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Bone marrow aplasia is a medullar failure (myelosuppression) that can be global, involving the three haematopoietic lineages — myeloid, erythroid and thrombocytic, or partial, leading to dissociated medullar insufficiencies: anaemia, leukopenia and thrombocytopenia. Myelosuppression is one of the most common complications in cancer patients, predisposing them to infections and haemorrhage, both leading...
Superior vena cava syndrome (SVCS) can be defined as the group of clinical signs resulting from obstruction of the superior vena cava (SVC) or from severe reduction in venous return from the upper part of the body. The causative mechanisms of SVCS in lung cancer are SVC extrinsic compression and, less frequently, injury to the venous endothelium associated with abnormalities of coagulation. The severity...
Airway obstruction is a common problem in patients with lung cancer. There are two major forms of airway obstruction: a) functional airway obstruction and b) morphological airway obstruction. In both forms, dyspnoea is the leading complaint. Functional obstruction is usually caused by an underlying obstructive lung disease, precipitated by a common noxious agent: cigarette smoke. But an upper airway...
The presence of pleural effusions is a common clinical problem in patients with neoplastic disease. At the time of diagnosis, approximately 15% of lung cancer patients have a pleural effusion (Naito et al. 1997).Twenty to 50% of patients with advanced or disseminated lung cancer develop a pleural effusion during the course of the ir disease (Emerson et al. 1959; Cohen and Hossein 1966).
This chapter considers the treatment of symptoms occurring in patients with lung cancer, by methods that are directed at the symptom itself (e.g. analgesics) rather than the disease itself (e.g. palliative radiotherapy).
Lung cancer is among the most frequently occurring malignancies in the world and an increasing cause of cancer death in both men and women (Centers for Disease Control and Prevention 2002). Fewer than 15% of patients who develop lung cancer survive five years (Fry et al. 1999; Quddus et al. 2001), underscoring the need to address palliative care needs and end-of-life issues with this patient population...
The purpose of this report is to identify what is already known about CT screening for lung cancer and what still remains to be proven. This distinction is important as resources should be expended in researching what remains to be proven and not on has already been clearly established. To this end, we reviewed the reported studies of CT screening and current knowledge about the curability of (early)...
This chapter concentrates on the bronchoscopic diagnosis of central or hilar type, non-small cell (NSC)lung cancer, in particular of the early variety. The gradual shift from central to peripheral lung cancers in the past 30 years has nonetheless left a sizeable minority of central, exfoliating lesions, whose cells can be found in sputum. We discuss these changes in lung cancer manifestation, stressing...
Lung cancer is a disease with a profound effect on society. The incidence of lung cancer has stabilized at approximately 170,000new cases each year in the United States, but unfortunately, the mortality from lung cancer remains high at approximately 150,000 patients per year in the United States alone (Jemal et al. 2002).These figures have not changed dramatically over the last 20 years. Unfortunately,...
In most cases, the typical clinical and radiological appearance of lung cancer with a primary lesion combined with hilar or mediastinal lymphadenopathy, or even distant metastases in frequently affected organs, will not raise the question of a differential diagnosis. Yet, a number of clinically relevant findings - such as solitary pulmonary nodules (SPNs), mediastinal lymphadenopathy or mass, parenchymal...
The occurrence of an abnormal thoracic imaging suggestive of lung cancer requires a histological diagnosis to confirm the presence of neoplastic disease, and a search for locoregional and metastatic spread to determine the optimal treatment strategy and prognosis. Despite a different therapeutic approach, the work-up is basically the same in terms of staging as that for nonsmall- cell and small-cell...
Positron emission tomography (PET) is an innovative imaging technique in lung cancer based on differences in the metabolism of tissues. Standard imaging techniques, such as chest X-ray (XR), computed tomography (CT), ultrasonography (US) and magnetic resonance imaging (MRI), are based on differences in the structure of tissues. Although these current technologies allow exquisite anatomic detail, the...
Lung cancer is the leading cause of death related to cancer in the developed countries. Therapeutic modalities and prognosis depend on accurate diagnosis of the tumour (mainly on the distinction between small and non-small cell lung cancer, SCLC and NSCLC) and on the locoregional and distant extension (staging of the tumour). Usually, a diagnosis is obtained from samplings originating from the tumour...
It has been well known for more than 20 years that the involvement of the mediastinal lymph nodes is the most important prognostic marker in patients with localized, nonmetastatic lung cancer. The assessment of lymph node stage is hence a major step in the pretreatment workup to avoid unnecessary surgery in patients with poor survival expectancy.
In principal, cures occur in the treatment of non-small cell lung cancer when the lesion can be surgically resected. Therefore, every effort must be made to see whether or not the patient is operable, and if such is the case, to determine as best as possible if the lesion will be resectable (Fry 1998). The difference in these two words is important, for they are often confused. If a patient is deemed...
A system classifying lung cancer based on the status of the primary tumour (T), regional lymph nodes (N), and metastatic involvement (M) was originally proposed by Denoix in 1946 (Denoix 1946).The concept of stage grouping came later. The first internationally accepted cancer staging system was proposed by the League of Nations for carcinoma of the uterine cervix. The foremost utility of a staging...
Lung carcinoma is currently perceived to be the result of complex mutational and epigenetic changes in the epithelial cells of the lung that impart to those cells a high capacity for proliferation, resistance to programmed cell (apoptosis), the ability to invade and destroy normal tissue and the capacity to metastasize. Lung cancer cells achieve these properties through series of genomic changes that...
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