WHAT DO YOU GET BY SMO1KING ? ASK YOURSELF .THE ANSWER WILL BE NOTHING or should I say LUNG CANCER!!!

Screening for lung cancer is not widely used, since no screening test (chest radiography, sputum cytology or CAT scan ) has been shown to reduce mortality from lung cancer.

Lung cancer occurs on an annual basis in less than 1% of heavily tobacco-exposed individuals, making it difficult to achieve a statistically powered study size. The other challenges include 'lead time bias‘, 'length time bias', over-diagnosis bias. Keeping in mind the challenges and issues, diagnosis and treatment at early stages, ideally in its precancerous stages, could increase the 5-year survival rate three- to four-fold. Given the possibility for cure, effort should therefore be continued in this field of research.

Expert Rev Mol Diagn. 2010;10(6):799-815. © 2010 Expert Reviews Ltd.

Figure 1. Non–Small-Cell Lung Cancer Detected by Screening. In Panel A, a CT scan of the chest shows a 5-mm nonsolid nodule abutting the pleura in the right middle lobe (arrowhead). In Panel B, histopathological analysis of tissue obtained from thoracic resection reveals a subpleural adenocarcinoma of a mixed subtype. The tumor nodule shows infiltrative changes along the left border, with the invasive acinar growth pattern of this carcinoma shown on the nodule (inset) (hematoxylin and eosin). Images are courtesy of the Early Lung Cancer Action Project.

Figure 2. Small-Cell Lung Cancer Detected by Screening. In Panel A, a prone position CT scan of the chest shows a peripheral 1.1-cm solid nodule in the posterior segment of the right upper lobe (arrowhead). In Panel B, cytopathological features of cells obtained by fine-needle aspiration biopsy are consistent with small-cell carcinoma (hematoxylin and eosin). Images are courtesy of the Early Lung Cancer Action Project

Symptoms may result from local effects of the tumor, from regional or distant spread, or from distant effectsnot related to metastasis (paraneoplastic symdrome) Apprx three-fourths of the pts have one or more symptoms at the time of the diagnosis.

Symptoms Patients (percent)Cough 45-74

Weight loss 46-68

Dyspnea 37-58

Chest pain 27-49

Hemoptysis 27-29

Bone pain 20-21

Hoarseness 8-18

Cough:Cough:•Occurs most frequently in pts with Sq cell and SCC, •New onset of cough in a smoker or former smoker should raise the suspicion•Bronchorrhea, feature of Bronchoalveolar cell carcinoma, usually indicates advance stage of disease.•Post obstructive pneumonia can be caused by both NSCLC and SCLC, however, bronchiectasis is uncommon (seen in slow growing neoplasms such as carcinoid tumor or hamartoma)Hemoptysis: Hemoptysis: •In smokers with hemoptysis and a nonsuspicious or normal CXR, bronchoscopy will diagnose lung cancer in 5% of cases!

Chest painChest pain: Dull, aching, persistent pain, Ipsilateral to side of tumor..mediastinal/ pleural/ chest wall extension.. r/o pleuritic pain may be due to direct pleural involvement, obstructive pneumonitis or a pulmonary embolus related to hypercoagulablity.

DyspneaDyspnea: : Causes include extrinsic or intraluminal airway obstruction, obstructive pneumonitis, atelectasis, lymphangitic tumor spread, tumor emboli, pneumothorax, pl effusion, or pericardial effusion with tamponade. Phrenic nerve invol may cause unilateral paralysis of diaphragm.

Pleural involvementPleural involvement: Not all pleural effusions in a lung ca pt are malignant as in lymphatic obstruction, post obstruction pneumonitis, or atelectasis

HoarsenessHoarseness: : DD in a smoker include laryngeal cancer, lung cancer with recurrent laryngeal nerve involvement along its course under the arch of the aorta.

Pancoast’s Syndrome: Pancoast’s Syndrome: lung cancers arising in the superior sulcus, manifested by pain, Horner’s syndrome, bony destruction and atrophy of hand muscles..commonly seen in NSCLC typically Sq cell ca than SCLC.

Superior Vena Cava Syndrome:Superior Vena Cava Syndrome:

Paraneoplastic Syndromes of the Nervous System.

Darnell RB, Posner JB. N Engl J Med 2003;349:1543-1554.

Proposed Pathogenesis of Paraneoplastic Neurologic Disorders.

Darnell RB, Posner JB. N Engl J Med 2003;349:1543-1554.

Herbst RS et al. N Engl J Med 2008;359:1367-1380.

Molecular Evolution of Lung Cancer.

Molecular-Profiling Approaches to the Development of Personalized Therapy.

Herbst RS et al. N Engl J Med 2008;359:1367-1380.