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Query: UMLS:C0242379 (lung cancer)
 71,905 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A study was conducted to determine the bronchoscopic and chest roentgenographic findings associated with a positive TBNA. One hundred fifty-seven of 465 patients who were diagnosed for the first time as having carcinoma of the lung had a positive aspirate. Bronchoscopic findings associated with a positive TBNA of N2 nodes were carinal widening and endobronchial disease, especially of the right upper lobe. Mediastinal adenopathy noted on chest roentgenograms and subcarinal nodes on CAT scans were associated with a positive aspirate as well. In 34 of 465 patients, TBNA was the only means of establishing the diagnosis of pulmonary malignancy. A useful, simple and safe procedure, TBNA can be used to stage the mediastinum in patients with lung cancer and is most likely to be positive with endobronchial and nodal disease. It can also facilitate therapeutic decision-making in patients whose surgical candidacy is marginal.
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PMID:Bronchoscopic and roentgenographic correlates of a positive transbronchial needle aspiration in the staging of lung cancer. 195 1

The p53 gene has been implicated as a tumor suppressor gene with mutations found in common human cancers. We examined 51 early stage, primary, resected non-small cell lung cancer specimens using an RNAase protection assay and cDNA sequencing. Mutations changing the p53 coding sequence were found in 23/51 (45%) tumor specimens, but not in the corresponding normal lung, were distributed between codons 132 to 283, and included tumors with and without 17p allele loss. Fifteen of the 23 mutations lay in the predicted binding regions for SV40 large T antigen, and 14 were located in regions highly conserved between species. G to T transversions were a common result of p53 mutations in lung cancer compared to other cancers suggesting exposure to different mutagens. In univariate and multivariate analysis the presence of p53 mutations was associated with younger age and squamous histology. However, the presence of p53 mutations was not significantly associated with tumor stage, nodal status or sex and was found in all histologic types of lung cancer. We conclude that somatic mutations in the p53 gene play an important role in the pathogenesis of early stage non-small cell lung cancer.
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PMID:Mutations in the p53 gene are frequent in primary, resected non-small cell lung cancer. Lung Cancer Study Group. 197 60

We have reviewed our experience of limited resections for Stage I lung cancer for the years 1971-88. Sixty-one cases of sublobar resection (wedge or segmental) were compared with 411 lobar resections (lobectomies or bilobectomies), performed over the same period. Operative mortality was 0% in the limited resection group and 3% (12/411) in the control group. Cancer recurrence was detected respectively in 36% and 38% of patients, and actuarial survival at 5 years was 55% versus 49% overall. Sublobar resection had a slightly better outcome than lobar resection in pathological T1 (5-year survival of 73% vs 55%) but a worse outcome in pT2 (35% vs 46%); however, none of the differences was statistically significant. In 28 patients with pre-existing cardiac or pulmonary co-morbidity, limited resection yielded the same 5-year survival as lobectomy (53% vs 51%) with no peri-operative deaths (0 vs 5%). Although derived from a retrospective analysis, these data offer a further confirmation that limited resection combined with adequate nodal staging is a reliable and effective technique for early stage lung cancer management.
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PMID:Limited resection for Stage I lung cancer. 199 56

A total of 1,289 patients with primary lung cancer were surgically treated at our hospital from January 1953 to December 1985. Surgical treatment for T4 lung cancer was studied in 93 patients who had pulmonary resections. The relationships between histologic type, stage, method of resection, curability, nodal involvement, pleural involvement, site of invasion, pleural metastasis, pleural effusion, combination therapy, and the survival rate were analyzed. The survival rate of 93 patients with T4 lung cancer was 17% at 3 years and 7% at 5 years. Three-year survival rate of 39 patients with adenocarcinoma, 34 patients with squamous cell carcinoma, and 9 patients with large cell carcinoma was 7%, 23%, and 14%, respectively. Two-year survival rate of 6 patients with small cell carcinoma was 17%. Four-year survival rate of 14 patients who had complete resection was 33%. On the other hand, four-year survival rate of 77 patients who had incomplete resection was 7%. Three-year survival rate of 6 patients with N0 disease, and 19 patients with N1 disease, 46 patients with N2 disease, and 22 patients with NX disease was 40%, 39%, 0%, and 15%, respectively. Two patients, who had partial resection of the left atrium because carcinoma made an invasion upon it, had survived more than 5 years. All patients with esophageal invasion or tracheal invasion had died within a year. Indications of surgical resection for patients with T4 lung cancer should be limited to patients with N0 and N1 disease. Radical pulmonary resection can be performed in patients who are expected to have complete resection.
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PMID:[T4 advanced lung cancer: results of surgical treatment and indications of surgical resection]. 205 75

Rule-based expert systems offer the ability to quickly retrieve considerable amounts of information relevant to specific situations; the technology can be potentially very useful to physicians in an era characterized by an explosion of medical data. A simple rule-based expert system that allows a microcomputer user to obtain staging, prognostic and therapeutic information relevant to patients with lung cancer is presented. The program was constructed by utilizing an inexpensive expert system development package (EXSYS). Using information from the literature, 194 rules were formulated; these rules can be expanded or updated at any time. The computer user interacting with the system is asked sequential questions regarding the characteristics of the tumor (T) of a particular patient, the nodal status (N), the presence or absence of metastasis (M), how the staging information was derived (clinically or at surgery), the tumor cell type and the therapeutic options being considered (different surgical procedures, radiotherapy, chemotherapy and others). The system selects the appropriate answers and displays the stage of the tumor and relevant prognostic information. The microcomputer user can also examine the rules that were selected by the system. These rules have relevant comments that apply to the specific condition, as well as appropriate references. The microcomputer user can change all or some of the conditions (i.e., therapeutic options) and compare the results of the various "WHAT-IF" simulations.
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PMID:Expert systems for efficient handling of medical information. I. Lung cancer. 206 14

This paper reports our results with sublobar resections for stage I non small cell lung cancer. Sixty-one cases of wedge or segmental resection were compared with 517 standard resections (411 lobectomies and 106 pneumonectomies), performed during the years 1971-88. Operative mortality was 0% in the limited resection group and 4% (19/517) in the standard resection group; cancer recurrence was detected in 36% of both groups; actuarial survival at 5 years was 55% versus 48% overall. In 28 patients with pre-existing cardiac or pulmonary co-morbidity, limited resection yielded a similar 5-year survival than standard resection (53% vs 49%) with no perioperative deaths (0 vs 6%). Our data support the experience of other authors on conservative management of stage I lung cancer. Particularly in patients with concomitant cardio-pulmonary disease, previous cancer or small peripheral tumors, limited resection combined with adequate nodal staging may be as effective as standard lobar resection with respect to long term survival.
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PMID:Results of conservative surgery for stage I lung cancer. 215 8

Cancer of the lung is one of the most frustrating yet important challenges facing medicine today. Despite screening programs and education of the public concerning the established link of lung cancer and cigarette smoking, the overall incidence of lung cancer continues to rise. Improved imaging has led to more accurate staging. Expanded treatment has yielded improving survivals of certain specific tumors. Accurate diagnosis and staging of lung cancer is important in detecting therapy and prognosis. Computed tomography (CT) has been established as an important component of the staging process. More recently, applications of magnetic resonance imaging (MRI) are ideally suited to evaluate tumor extent and nodal disease. We reviewed the uses and limitation of CT and MRI. Compared with CT, the relatively low signal in the lung limits the detection of pulmonary nodules and other lung parenchymal diseases, and noise due to motion has been a frequent and significant problem in thoracic MRI. Because of its superior spatial resolution and ability to detect calcification, CT is better than MRI for the detection and evaluation of lung nodules and mediastinal adenopathy when assessing lung cancer. For the detection of mediastinal invasion or lymph node metastases, CT and MRI generally provide similar information. However, volume averaging problems, which may occur on trasaxial CT, can be avoided or clarified using MRI, and nodes can sometimes be more clearly distinguished from vessels using this technique. In the diagnosis of hilar masses or lymphadenopathy, CT and MR provide similar information in the majority of cases, but occasionally MR may more clearly indicate the presence or absence of a mass. Because of superb vascular imaging capability (without the need for exogenous contrast agents), exquisite soft tissue contrast, the ability to image the chest directly in multiple planes, and the potential to characterize certain tissues, MRI appears to be superior to CT in defining the extent of chest-wall invasion. In general, CT is superior to MRI as an all-around tool for imaging the wide range of thoracic abnormalities that can be present in patients with lung cancer. Limited availability, and longer examination time of MRI compared with CT has restricted the use of thoracic MRI. If MRI is used selectively as a secondary imaging study to answer specific questions raised or unanswered by CT, its value can be optimized.
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PMID:[CT and MR imaging in the evaluation and staging of lung cancer]. 217 93

In 1986, Pearson reported on the lung cancer experience in Toronto over the past 25 years. The number of unresectable operations had decreased from 25 to 5%. Operative mortality was down from 10 to 3% and 5-year survival increased from 23 to 40%. The reason for these statistics, he stated, was not better surgery but better selection of surgical candidates, due to invasive and noninvasive techniques. CT and MR imaging are part of those noninvasive techniques and also play an important role in guiding the invasive techniques. Although controversy exists regarding the proper size criteria and axis length in nodal assessment, and the use of imaging in staging T1N0M0 lung cancer, most clinicians rely on CT scans to evaluate the patient with lung cancer. No other imaging test is as comprehensive in evaluating the patient with lung cancer. The main role of MR imaging at this time is as a problem-solving tool. Focused MR imaging examinations should be used to evaluate or to resolve specific questions related to invasion of the chest wall, vascular structures, or brachial plexus, and adrenal mass characterization. MR imaging is also useful in evaluating the hilum and mediastinum in patients who cannot receive intravenous contrast for CT evaluation. The overall accuracy of CT and MR imaging is disappointing, particularly in crucial areas of determining operability such as distinguishing between patients with Stage IIIA or IIIB disease. It is unlikely that CT diagnosis can significantly improve; however, there is substantial potential for improved diagnostic accuracy with MR imaging as continued research moves this technology forward. The future may bring improved tissue characterization and vascular evaluation. At present, CT remains the procedure of choice in the initial assessment of the patient with lung cancer. The radiologist must be prepared to interpret these imaging studies in light of the specific findings that determine the stage and thus potential resectability of lung cancer.
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PMID:Current uses of CT and MR imaging in the staging of lung cancer. 218 67

From 1953 to 1985, a total of 1289 patients with primary carcinoma of the lung underwent surgical treatment. Of these 116 (8.9%) had small-sized (less than or equal to 2 cm in diameter) peripheral type lung cancer lesions. This study had three purposes: 1) to analyse how small-sized lung cancer lesions were detected; 2) to evaluate the reliability of diagnosis of small-sized cancer lesions; and 3) to evaluate pre- and post-prognostic factors of such patients compared with patients with peripheral type lung cancer lesions 2.1-3 cm in diameter. Of the 115 patients with small-sized lung cancer lesions were detected in the course of mass surveys. Cytopathological diagnosis in 75% of the patients resulted from transbronchial brushing cytology. The 5-year survival rate of patients who underwent resection of small-sized peripheral type lung cancer lesions was 70% (2.1-3 cm; 52%). Various factors such as histologic type, nodal involvement, pleural involvement, pathological stage, and success of the operation were shown to significantly affect survival. A comparison of two groups, i.e., those with lesions smaller than 2 cm in diameter and those with lesions 2.1-3 cm in diameter, showed the rate of lymph node metastasis to be significantly different. Of the patients with peripheral lung cancer lesions smaller than 2 cm who underwent surgery, 21% had peribronchial, hilar, or mediastinal lymph node metastasis. On the other hand, lymph node metastasis was seen in 43% of cases with peripheral lung cancer lesions 2.1-3 cm in diameter who underwent surgery.
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PMID:[Analysis of patients with resected small-size (less than or equal to 2 cm in diameter) peripheral type lung cancer lesions]. 223 79

A small number of patients with lung cancer will have a tumour invading the chest wall. Pre-operative radiotherapy and surgical resection provide the best results in patients with Pancoast's tumours, although chest wall invasion is often considered to indicate incurability. We reviewed the outcome in 46 patients with bronchogenic carcinoma and non-apical chest wall invasion and have tried to clarify the role of adjuvant pre-operative radiotherapy. All patients underwent combined chest wall and lung resection for treatment of lung cancer which had extended grossly and microscopically into the chest wall. In this retrospective study, we identified two groups of patients, those (n = 21) who received and those (n = 25) who did not receive pre-operative radiotherapy. Curative resection had been possible in 80% of the patients. There was one early post-operative death, due to pneumonia. The survival in all 46 patients is 32% at 5 years. In the most favourable cases, those without nodal involvement and who received pre-operative radiotherapy, the 5-year survival is 56%. In our series, there was a notable difference in 5-year survival between irradiated and non-irradiated patients at every stage of disease.
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PMID:En bloc resection for bronchogenic carcinoma with chest wall invasion. Value of pre-operative radiotherapy. 224 47


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