Lung Cancer

Jack A. Roth, Waun Ki Hong, Ritsuko U. Komaki, Jack A. Roth, Waun Ki Hong, Ritsuko U. Komaki

• Publisher: Wiley-Blackwell
• Year: 2014
• ISBN:
  9781118468777
• Edition: 4
• Topic: Medicine
• Subtopic: Oncology

The best and most concise single source for state-of-the-art diagnosis and treatment of lung cancer – newly revised, updated, and expanded. Lung cancer has long been the number-one cause of death from cancer every year and the third most frequently diagnosed after breast and prostate cancers. In 2010, about 15% of all cancer diagnoses and 30% of all cancer deaths were due to lung cancer. Needless to say, there is a great need for more rapid advancements in diagnosis and treatment of this devastating disease.

Here is the comprehensively revised, updated, and expanded edition of the well-established, evidence-based reference book that deals with the most recent advances in lung cancer prevention, screening, diagnosis, research, and treatment for the clinician. Edited and authored by leading authorities in the field, this Fourth Edition of the highly regarded Lung Cancer is better than ever –featuring nine new chapters along with seven re-formatted ones that are nearly brand new in content and approach. It covers Smoking Prevention and Cessation; Molecular Profiling; Somatic Genome Alterations in Human Lung Cancers; Management of Multi-Focal Bronchioloalveolar Carcinoma (BAC); Primary Tracheal Tumors; Predictive Tumor Biomarkers for EGFR Inhibitors; Non-Small Cell and Small-Cell Lung Carcinoma; and more.

This Fourth Edition of Lung Cancer:

• Provides the very latest research in the identification of biomarkers to predict a high risk for developing lung cancer – vital for implementing screening, diagnosis, and prevention strategies
• Presents the newest lung cancer staging system, as well as updated and cutting-edge surgical and radiation therapy techniques that make local tumor control more effective and less invasive while sparing normal tissues
• Discusses combined modality therapy and new chemotherapeutic agents which are yielding higher response rates and improved survival when used in the adjuvant setting or concurrent with highly sophisticated radiation or proton treatment
• Offers novel and emergent approaches to preventative, diagnostic, and therapeutic modalities with an emphasis on the best evidence available from the latest studies and clinical trials

With almost half of the revised and updated content being brand new, Lung Cancer, Fourth Edition, is an important and vital resource for all medical professionals and students involved in the care and treatment of those struck with this catastrophic illness.

CHAPTER 1
Smoking Prevention and Cessation

Alexander V. Prokhorov¹ and Karen Suchanek Hudmon²

¹Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, USA

²Department of Pharmacy Practice, Purdue University, USA

Overview

It is well established that tobacco use is a leading cause of disease and death worldwide, and smoking is the primary risk factor for the development of lung cancer [1]. A considerable body of knowledge has been gained with respect to environmental, personal, and behavioral factors leading to smoking initiation and development of tobacco dependence. Two key elements of successful tobacco control are prevention and cessation. According to the 2012 Surgeon General's Report, prevention of tobacco use among adolescents and young adults is a matter of particular importance [2]. The dramatic downward trends in tobacco use rates among youth, observed since the mid-1990s, have stalled; furthermore, the use of smokeless tobacco is increasing among some age groups [2]. A variety of strategies, including policy change and education, have been shown to positively impact tobacco prevention [3]. Cessation of tobacco use provides extensive health benefits for everyone, regardless of age, sex, ethnicity, or health status [4]. Evidence-based treatment for smoking cessation includes behavioral counseling in conjunction with one or more FDA-approved pharmaceutical aids for cessation. The US Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence advocates a five-step approach to smoking cessation (Ask about tobacco use, Advise patients to quit, Assess readiness to quit, Assist with quitting, and Arrange follow-up) [5]. Systematic referral of patients who use tobacco to helpful resources, such as telephone quitlines, is recently emerging as a feasible and promising approach. Health care providers are encouraged to provide at least brief interventions at each encounter with a patient who uses tobacco [5].

Introduction

In 2011, an estimated 19% of adults in the United States were cigarette smokers [6], and in 2012, 17% of high-school seniors smoked at least 1 cigarette in the past 30 days [7]. This is despite the fact that five decades ago, the former US Surgeon General C. Everett Koop stated that cigarette smoking is the “chief, single, avoidable cause of death in our society and the most important public health issue of our time” [8]. Cigarette smoking is associated with nearly 443 000 deaths each year, including more than 49 000 deaths from exposure to secondhand smoke [9]. The economic implications are enormous: more than $75 billion in medical expenses and $81 billion in loss of productivity, as a result of premature death, are attributed to smoking each year [10]. While the public often associates tobacco use with elevated cancer risk, the negative health consequences are much broader. The 2004 Surgeon General's Report on the health consequences of smoking provides compelling evidence of the adverse impact of smoking and concluded that smoking harms nearly every organ in the body [11] (Table 1.1). In 2000, 8.6 million persons in the United States were living with an estimated 12.7 million smoking-attributable medical conditions [12]. There is convincing evidence that stopping smoking is associated with immediate as well as long-term health benefits, including reduced cumulative risk for cancer. This is true even among older individuals and among patients who have been diagnosed with cancer [13].

Table 1.1 Health consequences of smoking (USDHHS SGR report, 2004)

Cancer	Acute myeloid leukemia Bladder Cervical Esophageal Gastric Kidney Laryngeal Lung Oral cavity and pharyngeal Pancreatic
Cardiovascular diseases	Abdominal aortic aneurysm Coronary heart disease (angina pectoris, ischemic heart disease, myocardial infarction, sudden death) Cerebrovascular disease (transient ischemic attacks, stroke) Peripheral arterial disease
Pulmonary diseases	Acute respiratory illnesses –Pneumonia Chronic respiratory illnesses –Chronic obstructive pulmonary disease –Respiratory symptoms (cough, phlegm, wheezing, dyspnea) –Poor asthma control –Reduced lung function in infants exposed (in utero) to maternal smoking
Reproductive effects	Reduced fertility in women Pregnancy and pregnancy outcomes –Premature rupture of membranes –Placenta previa –Placental abruption –Pre-term delivery –Low infant birth weight Infant mortality (sudden infant death syndrome)
Other effects	Cataract Osteoporosis (reduced bone density in postmenopausal women, increased risk of hip fracture) Periodontitis Peptic ulcer disease (in patients who are infected with Helicobacter pylori) Surgical outcomes –Poor wound healing –Respiratory complications

Source: [11].

Of key importance, often undermined by health professionals, is the primary prevention of smoking initiation among youth. Indeed, 99% of first use of tobacco occurs by 26 years of age [2]. Thus, nearly all tobacco use starts in childhood or adolescence. Although a substantial decline in tobacco use rates among youth has been observed since the mid-1990s, this favorable trend appears to have stalled in the recent years, especially in smokeless tobacco use [7]. Tobacco use among adolescents is not just a social phenomenon. Rapidly developing physiological dependence on nicotine prevents many adolescents from quitting tobacco products; as such, about 80% of adolescent smokers will smoke into adulthood [2]. Each year, more than 1 million new tobacco users emerge in the United States. In his foreword to the 2012 Surgeon General's report, the Director of the Centers for Disease Control and Prevention, Dr Thomas R. Frieden, indicated that preventing smoking and smokeless tobacco use among young people is crucial to ending the epidemic of tobacco use [2].

Tobacco and lung cancer

In the United States, approximately 85% of all lung cancers occur among people who smoke or who have smoked [14]. Lung cancer is fatal for most patients, with the estimated number of deaths of lung cancer projected to exceed 1.3 million annually early in the third millennium [15]. Lung cancer is the leading cause of cancer-related deaths among both men and women in the USA, with 174 470 estimated newly diagnosed cases and 162 460 deaths each year [16,17]. The number of deaths due to lung cancer exceeds the annual number of deaths from breast, colon, and prostate cancer combined [18]. Recent advances in technology have enabled earlier diagnoses, and advances in surgery, radiation therapy, imaging, and chemotherapy have produced improved responses rates. However, despite these efforts, overall survival has not been appreciably affected in 30 years, and only 12–15% of patients with lung cancer are being cured with current treatment approaches [19]. The prognosis of lung cancer depends largely on early detection and immediate, premetastatic stage treatment [20]. Prevention of lung cancer is the most desirable [21]. The causal role of cigarette smoking in lung cancer mortality has been irrefutably established in longitudinal studies, one of which lasted as long as 50 years [15]. Tobacco smoke, which is inhaled either directly or as secondhand smoke, contains an estimated 4000 chemical compounds, including 69 substances that are known to cause cancer [22]. Tobacco irritants and carcinogens damage the cells in the lungs, and over time the damaged cells may become cancerous. Cigarette smokers have lower levels of lung function than nonsmokers [23,24], and quitting smoking greatly reduces cumulative risk for developing lung cancer [25,26].

The association of smoking with the development of lung cancer is the most thoroughly documented causal relationship in biome...