Bronchogenic Carcinoma

Lung cancer is a group of diseases resulting from malignant growth of cells of the respiratory tract, particularly the lung tissue, and one of the most frequent types of cancer worldwide. Lung cancer usually originates from epithelial cells, and may result in metastasis and infiltration to other tissues. Excluding those lung cancer tumors that metastasize to the lung tumors from other parts of the body.

The most common symptoms are respiratory difficulties including bloody cough-cough-and weight loss, as well as chest pain, hoarseness, and swelling in the neck and face.

The most common cause of lung cancer is smoking, with 95% of patients with lung cancer, smokers and former smokers. In nonsmokers, the development of lung cancer is caused by a combination of genetic, exposure to radon gas, asbestos, and air pollution including secondhand smoke (passive smoking).

Early diagnosis of lung cancer is the main factor in successful treatment. In early stages, lung cancer can, in about 20% of cases to be treated by surgical resection successful healing. However, due to its virulence and the difficulty of early detection, in most instances where diagnostic and metastasis occurs; lung cancer presents with cancer liver, pancreas and esophagus poorer prognosis, with an average life expectancy of about 8 months.

Lung cancer is one of the most serious diseases and one of the cancers with the highest incidence in humans, responsible for the highest rates of cancer mortality worldwide. It is the leading cause of cancer death in men and the third, after the colon and breast cancer in women, causing over one million deaths each year worldwide. In the United Kingdom (2004) and the United States ( 2006) is the main cause of cancer death in women and men. In Spain are about 20,000 cases diagnosed annually, accounting for 18.4% of tumors among men (18,000 cases) and 3.2% among women (2,000 cases). Despite the difficulty find consistent statistics between different countries of Latin America and the Caribbean, overall survival has increased, especially in patients on regular treatment with chemotherapy.

Lung cancer was uncommon before the spread of smoking and at least until 1791 with reports of John Hill, was not considered a disease entity of importance. It was not until 1819 when the features were published salient lung cancer, a disease then difficult to distinguish from tuberculosis. By 1878 malignant lung findings represented only 1% of cancers observed during autopsies. The figure rose to 10-15% in the first half of the century X X. Until 1912 there were only 374 cases reported in the medical literature on lung cancer. In 1926, pulmonary small cell cancer was first recognized as an entity of malignant disease, different from all other types of lung cancer. In reviewing these studies show an increased incidence of lung cancer during the autopsias two un 0,3% en 1852 un\’s 5.66% en 1952.

The German physician Fritz Lickint reported in 1929 the first statistical evidence linking lung cancer with cigarette smoking, which led to an impressive anti-smoking campaign in Nazi Germany. A study was begun in the 1950s by British doctors, found the first solid evidence epidemiological connection between smoking and lung cancer. As a result, in 1964, the United States began public campaigns on the harmful effects of cigarette smoking.

The connection with radon was first recognized in the region of the Ore Mountains near Schneeberg, on the border between Saxony (Germany) and Bohemia (Czech Republic). This region is very rich in fluorite, iron, copper, cobalt and silver, the latter extracted from the 1470s. The presence of large amounts of uranium and radium led to an intense and continuous exposure to radon, a radioactive gas with carcinogenic properties.

Miners developed a disproportionate amount of lung disease that, in making epidemiological monitoring, in 1870 led to the discovery of certain disorders and then many go unreported, which coincided with the characteristics described years later of lung cancer. estimated that about 75% of these miners died of lung cancer. Despite this discovery, mining uranium in the Soviet Union continued even until the 1950s, due to continued demand for the metal.

The first successful pneumonectomy for lung carcinoma was made on April 5, 1933. Radiation therapy in cases of palliative care has been used since the 1940s, while the radical radiotherapy (radiation attempt higher) dose began to be used from the 1950s onwards as therapy in people with lung cancer, but without indication for surgery. In 1997 the rapid, continuous and radiotherapy hyperfractionated (CHART, for its acronym in English) supplanted conventional radical radiotherapy for lung tumors.

As lung cancer small cell, initial surgical approaches in 1960 and radical radiotherapy given disappointing results. Successful chemotherapy regimens were not developed until the 1970s.

Lung carcinomas of non-small cell are grouped because of their prognosis and treatment are very similar There are three main subtypes. Squamous cell lung adenocarcinoma and large cell lung carcinoma.

Nearly 31% of all lung carcinoma corresponds to a squamous cell carcinoma usually starts near a central bronchi. is commonly necrosis and cavitation in the center of the tumor. Those distinct tumors often squamous cells grow more slowly than other types of cancer.

Adenocarcinomas account for 29.4% of all types of lung cancer. It usually originates in the peripheral lung tissue. Most cases of lung adenocarcinoma are associated with cigarette smoking and in patients with previous lung disease. However, among those who have never smoked, adenocarcinomas are the most common form of lung cancer. One of the subtypes of adenocarcinomas, carcinoma bronchioloalveolar, is seen more often in women who have never smoked and generally shows different responses to treatment of one individual to another.

The giant cell carcinomas represent 10.7% of all forms of lung cancer. These are tumors that grow rapidly and near the surface of the lung. They are often poorly differentiated cells and tend to metastasize soon.

About 15% of all lung carcinomas correspond to lung cancer small cell, also called carcinoma oat cell. tends to occur in the airways of higher caliber, as in the primary bronchi and side-and grows rapidly growing to a large size. oat cell contains dense neurosecretory granules, ie, vesicles containing neuroendocrine hormones, giving you a partnership with an endocrine or paraneoplastic syndrome that is characterized by non-related to the effect of local tumor symptoms. Although it is a type of cancer that initially is more sensitive to chemotherapy, carries a worse prognosis and spreads much faster than lung non-small cell cancer. Lung tumors of small cells divide in a limited stage and advanced or disseminated stage. This type of cancer is also associated with smoking.

The lung is a common site for metastasis from disseminated tumors that start in another part of the body. The most common tumors that spread to the lungs are bladder cancer, breast cancer, colon cancer, neuroblastomas, prostate cancer, sarcomas and Wilms tumor. These cancers are identified by the site of origin, so that breast cancer in the lung is still breast cancer. They often have a characteristic shape in the chest radiograph. Primary lung tumors metastasize especially in the adrenal glands, liver, brain, and bone.

Worldwide, lung cancer is the most common form of cancer in terms of incidence and mortality causing about 1.0 to 1,180,000 deaths each year, with the highest rates in European countries and North America. The population segment most affected are those over age 50 who have a history of smoking. The incidence of lung cancer by country has an inverse correlation with exposure to sunlight or ultraviolet rays, suggesting that the lack of ultraviolet B irradiation, which leads to a deficiency of vitamin D, may contribute to the incidence of lung cancer.

Lung cancer, or bronchogenic carcinoma accounts for over 90% of lung tumors. From this 90%, 93% corresponds to the primary lung cancer and 4% is made up of secondary tumors or metastatic. 2% corresponds to bronchial adenoma and 1% are benign tumors. Bronchogenic The term applies to the majority of lung cancers but it is wrong as it involves bronchial origin for all of them, although adenocarcinomas, which are peripherals are often bronchiolar origin. The relationship with smoking is such that the incidence of death from lung cancer is 46, 95, 108, 229 and 264 per 100,000 among those who smoke half box, half – 1 box, 1-2 boxes, 2 boxes and more than 2 packs per day, respectively.

The number of cases has been increasing since the early twentieth century, doubling every 15 years. The incidence has increased by 20 times between 1940 and 1970. Early twentieth century, it was considered that most of the lung tumors were metastatic and primary cancer that was rare. Lung cancer is less common in developing countries, however, the incidence is expected to increase significantly in the years in these countries especially in China and India.

Lung cancer is the most common in men, especially in eastern Europe, with rates close to 70 cases per 100 000 population per year in countries with more cases and a rate close to 20/100, 000 neoplasia in countries like Colombia, Switzerland and other countries reporting the lowest incidence. The rate among women is approximately half that of men, with rates close to 30 per 100 000 women per year in countries with more cases and close to 20 in countries like Colombia, Switzerland and other countries reporting the lowest incidence rate. India has a rate of 12.1 and 3.8 per 100 000 for men and women respectively. In women continues to have a lower incidence, but death from lung cancer has been located in some countries second only to breast cancer, even in the first place. Although the death rate among men in Western countries is decreasing the mortality rate of women from lung cancer is increasing due to the increase in the number of new smokers in this group.

Lung cancer mainly affects people between 60 and 65 years. Less than 15% of cases occur in patients under 30 years of age. The average age of the people who were diagnosed with lung cancer is 60 years. Since in many countries it has been observed an increase in the number of young smokers, changes were observed in mortality by age in the coming decades.

The main causes of lung cancer and cancer in general, including carcinogens such as cigarette smoke, ionizing radiation, and viral infections. Exposure to these agents causes changes on the DNA of the cells progressively accumulate genetic alterations that transform the epithelium lining the bronchi of the lung. As the damage becomes more extensive, increases the likelihood of developing cancer.

It has been established that the snuff and possibly air pollution, are a causal factor for lung cancer. Between 80-90% of lung cancers occur in smokers or in people who have recently stopped smoking, but there is no evidence that smoking is associated with a specific histological subtype, although it tends to relate more to squamous carcinoma and small cell cancer. Statistically not associated with adenocarcinoma. Smokers have a risk of 10 to 20 times more likely to develop lung cancer (according to the number of cigarettes smoked per day) than nonsmokers. Ie there is a linear dose-response relationship.

The more years of life a person smokes and especially if it\’s at an early age, is more related to cancer because the dose is cumulative carcinogenic. For example, the risk increases 60-70 times in a man I smoke two packs a day for 20 years, compared to non-smoker. Although smoking cessation reduces the risk of lung cancer does not reduce the levels of never smokers. Even abandoning the smoking habit remains a high risk of lung cancer during the first 5 years. In most studies the risk of former smokers approaches that of nonsmokers after 10 years, but can still high even after 20 years. In a study in Asturias (Spain), those who quit smoking 15 years before having lung cancer were 3 times greater risk than non-smokers.

Passive smoking is the person who does not smoke but who breathe the smoke of snuff smokers, whether at home, at work or in public places. Passive smoking has high levels of risk for lung cancer, although lower compared to active smoking. The active smoker has the possibility of contracting a disease from the snuff in 80% of cases, while in the passive smoking, the risk is 23%. There is no evidence that suggest that the risk of lung cancer is higher in active smokers than in passive smokers.

The cigar smoking, cigars or pipe is less likely to cause lung cancer than smoking cigarettes even though the amount of carcinogens in the smoke pipe and cigar is at least as large as in cigarettes. Cigarettes marijuana have less tar than of snuff. Many of the substances that cause cancer snuff are not in the combustion products of marijuana. Some medical reports indicate that these products burning marijuana not cause mouth and throat cancer more often than those of snuff. However, because marijuana is an illegal substance, it is not easy to obtain information about the relationship that the combustion products of marijuana are cancer based on molecular, cellular and histological grounds.

Cultural groups who defend smoking as part of their religion, as Latter-day Saints and the Seventh-day Adventists, have much lower rates of lung cancer and other cancers associated with drinking of snuff.

The snuff is responsible for 30% of cancers in general and in decreasing order of frequency are lung, lip, tongue, floor of the mouth, pharynx, larynx, esophagus, bladder and pancreas.

Lung cancer, like other forms of cancer, is initiated by activation of oncogenes or inactivation of tumor suppressor genes. Oncogenes are genes that appear to make an individual more susceptible to cancer. For their part, tend to become proto-oncogenes when exposed to particular carcinogens.

Several studies indicate that exposure to snuff like women are more likely to develop lung cancer than men. The siblings and children of people who have had lung cancer may have a slightly increased risk than the general population. If the father and grandfather of one individual died from lung cancer and smoking it, the most likely cause of death is lung cancer.

Asbestos is another risk factor for lung cancer. People who work with asbestos have a higher risk of lung cancer if they smoke well, the risk is greatly increased. Although asbestos has been used for many years, Western governments have almost eliminated the use work and in household products. The type of lung cancer related to asbestos, mesothelioma, often begins in the pleura.

Have increased risk for developing lung cancer related workers in the asbestos industry, arsenic, sulfur, (the three \’A\’) vinyl chloride, hematite, radioactive materials, nickel chromates, coal products, mustard gas, ethers chloromethyl, petrol and diesel derivatives, iron, beryllium, etc.. Even the worker smoking in these industries is still a risk five times greater chance of getting lung cancer than those not associated with them. All types of radiation are carcinogenic. Uranium is weakly radioactive but lung cancer is four times more prevalent among miners uranium mines no smoking in the general population and ten times more common among smokers miners. Radon is a radioactive gas produced by the natural decay of uranium. Radon is invisible and has no taste or smell. This gas can be concentrated in the inner house and become a possible risk of cancer.

Some studies conclude that a diet few foods of plant class, could increase the risk of lung cancer in people who are exposed to secondhand smoke snuff. You may apples, the onions and other fruits and plant foods contain substances that offer some protection against lung cancer.

It is thought that certain vitamins, especially vitamins A and C, are protective in the bronchial mucosa, for their ability to inactivate free radicals of the carcinogens, or by its ability to accurately regulate certain cellular functions, through various mechanisms. However, no studies have been shown that prolonged use of mulitivitaminas reduce the risk of developing lung cancer. Research relating to Vitamin E show conclusive evidence that vitamin taken in large doses, can increase the risk of lung cancer, a particularly important risk among smokers.

It has been shown that β-carotene was ineffective for chemoprevention of lung cancer Indeed, since 2007 the use of β-carotene as a chemopreventive supplement for lung cancer is not recommended in individuals with a history of consumption greater than 20 pack-years or a personal or family history of lung cancer cigarettes. Studies speculate that beta-carotene, an antioxidant traditionally considered could metabolized to “pro-oxidant” once within the human organism.

At the time of diagnosis less than 20% have localized extension, 25% have spread to lymph nodes and 55% had distant metastases. Lung cancer begins at a certain point in the mucosa and from there has a growth towards the interior and exterior of the bronchial lumen, up and down through the submucosa and circumferential growth, following a pattern of direct spread called “infiltration”.

The intra and extrabronchial growth is constant throughout lung cancer. Only 20% of cases, the cancer will be diagnosed in the lung parenchyma (localized), and which has a better prognosis.

25% of diagnosed cases of lung cancer, as have regional lymph nodes. Even in early stages, about 30% of patients with stage I non-small cell lung cancer die after complete resection of the tumor due to the presence of undetectable metastases at diagnosis.

The frequency of lymph node involvement varies slightly depending on the histological pattern, but hovers around 50%. Given the direct continuity with the supraclavicular paratracheal nodes, you can set all cancers located right lung and left lower lobe may invade lymph right supraclavicular fossa through the thoracic duct; however, supraclavicular lymph be affected left exclusively in the left upper lobe tumors, the thoracic duct.

40% in carcinomas of non-small cell and 70% of small cell carcinomas present and distant metastases at the time of diagnosis. Distant metastases are common, a fact that is justified by the relatively early involvement pulmonary venous vessels; in histopathological variety of cell anaplastic tumors oat is almost systematic, which has a poor prognosis significance. Metastases preferentially affect, and in descending order to the liver (30-50%), brain (20%), skeleton (20%) and kidney, the incidence in the adrenal glands and is also high, which is observed in approximately 30-50 % of autopsies of patients dying from lung cancer. Perhaps it is the result of lymphatic spread from distant connection with other para-aortic retroperitoneal lymph groups, and not through the blood. Finally, there is also to cite lung metastasis itself, as a result of embolization through the pulmonary artery. However, the existence of several tumor, unilateral or bilateral masses, also makes it be considered broncógenas disseminations, as supported on bronchiolar tumors.

In most patients, the diagnosis is brought before clinical and radiological study when a lung abnormality is detected. Less often will attempt to clarify the diagnosis in those patients in routine radiological study has shown them a suspect or trying to locate the tumor before a histological image showing neoplastic cells.

They usually perform additional tests to patients with lung cancer to determine the condition of the patient, including medical history and complete physical examination, complete blood count, blood chemistry (electrolytes, glucose, calcium and phosphorus levels and hepatic and renal function, albumin and LDH), electrocardiogram, pulmonary function tests such as spirometry and determination of arterial blood gases, tests Coagulation, tumor markers such as carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP).

On plain chest radiographs can observe any abnormalities in almost 98% of patients with bronchogenic carcinoma, and 85% are suggestive images to suspect the diagnosis of distal pulmonary abnormalities (atelectasis), presence of lymphadenopathy (enlargement mediastinal) or detecting invasion of the chest wall. Chest radiography detected suspicious items in most patients with lung tumors. No radiological mass sockets for early detection of lung cancer are recommended.

Tomography is a very demonstrative method of mediastinal involvement of carcinoma of the lung, assessment of retroperitoneal lymph nodes, femoral, and the condition of the liver, adrenal and kidney, frequently affected by metastases. It also allows the analysis of subpleural lesions and visualization of small spills, the possible effect of wall as it allows a correct view of the wall-costal and viewing tumor spread to other adjacent structures.

Sputum cytology is the most common diagnostic procedure in patients with suspected lung cancer and should be the first technique to use in all patient suspected of having lung cancer, either because he suggest the clinical and radiology, either because , while not suggestive, is whether an individual at high risk. From the year 2007, not recommended for single sputum cytology or serial for screening in lung cancer.

The use of radioactive isotopes, mainly albumin macroaggregates labeled with 131I or technetium 99 for the study of pulmonary perfusion. Scintigraphy is also available with Gallium 67 for the detection of metastases, especially ganglion. It is done with bleomycin labeled with Co57 or 67Ga. Another technique used is the Positron Emission Tomography (PET) using glucose labeled with a radioactive atom.

Studies in intrathoracic and extrathoracic extension and exploratory use different methodologies for various purposes, including to know the extent of the tumor or metastases.

For many reasons, including comparing treatment outcomes, it is useful that there is a uniform TNM staging for cancer based on their anatomical extent at diagnosis method.

The International Association for the Study of Lung Cancer classifies small cell lung cancer, only two stages. Localized to the chest and disseminated disease outside the chest disease

Treatment options for lung cancer are surgery, radiotherapy and chemotherapy, alone or combined, depending on the state as the cancer, the cell type of cancer and how it has spread, and the health status of the patient. For this reason it is very important that all necessary diagnostic tests are performed to determine the stage of cancer.

If diagnostic investigations confirm the presence of lung cancer, a CT scan can determine whether the disease is localized and if the surgical approach or if the spread is such that can not be cured with surgery is possible. It is also expected that blood tests and pulmonary function should be made to determine if the patient is able to be operated and if you will be enough healthy lung tissue after surgery. If it is discovered Respiratory deficient reservation, as in the case of smokers with chronic obstructive pulmonary disease, surgery may be contraindicated. Some advances in surgical techniques have made surgery possible in patients with serious coexisting medical problems.

In patients with adequate respiratory reserve, lobectomy is preferred because it minimizes the likelihood of a recurrence localized approach. If the pulmonary functions of the patient are low, wedge resection is advised. Possible complications include major hemorrhage, wound infection and pneumonia. Because the surgeon must make the cut through the ribs to get to the lungs, the ribs will hurt for a while after surgery. The activities are restricted for at least one or two months.

Lung surgery has a rate of post-operative near 4.4%, depending on the lung function and other risk factors for death.

Are established based on the functional status of the patient clinical situation in which lies before the intervention, and the possibility of functionally withstand the degree of pulmonary resection in each case is required.

In extreme situations should be performed, on one hand, functional studies with xenon measuring ventilation and perfusion rates in each lung separately and even right heart catheterization. Furthermore, assessment of the possibility of intervention based on these data and resection to be performed to remove the tumor.

The therapy involves the use of ionizing radiation, such as high energy X-rays to kill cancer cells and shrink tumors.

External radiation therapy is used generated outside the body by means of a linear accelerator and which is concentrated in the cancer. This type of radiation therapy is used most often to treat primary lung cancer or metastases in other organs.

In internal radiation therapy or brachytherapy small disc material or radioactive isotope that is placed directly into the cancerous area or in the air next to the cancerous area are used. This type of brachytherapy is generally palliative type and its main indication is obstructive atelectasis by cancer. Brachytherapy in the margins of resection may reduce recurrence.

Sometimes radiotherapy as the primary treatment for lung cancer is used, especially when the patient\’s general health is too poor to undergo surgery. may also be used to help relieve blockage of large airways from cancer.

Radiation therapy may be used after surgery to destroy very small traces of cancer that can not be seen and removed during surgery (residual microscopic disease). In addition, radiation therapy can be used to relieve some symptoms of lung cancer such as pain, bleeding, difficulty swallowing, and problems caused by brain metastases.

Side effects from radiation therapy may include mild skin problems, nausea, vomiting and fatigue. Often these side effects last for a short time. Radiation therapy can also worsen the effects of chemotherapy. The chest radiation can damage the lungs and cause difficulty breathing. The esophagus is located in the center of the chest and will be exposed to radiation. For this reason, it is possible that experience difficulty swallowing during treatment (esophagitis). These effects improve after treatment ends.

Chemotherapy involves the administration of antineoplastic or cytostatic drugs intravenously or orally to prevent the multiplication of cancer cells. These drugs enter the bloodstream and reach all areas of the body, allowing this treatment useful even for those cancers that have spread or metastasized to distant organs of the lung. he Depending on the type and stage of cancer lung, chemotherapy can be given as (primary) treatment or as adjunctive treatment (adjuvant) surgery or radiotherapy. Generally during chemotherapy for lung cancer a combination of anticancer drugs (polychemotherapy) is used.

Cisplatin (CDDP), or the like, carboplatin, are the chemotherapeutic agents used most often to treat lung cancer non-small cell (NSCLC). Recent studies have found that the combination of any of with these drugs as gemcitabine, paclitaxel, docetaxel, etoposide (V P-16), or vinorelbine appears to improve effectiveness in the treatment of NSCL C. Gemcitabine was initially approved for the treatment of pancreatic cancer and is now widely used in the treatment of NSCLC C. is an alkaloid Vinorelbine inhibits mitosis in cells in the M phase of the cell cycle by inhibiting tubulin polymerization. Myelosuppression, ie, a reduction in the production of granulocytic white blood cells is the only adverse effect that limits the dosage of these drugs. Research is continuing in the best trials how to use this combination of drugs. Other drugs have appeared with promising results, such as pemetrexed, recommended for local advanced stages of metastatic NSCL and even C.

New drugs such as gemcitabine, paclitaxel, vinorelbine, topotecan and teniposide have shown promise in some studies SCL C. If the patient\’s health is relatively good, it is possible that higher doses of chemotherapy are administered together with medicines called growth factors (colony-stimulating factor and erythropoietin neutrophils or macrophages). These help prevent side effects of chemotherapy in the bone marrow.

Chemotherapy drugs kill cancer cells but also damage some normal cells. Side effects of chemotherapy depend on the type of drugs used, the amount and the length of treatment. Temporary side effects may include nausea and vomiting, loss of appetite (anorexia), hair loss (alopecia) and sores in the mouth (mucositis). Since cisplatin vinorelbine, docetaxel or paclitaxel can damage nerves, you may experience is numbness, particularly in the fingers and toes, and sometimes weakness in the arms and legs (neuropathy).

Some studies have suggested that cannabinoids derived from marijuana during chemotherapy used reduced nausea and vomiting associated with the treatment, allowing the patient to eat.

Has recently been approved in some countries biological therapy or immunotherapy for the treatment of lung cancer. Immunotherapy may be given in conjunction with surgery, chemotherapy and radiotherapy. These biological therapies use the body\’s immune system, either directly or indirectly, to fight cancer or to lessen the side effects that can cause some cancer treatments. The compounds most frequently used include interferons, interleukins, inhibitors of growth factors such as erlotinib, monoclonal antibodies such as bevacizumab, vaccines, gene therapy and non-specific immunomodulating agents.

The progress that has been made toward understanding the biology and mechanism oncogenéticos lung cancer has allowed the development of treatments based on the molecular composition of cancer cells. Some of the molecular targets studied include the vascular endothelial growth factor and its receptors and the receptor for epidermal growth factor. The drugs appear to be safe and effective in certain histologic subtypes lung cancer, including non-small cell and its advanced stages. The only downside so far is that it requires a histological diagnosis of cancer.

Primary prevention through abandonment or avoid consumption of snuff, along with early detection control measures represent the most important lung cancer. The anti-tabáquicos efforts initiated since the 1970s have resulted in a stabilization the death rate from lung cancer in white males, while among women the cases are still increasing, as this group has increased the prevalence of consumption, decreased the age of onset and increased the number of cigarettes smoked. Not all cases of lung cancer are due to cigarette smoking, as the role of passive smoking has been increasing its importance as a risk factor for the occurrence of lung cancer. This has encouraged the creation of policies to reduce contact with cigarette smoke among non-smokers.

Smoke from cars, factories and power plants also pose a risk of lung cancer. Multivitamins taken no long term help prevent lung cancer, while vitamin E seems increase the risk of lung cancer in smokers.

To prevent lung cancer reach clinically manifest, health policy focus on screening and early detection of disease through screening programs and tumor control. Another way to perform secondary prevention is through knowledge by the population through advertising campaigns of the early symptoms of suspected lung cancer. Screening is not recommended nor chest radiography sputum cytology in asymptomatic persons.

It is likely that early detection of lung cancer through research do not reduce mortality rates, although it has been shown to improve survival of patients diagnosed with the disease.