Lung Cancer: Textbook for General Practitioners PDF
Preview Lung Cancer: Textbook for General Practitioners
EUROPE AGAINST CANCER *** * * European Commission Series for General Practitioners * * * * *** •••••• Prepared for the Commission •• •• • of the European Communities ••••• •••••• by the ~ ~ •••0 nClaI0gr Heine H. Hansen (Ed.) Lung Cancer Textbook for General Practitioners With 24 Figures and 21 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona HEINE H. HANSEN, M. D. Department of Oncology Rigshospital University Hospital 9, Blegdamsvej 2100 Copenhagen, Denmark Warning: Neither the Commission of the European Communities nor any person acting on its behalf can accept responsibility for any use made of the information contained herein. ISBN-13: 978-3-540-53075-6 e-ISBN-13: 978-3-642-76031-0 001: 10.1007/978-3-642-76031-0 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its current version, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1990 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 2123/3145-543210 - Printed on acid-free paper Foreword The "Europe against Cancer" programme has, from its inception, emphasised the key role which general practitioners must play in the actions necessary to achieve its aim of reduc ing the incidence and the mortality from cancer in the European Community. General practitioners, because of their day-to-day direct and continuing contact with patients, playa role not only in primary prevention and education of patients, but also in motivating their patients to accept secondary prevention and screening, some of it carried out by general practitioners themselves. These preventive activities are in addition to their traditional role in the care and management of patients with cancer at home, and increas ingly, their role in active treatment. In view of the importance of the general practitioner in the "Europe against Cancer" pro gramme, the European Commission, with a view to providing general practitioners with up-to-date useful information, has sponsored the production of this series of publications on organ based cancers, especially written for general practitioners. MICHEL RICHONNIER Coordinator ofthe "Europe against Cancer" programme, Commission ofthe European Communities, Brussels Preface To decrease the death rate of lung cancer is today one of the major challenges of medical doctors all over the world. In Europe alone, one person is dying of lung cancer every two minutes. Accordingly, most physicians will regularly in their career be confronted with a patient being either suspect of or having a lung cancer. In most European countries, the incidence of lung cancer is increasing, especially among females, in spite of the fact that it is now well established that changes in smoking habits are an efficient way of reducing the incidence. The present book is the first of a series on major cancer diseases specifically designed for the European family doctor, and it will be published by the Commission of the European Communities within the context of the "Europe Against Cancer" Programme. The first part, which can be read in fifteen minutes, is a summary of the various aspects, presented as relevant "questions". The second part is a concise review focused on practical pro blems, as they appear to the general practitioner in day-by-day practice. Additionally, selected references are given after each section, including a list of recent textbooks and monographs on lung cancer. The book has been produced thanks to a very efficiently working group of experts covering the many disciplines of lung cancer. I am grateful to all my co-authors for their excellent cooperation and special thanks are due to Ugo Pastorino, Milan, who has functioned as an indefatigable secretary during the preparation of this book. HEINE H. HANSEN Contents First Part How frequent is lung cancer? . 1 Is it still a male problem? 2 Who is at high risk? ... 3 Can you reduce the risk? 4 Is screening useful? . . 5 What are the symptoms? 6 Which are the initial steps in diagnosis? 7 What are the major histologic types? . 8 Who is a candidate for surgery? ... 9 Who is a candidate for radiotherapy? . 10 Who is a candidate for chemotherapy? 11 What are the results? ........ . 12 How to support incurable patients. . . 13 What are the strategies for prevention? . 14 Second Part Epidemiology and aetiology. . . . . . . 15 Pathology .............. . .23 Clinical diagnosis and basic evaluation .24 Non-small cell lung cancer: staging and surgery .30 Non-small cell lung cancer: radiotherapy and chemotherapy . .42 Small cell lung cancer. . . . . . . . . . . . . . .44 The role of the general practitioner in treatment. .47 Strategies for prevention . . . . . . . . . . . . .50 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Editorial Board HEINE HANSEN, M. D. (Chief Editor) Department of Oncology The Finsen Institute/Rigshospitalet 9, Blegdamsvej 2100 Copenhagen, Denmark FRANCO BERRINO, M. D. Department of Epidemiology Istituto Nazionale Tumori Via Venezian, 1 20133 Milano, Italy ROBERT FONTANA, M. D. Department of Thoracic Diseases Mayo Clinic Rochester, Minnesota 55905, U.S.A. PETER GOLDSTRAW, M. D. Department of Thoracic Surgery Brompton Hospital Fulham Road London, SW3 6Hp, U.K. ANNA GREGOR, M. D. Department of Clinical Oncology W. General Infirmary Edinburgh, Scotland JAMES R. JETI, M. D. Department of Thoracic Diseases Mayo Clinic Rochester, Minnesota 55905, U.S.A. UGO PASTORINO, M. D. (Secretary) Department of Thoracic Surgery Istituto Nazionale Tumori Via Venezian, 1 20133 Milano, Italy HOW FREQUENT IS LUNG CANCER ? Lung cancer is the most frequent cancer among males in most European countries. The only exception among EEC countries is Portugal, where the frequency of lung cancer is increasing but it is still lower than that of stomach cancer. From data collected by over 20 cancer registries within the EEC, we know that the lifetime probability ranges from 4 t012% in males and from 0.5 to 3% in females. Overall, more than 150,000 new cases of lung cancer occur in the EEC every year and the number is increasing. Mortality and incidence figures for lung cancer are very similar. The map shows the yearly mortality rates for 100,000 males by region, according to the best available geographical details in official mortality statistics. The Mediterranean countries have lower rates than Northern European countries, for instance Scotland, the Netherlands and Belgium. In Southern countries, however, the rates are rapidly increasing, while in high-incidence countries they tend to become stable and even to decrease over time. Number of deaths for 100,000 males in EEC Countries II 68,0 II1II 56,0 filii 44 , 0 D 32,0 D 20,0 D 0,0 2 IS IT STILL A MALE PROBLEM? Female incidence is much lower, but it is increasing in all countries; it is higher in those regions where there is high incidence for men. The sex ratio of lung cancer (M/F) varies widely among countries and is rapidly changing, following the increased popularity of cigarette smoking among women. M/F ratio of incident cases ranges from 3-4 in the U.K. to more than 10 in Southern Europe. In recent years, the rate of increase in lung cancer mortality has been higher among women than among men in Northern Europe, reflecting the growing popularity of cigarette smoking among women. In the U.K. the rates among males are no longer increasing, at least not in younger birth cohorts. By contrast, in Southern Europe the rate of increase is still higher among males. Also in Southern countries there is evidence that the trend of per capita tobacco consumption has been levelling off in recent years, but no reduction in lung cancer incidence is to be expected shortly. In fact, the time trend of lung cancer incidence follows several decades behind a parallel trend in cigarette smoking. As most women started smoking after the dramatic decrease in cigarette tar content, the epidemic of lung cancer among women might be somewhat less than it has been for men. It is likely, however, that in most populations lung cancer mortality among women will become as high as breast cancer mortality. In the United States lung cancer mortality has already surpassed breast cancer mortality. 80 60 0 0 0 MALES ci ENGLAND ,0.. .. ..... 40 & WALES C/) :I: ~ UJ Cl 20 FEMALES YEARS 55 60 65 70 75 80 3 WHO IS AT HIGH RISK? Tobacco, and particularly cigarette smoking, is the major cause of lung cancer. The lung cancer mortality rates increase regularly with the number of cigarettes smoked per day, up to 20-30 times. Among otherwise similar smokers, those smoking only cigarettes have a much higher risk of lung cancer than those smoking only pipes and/or cigars, although pipe and cigar smokers do also have an appreciable risk of lung and oral cancer. Individuals who are occupationally exposed to lung carcinogens such as asbestos or combustion products of fossil fuels have an even higher risk. Inhaling ambient smoke slightly increases the risk of lung cancer . .... 30 Lt') N ~ 20 iaf): w > i= ~ w 10 a: o-l--ll-~ o 1 -1 4 15-24 25+ CIGARETIES / DAY
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