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172,570 new cases of lung cancer were diagnosed in 2005 (13% of all new cancer cases).
163,510 Americans died in 2005 from lung cancer (28% of all cancer deaths).
The incidence of lung cancer is decreasing in men but increasing in women.
Between 1960 and 1990, deaths from lung cancer among women increased by more than 400%.
Women are 1.5 times more likely to develop lung cancer than men with the same smoking habits.
Incidence and mortality rates are higher for African Americans than white Americans.
Lung cancer is the second most common cancer among African- American men and women, and
Lung cancer kills more African Americans than any other cancer.
Non-small cell lung cancer (NSCLC) accounts for 80% of all lung cancers.
87% of lung cancers are related to smoking.
90% of new smokers begin as teenagers. One-third of these new smokers will eventually die of tobacco-related diseases.
Tumors previously deemed inoperable with conventional methods may be amenable to minimally invasive techniques. The operation has become a subcutaneous procedure with no skeletal violation and similar outcomes to the standard open technique.
Treatment options for lung cancer include surgery, radiation therapy and cytotoxic chemotherapy. For early stage NSC patients (I and II), surgical resection is the optimal treatment. Adjuvant chemotherapy has also been shown to offer survival benefit in early stage NSC lung cancer. When the tumor has spread to the mediastinal lymph nodes (stage III), chemotherapy and radiation are considered standard therapy. However, selected patients benefit from neoadjuvant chemoradiation followed by surgical resection. Just as with other cancers, we have recognized lung cancer as a systemic disease, and treatment should be directed as such. Detection of occult bone marrow micrometastases may indicate metastatic potential of the tumor and thereby direct systemic therapy. Newer chemotherapeutic agents offer promise for many patients.Advanced metastatic spread generally requires chemotherapy alone except in a few patients with isolated metastatic disease who may benefit from addition of radiation or surgery. Patients with SC lung cancer are treated with chemotherapy and radiation except in a few rare instances. If the diagnosis is in doubt or the patient has failed nonsurgical treatment, then surgery may have a role.
Minimally invasive surgical techniques have been developed which greatly decrease morbidity without sacrificing the quality of resection and outcome for lung cancer patients. We have been able to offer smaller, less painful muscle-sparing incisions. Also, technologic advances in instrumentation and video surgery have made possible minimally invasive major resections. Video- assisted thoracoscopic surgery (VATS) can be used for evaluation of the primary tumor, mediastinal lymph nodes, pericardium and pleura. It can be used to assess extent of the primary tumor regarding chest wall and mediastinal involvement as well as performing primary biopsy. Localization procedures are also possible with assistance from our radiology colleagues. Once preoperative and intraoperative evaluation has been completed, at the same anesthetic setting, one may then progress to formal resection as indicated. If possible a VATS lobectomy may then be performed via one or two small port incisions and a separate 4-5 cm utility incision with no rib spreading. These patients then require very little pain medicine, drains are removed sooner and length of stay is shortened. Tumors in high-risk patients previously deemed inoperable with conventional methods may be amenable to minimally invasive techniques. The operation has essentially become a subcutaneous procedure with no skeletal violation and similar outcomes to the standard open technique.