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LungCancerChemotherapy
LimingxiathefirstaffiliatedhospitalofAnhuiCollegeofTraditionalChineseMedicine
Alsocalled:Bronchogeniccarcinoma
Lungcancerisoneofthemostcommoncancersintheworld.Itisaleadingcauseofcancerdeathinmenandwomenintheworld.Cigarettesmokingcausesmostlungcancers.Riskfactors:cigarettes,highlevelsofpollution,radiationandasbestosexposure,etc.Yourlungsaretwospongyorgansinyourchestthataredividedintosections(lobes).Everytimeyouinhale,airiscarriedthroughthewindpipetoyourlungsintwomajorairways(bronchi).Insideyourlungs,thebronchisubdivideintoamillionsmallerairways(bronchioles),whichfinallyendinclustersoftinyairsacs(alveoli).Withintheairsacs,oxygenisabsorbedintoyourbloodstreamandcarbondioxideisreleased.HowIsLungCancerDiagnosed?SymptomsandsyndromesPulmonarysymptoms
Symptomsinotherorgans
Symptomslinkedtotumormetabolism
Blood(hematologic)syndromes
Veinandartery(vascular)syndromes
Skin(cutaneous)syndromes
Musculoskeletalsyndromes
Nervoussystem(neurologic)syndromes
Hormonal(endocrine)syndromes
Miscellaneoussyndromes
Testsanddiagnosis
ScreeningDiagnosis
ImagingtestsSputumcytologyTissuesamples(biopsy)
bronchoscopy
mediastinoscopy
needlebiopsy
(Left)ConventionalCTscanwithoutcontrastshowingpossibletumorintheliver.(Right)ConventionalCTscanofthesamepatientusingcontrast.ImagescourtesyofDr.PeterChoyke,DepartmentofRadiology,ClinicalCenter,NationalInstitutesofHealth.SmallCellLungCarcinoma(above)accountsforabout15percentofalllungcancercases.Normallungcells(above).StageI.Canceratthisstagehasinvadedtheunderlyinglungtissuebuthasn'tspreadtothelymphnodes.StageII.Thisstagecancerhasspreadtoneighboringlymphnodesorinvadedthechestwall.StageIIIA.Atthisstage,cancerhasspreadfromthelungtolymphnodesinthecenterofthechest.StageIIIB.Thecancerhasspreadlocallytoareassuchastheheart,bloodvessels,tracheaandesophagus—allwithinthechest—ortolymphnodesintheareaofthecollarboneortothetissuethatsurroundsthelungswithintheribcage(pleura).StageIV.Thecancerhasspreadtootherpartsofthebody,suchastheliver,bonesorbrain.Stagesofnon-smallcelllungcancer
Staging
Limited.Cancerisconfinedtoonelungandtoitsneighboringlymphnodes.Extensive.Cancerhasspreadbeyondonelungandnearbylymphnodes,andmayhaveinvadedbothlungs,moreremotelymphnodesorotherorgans.Stagesofsmallcelllungcancer
LungcancersurgeryStage
Commonoptions
Treatmentoptionsfornon-smallcelllungcancers
ISurgeryIISurgery,chemotherapy,radiationIIIACombinedchemotherapyandradiation,sometimessurgerybasedonresultsoftreatmentIIIBChemotherapy,sometimesradiationIVChemotherapy,targeteddrugtherapy,clinicaltrials,supportivecareStage
Commonoptions
TreatmentoptionsforsmallcelllungcancersLimitedCombinedchemotherapyandradiation,sometimessurgeryExtensiveChemotherapy,clinicaltrials,supportivecareChemotherapyisusuallythemaintreatmentforSCLC
ChemotherapyforSCLCgenerallyusesacombinationof2drugs.ThedrugcombinationsmostoftenusedforinitialchemotherapyforSCLCare:
cisplatinandetoposidecarboplatinandetoposidecisplatinandirinotecancarboplatinandirinotecancyclophosphamide,doxorubicin(Adriamycin),andvincristineIfthecancerprogressesduringtreatmentorreturnsaftertreatmentisfinished,differentchemotherapydrugsmaybetried.Thechoiceofdrugsdependstosomeextentonhowsoonthecancerbeginstogrowagain.(Thelongerittakesforthecancertoreturn,themorelikelyitistorespondtofurthertreatment.)ChemotherapyforSCLC
Ifthecancerprogressesduringtreatmentorrelapseswithin2to3monthsoffinishingtreatment,drugssuchastopotecan,ifosfamide,paclitaxel,docetaxel,irinotecan,orgemcitabinemaybetried.Iftherelapseoccursfrom2to3monthsto6monthsaftertreatment,topotecanisoftenthedrugofchoice.Otherdrugsthatmaybetriedincludeirinotecan,cyclophosphamide/doxorubicin/vincristine(knownastheCAVregimen),gemcitabine,paclitaxel,docetaxel,oraletoposide,orvinorelbine.Forrelapses6ormoremonthsaftertreatment,theoriginalchemotherapyregimenmaystillbeeffectiveandcanoftenbetriedagain.ChemotherapyforSCLC
Chemotherapyistreatmentwithanti-cancerdrugsinjectedintoaveinortakenbymouth.Thesedrugsenterthebloodstreamandgothroughoutthebody,makingthistreatmentusefulforcancerthathasspread(metastasized)todistantorgans.Dependingonthetypeandstageoflungcancer,chemotherapymaybegivenasthemain(primary)treatmentorasanaddition(adjuvant)tosurgeryorradiationtherapy.Doctorsgivechemotherapyincycles,witheachperiodoftreatmentfollowedbyarestperiodtoallowthebodytimetorecover.Chemotherapycyclesgenerallylastabout3to4weeks,andinitialtreatmenttypicallyinvolves4to6cycles.Chemotherapyisoftennotrecommendedforpatientsinpoorhealth,butadvancedagebyitselfisnotabarriertogettingchemotherapy.NSCLCChemotherapyMostoften,initialtreatmentforadvancedlungcancerusesacombinationof2chemotherapydrugs.Studieshaveshownthataddingathirdchemotherapydrugdoesn'taddmuchbenefitandislikelytocausemoresideeffects.ThedrugsmostfrequentlyusedforinitialchemotherapyforNSCLCare:cisplatincarboplatinpaclitaxeldocetaxelgemcitabinevinorelbineirinotecanetoposidevinblastinepemetrexedNSCLCChemotherapyThemostcommoncombinationsincludeeithercisplatinorcarboplatinplusoneotherdrug,althoughsomestudieshavefoundthatusingcombinationswithlessseveresideeffects,suchasgemcitabinewithvinorelbineorpaclitaxel,maybejustaseffectiveformanypatients.Forpeoplewhosecancersmeetcertaincriteria,targetedthe
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