eMedicine Specialties > Oncology > Carcinomas of the Lung and Other Intrathoracic Carcinomas

Lung Cancer, Non-Small Cell: Follow-up

Author: Syed Huq, MD, Fellow, Division of Hematology-Oncology, Department of Internal Medicine, University of Missouri-Columbia School of Medicine, Ellis Fischel Cancer Center
Coauthor(s): Irfan Maghfoor, MD, Consulting Oncologist, Department of Oncology, King Faisal Specialist Hospital and Research Center, Saudi Arabia; Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri/Ellis Fischel Cancer Center
Contributor Information and Disclosures

Updated: Nov 10, 2009

Follow-up

Deterrence/Prevention

Cigarette smoking is the most common etiologic factor for lung cancer. The primary way to decrease the prevalence of lung cancer is to decrease the prevalence of smoking. Some measures for doing so include the following:

  • Public education about the hazards of smoking
  • More stringent legislation for tobacco control, including the increase of tax levies
  • Banning of tobacco smoking in public areas
  • Offering comprehensive strategies for smoking cessation to smokers, which include behavioral counseling, pharmaceutical aids such as varenicline, bupropion, and nicotine replacement therapy (eg, gum, transdermal patches).
Screening

No established role exists at this time for screening modalities for non-small cell lung cancer. Prevention is the more effective modality for decreasing the prevalence of non-small cell lung cancer. Current modalities including chest radiograph, chest computed tomography (CT), and sputum cytology has been studied. While both chest radiograph and CT scanning have the potential to pick up early lung cancer, they have not been proven to decrease cancer-specific mortality. The controversial I-ELCAP study was an observational cohort study that showed that lung cancers could be diagnosed at an early stage with protocol-based CT screening, but this study had no control group to determine the mortality benefits of such an approach. The authors’ conflicts of interest have also caused the findings of this study to be questioned. A large National Cancer Institute (NCI)-sponsored national lung cancer screening trial is ongoing to evaluate screening CTs as compared to screening chest radiographs.56

Complications

  • Spinal cord compression
    • The skeletal system is a common site of spread of lung cancer. When cancer metastasizes to the axial skeleton, it may grow and compress the spinal cord.
    • Patients usually report back pain and neurological symptoms in the form of decreased sensation in the lower half of the body, decreased strength, loss of bowel control, and loss of bladder control. A careful neurologic examination usually localizes the level of compression.
    • Suspected spinal cord compression is an emergency. Patients should immediately receive an adequate dose of a corticosteroid (usually intravenous dexamethasone at 10 mg followed by 4 mg q6h) and should undergo an immediate MRI scan of the vertebral column. If documented, spinal cord compression should be treated emergently with radiation therapy, and steroids should be tapered slowly.
  • Metabolic complications
  • Complications of therapy: Chemotherapy can give rise to various adverse effects.
    • Febrile neutropenia or bleeding may result from bone marrow suppression.
    • Hyponatremia or hypomagnesemia may result from cisplatin nephrotoxicity.
    • Renal failure or ototoxicity may result from cisplatin.
    • Peripheral neuropathy may result from cisplatin, paclitaxel, and vinorelbine.

Prognosis

Prognostic factors for non-small cell lung cancer are summarized in the image below.

Non–small cell lung cancer. Prognostic fact...

Non–small cell lung cancer. Prognostic factors for lung cancer.

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Non–small cell lung cancer. Prognostic fact...

Non–small cell lung cancer. Prognostic factors for lung cancer.


Estimated 5-year survival rates are as follows:

  • Stage IA - 75%
  • Stage IB - 55%
  • Stage IIA - 50%
  • Stage IIB - 40%
  • Stage IIIA - 10-35%
  • Stage IIIB - Less than 5%
  • Stage IV - Less than 5%

Patient Education

For excellent patient education materials, please see the eMedicineHealth article, Lung Cancer.

 


More on Lung Cancer, Non-Small Cell

Overview: Lung Cancer, Non-Small Cell
Differential Diagnoses & Workup: Lung Cancer, Non-Small Cell
Treatment & Medication: Lung Cancer, Non-Small Cell
Follow-up: Lung Cancer, Non-Small Cell
Multimedia: Lung Cancer, Non-Small Cell
References
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Further Reading

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Keywords

bronchogenic carcinoma, NSCLC, non-small cell lung cancer, non-small-cell lung cancer, nonsmall cell lung cancer, adenocarcinoma, squamous cell carcinoma, SCC, lung SCC, large cell carcinoma, bronchoalveolar carcinoma, broncho-alveolar carcinoma, lung carcinoma, lung malignancy, tobacco, smoking, asbestos, radon, secondhand smoke, passive smoking, second-hand smoke, smoking-related cancer, lung cancer

acinar adenocarcinoma, papillary adenocarcinoma, bronchoalveolar adenocarcinoma, mucus-secreting adenocarcinoma, large cell neuroendocrine carcinoma, lobectomy, pneumonectomy, ras oncogene, H-ras, K-ras, N-ras, c-myc, c-raf, ectopic hormone production, atelectasis, postobstructive pneumonia, wheezing, hemoptysis, pleural effusion, superior vena cava obstruction, superior vena cava syndrome, paralysis of recurrent laryngeal nerve, phrenic nerve palsy, paralysis of the diaphragm, Horner syndrome, dysphagia, esophageal compression, pericardial effusion, Pancoast tumor, paraneoplastic syndromes, hypercalcemia, clubbing, hypertrophic pulmonary osteoarthropathy, Trousseau syndrome of hypercoagulability, scar carcinoma, gynecomastia, galactorrhea, spinal cord compression, silicate type of asbestos, HIV infection, diesel exhaust

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Contributor Information and Disclosures

Author

Syed Huq, MD, Fellow, Division of Hematology-Oncology, Department of Internal Medicine, University of Missouri-Columbia School of Medicine, Ellis Fischel Cancer Center
Syed Huq, MD is a member of the following medical societies: American Medical Informatics Association, American Society of Clinical Oncology, and American Society of Hematology
Disclosure: Nothing to disclose.

Coauthor(s)

Irfan Maghfoor, MD, Consulting Oncologist, Department of Oncology, King Faisal Specialist Hospital and Research Center, Saudi Arabia
Irfan Maghfoor, MD is a member of the following medical societies: American Society of Hematology
Disclosure: Nothing to disclose.

Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri/Ellis Fischel Cancer Center
Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association
Disclosure: Bionumerik Consulting fee Consulting; Proactya Consulting fee Consulting; GSK Consulting fee Consulting; NovoNordisk Consulting fee Consulting; Amgen Honoraria Speaking and teaching; GSK Consulting fee Speaking and teaching

Medical Editor

Antoni Ribas, MD, Department of Medicine, Division of Hematology-Oncology, Assistant Professor of Medicine, University of California at Los Angeles Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Benjamin Movsas, MD, Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center
Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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