancerinEnvironmentalMedicine".DtschArzteblInt.107(11):1816.doi:10.3238/arztebl.2010.0181.
PMC2853156 .PMID20386676.
42.EPA(February2013)."Radiationinformation:radon".EPA.
43.Tobias,JHochhauserD(2010)."Chapter12".CanceranditsManagement(6thed.).WileyBlackwell.p.199.
ISBN9781405170154.
44.Davies,RJOLeeYCG(2010)."18.19.3".OxfordTextbookMedicine(5thed.).OUPOxford.ISBN978019
9204854.
45.Chen,HGoldbergMSVilleneuvePJ(OctDec2008)."Asystematicreviewoftherelationbetweenlongterm
exposuretoambientairpollutionandchronicdiseases".ReviewsonEnvironmentalHealth.23(4):243297.
doi:10.1515/reveh.2008.23.4.243.PMID19235364.
46.Clapp,RWJacobsMMLoechlerEL(JanMar2008)."EnvironmentalandOccupationalCausesofCancerNew
Evidence,20052007".ReviewsonEnvironmentalHealth.23(1):137.doi:10.1515/REVEH.2008.23.1.1.
PMC2791455 .PMID18557596.
47.Lim,WYSeow,A(January2012)."Biomassfuelsandlungcancer.".Respirology(Carlton,Vic.).17(1):2031.
doi:10.1111/j.14401843.2011.02088.x.PMID22008241.
48.Sood,A(December2012)."Indoorfuelexposureandthelunginbothdevelopinganddevelopedcountries:an
update.".Clinicsinchestmedicine.33(4):64965.doi:10.1016/j.ccm.2012.08.003.PMID23153607.
49.Yang,IAHolloway,JWFong,KM(October2013)."Geneticsusceptibilitytolungcancerandcomorbidities".
JournalofThoracicDisease.5(Suppl.5):S454S462.doi:10.3978/j.issn.20721439.2013.08.06.PMC3804872 .
PMID24163739.
50.DelaCruz,CSTanoue,LTMatthay,RA(2015)."Chapter109:Epidemiologyoflungcancer".InGrippi,MAElias,
JAFishman,JAKotloff,RMPack,AISenior,RM.Fishman'sPulmonaryDiseasesandDisorders(5thed.).
McGrawHill.p.1673.ISBN9780071796729.
51.Larsen,JEMinnaD(December2011)."Molecularbiologyoflungcancer:clinicalimplications".ClinicsinChest
Medicine.32(4):703740.doi:10.1016/j.ccm.2011.08.003.PMC3367865 .PMID22054881.

https://en.wikipedia.org/wiki/Lung_cancer 19/25
14/02/2017 LungcancerWikipedia

52.Cogliano,VJBaan,RStraif,KGrosse,YLaubySecretan,BElGhissassi,FBouvard,VBenbrahimTallaa,L
Guha,NFreeman,CGalichet,LWild,CP(21December2011)."Preventableexposuresassociatedwithhuman
cancers."(PDF).JournaloftheNationalCancerInstitute.103(24):182739.doi:10.1093/jnci/djr483.
PMID22158127.
53.Cooper,WALamDLCO'TooleSA(October2013)."Molecularbiologyoflungcancer"(PDF).JournalofThoracic
Disease.5(Suppl.5):S.479490.doi:10.3978/j.issn.20721439.2013.08.03.PMC3804875 .PMID24163741.
54.Tobias,JHochhauserD(2010)."Chapter12".CanceranditsManagement(6thed.).WileyBlackwell.p.200.
ISBN9781405170154.
55.Herbst,RSHeymachJVLippmanSM(September2008)."Lungcancer".NewEnglandJournalofMedicine.359
(13):13671380.doi:10.1056/NEJMra0802714.PMID18815398.
56.AvielRonen,SBlackhallFHShepherdFATsaoMS(July2006)."Krasmutationsinnonsmallcelllung
carcinoma:areview".ClinicalLungCancer.CancerInformationGroup.8(1):3038.doi:10.3816/CLC.2006.n.030.
PMID16870043.
57.Kumar,VAbbasAKAsterJC(2013)."Chapter5".RobbinsBasicPathology(9thed.).ElsevierSaunders.p.212.
ISBN9781437717815.
58.Jakopovic,MThomasABalasubramaniamS(October2013)."Targetingtheepigenomeinlungcancer:expanding
approachestoepigenetictherapy"(PDF).FrontiersinOncology.3(261).doi:10.3389/fonc.2013.00261.
PMC3793201 .PMID24130964.
59.Mulvihill,MSKratzJRPhamP(February2013)."Theroleofstemcellsinairwayrepair:implicationsforthe
originsoflungcancer".ChineseJournalofCancer.32(2):7174.doi:10.5732/cjc.012.10097.PMC3845611 .
PMID23114089.
60.Powell,CAHalmosBNanaSinkamSP(July2013)."Updateinlungcancerandmesothelioma2012"(PDF).
AmericanJournalofRespiratoryandCriticalCareMedicine.188(2):157166.doi:10.1164/rccm.2013040716UP.
PMC3778761 .PMID23855692.
61.Ost,D(2015)."Chapter110:Approachtothepatientwithpulmonarynodules".InGrippi,MAElias,JAFishman,
JAKotloff,RMPack,AISenior,RM.Fishman'sPulmonaryDiseasesandDisorders(5thed.).McGrawHill.
p.1685.ISBN9780071796729.
62.Frank,LQuint,LE(March2012)."ChestCTincidentalomas:thyroidlesions,enlargedmediastinallymphnodes,
andlungnodules".CancerImaging.12(1):4148.doi:10.1102/14707330.2012.0006.PMC3335330 .
PMID22391408.
63.AmericanCollegeofChestPhysiciansAmericanThoracicSociety(September2013),"FiveThingsPhysiciansand
PatientsShouldQuestion",ChoosingWisely:aninitiativeoftheABIMFoundation,AmericanCollegeofChest
PhysiciansandAmericanThoracicSociety,retrieved6January2013
64.Smokersdefinedascurrentorformersmokerofmorethan1yearofduration.SeeimagepageinCommonsfor
percentagesinnumbers.Reference:Table2(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044470/table/T2/)in:
Kenfield,SAWei,EKStampfer,MJRosner,BAColditz,GA(2008)."Comparisonofaspectsofsmoking
amongthefourhistologicaltypesoflungcancer".TobaccoControl.17(3):198204.doi:10.1136/tc.2007.022582.
PMC3044470 .PMID18390646.
65.Kumar,VAbbasAKAsterJC(2013)."12".RobbinsBasicPathology(9thed.).ElsevierSaunders.p.505.
ISBN9781437717815.
66.Subramanian,JGovindanR(February2007)."Lungcancerinneversmokers:areview".JournalofClinical
Oncology.AmericanSocietyofClinicalOncology.25(5):561570.doi:10.1200/JCO.2006.06.8015.
PMID17290066.
67.Raz,DJHeBRosellRJablonsDM(March2006)."Bronchioloalveolarcarcinoma:areview".ClinicalLung
Cancer.7(5):313322.doi:10.3816/CLC.2006.n.012.PMID16640802.
68.RostiG,BevilacquaG,BidoliP,etal.(March2006)."Smallcelllungcancer".AnnalsofOncology.17(Suppl.2):5
10.doi:10.1093/annonc/mdj910.PMID16608983.
69.SeoJB,ImJG,GooJM,etal.(1March2001)."Atypicalpulmonarymetastases:spectrumofradiologicfindings".
Radiographics.21(2):403417.doi:10.1148/radiographics.21.2.g01mr17403.PMID11259704.
70.TanD,ZanderDS(2008)."ImmunohistochemistryforAssessmentofPulmonaryandPleuralNeoplasms:AReview
andUpdate".IntJClinExpPathol.1(1):1931.PMC2480532 .PMID18784820.
71.ConnollyJL,GoldsmithJD,WangHH,etal.(2010)."37:PrinciplesofCancerPathology".HollandFreiCancer
Medicine(8thed.).People'sMedicalPublishingHouse.ISBN9781607950141.
72.Chheang,SBrownK(June2013)."Lungcancerstaging:clinicalandradiologicperspectives".Seminarsin
InterventionalRadiology.30(2):99113.doi:10.1055/s00331342950.PMC3709937 .PMID24436525.
73.RamiPorta,RCrowleyJJGoldstrawP(February2009)."TherevisedTNMstagingsystemforlungcancer"(PDF).
AnnalsofThoracicandCardiovascularSurgery.15(1):49.PMID19262443.
74.DelaCruz,CSTanoueLTMatthayRA(December2011)."Lungcancer:epidemiology,etiology,andprevention"
(PDF).ClinicinChestMedicine.32(4):605644.doi:10.1016/j.ccm.2011.09.001.PMC3864624 .
PMID22054876.

https://en.wikipedia.org/wiki/Lung_cancer 20/25
14/02/2017 LungcancerWikipedia

75.Goodman,GE(November2002)."Lungcancer.1:preventionoflungcancer"(PDF).Thorax.57(11):994999.
doi:10.1136/thorax.57.11.994.PMC1746232 .PMID12403886.
76.McNabola,AGillLW(February2009)."Thecontrolofenvironmentaltobaccosmoke:apolicyreview".
InternationalJournalofEnvironmentalResearchandPublicHealth.6(2):741758.doi:10.3390/ijerph6020741.
PMC2672352 .PMID19440413.
77.Pandey,G(February2005)."Bhutan'ssmokersfacepublicban".BBC.Retrieved7September2007.
78.Pandey,G(2October2008)."Indianbanonsmokinginpublic".BBC.Retrieved25April2012.
79."UNhealthagencycallsfortotalbanontobaccoadvertisingtoprotectyoung"(Pressrelease).UnitedNationsNews
service.30May2008.
80.Gutierrez,ASuhRAbtinF(June2013)."Lungcancerscreening".SeminarsinInterventionalRadiology.30(2):
114120.doi:10.1055/s00331342951.PMC3709936 .PMID24436526.
81.UsmanAli,MMiller,JPeirson,LFitzpatrickLewis,DKenny,MSherifali,DRaina,P(August2016).
"Screeningforlungcancer:Asystematicreviewandmetaanalysis.".Preventivemedicine.89:30114.
doi:10.1016/j.ypmed.2016.04.015.PMID27130532.
82.JaklitschMT,JacobsonFL,AustinJH,etal.(July2012)."TheAmericanAssociationforThoracicSurgery
guidelinesforlungcancerscreeningusinglowdosecomputedtomographyscansforlungcancersurvivorsandother
highriskgroups".JournalofThoracicandCardiovascularSurgery.144(1):3338.doi:10.1016/j.jtcvs.2012.05.060.
PMID22710039.
83.BachPB,MirkinJN,OliverTK,etal.(June2012)."BenefitsandharmsofCTscreeningforlungcancer:a
systematicreview".JAMA:TheJournaloftheAmericanMedicalAssociation.307(22):24182429.
doi:10.1001/jama.2012.5521.PMC3709596 .PMID22610500.
84.Aberle,D.R.Abtin,F.Brown,K.(2013)."ComputedTomographyScreeningforLungCancer:HasItFinally
Arrived?ImplicationsoftheNationalLungScreeningTrial".JournalofClinicalOncology.31(8):10021008.
doi:10.1200/JCO.2012.43.3110.ISSN0732183X.PMID23401434.
85.BachPB,MirkinJN,OliverTK,etal.(June2012)."BenefitsandharmsofCTscreeningforlungcancer:a
systematicreview".JAMA.307(22):241829.doi:10.1001/jama.2012.5521.PMC3709596 .PMID22610500.
86.ManserR,LethabyA,IrvingLB,StoneC,ByrnesG,AbramsonMJ,CampbellD(2013)."Screeningforlung
cancer".CochraneDatabaseofSystematicReviews.6(6):CD001991.doi:10.1002/14651858.CD001991.pub3.
PMID23794187.
87.Moyer,VAU.S.PreventiveServicesTask,Force(Mar4,2014)."Screeningforlungcancer:U.S.Preventive
ServicesTaskForcerecommendationstatement.".AnnalsofInternalMedicine.160(5):3308.doi:10.7326/M13
2771.PMID24378917.
88.Baldwin,DRHansell,DMDuffy,SWField,JK(Mar7,2014)."Lungcancerscreeningwithlowdosecomputed
tomography.".BMJ(Clinicalresearched.).348:g1970.doi:10.1136/bmj.g1970.PMID24609921.
89.Fabricius,PLangeP(JulySeptember2003)."Dietandlungcancer".MonaldiArchivesforChestDisease.59(3):
207211.PMID15065316.
90.FritzH,KennedyD,FergussonD,etal.(2011)."VitaminAandRetinoidDerivativesforLungCancer:ASystematic
ReviewandMetaAnalysis".PLoSONE.6(6):e21107.doi:10.1371/journal.pone.0021107.PMC3124481 .
PMID21738614.
91.HerrC,GreulichT,KoczullaRA,etal.(March2011)."TheroleofvitaminDinpulmonarydisease:COPD,asthma,
infection,andcancer".RespiratoryResearch.12(1):31.doi:10.1186/146599211231.PMC3071319 .
PMID21418564.
92.Key,TJ(January2011)."Fruitandvegetablesandcancerrisk".BritishJournalofCancer.104(1):611.
doi:10.1038/sj.bjc.6606032.PMC3039795 .PMID21119663.
93.Bradbury,KEAppleby,PNKey,TJ(June2014)."Fruit,vegetable,andfiberintakeinrelationtocancerrisk:
findingsfromtheEuropeanProspectiveInvestigationintoCancerandNutrition(EPIC)".AmericanJournalof
ClinicalNutrition.100(Suppl.1):394S398S.doi:10.3945/ajcn.113.071357.PMID24920034.
94.Ferrell,BKoczywasMGrannisFHarringtonA(April2011)."Palliativecareinlungcancer".SurgicalClinicsof
NorthAmerica.91(2):403417.doi:10.1016/j.suc.2010.12.003.PMID21419260.
95.Chang,LRivera,MP(2015)."Chapter112:Clinicalevaluation,diagnosis,andstagingoflungcancer".InGrippi,
MAElias,JAFishman,JAKotloff,RMPack,AISenior,RM.Fishman'sPulmonaryDiseasesandDisorders
(5thed.).McGrawHill.p.1728.ISBN9780071796729.
96.Reznik,SISmythe,WR(2015)."Chapter113:Treatmentofnonsmallcelllungcancer:surgery".InGrippi,MA
Elias,JAFishman,JAKotloff,RMPack,AISenior,RM.Fishman'sPulmonaryDiseasesandDisorders(5th
ed.).McGrawHill.p.17371738.ISBN9780071796729.
97.Alam,NFloresRM(JulySeptember2007)."Videoassistedthoracicsurgery(VATS)lobectomy:theevidence
base".JournaloftheSocietyofLaparoendoscopicSurgeons.11(3):368374.PMC3015831 .PMID17931521.
98.Rueth,NMAndradeRS(June2010)."IsVATSlobectomybetter:perioperatively,biologicallyandoncologically?".
AnnalsofThoracicSurgery.89(6):S2107S2111.doi:10.1016/j.athoracsur.2010.03.020.PMID20493991.
99.SimonGR,TurrisiA(September2007)."Managementofsmallcelllungcancer:ACCPevidencebasedclinical
practiceguidelines(2ndedition)".Chest.132(3Suppl):324S339S.doi:10.1378/chest.071385.PMID17873178.
https://en.wikipedia.org/wiki/Lung_cancer 21/25
14/02/2017 LungcancerWikipedia

100.Goldstein,SDYangSC(October2011)."Roleofsurgeryinsmallcelllungcancer".SurgicalOncologyClinicsof
NorthAmerica.20(4):769777.doi:10.1016/j.soc.2011.08.001.PMID21986271.
101.Arriagada,RGoldstrawPLeChevalierT(2002).OxfordTextbookofOncology(2nded.).OxfordUniversityPress.
p.2094.ISBN0192629263.
102.Hatton,MQMartinJE(June2010)."Continuoushyperfractionatedacceleratedradiotherapy(CHART)andnon
conventionallyfractionatedradiotherapyinthetreatmentofnonsmallcelllungcancer:areviewandconsiderationof
futuredirections".ClinicalOncology(RoyalCollegeofRadiologists).22(5):356364.
doi:10.1016/j.clon.2010.03.010.PMID20399629.
103.PORTMetaanalysisTrialistsGroup(2005).Rydzewska,Larysa,ed."Postoperativeradiotherapyfornonsmallcell
lungcancer".CochraneDatabaseofSystematicReviews(2):CD002142.doi:10.1002/14651858.CD002142.pub2.
PMID15846628.
104.LePchoux,C(2011)."Roleofpostoperativeradiotherapyinresectednonsmallcelllungcancer:areassessment
basedonnewdata".Oncologist.16(5):672681.doi:10.1634/theoncologist.20100150.PMC3228187 .
PMID21378080.
105.Ikushima,H(February2010)."Radiationtherapy:stateoftheartandthefuture".JournalofMedicalInvestigation.
57(12):111.doi:10.2152/jmi.57.1.PMID20299738.
106.Reveiz,LRueda,JRCardona,AF(12December2012)."Palliativeendobronchialbrachytherapyfornonsmallcell
lungcancer".TheCochranedatabaseofsystematicreviews.12:CD004284.doi:10.1002/14651858.CD004284.pub3.
PMID23235606.
107.Paumier,ACuencaXLePchouxC(June2011)."Prophylacticcranialirradiationinlungcancer".Cancer
TreatmentReviews.37(4):261265.doi:10.1016/j.ctrv.2010.08.009.PMID20934256.
108.Girard,NMornexF(October2011)."Stereotacticradiotherapyfornonsmallcelllungcancer:Fromconceptto
clinicalreality.2011update".CancerRadiothrapie.15(67):522526.doi:10.1016/j.canrad.2011.07.241.
PMID21889901.
109.FairchildA,HarrisK,BarnesE,etal.(August2008)."Palliativethoracicradiotherapyforlungcancer:asystematic
review".JournalofClinicalOncology.26(24):40014011.doi:10.1200/JCO.2007.15.3312.PMID18711191.
110.HannCL,RudinCM(30November2008)."Managementofsmallcelllungcancer:incrementalchangesbuthopefor
thefuture".Oncology(WillistonPark).22(13):148692.PMID19133604.
111.Murray,NTurrisiAT(March2006)."Areviewoffirstlinetreatmentforsmallcelllungcancer".Journalof
ThoracicOncology.1(3):270278.PMID17409868.
112.Azim,HAGantiAK(March2007)."Treatmentoptionsforrelapsedsmallcelllungcancer".AntiCancerDrugs.18
(3):255261.doi:10.1097/CAD.0b013e328011a547.PMID17264756.
113.MacCallum,CGillenwaterHH(July2006)."Secondlinetreatmentofsmallcelllungcancer".CurrentOncology
Reports.8(4):258264.doi:10.1007/s1191200600308.PMID17254525.
114.NSCLCMetaAnalysesCollaborativeGroup(October2008)."ChemotherapyinAdditiontoSupportiveCare
ImprovesSurvivalinAdvancedNonSmallCellLungCancer:ASystematicReviewandMetaAnalysisofIndividual
PatientDataFrom16RandomizedControlledTrials".J.Clin.Oncol.26(28):461725.
doi:10.1200/JCO.2008.17.7162.PMC2653127 .PMID18678835.
115.Carr,LLJett,JR(2015)."Chapter114:Treatmentofnonsmallcelllungcancer:chemotherapy".InGrippi,MA
Elias,JAFishman,JAKotloff,RMPack,AISenior,RM.Fishman'sPulmonaryDiseasesandDisorders(5th
ed.).McGrawHill.p.1752.ISBN9780071796729.
116.CleggA,ScottDA,HewitsonP,etal.(January2002)."Clinicalandcosteffectivenessofpaclitaxel,docetaxel,
gemcitabine,andvinorelbineinnonsmallcelllungcancer:asystematicreview".Thorax.BMJPublishingGroup.57
(1):2028.doi:10.1136/thorax.57.1.20.PMC1746188 .PMID11809985.
117.FuldAD,DragnevKH,RigasJR(June2010)."Pemetrexedinadvancednonsmallcelllungcancer".ExpertOpin
Pharmacother.11(8):1387402.doi:10.1517/14656566.2010.482560.PMID20446853.
118.Carbone,DPFelipE(September2011)."Adjuvanttherapyinnonsmallcelllungcancer:futuretreatmentprospects
andparadigms".ClinicalLungCancer.12(5):261271.doi:10.1016/j.cllc.2011.06.002.PMID21831720.
119.LeChevalier,T(October2010)."Adjuvantchemotherapyforresectablenonsmallcelllungcancer:whereisit
going?".AnnalsofOncology.21(Suppl.7):vii196198.doi:10.1093/annonc/mdq376.PMID20943614.
120.Horn,LSandlerABPutnamJBJrJohnsonDH(May2007)."TherationaleforadjuvantchemotherapyinstageI
nonsmallcelllungcancer".JournalofThoracicOncology.2(5):377383.
doi:10.1097/01.JTO.0000268669.64625.bb.PMID17473651.
121.Wakelee,HASchillerJHGandaraDR(July2006)."CurrentstatusofadjuvantchemotherapyforstageIBnon
smallcelllungcancer:implicationsfortheNewIntergroupTrial".ClinicalLungCancer.CancerInformationGroup.
8(1):1821.doi:10.3816/CLC.2006.n.028.PMID16870041.
122.NSCLCMetaanalysisCollaborative,Group(May3,2014)."Preoperativechemotherapyfornonsmallcelllung
cancer:asystematicreviewandmetaanalysisofindividualparticipantdata.".Lancet.383(9928):156171.
doi:10.1016/S01406736(13)621595.PMC4022989 .PMID24576776.

https://en.wikipedia.org/wiki/Lung_cancer 22/25
14/02/2017 LungcancerWikipedia

123.SouquetPJ,ChauvinF,BoisselJP,BernardJP(April1995)."Metaanalysisofrandomisedtrialsofsystemic
chemotherapyversussupportivetreatmentinnonresectablenonsmallcelllungcancer".LungCancer.12Suppl1:
S14754.doi:10.1016/01695002(95)004309.PMID7551923.
124.SrensonS,GlimeliusB,NygrenP(2001)."Asystematicoverviewofchemotherapyeffectsinnonsmallcelllung
cancer".ActaOncologica.40(23):32739.doi:10.1080/02841860151116402.PMID11441939.
125.CleggA,ScottDA,SidhuM,HewitsonP,WaughN(2001)."Arapidandsystematicreviewoftheclinical
effectivenessandcosteffectivenessofpaclitaxel,docetaxel,gemcitabineandvinorelbineinnonsmallcelllung
cancer".HealthTechnologyAssessment.5(32):1195.PMID12065068.
126.NonSmallCellLungCancerCollaborative,Group(12May2010)."Chemotherapyandsupportivecareversus
supportivecarealoneforadvancednonsmallcelllungcancer.".TheCochranedatabaseofsystematicreviews(5):
CD007309.doi:10.1002/14651858.CD007309.pub2.PMID20464750.
127.D'AntonioPassaroAGoriB(May2014)."Boneandbrainmetastasisinlungcancer:recentadvancesintherapeutic
strategies".TherapeuticAdvancesinMedicalOncology.6(3):101114.doi:10.1177/1758834014521110.
PMC3987652 .PMID24790650.
128.Lazarus,DREapen,GA(2014)."Chapter16:Bronchoscopicinterventionsforlungcancer".InRoth,JAHong,
WKKomaki,RU.LungCancer(4thed.).WileyBlackwell.ISBN9781118468746.
129.Khemasuwan,DMehta,ACWang,KP(December2015)."Past,present,andfutureofendobronchiallaser
photoresection".JournalofThoracicDisease.7(Suppl.4):S380S388.doi:10.3978/j.issn.20721439.2015.12.55.
PMC4700383 .PMID26807285.
130.Parikh,RBKirch,RASmith,TJTemel,JS(12December2013)."Earlyspecialtypalliativecaretranslatingdata
inoncologyintopractice.".TheNewEnglandJournalofMedicine.369(24):234751.doi:10.1056/nejmsb1305469.
PMC3991113 .PMID24328469.
131.KelleyAS,MeierDE(August2010)."Palliativecareashiftingparadigm".NewEnglandJournalofMedicine.363
(8):7812.doi:10.1056/NEJMe1004139.PMID20818881.
132.PrincePaulM(April2009)."Whenhospiceisthebestoption:anopportunitytoredefinegoals".Oncology(Williston
Park,N.Y.).23(4SupplNurseEd):137.PMID19856592.
133.Ridge,CAMcErleanAMGinsbergMS(June2013)."Epidemiologyoflungcancer".SeminarsinInterventional
Radiology.30(2):9398.doi:10.1055/s00331342949.PMC3709917 .PMID24436524.
134."Lungcancersurvivalstatistics".CancerResearchUK.
135."Lungcancersurvivalstatistics".Retrieved28October2014.
136."NonSmallCellLungCancerTreatment".PDQforHealthProfessionals.NationalCancerInstitute.
PMID26389304.Retrieved17November2015.
137."SmallCellLungCancerTreatment".PDQforHealthProfessionals.NationalCancerInstitute.2012.Retrieved
16May2012.
138.Spiro,SG(2010)."18.19.1".OxfordTextbookMedicine(5thed.).OUPOxford.ISBN9780199204854.
139.SEERdata(SEER.cancer.gov)MedianAgeofCancerPatientsatDiagnosis20022003(http://seer.cancer.gov/csr/19
75_2003/results_single/sect_01_table.11_2pgs.pdf)
140.SEERdata(SEER.cancer.gov)MedianAgeofCancerPatientsatDeath20022006(http://seer.cancer.gov/csr/1975_2
006/results_single/sect_01_table.13_2pgs.pdf)
141.Slatore,CGAuDHGouldMK(November2010)."AnofficialAmericanThoracicSocietysystematicreview:
insurancestatusanddisparitiesinlungcancerpracticesandoutcomes".AmericanJournalofRespiratoryandCritical
CareMedicine.182(9):11951205.doi:10.1164/rccm.2009038ST.PMID21041563.
142.Stewart,editedbyBernardW.Wild,ChristopherP.(2014).Worldcancerreport2014.Lyon:IARCPress.pp.350
352.ISBN9789283204299.
143.JemalA,TiwariRC,MurrayT,etal.(2004)."Cancerstatistics,2004".CA:ACancerJournalforClinicians.54
(1):829.doi:10.3322/canjclin.54.1.8.PMID14974761.
144.Proctor,RN(March2012)."Thehistoryofthediscoveryofthecigarettelungcancerlink:evidentiarytraditions,
corporatedenial,globaltoll".TobaccoControl.21(2):8791.doi:10.1136/tobaccocontrol2011050338.
PMID22345227.
145.Lum,KLPolanskyJRJacklerRKGlantzSA(October2008)."Signed,sealedanddelivered:"bigtobacco"in
Hollywood,19271951".TobaccoControl.17(5):313323.doi:10.1136/tc.2008.025445.PMC2602591 .
PMID18818225.
146.Lovato,CWattsASteadLF(October2011)."Impactoftobaccoadvertisingandpromotiononincreasingadolescent
smokingbehaviours".CochraneDatabaseofSystematicReviews(10):CD003439.
doi:10.1002/14651858.CD003439.pub2.PMID21975739.
147.Kemp,FB(JulSep2009)."SmokefreepoliciesinEurope.Anoverview".Pneumologia.58(3):155158.
PMID19817310.
148.NationalCancerInstituteSEERstatfactsheets:LungandBronchus.SurveillanceEpidemiologyandEndResults.
2010[1](http://seer.cancer.gov/statfacts/html/lungb.html#incidencemortality)
149."Genderinlungcancerandsmokingresearch"(PDF).WorldHealthOrganization.2004.Retrieved26May2007.

https://en.wikipedia.org/wiki/Lung_cancer 23/25
14/02/2017 LungcancerWikipedia

150.Zhang,JOuJXBaiCX(November2011)."TobaccosmokinginChina:prevalence,diseaseburden,challengesand
futurestrategies".Respirology.16(8):11651172.doi:10.1111/j.14401843.2011.02062.x.PMID21910781.
151.Behera,DBalamugeshT(2004)."LungcancerinIndia"(PDF).IndianJournalofChestDiseasesandAllied
Sciences.46(4):269281.PMID15515828.
152."HONORINGVETERANSWITHGOODHEALTH".November7,2014.Retrieved1December2015.
153."LungCancerAsItAffectsVeteransAndMilitary".Retrieved1December2015.
154."Cancerincidencestatistics".CancerResearchUK.Retrieved20December2016.
155."Lungcancerstatistics".CancerResearchUK.Retrieved20December2016.
156.CharlouxA,QuoixE,WolkoveN,etal.(February1997)."Theincreasingincidenceoflungadenocarcinoma:reality
orartefact?Areviewoftheepidemiologyoflungadenocarcinoma".InternationalJournalofEpidemiology.26(1):
1423.doi:10.1093/ije/26.1.14.PMID9126499.
157.Kadara,HKabboutMWistubaII(January2012)."Pulmonaryadenocarcinoma:arenewedentityin2011".
Respirology.17(1):5065.doi:10.1111/j.14401843.2011.02095.x.PMID22040022.
158.Morgagni,GiovanniBattista(1761).Desedibusetcausismorborumperanatomenindagatis.OL24830495M.
159.Bayle,GaspardLaurent(1810).Recherchessurlaphthisiepulmonaire(inFrench).Paris.OL15355651W.
160.Witschi,H(November2001)."Ashorthistoryoflungcancer".ToxicologicalSciences.64(1):46.
doi:10.1093/toxsci/64.1.4.PMID11606795.
161.Adler,I(1912).PrimaryMalignantGrowthsoftheLungsandBronchi.NewYork:Longmans,Green,andCompany.
OCLC14783544.OL24396062M.,citedinSpiroSG,SilvestriGA(2005)."Onehundredyearsoflungcancer".
AmericanJournalofRespiratoryandCriticalCareMedicine.172(5):523529.doi:10.1164/rccm.200504531OE.
PMID15961694.
162.Grannis,FW."Historyofcigarettesmokingandlungcancer".smokinglungs.com.Archivedfromtheoriginalon18
July2007.Retrieved6August2007.
163.Proctor,R(2000).TheNaziWaronCancer.PrincetonUniversityPress.pp.173246.ISBN0691001960.
164.Doll,RHillAB(November1956)."LungCancerandOtherCausesofDeathinRelationtoSmoking".British
MedicalJournal.2(5001):10711081.doi:10.1136/bmj.2.5001.1071.PMC2035864 .PMID13364389.
165.USDepartmentofHealthEducationandWelfare(1964)."Smokingandhealth:reportoftheadvisorycommitteeto
theSurgeonGeneralofthePublicHealthService"(PDF).Washington,DC:USGovernmentPrintingOffice.
166.Greaves,M(2000).Cancer:theEvolutionaryLegacy.OxfordUniversityPress.pp.196197.ISBN0192628356.
167.Greenberg,MSelikoffIJ(February1993)."LungcancerintheSchneebergmines:areappraisalofthedatareported
byHartingandHessein1879".AnnalsofOccupationalHygiene.37(1):514.doi:10.1093/annhyg/37.1.5.
PMID8460878.
168.Samet,JM(April2011)."Radiationandcancerrisk:acontinuingchallengeforepidemiologists".Environmental
Health.10(Suppl.1):S4.doi:10.1186/1476069X10S1S4.PMC3073196 .PMID21489214.
169.Horn,LJohnsonDH(July2008)."EvartsA.Grahamandthefirstpneumonectomyforlungcancer".Journalof
ClinicalOncology.26(19):32683275.doi:10.1200/JCO.2008.16.8260.PMID18591561.
170.Edwards,AT(1946)."CarcinomaoftheBronchus".Thorax.1(1):125.doi:10.1136/thx.1.1.1.PMC1018207 .
PMID20986395.
171.Kabela,M(1956)."ErfahrungenmitderradikalenRntgenbestrahlungdesBronchienkrebses"[Experiencewith
radicalirradiationofbronchialcancer].CeskoslovenskOnkolgia(inGerman).3(2):109115.PMID13383622.
172.SaundersM,DischeS,BarrettA,etal.(July1997)."Continuoushyperfractionatedacceleratedradiotherapy
(CHART)versusconventionalradiotherapyinnonsmallcelllungcancer:arandomisedmulticentretrial".Lancet.
Elsevier.350(9072):161165.doi:10.1016/S01406736(97)063058.PMID9250182.
173.LennoxSC,FlavellG,PollockDJ,etal.(November1968)."Resultsofresectionforoatcellcarcinomaofthelung".
Lancet.Elsevier.2(7575):925927.doi:10.1016/S01406736(68)91163X.PMID4176258.
174.Miller,ABFoxWTallR(September1969)."FiveyearfollowupoftheMedicalResearchCouncilcomparative
trialofsurgeryandradiotherapyfortheprimarytreatmentofsmallcelledoroatcelledcarcinomaofthebronchus".
Lancet.Elsevier.2(7619):501505.doi:10.1016/S01406736(69)902128.PMID4184834.
175.CohenM,CreavenPJ,FossieckBEJretal.(1977)."Intensivechemotherapyofsmallcellbronchogeniccarcinoma".
CancerTreatmentReports.61(3):349354.PMID194691.
176.Brahmer,JR(February2014)."Immunecheckpointblockade:thehopeforimmunotherapyasatreatmentoflung
cancer?".Seminarsinoncology.41(1):12632.doi:10.1053/j.seminoncol.2013.12.014.PMID24565586.
177.Powell,CAHalmos,BNanaSinkam,SP(July2013)."Updateinlungcancerandmesothelioma2012".American
JournalofRespiratoryandCriticalCareMedicine.188(2):157166.doi:10.1164/rccm.2013040716UP.
PMC3778761 .PMID23855692.
178.Forde,PMBrahmer,JRKelly,RJ(1May2014)."Newstrategiesinlungcancer:epigenetictherapyfornonsmall
celllungcancer.".ClinicalCancerResearch.20(9):22448.doi:10.1158/10780432.ccr132088.PMID24644000.
179.JamalHanjani,MHackshaw,ANgai,Yetal.(July2014)."Trackinggenomiccancerevolutionforprecision
medicine:thelungTRACERxstudy.".PLOSBiology.12(7):e1001906.doi:10.1371/journal.pbio.1001906.
PMC4086714 .PMID25003521.

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180.TRACERxproject,CancerResearchUKscienceblog(http://scienceblog.cancerresearchuk.org/2013/07/18/anewera
inlungcancerresearchthetracerxstudy/)
181.Spaans,JNGoss,GD(August2014)."TrialstoovercomedrugresistancetoEGFRandALKtargetedtherapies
past,present,andfuture".FrontiersinOncology.4(233).doi:10.3389/fonc.2014.00233.PMC4145253 .
PMID25221748.

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