"The ABC of Lung Cancer" is a concise, up-to-date evidence-based review of one of the most common cancers in the western world. Written by primary care physicians, cancer nurses and specialists, this book provides a reference for the healthcare professional in caring and treating the lung cancer patient in the most appropriate way. This new title covers the epidemiology and diagnosis of lung cancer, focusing particularly on primary care issues such as what symptoms require urgent investigation, and when to refer to a specialist. It follows the launch of a UK Lung cancer guideline by NICE and is written by many of the specialists involved in that publication. This is a practical guide for those involved in the care of the lung cancer patient.
Symptoms, assessment and guidelines for referral The first chapter is in 2 parts: the first deals with the common well known symptoms and signs and will include an indication of frequency at presentation as well as how they occur. The choice and usefulness of initial investigations will also be reviewed. The second part deals with referring practices, the MDT and the specialist likely to be involved depending on the stage the patient presents with - it lays the framework for the other chapters by giving the reader some sense of the 'patient journey'. Epidemiology, Risk factors and primary prevention Lung cancer is the commonest cancer and is an epidemic closely linked to the habit of smoking cigarettes. The discovery of the link is itself a classical piece of epidemiological research37;38. In this chapter we will give the current position and describe the measures that might help reduce smoking. The continued promotion of smoking in the third world will be included to add a world perspective39 as well the latest information on passive smoking and the developing role for public health and the law in limiting smoking in public places Screening for Lung cancer This is a hot topic. It seems self evident that in a disease where cure is only possible in early stage disease, we should go and seek them out40-44. We know that chest x-ray will not do it, or sputum cytology. What about the new technology of fast spiral CT? As with all screening the statistical issues of setting sensitivity and specificity are important (written well, it can be interesting!). How far do we investigate the shadows we find (for there are many are false positives) and how do we explain to the patient the ones we miss? Who to screen? And then there is the cost to consider. This could be a very educational chapter. Diagnosis and staging This is an important subject for primary care and the growing role of the nurse specialist who shepherds patients through this worrying "Do I have cancer?" and if so, "how bad is it?" experience. It deals with the choice of which test first, why and what is the yield? It also covers the basic histological pathologies of lung cancer "Cures" in the management of lung cancer depend on staging. If the cancer is spread to liver and bones, neither surgery nor radiotherapy can cure it. CT, PET scanning and surgical staging (mediastinoscopy) are worth careful explanations and are important part of understanding what the "specialists" are up to for the GP and the cancer nurse. . Surgery for NSCLC with intent to cure About 3,500 lung cancer operations are performed in the UK each year and the number is falling; less than 10% of lung cancer patients get to surgery. Is this because better selection correctly narrows the target to those curable or are we simply short of surgeons45? Mortalities are low46 but is that because we are too cautious about comorbidity47 and deny surgery to older patients?48 This merits a rather more critical analysis that the more resources = more cures view of cancer care. Radiotherapy and Chemotherapy for NSCLC with intent to cure In patients deemed not fit for surgery with stage I-III NSCLC radical radiotherapy with or without chemotherapy may offer the potential for cure. The chapter will examine how radical radiotherapy in particular has developed, how it's delivered, the time course of treatment, the potential side-effects and the role of the primary care team in monitoring for such complications. The survival benefits compared to surgical treatment will be highlighted. Role of combination therapies in NSCLC This is an expanding area and the chapter ties up the multi-modality approach covering both the patient with potentially curable disease undergoing surgery or radical RT and the patient with advanced NSCLC. Should we precede or follow surgery with chemotherapy72 or radiotherapy? This chapter will need strong presence of the lung cancer nurses who see the patients through. Multimodality therapy comes at the price of multi-doctors and someone needs to be there. Small cell lung cancer In the 1980s the devastating form of small cell lung cancer (formerly known as "oat cell" melted away with chemotherapy49 and a new age seemed to dawn. But they all came back. However chemotherapy has been shown to extend life and improve its quality. General readers will want to know what is in it for the patient and what do they go through to get sometimes small benefit. Mesothelioma There is an epidemic53 and the future will lie in using all the treatments at our disposal as well as we can54 . We could do a lot better by making the diagnosis early and by using the treatments we already have promptly and efficiently. We think this is worth its own chapter and a review of what we know and do not know about its treatment55. Palliative and Supportive care in advanced disease 95% of lung cancer patients die of their disease and many can benefit from expert palliation and supportive care. There are technical aspects such as stenting open the bronchus56, medical issues such as the judicious use of chemotherapy and radiotherapy, and the nursing and hospice aspects to consider. Service organisation What are the trade offs of centralised expert care versus local availability of care? As patients "journey" between specialist centres, who provides support and continuity? What is the (therapeutic) gain and what is the (psychological) harm in regularly bringing patients back for follow up? Nurse have a role in this and there may be a place for patient triggered easy access follow up rather than the traditional paradigm of the follow-up clinic57.