Epidemiology, diagnosis, staging and the medical-surgical management of lung cancers

Lung cancer (LC) is the leading cause of cancer mortality, and even as the annual incidence of LC may have reached a plateau in the United States, making it the second most prevalent cancer for both men and women. LC mortality continues to exceed the deaths from breast, prostate and colon cancers combined (1). of note, LC mortality as a single cause of death is even greater than deaths due to cerebral vascular accidents, hence making it the second single cause of death in the United States, after heart diseases. The widespread availability of high-speed multi-slice detector computer-axial tomography (MDCT) scanners, implementation of prospective controlled and uncontrolled LC screening studies (2, 3), unwarranted proprietary “screening” services and incidental findings on scans performed for other thoracoabdominal indications have led to the frequent finding of lung nodules. If experience with other early detection tests such as mammography and prostate-specific antigen is any indication, there will be an expected increase in the diagnosis of “early stage” LCs (1), although whether this would lead to meaningful reduction in disease-specific mortality remains to be seen as there is much debate about the potential efficacy of such screenings (4–6). Parallel with the improvement in diagnostic imaging are advances made in the fields of cancer diagnosis, including real-time image-guided tissue biopsies and molecular characterization of thoracic malignancies.