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Lung Cancer Stage 4 - Medical Advances Improve Lung Cancer Stage 4 Survival Rates

carcinoma patients cell chemotherapy

Lung cancer is the leading cause of all deaths from cancer within the United States (1). The vast majority (90%) of lung cancer cases are attributable to tobacco smoke inhalation (2). There are approximately 45 million smokers in the United States today and each year approximately 144,000 will die of lung cancer (3). Other causative factors that have been linked to an increased risk of developing lung cancer include exposure to automobile exhaust, petroleum products, radon, airborne asbestos fibers, and a family history (2).

Lung cancer is typically divided into two major categories, small cell lung carcinoma (15-20%) and non-small cell lung carcinoma (80-85%). The latter category is further divided into squamous cell carcinoma and non-squamous cell carcinoma. The distinctions between these and other types of lung cancer are defined by pathology assays using molecular probes. These assays depend on the collection of saliva, tissue biopsies, and extracting pleural effusions when available. These diagnostic tests, in combination with others, help to determine which treatments are most appropriate.

The choice of which treatment to use also depends on how far the cancer has progressed (4). There are four main stages of lung cancer. Stage 1 (I) indicates the presence of a single tumor no larger than 3 cm and no evidence of metastasis (metastatic cells are tumor cells that have left the primary tumor and have migrated to other tissues and organs). An assignment of stage 2 (II) requires the size of the tumor to be between 3 and 7 cm, with evidence of limited metastases into other parts of the affected lung and nearby pleura (thin tissue surrounding the lung). Stage 2 may also involve localized obstructive pneumonia. Stage 3 (III) is defined by the presence of tumors greater than 7 cm in size and evidence of metastases into at least one nearby chest structure. The most severe stage, stage 4 (IV), involves a primary tumor of any size and metastases to more remote chest structures or other parts of the body. The detection of metastases into distant regions of the chest, liver, brain, or bone, is typically an indication of an aggressive and advanced stage of the disease regardless of the size of the primary tumor in the lung.

The types of symptoms that first cause patients to visit their doctor include: chronic cough, coughing up blood, trouble breathing, easily fatigued, chest pain, wheezing, hoarseness, unexplained weight loss, bone pain, and headache (1). Unfortunately, by the time these symptoms cause a patient to seek medical care approximately half have progressed to lung cancer stage 4 (4). This represents 40-50% of non-small cell lung carcinoma and 60-70% of small cell lung carcinoma patients. At this stage treatment options are usually limited to palliative care (treatments designed to prolong life and improve the quality of life, rather than attempting to cure the disease) and typically involve platinum chemotherapy in combination with other drugs. For patients with stage 4 small cell lung carcinoma, both platinum chemotherapy and radiotherapy may be used. Even with these types of treatment, the median life expectancy for lung cancer stage 4 patients is around 6 months, and the 5-year survival rate is only 2% (4).

For some lung cancer stage 4 patients, treatment advances have begun to make a difference. When platinum-based chemotherapy was first introduced, life expectancies were only 3 to 4 months (4). When more recent chemotherapy drugs were combined with platinum chemotherapy survival rates increased to 10 months.

‘Designer Drugs’ or ‘Smart Drugs’ are also having an impact. For example, a drug targeting a specific protein (VEGF) over-expressed on the surface of some lung cancer cells in some patients can be used to tag these cells for destruction by the patient’s own immune system. When combined with other chemotherapy treatments, these patients have been experiencing survival rates longer than 12 months (4).

Which treatments an oncologist will finally decide to use will therefore depend on the type of lung cancer the patient has, the stage of the cancer, the age of the patient, and any other medical problems that could complicate or preclude standard treatment approaches.

1. Mayo Clinic Health Information: http://www.mayoclinic.com/health/lung-cancer/DS00038
/> 2. J Toxicol Sci (2008), 33(3):251-267
3. Oncogene (2002), 21:7326-7340
4. Dtsch Arzebl Int (2009), 106(49):809-820

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