Oncodiagnosis panel: 1999. Cancer of the lung: oncodiagnosis.

Introduction Lung cancer continues to be the leading cause of death from cancer. In the year 2000, there were an estimated 171,600 new cases, and 85% of those patients will succumb to the disease (1). Death from lung cancer has surpassed death from breast cancer in women. Early detection is still a major problem because there are no definitive imaging findings nor markers for detecting this disease at an early stage. Diagnosis is still dependent on accurate imaging studies and histologic or cytologic evaluation. After diagnosis and metastatic work-up, providing adequate treatment without causing further deterioration of the cardiovascular system is a challenge because most patients are current or previous smokers and their cardiopulmonary status has been compromised. Three cases of lung cancer were presented to the Oncodiagnosis Panel at the 1999 scientific assembly of the Radiological Society of North America. The patient in case 1 had limited small cell lung cancer (SCLC) and a history of heavy smoking. The importance of differentiating the diagnosis of pure SCLC from small cell carcinoma mixed with adenocarcinoma or neuroendocrine carcinoma is discussed. The metastatic work-up for SCLC and associated paraneoplastic syndromes is described. The discussion emphasizes combined chemotherapy and radiation therapy (RT), including the timing and dose of thoracic RT as related to the course of chemotherapy and the importance of prophylactic cranial irradiation (PCI) in improving survival. The patient in case 2 had squamous cell carcinoma of the left lung. Radiologic imaging showed probable invasion of the tumor into the mediastinum, which influenced the resectability of this lesion. The patient had a cardiovascular problem as well. Treatment decisions include the medical condition of the patient in addition to the extent of the disease. The patient in case 3 had poorly differentiated adenocarcinoma of the left pulmonary apex that manifested as a superior sulcus tumor. He was found to have extensive tumor involving the left subclavian artery. Despite the extensive disease, this young, physically fit patient underwent surgery with a subclavian artery graft and received postoperative chemotherapy, RT, and PCI. The preand postoperative adjuvant treatment for superior sulcus tumor is discussed.