Group 4 PresentationTopic: Colds, Flu , and Lung Cancer

Common Cold

The common cold also known as nasopharyngitis, rhinopharyngitis, acute coryza, head cold, or simply a cold) is a contagious infection of the upper respiratory tract .

Symptoms of a common cold Infection with a cold virus affects the mucous membranes of the

nose and throat, causing such symptoms as nasal congestion and discharge, sore throat, and coughing. These symptoms are typical also of respiratory infections caused by bacteria, and of allergic conditions such as hay fever and asthma; therefore, the common cold is difficult to diagnose with certainty.

Normally a cold runs a mild course, without fever, and goes away on its own in about seven days. If the symptoms do not go away after two weeks, they may result from an allergy. The medical significance of a cold lies in the possible complications that may follow. Various diseases, such as bronchitis, pneumonia, and sinus or middle-ear infections, may arise from the cold. A cold accompanied by high fever, by a cough that brings up mucus, or by severe sinus pain may call for attention from a physician.

Causes and transmission of a cold The great majority of colds are caused by viruses, and the rhinoviruses cause about

half of all colds. Research indicates that there are several strains of each type of cold virus with varying degrees of virulence. Infection with one strain of cold virus provides only a brief immunity to reinfection by the same strain, and gives no immunity against the other viral strains.

The common cold was once thought to result from exposure to cold weather, a belief probably traceable to the fact that people tend to crowd together indoors at this time, causing a more efficient transmission of virus from person to person. Chilling was also believed to cause a cold, but there is no scientific evidence for the belief that chills or exposure to cold play a role in causing colds. Research does suggest, however, that stress may weaken the body’s immune response and thereby make it easier to become infected.

Cold viruses are transmitted from person to person through droplets of mucus in the air. The droplets containing cold viruses enter the air when an infected person sneezes. The viruses can also be spread by hand—for example, by touching the hand of an infected person, or by touching a telephone, piece of paper, or other contaminated surface, and then touching the eyes or nose

Prevention The only possibly useful ways to reduce the spread of cold viruses

are physical measures such as hand washing and face masks; in the healthcare environment, gowns and disposable gloves are also used. Isolation, e.g. quarantine, is not possible as the disease is so widespread and symptoms are non-specific. Vaccination has proved difficult as there are so many viruses involved and they mutate rapidly. Creation of a broadly effective vaccine is thus highly improbable.

Regular hand washing appears to be effective in reducing the transmission of cold viruses, especially among children.[46] Whether the addition of antivirals or anti bacterials to normal hand washing provides greater benefit is unknown. Wearing face masks when around people who are infected may be beneficial; however, there is insufficient evidence for maintaining a greater social distance. Zinc supplements may help to reduce the prevalence of colds. Routine vitamin C supplements do not reduce the risk or severity of the common cold, though they may reduce its duration.

No medications or herbal remedies have been conclusively demonstrated to shorten the duration of infection.[49] Treatment thus comprises symptomatic relief.[50] Getting plenty of rest, drinking fluids to maintain hydration, and gargling with warm salt water, are reasonable conservative measures.[21] Much of the benefit from treatment is however attributed to the placebo effect.[51]

Symptomatic Treatments that help alleviate symptoms include simple analgesics and antipyretics such

as ibuprofen[52] and acetaminophen/paracetamol.[53] Evidence does not show that cough medicines are any more effective than simple analgesics[54] and they are not recommended for use in children due to a lack of evidence supporting effectiveness and the potential for harm.[55][56] In 2009, Canada restricted the use of over-the-counter cough and cold medication in children six years and under due to concerns regarding risks and unproven benefits.[55] In adults there is insufficient evidence to support the use of cough medications.[57] The misuse of dextromethorphan (an over-the-counter cough medicine) has led to its ban in a number of countries.[58]

In adults the symptoms of a runny nose can be reduced by first-generation antihistamines; however, these sometimes have adverse effects such as drowsiness.[50] Other decongestants such as pseudoephedrine are also effective in adults.[59] Ipratropium nasal spray may reduce the symptoms of a runny nose but has little effect on stuffiness.[60] Second-generation antihistamines however do not appear to be effective.[61]

Due to lack of studies, it is not known whether increased fluid intake improves symptoms or shortens respiratory illness[62] and a similar lack of data exists for the use of heated humidified air.[63] One study has found chest vapor rub to provide some relief of nocturnal cough, congestion, and sleep difficulty.[64]

Antibiotics and antivirals Antibiotics have no effect against viral infections and thus have no effect against

the viruses that cause the common cold.[65] Due to their side effects, antibiotics cause overall harm, but are still frequently prescribed.[65][66] Some of the reasons that antibiotics are so commonly prescribed include people's expectations for them, physicians' desire to help, and the difficulty in excluding complications that may be amenable to antibiotics.[67] There are no effective antiviral drugs for the common cold even though some preliminary research has shown benefits.[50][68]

Alternative medicine While there are many alternative treatments used for the common cold, there is

insufficient scientific evidence to support the use of most.[50] As of 2010 there is insufficient evidence to recommend for or against either honey or nasal irrigation.[69][70] Zinc has been used to treat symptoms, with studies suggesting that zinc, if taken within 24 hours of the onset of symptoms, reduces the duration and severity of the common cold in otherwise healthy people.[47] Due to wide differences between the studies, further research may be needed to determine how and when zinc may be effective.[71] Whereas the zinc lozenges may produce side effects, there is only a weak rationale for physicians to recommend zinc for the treatment of the common cold.[72] Vitamin C's effect on the common cold, while extensively researched, is disappointing, except in limited circumstances, specifically, individuals exercising vigorously in cold environments.[48][73] There is no firm evidence that Echinacea products provide any meaningful benefit in treating or preventing colds.[74] It is unknown if garlic is effective.[75] A single trial of vitamin D did not find benefit.[76]

INFLUENZADEFINITIONCAUSESYMPTOMS

Influenza Influenza, also known as flu, contagious

infection primarily of the respiratory tract. Influenza is sometimes referred to as grippe. Influenza is caused by a virus transmitted from one person to another in droplets coughed or sneezed into the air.

Types of Influenza Influenzavirus A This genus has one species, influenza A virus. Wild aquatic birds are the natural hosts

for a large variety of influenza A. Occasionally, viruses are transmitted to other species and may then cause devastating outbreaks in domestic poultry or give rise to human influenza pandemics.[37] The type A viruses are the most virulent human pathogens among the three influenza types and cause the most severe disease. The influenza A virus can be subdivided into different serotypes based on the antibody response to these viruses.[38] The serotypes that have been confirmed in humans, ordered by the number of known human pandemic deaths, are:

H1N1, which caused Spanish Flu in 1918, and Swine Flu in 2009 H2N2, which caused Asian Flu in 1957 H3N2, which caused Hong Kong Flu in 1968 H5N1, which caused Bird Flu in 2004 H7N7, which has unusual zoonotic potential[39] H1N2, endemic in humans, pigs and birds H9N2 H7N2 H7N3 H10N7 H7N9

Influenzavirus B

Influenza virus nomenclature (for a Fujian flu virus)This genus has one species, influenza B virus. Influenza B almost exclusively infects humans[38] and is less common than influenza A. The only other animals known to be susceptible to influenza B infection are the seal[40] and the ferret.[41] This type of influenza mutates at a rate 2–3 times slower than type A[42] and consequently is less genetically diverse, with only one influenza B serotype.[38] As a result of this lack of antigenic diversity, a degree of immunity to influenza B is usually acquired at an early age. However, influenza B mutates enough that lasting immunity is not possible.[43] This reduced rate of antigenic change, combined with its limited host range (inhibiting cross species antigenic shift), ensures that pandemics of influenza B do not occur.[44]

Influenzavirus CThis genus has one species, influenza C virus, which infects humans, dogs and pigs, sometimes causing both severe illness and local epidemics.[45][46] However, influenza C is less common than the other types and usually only causes mild disease in children

Cause The word influenza is derived from the Latin word influentia. Italians in the early

16th century first applied the word influenza to outbreaks of any epidemic disease because they blamed such outbreaks on the influence of heavenly bodies. The first known use of the name specifically for the flu occurred in 1743 when an epidemic swept through Rome and its environs.

Today scientists know that members of the family Orthomyxoviridae, a group of viruses that infect vertebrate animals, cause influenza. The virus consists of an inner core of the genetic material ribonucleic acid (RNA) surrounded by a protein coat and an outer lipid (fatty) envelope. From this envelope, spikes of proteins called hemagglutinin and neuraminidase stick out. Hemagglutinin enables the virus to bind to and invade cells, and neuraminidase allows the virus to move among cells. But these proteins also act as antigens—that is, they are recognized as foreign matter by the human or other host organism, and this recognition triggers an immune response in the host.

Transmission Influenza viruses pass from person to person mainly in droplets expelled during

sneezes and coughs. When a person breathes in virus-laden droplets, the hemagglutinin on the surface of the virus binds to enzymes in the mucous membranes that line the respiratory tract. The enzymes, known as proteases, cut the hemagglutinin in two, which enables the virus to gain entry into cells and begin to multiply. These proteases are common in the respiratory and digestive tracts but not elsewhere, which is why the flu causes primarily a respiratory illness with occasional gastrointestinal symptoms. In the 1990s scientists discovered that some flu strains also can use the enzyme plasmin to cut hemagglutinin. Plasmin is common throughout the body, enabling the flu strains to infect a variety of tissues.

Although an influenza epidemic can occur at any time of year, flu season in temperate regions typically begins with the approach of winter—November in the Northern Hemisphere, April in the Southern Hemisphere. Flu viruses spread more easily during cold weather. An influenza epidemic may be restricted to a town or city or may quickly spread geographically as infected people travel.

Scientists long thought that the flu season occurred in winter because that is when people tend to spend more time crowded together in homes and schools, as well as in buses, subways, and other places with poor ventilation. A study on guinea pigs, reported in 2007, found that transmission of the virus depends upon temperature and humidity. Transmission among the guinea pigs declined as the temperature rose above 5°C (41°F) and stopped completely at 30°C (86°F). Low humidity favors transmission of the virus. The scientists who conducted the study believe the flu virus is most stable at low temperatures and in dry air, conditions prevalent in winter.

.

Symptoms and diagnosis Influenza is an acute disease with a rapid onset and pronounced symptoms. After

the influenza virus invades a person’s body, an incubation period of one to two days passes before symptoms appear. Classic symptoms include sore throat, dry cough, stuffed or runny nose, chills, fever with temperatures as high as 39ºC (103ºF), aching muscles and joints, headache, loss of appetite, occasional nausea and vomiting, and fatigue. For most people flu symptoms begin to subside after two to three days and disappear in seven to ten days. However, coughing and fatigue may persist for two or more weeks.

Death from influenza itself is rare. But influenza can aggravate underlying medical conditions, such as heart or lung disease. Invading influenza viruses produce inflammation in the lining of the respiratory tract, damage that increases the risk that secondary infections will develop. Common complications include bronchitis, sinusitis, and bacterial pneumonia, occurring most frequently in older people, people on chemotherapy, and people with acquired immunodeficiency syndrome (AIDS) or other diseases that compromise the immune system. If properly treated, these complications seldom are fatal.

Because influenza is so common and exhibits standard symptoms, doctors often diagnose the illness based on the season and whether flu cases have recently been reported in the area. To prove a diagnosis of influenza in a patient, the virus must be isolated from the person’s nasal or cough secretions or blood and identified under a microscope.

TREATMENT AND PREVENTION There is no specific cure for influenza.

Recommended treatment usually consists of bed rest and increased intake of non alcoholic fluids until fever and other symptoms lessen in severity. Certain drugs have been found effective in lessening flu symptoms, but medical efforts against the disease focus chiefly on prevention by means of vaccines that create immunity.

Drugs that ease symptoms No drugs can cure influenza, but certain antiviral

medicines can relieve flu symptoms. Available by prescription, these drugs provide modest relief, but only if taken on the first or second day of symptoms. The drugs amantadine (sold under the brand name Symmetrel) and rimantadine (Flumadine), both in pill form, work against hemagglutinin and are effective in treating type A influenza. Two other drugs inhibit neuraminidase and are effective against both type A and type B strains: oseltamivir (Tamiflu) is in pill form and zanamivir (Relenza) is an inhalant.

Vaccines A flu vaccine consists of greatly weakened or killed flu viruses, or fragments of dead

viruses. Antigens in the vaccine stimulate a person’s immune system to produce antibodies against the viruses. If the flu viruses invade a vaccinated person at a later time, the sensitized immune system recognizes the antigens and quickly responds to help destroy the viruses.

About 5 to 10 percent of people who receive a flu vaccine experience mild, temporary side effects, typically soreness at the injection site. Young children who have not previously been exposed to the influenza virus are most likely to have side effects.

Flu viruses constantly change so different virus strains must be incorporated in vaccines from one year to the next. Scientists try to provide a good match between the vaccine and the most serious virus strains circulating at the time. But because it takes months to manufacture and distribute vaccines, decisions on their composition must be made well before the start of each flu season. Each February experts at the World Health Organization (WHO) recommend the composition of the vaccine for the forthcoming winter in the Northern Hemisphere; a second recommendation is made in September for vaccines to be used in the Southern Hemisphere. Typically vaccines contain antigens from three virus strains, usually two type A and one type B.

According to the CDC, the success of flu vaccines varies from one person to another. In healthy young adults, the vaccines are 70 to 90 percent effective in preventing the disease. In the elderly and people with certain chronic medical conditions, the vaccines are less effective in preventing illness but help reduce the severity of an infection and the risk of major complications or death. Studies show that flu vaccines reduce hospitalization by about 70 percent and death by about 85 percent among elderly people.

Recommendations for flu shots The CDC recommends annual flu shots for people who are at high risk for developing

serious complications as a result of an influenza infection. This group includes all people age 65 and older; people in nursing homes and other facilities that house people with chronic medical conditions; people with chronic heart, lung or kidney disease, diabetes, an impaired immune system, or severe forms of anemia; children and adolescents with conditions treated for long periods of time with aspirin (which makes them vulnerable to Reye’s syndrome); and women who will be in the second or third trimester of pregnancy during the influenza season.

To help stop the disease’s spread, the CDC also recommends vaccination for health-care workers, employees of nursing homes and chronic-care facilities, and household members of people in high-risk groups. Doctors encourage individuals who travel to areas of the world where influenza viruses circulate to receive the most current vaccine, particularly if they are at higher risk of complications.

It takes the human immune system one to two weeks after vaccination to develop antibodies to the flu antigens. According to the CDC, the best time to get flu shots in the United States is between October 1 and mid-November—sufficiently in advance of the peak of influenza activity, which in the United States generally lasts from late December until early March.

Flu shots must be given annually for two reasons. First, antibody protection provided by the vaccine decreases during the year following vaccination. Second, vaccines created for pre-existing viral strains may not work against new strains; nor does an infection with one flu strain confer immunity to infection by another strain.

LUNG CANCER

Lung Cancer Lung cancer, also known as carcinoma of the lung or pulmonary carcinoma, is a malignant lung

tumor characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung by process of metastasis into nearby tissue or other parts of the body. Most cancers that start in the lung, known as primary lung cancers, are carcinomas that derive from epithelial cells. The main primary types are small-cell lung cancer (SCLC), and non-small-cell lung cancer (NSCLC). The most common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest pains.[1]

The most common cause is long-term exposure to tobacco smoke,[2] which causes 80–90% of lung cancers.[1] Non smokers account for 10–15% of lung cancer cases,[3] and these cases are often attributed to a combination of genetic factors,[4] and exposure to; radon gas,[4] asbestos,[5] and air pollution[4] including second-hand smoke.[6][7] Lung cancer may be seen on chest radiographs and computed tomography (CT) scans. The diagnosis is confirmed by biopsy[8] which is usually performed by bronchoscopy or CT-guidance.

Treatment and long-term outcomes depend on the type of cancer, the stage (degree of spread), and the person's overall health, measured by performance status. Common treatments include surgery, chemotherapy, and radiotherapy. NSCLC is sometimes treated with surgery, whereas SCLC usually responds better to chemotherapy and radiotherapy.[9] Overall, 17% of people in the United States diagnosed with lung cancer survive five years after the diagnosis,[10] while outcomes on average are worse in the developing world. Worldwide, lung cancer is the most common cause of cancer-related death in men and women, and was responsible for 1.56 million deaths annually, as of 2012.[11]

Signs and symptoms respiratory symptoms: coughing, coughing up blood, wheezing or shortness of breath systemic symptoms: weight loss, fever, clubbing of the fingernails, or fatigue symptoms due to local compress: chest pain, bone pain, superior vena cava obstruction, difficulty

swallowing If the cancer grows in the airways, it may obstruct airflow, causing breathing difficulties. The

obstruction can lead to accumulation of secretions behind the blockage, and predispose to pneumonia.[1]

Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to the disease.[12] In lung cancer, these phenomena may include Lambert–Eaton myasthenic syndrome (muscle weakness due to autoantibodies), hypercalcemia, or syndrome of inappropriate antidiuretic hormone (SIADH). Tumors in the top of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous system, leading to Horner's syndrome (dropping of the eyelid and a small pupil on that side), as well as damage to the brachial plexus.[1]

Many of the symptoms of lung cancer (poor appetite, weight loss, fever, fatigue) are not specific.[8] In many people, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Common sites of spread include the brain, bone, adrenal glands, opposite lung, liver, pericardium, and kidneys.[13] About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are incidentally found on routine chest radiography.[14]

Causes Smoking, particularly of cigarettes, is by far the main contributor to lung

cancer. Cigarette smoke contains at least 73 known carcinogens,[including benzopyrene,radioisotopes from the radon decay sequence, and nitrosamine. Additionally, nicotine appears to depress the immune response to cancerous growths in exposed tissue.Across the developed world, 90% of lung cancer deaths in men during the year 2000 were attributed to smoking (70% for women. Smoking accounts for 80–90% of lung cancer cases.

Passive smoking—the inhalation of smoke from another's smoking—is a cause of lung cancer in non smokers. A passive smoker can be defined as someone living or working with a smoker. Studies from the US, Europe and the UK have consistently shown a significantly increased risk among those exposed to passive smoke. Those who live with someone who smokes have a 20–30% increase in risk while those who work in an environment with second hand smoke have a 16–19% increase in risk. Investigations of side stream smoke suggest it is more dangerous than direct smoke.[Passive smoking causes about 3,400 deaths from lung cancer each year in the USA.

The tar from marijuana smoke contains many of the same carcinogens of that of tobacco smoke.[

Picture of a healthy lungs and a lung with cancer cause by smoking

Radon gas Radon is a colorless and odorless gas generated by the breakdown of radioactive

radium, which in turn is the decay product of uranium, found in the Earth's crust. The radiation decay products ionize genetic material, causing mutations that sometimes turn cancerous. Radon is the second-most common cause of lung cancer in the USA, after smoking.[23] The risk increases 8–16% for every 100 Bq/m³ increase in the radon concentration.[30] Radon gas levels vary by locality and the composition of the underlying soil and rocks. For example, in areas such as Cornwall in the UK (which has granite as substrata), radon gas is a major problem, and buildings have to be force-ventilated with fans to lower radon gas concentrations. The United States Environmental Protection Agency (EPA) estimates one in 15 homes in the US has radon levels above the recommended guideline of 4 picocuries per liter (pCi/l) (148 Bq/m³).[31]

Asbestos Asbestos can cause a variety of lung diseases, including lung cancer. Tobacco

smoking and asbestos have a synergistic effect on the formation of lung cancer.In smokers who work with asbestos, the risk of lung cancer is increased 45-fold compared to the general population.Asbestos can also cause cancer of the pleura, called mesothelioma (which is different from lung cancer).

Air pollution Outdoor air pollution has a small effect on increasing the risk of lung cancer.[4] Fine

particulates (PM2.5) and sulfate aerosols, which may be released in traffic exhaust fumes, are associated with slightly increased risk.For nitrogen dioxide, an incremental increase of 10 parts per billion increases the risk of lung cancer by 14%.Outdoor air pollution is estimated to account for 1–2% of lung cancers.

Genetics It is estimated that 8 to 14% of lung cancer is due to inherited factors.In

relatives of people with lung cancer, the risk is increased 2.4 times. This is likely due to a combination of genes. Polymorphisms on chromosomes 5, 6 and 15 are known to affect the risk of lung cancer.

Other causes[edit] Numerous other substances, occupations, and environmental exposures

have been linked to lung cancer. The International Agency for Research on Cancer (IARC) states there is "sufficient evidence" to show the following are carcinogenic in the lungs:

Some metals (aluminum production, cadmium and cadmium compounds, chromium(VI) compounds, beryllium and beryllium compounds, iron and steel founding, nickel compounds, arsenic and inorganic arsenic compounds, underground hematite mining)

Some products of combustion (incomplete combustion, coal (indoor emissions from household coal burning), coal gasification, coal-tar pitch, coke production, soot, diesel engine exhaust)

Ionizing radiation (X-radiation, radon-222 and its decay products, gamma radiation, plutonium)

Some toxic gases (methyl ether (technical grade), Bis-(chloromethyl) ether, sulfur mustard, MOPP (vincristine-prednisone-nitrogen mustard-procarbazine mixture), fumes from painting)

Rubber production and crystalline silica dust

Staging Staging Lung cancer staging is an assessment of the degree of spread of the cancer

from its original source. It is one of the factors affecting the prognosis and potential treatment of lung cancer.

The initial evaluation of non-small-cell lung cancer (NSCLC) staging uses the TNM classification. This is based on the size of the primary tumor, lymph node involvement, and distant metastasis. After this, using the TNM descriptors, a group is assigned, ranging from occult cancer, through stages 0, IA (one-A), IB, IIA, IIB, IIIA, IIIB and IV (four). This stage group assists with the choice of treatment and estimation of prognosis. Small-cell lung carcinoma (SCLC) has traditionally been classified as 'limited stage' (confined to one half of the chest and within the scope of a single tolerable radiotherapy field) or 'extensive stage' (more widespread disease).[1] However, the TNM classification and grouping are useful in estimating prognosis.

For both NSCLC and SCLC, the two general types of staging evaluations are clinical staging and surgical staging. Clinical staging is performed prior to definitive surgery. It is based on the results of imaging studies (such as CT scans and PET scans) and biopsy results. Surgical staging is evaluated either during or after the operation, and is based on the combined results of surgical and clinical findings, including surgical sampling of thoracic lymph nodes.

prevention Prevention is the most cost-effective means of decreasing lung cancer development. While

in most countries industrial and domestic carcinogens have been identified and banned, tobacco smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of lung cancer, and smoking cessation is an important preventive tool in this process.

Policy interventions to decrease passive smoking in public areas such as restaurants and workplaces have become more common in many Western countries. Bhutan has had a complete smoking ban since 2005while India introduced a ban on smoking in public in October 2008.[The World Health Organization has called for governments to institute a total ban on tobacco advertising to prevent young people from taking up smoking. They assess that such bans have reduced tobacco consumption by 16% where instituted.[

The long-term use of supplemental vitamin A,[vitamin C, vitamin D or vitamin E does not reduce the risk of lung cancer. Some studies suggest that people who eat diets with a higher proportion of vegetables and fruit tend to have a lower risk, but this may be due to confounding—with the lower risk actually due to the association of a high fruit/vegetables diet with less smoking. More rigorous studies have not demonstrated a clear association between diet and lung cancer risk.

Screening Screening refers to the use of medical tests to detect disease in asymptomatic people. Possible screening

tests for lung cancer include sputum cytology, chest radiograph (CXR), and computed tomography (CT). Screening programs using CXR or cytology have not demonstrated benefit. Screening those at high risk (i.e. age 55 to 79 who have smoked more than 30 pack years or those who have had previous lung cancer) annually with low-dose CT scans may reduce the chance of death from lung cancer by an absolute amount of 0.3% (relative amount of 20%).There is, however, a high rate of falsely positive scans which may result in unneeded invasive procedures as well as substantial financial cost. For each true positive scan there are more than 19 false positives. Radiation exposure is another potential harm from screening.

Management SURGERY If investigations confirm NSCLC, the stage is assessed to determine whether the disease

is localized and amenable to surgery or if it has spread to the point where it cannot be cured surgically. CT scan and positron emission tomography are used for this determination.[1] If mediastinal lymph node involvement is suspected, mediastinoscopy may be used to sample the nodes and assist staging.[76] Blood tests and pulmonary function testing are used to assess whether a person is well enough for surgery.[14] If pulmonary function tests reveal poor respiratory reserve, surgery may not be a possibility.[1]

In most cases of early-stage NSCLC, removal of a lobe of lung (lobectomy) is the surgical treatment of choice. In people who are unfit for a full lobectomy, a smaller sublobar excision (wedge resection) may be performed. However, wedge resection has a higher risk of recurrence than lobectomy.[77] Radioactive iodine brachytherapy at the margins of wedge excision may reduce the risk of recurrence.[78] Rarely, removal of a whole lung (pneumonectomy) is performed.[77] Video-assisted thoracoscopic surgery (VATS) and VATS lobectomy use a minimally invasive approach to lung cancer surgery.[79] VATS lobectomy is equally effective compared to conventional open lobectomy, with less postoperative illness.[80]

In SCLC, chemotherapy and/or radiotherapy is typically used.[81] However the role of surgery in SCLC is being reconsidered. Surgery might improve outcomes when added to chemotherapy and radiation in early stage SCLC.[82]

Radiotherapy Radiotherapy is often given together with chemotherapy, and may be used with curative intent

in people with NSCLC who are not eligible for surgery. This form of high-intensity radiotherapy is called radical radiotherapy.[83] A refinement of this technique is continuous hyperfractionated accelerated radiotherapy (CHART), in which a high dose of radiotherapy is given in a short time period.[84] Postoperative thoracic radiotherapy generally should not be used after curative intent surgery for NSCLC.[85] Some people with mediastinal N2 lymph node involvement might benefit from post-operative radiotherapy.[86]

For potentially curable SCLC cases, chest radiotherapy is often recommended in addition to chemotherapy.[8]

If cancer growth blocks a short section of bronchus, brachytherapy (localized radiotherapy) may be given directly inside the airway to open the passage.[87] Compared to external beam radiotherapy, brachytherapy allows a reduction in treatment time and reduced radiation exposure to healthcare staff.[88]

Prophylactic cranial irradiation (PCI) is a type of radiotherapy to the brain, used to reduce the risk of metastasis. PCI is most useful in SCLC. In limited-stage disease, PCI increases three-year survival from 15% to 20%; in extensive disease, one-year survival increases from 13% to 27%.[89]

Recent improvements in targeting and imaging have led to the development of stereotactic radiation in the treatment of early-stage lung cancer. In this form of radiotherapy, high doses are delivered in a small number of sessions using stereotactic targeting techniques. Its use is primarily in patients who are not surgical candidates due to medical comorbidities.[90]

For both NSCLC and SCLC patients, smaller doses of radiation to the chest may be used for symptom control (palliative radiotherapy).[91]

Chemotherapy[edit]The chemotherapy regimen depends on the tumor type.[8] Small-cell lung carcinoma (SCLC), even relatively early stage disease, is treated primarily with chemotherapy and radiation.[92] In SCLC, cisplatin and etoposide are most commonly used.[93] Combinations with carboplatin, gemcitabine, paclitaxel, vinorelbine, topotecan, and irinotecan are also used.[94][95] In advanced non-small cell lung carcinoma (NSCLC), chemotherapy improves survival and is used as first-line treatment, provided the person is well enough for the treatment.[96] Typically, two drugs are used, of which one is often platinum-based (either cisplatin or carboplatin). Other commonly used drugs are gemcitabine, paclitaxel, docetaxel,[97][98] pemetrexed,[99] etoposide or vinorelbine.[98]

Adjuvant chemotherapy refers to the use of chemotherapy after apparently curative surgery to improve the outcome. In NSCLC, samples are taken of nearby lymph nodes during surgery to assist staging. If stage II or III disease is confirmed, adjuvant chemotherapy improves survival by 5% at five years.[100][101] The combination of vinorelbine and cisplatin is more effective than older regimens.[101] Adjuvant chemotherapy for people with stage IB cancer is controversial, as clinical trials have not clearly demonstrated a survival benefit.[102][103] Trials of preoperative chemotherapy (neoadjuvant chemotherapy) in resectable NSCLC have been inconclusive.[104]

Chemotherapy may be combined with palliative care in the treatment of the NSCLC. In advanced cases, appropriate chemotherapy improves average survival over supportive care alone, as well as improving quality of life.[105] With adequate physical fitness maintaining chemotherapy during lung cancer palliation offers 1.5 to 3 months of prolongation of survival, symptomatic relief, and an improvement in quality of life, with better results seen with modern agents.[106][107] The NSCLC Meta-Analyses Collaborative Group recommends if the recipient wants and can tolerate treatment, then chemotherapy should be considered in advanced NSCLC.[96][108]

Palliative carePalliative care when added to usual cancer care benefits people even when they are still receiving chemotherapy.[109] These approaches allow additional discussion of treatment options and provide opportunities to arrive at well-considered decisions.[110][111] Palliative care may avoid unhelpful but expensive care at the end of life.[111] For individuals who have more advanced disease, hospice care may also be appropriate.[14]