Symposium on the diagnosis and treatment of common cancers. 1. Lung cancer--1983

The frequency of lung cancer, common in both men and women, seems to be increasing rapidly, particularly in women. The main causative factor appears to be cigarette smoking. Diagnosis and staging have not changed notably in the last few years, although the advent of computerized tomography and gallium scanning have been of some help in identifying mediastinal tumours, which are unresectable. Further refinements in these techniques may allow us to avoid mediastinoscopy but, at present, this is still usually necessary before operation for lung cancer. Operation is the major form of therapy for non-small cell cancer when this is medically and technically possible. Adjuvant therapy in the treatment of this type of lung cancer has so far been of little help. Radiotherapy as primary treatment, although occasionally curative, should be used only if patients refuse operation or clearly have medical contraindications for thoracotomy. Radiotherapy is very useful for palliation. Chemotherapy is of little value in treating advanced, non-small cell lung cancer, although responses can be seen in up to 40% of patients. This does not translate into important, long-term survival, but responders do survive longer than non-responders. Patients with small cell lung cancer should be treated with combination chemotherapy, with or without thoracic irradiation and with or without cranial irradiation. The latter two modalities have not yet been proved to prolong survival, but may reduce the morbidity. Immunotherapy has not been shown to benefit those with non-small cell lung cancer. Thymosin was beneficial in one controlled trial in patients with small cell lung cancer, but this must be confirmed. In the future, many new approaches will be necessary to control or eradicate this steadily increasing cause of cancer death.