Lung cancer is a disease caused by uncontrolled cell growth of lung tissue. The main symptoms are cough (sometimes accompanied by blood), shortness of breath and weight loss.
Lung cancer is the leading cause of cancer deaths in men and second among women.
The french network of Cancer Registries (Francim) and the National Institute of Health and Medical Research (INSERM) estimate the total number of new cancer cases in France, 2000, at 280 000, of which 58% occurring in men. For the same year, the number of cancer deaths is estimated at 150 000 with 61% in humans. Lung cancer is the 4th position for its impact (28 000 new cases) after breast cancer (42 000), prostate (40 000), and colon and rectum (36, 000) and in first place for his mortality. 23 152 lung cancers were diagnosed in humans in 2000 and 4 591 in women. Given the modest effectiveness of treatments, lung cancer is the leading cause of death by cancer with approximately 27 000 deaths in 2000, of which 23 000 in men and 4 500 in women. According to health insurance, 14 237 new cases in metropolitan France in 2002.
* Smoking is responsible in more than 90% of cases. This is by far the main risk factor.
* The air pollution and asbestos are also responsible, to a lesser extent: the fine particles emitted by automobiles in the city would be responsible for the death of 6 500 to 9 500 people in France, more than 1000 per lung cancer; asbestos, it is behind 2 000 to 3 000 lung cancer each year in France (these figures could grow in the future).
* Exposure to radon is a lesser known cause of lung cancer. It would, in France, 13% of deaths from lung cancer, or about 3 350 each year in Europe by 9% of deaths by lung cancer. The EPA believes that USA radon is the leading cause of lung cancer among non-smokers, and the second leading cause after active smoking.
A decline begins in men in industrialized countries but among women the number of lung cancers continues to rise (figure to correlate with the explosion of tobacco consumption among women from a dozen of years).
In the USA, the number of women who died of lung cancer exceeds that of recent deaths from breast cancer.
Causes or risk factors
The primary risk factor of lung cancer is the active smoking, responsible for 90% of cases. Tobacco contains many carcinogens, the main one being benzo-a-pyrene (tar).
Other environmental factors are less known or less often because of exposure to radon in regions granite, inhalation of asbestos fibers, exposure to radioactivity; exposure to many carcinogenic materials (Chrome , Arsenic, iron oxides ...)
The lung cancer is recognized as an occupational disease, France, in the event of exposure to ionizing radiation, asbestos, chromium, nickel, tar, the arsenates and certain chemicals.
The role of passive smoking is proved: it multiplies by three the risk of lung cancer, but is directly responsible for only 100 cancers per year in France, and the role of human papillomavirus (HPV), well known for its role in cancers of the cervix, is discussed. A recent study also demonstrates the increased incidence of lung cancer in patients infected with HIV.
Of course there is also, as for all cancers, individual susceptibility of genetic origin.
Signs and symptoms
The clinical signs are manifold, but often not expressive.
The main symptoms are:
* The appearance of bloody sputum (hemoptysis)
* Recurrent respiratory infections or responding poorly to treatment
* A persistent cough different than the usual smoking
* A difficulty breathing (dyspnea)
* An abnormal shortness of breath
* A chest pain sometimes associated with a pleurisy
* An unexplained pain in the neck, shoulder or arm
* A change of voice
* An unexplained weight loss, fatigue (state of weakness, extreme fatigue), altered the overall condition.
These signs are not specific to cancer. However, we must conduct reviews.
Furthermore, there is a tumor marker carcinomas epidermoides: CYFRA 21-1
Cancers of the lung other non-small cell
* Carcinoma epidermoid
* A large cell carcinoma
The treatment of cancer non-small cell lung appealed to the surgical treatments, radiotherapy, chemotherapy and new therapies (targeted therapies), currently Erlotinib and Cetuximab. The early forms (Stages I and II) are treated surgically (lobectomy or pneumonectomy), with additional chemotherapy in some cases, called adjuvant chemotherapy. The bronchial cancers that are not easily operable because of a violation chest too great, but without metastases are treated with chemotherapy and radiotherapy, or radiotherapy after chemotherapy, either at the same time (radio-chemotherapy concurrently) for efficiency higher but with significant toxicities. The patients with metastatic cancer (stage 4 or "generally available") may benefit from chemotherapy and targeted therapies, radiation therapy can be administered in certain cases, referred to palliative, to reduce the symptoms: for example to reduce pain a bone metastasis. All stages combined, only 10% of patients with lung cancer are alive 5 years, mostly among those with an early stage, operable from the outset. At the time of diagnosis, approximately 30% of patients present with an early stage, 30% with a localized tumor in the chest but too late to be eligible for surgical treatment, and 30% with metastatic disease at the stage.
The cancer-small cell lung are exceptionally treated surgically. They are very cancer chemotherapy and radiosensitive. When the tumor is located in the thorax, it can be treated with a combination of chemotherapy and radiotherapy, which allows a significant improvement in at least 80% of cases. It is often administered radiation to the brain (the so-called prophylactic) to avoid relapses at this level, and therefore increase the chances of recovery. About 20% of these patients can be considered cured to 5 years. But in 80% of cancer relapse, with little chance of recovery. When the cancer-small cell lung metastatic east from the outset, treatment consists solely of chemotherapy, with a performance in about 60% of cases. Unfortunately cancer relapse usually very quickly, without the possibility of effective treatment. The median survival (50% of patients die before this median, 50% of patients exceeding the median) of patients with lung cancer metastatic small cell is 9 months.
Monitoring of patients
There are no standardized procedures for monitoring patients being treated for lung cancer. Given the low effectiveness of treatments currently available in case of relapse, the question is whether it is interesting to detect early relapse of the disease, to administer early treatment can improve survival of patients. The methods of surveillance include the clinical examination, chest X-ray, scan the chest, lung fibroscopy. The practice of these examinations and their rhythmicity is very variable depending on the medical teams, but also the type and stage of the disease treated, and treatment previously administered.
The prevention of bronchial cancer is essentially in the fight against smoking, since 90% of lung cancers are attributed to him. Without smoking, lung cancer is a rare disease, although it is currently in France the 1st cause of cancer mortality…
There is not, at present, effective method of screening of lung cancer. Some studies are underway, with the practice of thoracic scanner (with low doses of radiation) in patients at risk, or subjects smokers.
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