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Lung Cancer

In This Article

Introduction

When we talk about lung cancer, we are generally referring to tumour of the bronchus.
  • 95% of lung cancers are carcinoma of the bronchus
  • 2% are alveolar tumours
  • 3% are benign or less invasive malignant tumours.
Death normally occurs after 30 ‘cell doublings’ of malignant cells.
In this document I will be referring to bronchial carcinoma unless otherwise stated
 
The vast majority of these are primary, and related to smoking, however, you can also get lung secondaries from cancer of the:
  • Breast
  • Kidney
  • Uterus
  • Ovary
  • Testes
  • thyroid
The prognosis is extremely poor
  • 1 year survival is about 20%
  • 5 year survival is about 5%
  • These values vary depending on the type of tumour present
 
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Epidemiology

  • This is the most common cancer worldwide
  • 3x increase since 1950
  • 32,000 deaths per year in the UK – 40,000 new cases per year
  • Increasing in women, particularly in northern Europe. It now causes more deaths in women than any other malignant tumour (it has overtaken breast cancer).  
  • the male to female ratio is 3:1
  • Accounts for 19% of all cancers in the UK
  • Accounts for 27% of all cancer deaths in the UK
  • It is the third most common cause of death in the UK. The first two are heart disease and pneumonia.
  • The highest mortality rates in the world are in Scotland, closely followed by England and Wales. 
 
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Aetiology

  • SMOKING! – this is a huge risk factor – causes 90% of cases
  • Living in an urban, as opposed to a rural area
  • Passive smoking increases the risk 1.5x
  • Asbestos
    • There are three colours of asbestos – white, blue and brown – blue is the worst! You are only at risk when the asbestos is broken up – as this releases the fibres. It usually causes a specific type of tumour – mesothelioma.
  • Arsenic (in batteries and paints and fertilizer)
  • Iron oxide
  • Chromium
  • Petroleum products
  • Oil
  • Coal mining – this link is controversial – it is not actually the coal, it is the haemotite (iron ore) and silica that causes the cancer. Evidence is controversial – some coal mining areas have a higher incidence than the general population, whilst other areas don’t.
  • Radiation
  • Radon
  • Scarring – e.g. post TB
  • Tumours associated with occupational factors tend to be adenocarcinomas.
 
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Smoking as a risk factor

Relative smoking risk:
Never Smoked
1%
Smoker
43%