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Lung Cancer at St. Luke's Hospital: A Closer Look
By Albert Van Amburg III, MD

Lung cancer continues to be a major cause of morbidity and mortality in the world and in the United States. St. Luke's Hospital has been a provider of multi-modality therapy for lung cancer for many years. Lung cancer is divided in two classes - small cell and non-small lung cancer. The non-small cell cancers include adenocarcinoma, squamous cell carcinoma, large cell carcinoma and bronchioalveolar carcinoma. Multimodality treatments include local therapies such as surgery and radiation therapy as well as systemic therapy with intravenous and oral medications.

Physicians at St. Luke's Hospital treat approximately 140 to 150 patients annually with non-small cell lung cancer. Most of the patients are older, with the median age between 60 and 70 with 14 percent of patients over the age of 80. Half of the patients seen at St. Luke's Hospital were female, reflecting the national trend of increasing incidence of lung cancer among women.

Lung cancer is staged by evaluating the extent of the disease by computed tomography (CT) and positron emission tomography (PET) scans. Stage I disease is a tumor confined to the lung and is removed surgically unless the patient is medically inoperable. Stage II disease includes patients with the spread of cancer to local lymph nodes and is also usually treated with surgery. In some Stage II cases, post-operative chemotherapy and/or radiation therapy is recommended. Stage III disease includes tumors which have spread to lymph nodes in the middle of the chest (mediastinum) and are treated with a combination of chemotherapy and radiation therapy. Stage IV lung cancer tumor nodules spread to the opposite lung (pleural or pericardium) or spread outside the chest. Stage IV disease is treated primarily with systemic therapy.

In a review of cases from 2004 at St. Luke's 22 percent of cases were stage I, 5 percent stage II, 20 percent stage III and 31 percent stage IV at diagnosis. Twenty percent of patients were treated with surgery, fourteen percent with radiation alone, five percent with surgery and chemotherapy and 20 percent with the combination of chemotherapy and radiation therapy. Stage IV patients were treated primarily with chemotherapy.

Lung cancer continues to be a challenge for physicians and patients. However, the last several years have seen a marked improvement in treatment with newly developed targeted therapies.

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