Lung Cancer: A Comprehensive Guide for the Clinician (Respiratory Medicine)

✍ Scribed by Christina R. MacRosty (editor), M. Patricia Rivera (editor)

• Publisher: Humana
• Year: 2023
• Tongue: English
• Leaves: 312
• Category: Library

✦ Synopsis

This book provides a comprehensive yet succinct update for the clinician in the diagnosis, staging, and treatment of lung cancer. Lung cancer is a leading cause of death in the US and worldwide and its prevention, screening, and treatment is a large part of clinical practice across specialties. Frequent updates in recommendations and guidelines in screening, diagnosis, staging, treatment, and management are vital, and it can be difficult for the busy clinician to stay up to date. This book provides a comprehensive update for the chest clinician across the continuum of lung cancer care.

Each of the thirteen chapters covers a specific component of lung cancer care and is written by experts in the field who are practicing clinicians. The objectives are to provide an organized and easily-referenced resource for the chest clinician; to provide comprehensive evidence-based information on the following topics: lung cancer screening and prevention, approach to lung nodules, diagnosis and staging of lung cancer, treatment of lung cancer, pleural disease in lung cancer, and treatment complications; and to provide source information for clinicians so they can stay up-to-date on any new guidelines or recommendations related to lung cancer screening, tobacco treatment, staging, and diagnosis. This book is written specifically for the busy clinician that focuses on clinically relevant and evidence-based principles around lung cancer while providing references for ease of finding source information to enable clinicians to stay updated as guidelines change.

This is an ideal guide for practicing pulmonary clinicians, practicing general practice clinicians, trainees in chest and general medicine, as well as some advanced practice providers who need a refresher.

✦ Table of Contents

Preface
Contents
Contributors
Chapter 1: US and Global Epidemiology and Incidence Rates of Lung Cancer
Introduction
Influential Factors of Lung Cancer Incidence
Age
Sex
Tobacco Use
Socioeconomic Factors
Smoking-Related Risk Factors
Cigarette Smoking
Secondhand Smoke
Cigar Smoking
Cannabis Smoking
Electronic Cigarette Smoking
Smoking Cessation
Never-Smoking
Nonsmoking-Related Risk Factors
Sex
Race
Diet and Supplements
Weight
Underlying Lung Disease
Radiation Therapy
Familial Risk Factors
Occupational and Environmental Factors
Asbestos
Radon
Environmental Pollution
Conclusion
References
Chapter 2: Lung Cancer Screening
The History of Lung Cancer Screening
Sputum Cytology and Chest Radiography
Chest Computed Tomography for Lung Cancer Screening
Preventative Care Coverage Policy in the United States
Evidence for Lung Cancer Screening
The National Lung Screening Trial (NLST)
Global Lung Cancer Screening Trials
Limitations in LCS Evidence
2021 USPSTF LCS Recommendations
Lung Cancer Screening Methods
Low-Dose CT Screening Exam Technique
Interpretation
Risks and Benefits
Does Lung Cancer Screening Result in Stage Shift?
Screening Strategy
Implementation of Lung Cancer Screening
State of Implementation
System-Level Barriers
Clinician-Level Barriers
Shared Decision-Making Visit and Decision Aids
LCS Program Structure
Adherence to Screening
Patient-Level Barriers
Lung Cancer Screening and Smoking Cessation
Emerging Issues in Lung Cancer Screening
Future Directions for Lung Cancer Screening Tests
Lung Cancer Screening for Other High-Risk individuals
Lung Cancer Screening During the COVID-19 Pandemic
Conclusions
References
Chapter 3: Tobacco Prevalence and Treatment
Introduction
Disparities in Tobacco Use Patterns
Carcinogenesis of Tobacco Smoke and the Development of Lung Cancer
Lung Cancer Continuum: An Opportunity to Promote Smoking Cessation
Lung Cancer Screening
Lung Cancer Care
Informed by Ongoing Research
Understanding Nicotine Addiction
Dismantling Stigma through Healthcare Provider Self-Awareness and Proactive Work
Taking a Structured and Comprehensive Tobacco Use History
Assessing Nicotine Dependency
Motivational Interviewing for Behavior Change
Leveraging the 5As Model for Behavior Change in Cessation Work
Taking a Comprehensive Tobacco History and Examination for Success
Counseling
Pharmacotherapy
Nicotine Replacement Therapy
Varenicline
Bupropion Sustained Release
Extended Duration of Cessation Therapy
Examining the Role of Electronic Cigarettes in Promoting Smoking Cessation
Relapse Prevention
Conclusion
References
Chapter 4: Approach to Lung Nodules
Introduction
Etiology
Evaluation
Imaging
Chest X-ray and Chest CT
Classification of Pulmonary Nodules by Imaging
Specific Morphologic Features
Nodule Size: Solid Pulmonary Nodules
Subsolid Pulmonary Nodules
Pure Ground-Glass Nodules
Semisolid Nodules (Part Solid, Part Ground-Glass)
Pulmonary Nodule Number
Unique Considerations for Screen-Detected Lung Nodules
Risk Stratification Models
Diagnostic Testing
PET Imaging
Biopsy
Lymph Node Staging
Pulmonary Biomarkers: Current and Future Directions
Conclusions
References
Chapter 5: Staging and Diagnosis of Lung Cancer
Significance of Staging
Staging Overview
Clinical Versus Pathological Staging Prefixes
TNM
T Component
N Component
M Component and Stage Grouping
Lung Cancers with Multiple Lesions
Noninvasive Staging
Invasive Staging
Who Requires Invasive Staging
Conventional TBNA
EBUS/TBNA
Endoscopic Ultrasound
Combined EUS/EBUS
Endobronchial Ultrasound Using the EBUS Scope (EUS-B)
Sampling of Metastatic Disease
Surgical Staging
Mediastinoscopy
Transcervical Lymphadenectomies
Endosonography Versus Mediastinoscopy
VATS
Prediction Models
Pathologic Staging
Pathologic Staging of Adenocarcinoma
Patients Without Nodal Metastases
Conclusion
References
Chapter 6: Treatment of Early-Stage (Stage I and II) Non-Small Cell Lung Cancer
Introduction
Presentation
Staging Schema
Treatment Options for Early-Stage Lung Cancer
Adjuvant Chemotherapy in Resected Early-Stage NSCLC
Radiotherapy in Resected Early-Stage NSCLC
Radiotherapy in Unresected Early-Stage NSCLC
Determination of Operability
Determination of Extent of Resection
Preoperative Workup
Surgical Approach
Surgical Techniques
Lobectomy
Anatomic and Positioning Considerations
Operative Flow
Segmentectomy
Wedge Resection
Pneumonectomy and Sleeve Lobectomy
Mediastinal Lymph Sampling Versus Dissection
Surgical Outcomes
Quality of Life
Disparities
Radiotherapy Techniques
Outcomes After SBRT
Conclusion
References
Chapter 7: Treatment of Stage III Non-small Cell Lung Cancer
Introduction
Current Treatment Strategies for Stage III NSCLC
Treatment Modalities in the Pre-immunotherapy Era
Surgery Plus Adjuvant Therapy
Neoadjuvant Therapy Plus Surgery
Nonsurgical Treatment
Immunotherapy for Stage III NSCLC
Immunotherapy in the Neoadjuvant Setting
Combination Immunotherapy Chemoradiotherapy
Molecular Targeting Agents
Conclusion
References
Chapter 8: Treatment of Stage IV Non-small Cell Lung Cancer
Introduction
Choosing First-Line Therapy
Histology
Adenocarcinoma Versus Squamous Cell Carcinoma
Large Cell Neuroendocrine Carcinoma
Sarcomatoid Carcinoma
Actionable Mutations
EGFR
ALK
ROS1
KRAS G12C
HER2
MET Exon 14, RET, BRAF V600E, and NTRK
Chemotherapy
Bevacizumab
Immunotherapy
Single Agent Immunotherapy: Anti-PD1/PD-L1
Chemoimmunotherapy
Dual Immunotherapy: Anti-CTLA-4 with Anti-PD1/PD-L1
Deciding on Treatment: PD-L1 ≥50% and No Actionable Mutations
Deciding on Treatment: PD-L1 1–49% and No Actionable Mutations
Deciding on Treatment: PD-L1 <1% and No Actionable Mutations
Summary
References
Chapter 9: Treatment of Small Cell Lung Cancer
Staging and Diagnosis
Treatment of Limited Stage Disease
Systemic Treatment Considerations
Surgical Considerations
Thoracic Radiation Considerations
Fractionation and Dose of Thoracic Radiation
Radiation Target Volumes
Normal Tissue Dose Objectives
Timing of Systemic and Local Therapies
Particle-Based Therapy
Treatment of Extensive Stage Disease
Systemic Therapy Considerations
Initial Systemic Treatment
Systemic Treatment for Relapsed Disease
Topotecan
Lurbinectedin
Metronomic Chemotherapy
Cyclophosphamide, Doxorubicin, and Vincristine (CAV)
Temozolomide
Pembrolizumab
Other Systemic Regimens
Thoracic Radiation Considerations
Local Therapy for Oligometastatic SCLC
Palliative, Attenuated Dose Radiotherapy in ED SCLC
Prophylactic Cranial Irradiation (PCI)
PCI in Limited Stage Disease
PCI in Extensive Stage Disease
Hippocampal Avoidance PCI
Summary of Recommendations
References
Chapter 10: Management of Malignant Pleural Effusion
Introduction
Epidemiology
The Cause of Malignant Pleural Effusion by Cancer Type
Clinical Presentation
Pathophysiology
Diagnosis
Imaging
Pleural Fluid Analysis
Pleural Biopsy
Management
Therapeutic Thoracentesis
Definitive Pleural Intervention
Chemical Pleurodesis
Indwelling Pleural Catheter
Comparator Trials and Combination Approaches
Surgical Management
Special Situations
Nonexpandable Lung
Loculated or Septated MPE
Conclusion
References
Chapter 11: Pulmonary Complications of Lung Cancer Treatment
Introduction
Approach to the Patient with Lung Cancer and New Pulmonary Symptoms
General Approach to Evaluation
Pulmonary Complications of Radiation Therapy
Epidemiology, Risk Factors, and Risk Reduction
Phases of Radiation-Induced Lung Injury
Evaluation of Suspected Radiation-Induced Lung Injury
Management of Radiation-Related Pulmonary Toxicity
General Approach to Evaluation of Suspected Drug-Induced Lung Disease
Patient Assessment
Diagnostic Testing
Assessing Severity and Principles of Management
Management of Pulmonary Complications of Systemic Therapies
Traditional Chemotherapies
Platinum Agents
Taxanes
Pemetrexed
Gemcitabine
Etoposide
Topoisomerase I Inhibitors
Vinorelbine
Alkylating Agents
Immunotherapy/Immune Checkpoint Inhibitors
Pneumonitis Epidemiology and Risk Factors
Clinical Presentation and Evaluation of ICI Pneumonitis
Management of ICI Pneumonitis
ICI-Related Sarcoidosis
Molecularly Targeted Agents
VEGF
EGFR
ALK and ROS1
BRAF
Other Newer Agents
Summary
References
Chapter 12: Multidisciplinary Approach to Lung Cancer Care
Introduction
A Framework for a Multidisciplinary Lung Cancer Program: The Front Desk Experience
The Serial Referral Model
The Joint Practice Model
The Hub, Joint Decision-Making Model
Challenges
Multidisciplinary Lung Cancer Care: Are There Knowledge Gaps?
Evidence Supporting Multidisciplinary Care Teams
Reducing Delays in Diagnosis and Staging
Treatment Utilization
Patient-Reported Outcomes
Improving Patient Survival
Disparities in the Receipt of Multidisciplinary Care
Conclusion
References
Chapter 13: Physiologic and Patient-Centered Considerations in Lung Cancer Care
Introduction
Pulmonary Function Testing
Exercise Testing
Cardiopulmonary Exercise Testing
Simple Field Exercise Tests
Additional Physiologic and Other Measures
Adjunct Physiologic Measures
Other Measures
Practical Challenges and Considerations
Variations in Guideline Recommendations
Defining Risk and Acceptable Thresholds
Real-World Challenges
Patient-Centered Care
Additional Considerations
Mitigating Risk
Care Team Characteristics
A Consolidated Approach
References
Index