Lung cancer
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Lung cancer
A rapidly rising cancer in India, with smoking and air pollution as major contributors
Common Sites of Origin
Lung Cancer Type
Site of Origin
Non-Small Cell Lung Cancer (NSCLC)
Bronchi, peripheral lung parenchyma
Small Cell Lung Cancer (SCLC)
Central airways (bronchi); rapidly spreading
- Lobes involved: Upper lobes are more commonly affected
- May involve mediastinal nodes, pleura, chest wall, and distant organs
Risk Factors
Risk Factor
Explanation
Smoking
Primary cause (~85–90% of all lung cancers
Passive smoke exposure
Increases risk in non-smokers
Air pollution
Especially in urban and industrial areas
Occupational exposure
Asbestos, arsenic, radon gas, silica, diesel exhaust
Family history/genetics
Some hereditary risk
Radiation exposure
Prior chest radiation for other cancers (e.g., lymphoma)
Staging Overview
- NSCLC: Stages I–IV (TNM staging)
- SCLC: Limited vs Extensive stage
Modalities of Treatment
Modality
Role
Surgery
Best for early-stage NSCLC; may involve lobectomy, pneumonectomy
Radiation Therapy
Curative (SBRT, chemoradiation) or palliative
Chemotherapy
Platinum-based doublets (cisplatin/carboplatin + etoposide/ pemetrexed)
Targeted Therapy
For EGFR, ALK, ROS1, BRAF, MET, RET, etc. mutations
Immunotherapy
Anti-PD-1/PD-L1 agents (e.g., pembrolizumab, nivolumab) in eligible patients
Palliative Care
Symptom control in advanced disease (e.g., pain, cough, breathlessness)
Role of Radiation Therapy
Setting
Details
Curative (Definitive)
For early or locally advanced NSCLC in patients unfit for surgery
Postoperative RT (PORT)
For positive margins or N2 nodal disease post-surgery
Stereotactic Body Radiotherapy (SBRT)
For Stage I NSCLC (medically inoperable); highly precise, ablative doses
Concurrent Chemoradiation
For locally advanced NSCLC (Stage III) or Limited-stage SCLC
Palliative RT
For symptom relief (e.g., cough, hemoptysis, SVC syndrome, bone metastases)
Common Regimens
Indication
Dose & Fractionation
SBRT (early-stage NSCLC)
48–60 Gy in 3–5 fractions
Definitive RT for Stage III
60–66 Gy in 30–33 fractions over 6–6.5 weeks
Palliative RT
20 Gy in 5 fractions or 30 Gy in 10 fractions
PCI (SCLC)
25 Gy in 10 fractions
Key Takeaways
- SBRT is the gold standard for inoperable early-stage NSCLC.
- Concurrent chemoradiation is standard for locally advanced disease.
- PCI helps reduce CNS relapse in SCLC.
- Palliative RT is highly effective in relieving symptoms.
- Targeted and immunotherapy revolutionized treatment in metastatic NSCLC
- SCLC is treated primarily with systemic therapy + RT due to early spread