80% of lung cancers are linked to tobacco.
Other risk factors are environmental factors or professional exposure to asbestos, in particular.
Lung cancers are traditionally divided according to their appearance when analysed:
- Non-small cell lung cancer
- Small cell lung cancer
In any event, the assessment includes a bronchial fibroscopy, a thoraco-abdomino-pelvic scan, a PET scan, and brain imaging.
On completion of this assessment, the disease is ranked in stages (simplified here)
- Stage I: nodule of less than 5 cm isolated in a lung
- Stage II: Mass of over 5 cm or combined with lymph nodes limited to the hilum of the lung on the same side as the tumour
- Stage III: Presence of lymph nodes in the mediastinum
- Stage IV: Remote metastases (extra-pulmonary)
Treatments are then determined based on the type of disease, its state, and the patient’s general condition. For surgery to be feasible, the patient’s respiratory function must allow it.
For non-small cell lung cancers:
Stage I: Surgery, or if this is not possible, stereotactic radiotherapy over 3 to 8 sessions depending on localisation.*
Stage II: Surgery, or chemoradiotherapy if surgery is not feasible
Stage III: Chemoradiotherapy over 30 to 33 radiotherapy sessions, Surgery to be considered in certain cases
Stage IV: Chemotherapy, immunotherapy, or targeted therapy
* In this case, stereotactic radiotherapy allows for local control in the order of 90% with very few toxicities, and has completely transformed the prognosis of non-operable patients.
For small cell lung cancers:
Stages I to III: Chemoradiotherapy
Stage IV: Chemotherapy
The radiotherapy must be carried out using modern techniques and as precisely as possible. The dose received by the heart must be limited as much as possible. If this is too high, infarction or other cardiac complications may occur.
In metastatic stages, radiotherapy also plays a major role in treating brain and bone metastases, or in the event of oligometastatic disease.
