The Cancer of the Poumon is the first cause of death by cancer at the man and also at the woman.

Epidemiology

The French network of the registers of cancers (Francim) and the National institute of health and the medical research (Inserm) estimate the full number of new cases of cancers in France, in 2000, to 280.000, including 58% occurring at the men. For the same year, the number of deaths per cancer is estimated at 150.000 including 61% at the man. Lung cancer comes in 4th position for its incidence (28 000 new cases) after the Breast cancer (42 000), of the prostate (40 000), and of the colonist and rectum (36 000). 23.000 lung cancers were diagnosed at the man in 2000 and 4.600 at the woman. Taking into account the modest effectiveness of the treatments, lung cancer is the first cause of died by cancer with approximately 27.000 deaths in 2000, including 23.000 at the man and 4.500 at the woman. According to the health insurance, 14.237 new cases in Metropolitan France in 2002.

• the Tabagisme is responsible in more than 90% for the cases.

• air pollution and the Amiante are also responsible, to a lesser extent: the fine particles emitted by the cars downtown thus responsible for would have died for 6500 to 9500 people in France, including more than 1000 per lung cancer; asbestos, it, is at the origin of 2000 to 3000 lung cancers each year in France (these figures could increase in the future).
• the exposure to the Radon is a less known cause of lung cancer. It would be responsible, in France, of 13% of cancer deaths of the lung, that is to say approximately 3350 each year, in Europe of 9% of cancer deaths of the lung. The EPA estimates that in the United States radon is the first cause of lung cancer in the nonsmokers, and the second cause after the active nicotinism.

Lung cancer arrives at the first rank of cancer deaths at the man and at the second at the woman. In 2000, nearly 28.000 new cases were diagnosed.

A decrease starts at the men in the industrialized countries but among women the number of lung cancers does not cease increasing (figure to be correlated with the explosion of cigarette smoking among women since ten years).

In the United States, the number of women deceased of a lung cancer recently exceeds that of cancer deaths of the center.

Causes or risk factors

The principal risk factor of bronchial cancer is the active Tabagisme, person in charge of 90% of the cases. The tobacco contains many carcinogenic, the 2 principal ones being benzo-have-pyrene (the " goudrons") and the Nicotine.

Other environmental factors are known or less often in question: the exposure to the Radon in the ic areas Granite, the fiber inhalation of Asbestos, the exposure to the Radioactivity.

Bronchial cancer is recognized like Occupational disease, in France, in the event of exposure: with the ionizing radiations, with the asbestos, the chromium, the nickel, the tar, the arsenates and certain chemicals.

The role of the Passive smoking is discussed, as well as the role of the Papillomavirus human (HPV) well-known for its role in cancers of the uterine collar. A recent study shows also the increase in the incidence of bronchial cancers at the subjects infected by HIV.

Of course there also exists, as for all cancers, an individual susceptibility of origin Génétique.

Signs and symptoms

The clinical signs are multiple but often not very expressive.

The principal symptoms are:

• appearance of bloody spittles (hemoptysy)

• Of the respiratory infections repeating or answering the treatment
• badly a persistent cough different from that usual with the smoker
• abnormal breathlessness
• a pain in the chest sometimes related to a Pleurisy
• an unexplained pain on the level of the neck, shoulder or arm
• a modification of the voice
• an unexplained slimming, Asthenia (state of weakness, great tiredness), deterioration of the general state.

These signs are not specific to cancer. However, examinations should be carried out.

Histological types

Different lung cancers not with small cells

Lung cancer with small cells

• pulmonary Carcinome with small cells

Other types

bronchiolo-alveolar carcinome

Treatment

The bronchial treatment of cancers not with small cells calls upon the surgical treatments, the Radiothérapie, the Chimiothérapie and new therapeutic (therapeutic targeted), currently Erlotinib and the Cetuximab. The early forms (Stages I and II) are treated surgically (lobectomy or pneumonectomy), with a complementary chemotherapy in certain cases, called auxiliary chemotherapy. Bronchial cancers which are not easily operable because of a too important thoracic attack, but without metastases, are treated by chemotherapy and radiotherapy, either the radiotherapy after chemotherapy, or at the same time (concomitant radio-chemotherapy) for a higher effectiveness but with important toxicities. Patients with a metastatic cancer (of stage 4 or " généralisé") can profit from a chemotherapy and the therapeutic ones targeted, the radiotherapy can be managed in certain case, with palliative aiming, to reduce the symptoms: for example to reduce pains of an osseous metastasis. All confused stages, only 10% of the patients presenting a bronchial cancer are in life at 5 years, primarily among those presenting an early, operable stage from the start. At the time of the diagnosis, approximately 30% of the patients are presented with an early stage, 30% with a tumor located with the thorax but too advanced to be able to profit from a surgical treatment, and 30% with a disease at the metastatic stage.

Bronchial cancers with small cells are exceptionally treated surgically. They are cancers very chimio and radiosensitive. When the tumor is localized with the thorax, it can be treated by an association of chemotherapy and radiotherapy, which allows an important improvement in at least 80% of the cases. It is often also managed a radiotherapy on the level of the brain (known as prophylactic) to avoid the relapses on this level, and thus to increase the chances of cure. Approximately 20% of these patients can be regarded as cured at 5 years. But in 80% of the cases cancer relapses, without much possibility of cure. When bronchial cancer with small cells is metastatic from the start, the treatment consists only of one chemotherapy, with an effectiveness in approximately 60% of the cases. Unfortunately cancer relapses in general very quickly, without possibility of effective cure. Median survival (50% of the patients die before this median, 50% of the patients exceed this median) patients with a bronchial cancer with small metastatic cells is 9 months.

Follow-up of the patients

There do not exist standardized methods of monitoring of the patients having been treated for a bronchial cancer. Taking into account the low effectiveness of the currently available treatments in the event of relapse, the question is to know if it is interesting to detect a relapse of the disease precociously, precociously to manage a treatment which can improve survival of the patients. The methods of monitoring include/understand the clinical examination, thoracic radiography, the thoracic scanner, the bronchial fibroscopy. The practice of these examinations and their rythmicity is very variable according to the medical teams, but also of the type and the stage of the treated disease, and the treatment managed beforehand. Currently studies try to appreciate if a monitoring " lourde" by clinical examination, thoracic scanner and fibroscopy every 6 months, in comparison with a monitoring " légère" by clinical examination and thoracic radiography at the same rate/rhythm, allows to improve survival of patients having been able to profit from an initial surgical treatment.

Prevention

The cancer prevention bronchial consists primarily in the fight against the nicotinism, since 90% of the bronchial cases of cancers are charged to him. Without nicotinism, bronchial cancer would be a rare disease, whereas it is currently in France the 1st cause of mortality per cancer… The preventive measures are thus, in France: information on the dangerosity of the tobacco, raising of prices (the most effective measurement in general), prohibition in the public places…

There does not exist, at present, of method of tracking effective of bronchial cancer. Certain studies are in hand, with the thoracic practice of scanner (with weak irradiation) at the subjects at the risk, that is to say the subjects smokers.

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