Clinical Presentation and Management of Patients with Carcinoma of the Lung: A 14-Year Experience Marvin M. Kirsh, MD, Jeanne Tashian, and Herbert Sloan, MD Ann A rbor, M ichigan C a r c i n o m a o f t h e l u n g h a s b e e n s t e a d i l y i n c r e a s i n g s i n c e W o r l d W a r I I , a n d t h e f a m i l y p h y s i c i a n c a n n o w e x p e c t t o s e e a g r e a t e r i n c i d e n c e o f t h e d i s e a s e i n w o m e n a n d p e r s o n s u n d e r a g e 5 0 y e a r s . T h e c l i n i c a l m a n i f e s t a t i o n s o f c a r c i n o m a o f t h e l u n g a r e d e s c r i b e d , b a s e d o n a 1 4 - y e a r e x p e r i e n c e a t t h e U n i v e r s i t y o f M i c h i g a n . D i a g n o s t i c p r o c e d u r e s a r e o u t l i n e d . T h e p r e f e r r e d t r e a t m e n t f o r c a r c i n o m a o f t h e l u n g i s p u l m o n a r y r e s e c t i o n , c o m b i n e d , i n a p p r o p r i a t e s i t u a t i o n s , w i t h m e d i a s t i n a l l y m p h n o d e i r r a d i a t i o n . S u r v i v a l i s d e p e n d e n t t o s o m e d e g r e e o n t h e t u m o r c e l l t y p e a s w e l l a s t h e e x t e n t o f m e t a s t a s i s . A n e w i m m u n o t h e r a p e u t i c a d j u n c t t o r e s e c t i o n a n d i r r a d i a t i o n i s b e i n g d e v e l o p e d . F i v e t o t e n - y e a r s u r v i v o r s o f r e s e c t i o n s f o r l u n g c a n c e r a n d n o r m a l p e r s o n s s e r v e a s l y m p h o c y t e d o n o r s . T r a n s f e r f a c t o r i s e x t r a c t e d f r o m t h e s e l y m p h o c y t e s a n d i n j e c t e d i n t o s e l e c t e d p a t i e n t s w h o h a v e r e c e n t l y h a d r e s e c t i o n s f o r l u n g c a n c e r . I t i s t o o s o o n t o e v a l u a t e t h e r e s u l t s o f t h i s e x p e r i m e n t , b u t i t i s h o p e d t h a t i m m u n o t h e r a p y u s i n g t r a n s f e r f a c t o r w i l l b e o f h e l p t o p a t i e n t s w i t h c a r c i n o m a o f t h e l u n g . D u r i n g t h e p a s t 6 0 y e a r s t h e r e h a s b e e n a m a r k e d r i s e h a s b e e n a s s o c i a t e d p r i m a r i l y w i t h a n m a r k e d i n c r e a s e i n t h e i n c i d e n c e o f c a r c i n o m a o f i n c r e a s e i n c i g a r e t t e s m o k i n g , b u t a l s o w i t h e n th e l u n g , w i t h a n e s t i m a t e d 8 5 , 0 0 0 t o 9 2 , 0 0 0 p e r v i r o n m e n t a l f a c t o r s s u c h a s u r b a n a i r p o l l u t i o n a n d s o n s i n t h e U n i t e d S t a t e s d y i n g o f t h e d i s e a s e e a c h e x p o s u r e t o c e r t a i n i n d u s t r i a l a g e n t s s u c h a s a s y e a r . 1 W i t h t h e t o t a l n u m b e r o f n e w c a s e s e x p e c t e d b e s t o s , c h r o m i u m , a n d n i c k e l . A b o u t 9 0 p e r c e n t o f to b e a b o u t 1 0 2 , 0 0 0 i n 1 9 7 8 , t h e f a m i l y p h y s i c i a n a l l l u n g c a n c e r i s d i r e c t l y a t t r i b u t a b l e t o h e a v y c a n w e l l e x p e c t t o e n c o u n t e r p a t i e n t s w i t h c a r c i g a r e t t e s m o k i n g , i e , t w o t o t h r e e p a c k s a d a y f o r c i n o m a o f t h e l u n g i n t h e c o u r s e o f t h e y e a r . T h i s 2 0 o r m o r e y e a r s . T h i r t y y e a r s a g o t h e m a l e - f e m a l e i n c i d e n c e o f l u n g c a n c e r w a s a l m o s t 5 : 1 , b u t w i t h t h e i n c r e a s e i n s m o k i n g a m o n g w o m e n w h i c h b e g a n d u r i n g From the Departm ent of Surgery, Section of Thoracic Surgery, The U niversity of M ichigan Medical Center, Ann W o r l d W a r I I , t h i s r a t i o h a s b e e n c l o s i n g . O f t h e Arbor, Michigan. Requests for reprints should be ad 9 2 , 0 0 0 d e a t h s f r o m l u n g c a n c e r p r e d i c t e d f o r 1 9 7 8 , dressed to Dr. M arvin M. Kirsh, C7079 Out-Patient Building, University Hospital, Ann Arbor, Ml 48109. t h e A m e r i c a n C a n c e r S o c i e t y e s t i m a t e s 7 0 , 5 0 0 w i l l 0094-3509/79/061127-05$01.25 0 1979 Appleton-Century-Crofts TH E j o u r n a l o f f a m i l y 1127 PRACTICE, VOL. 8, NO. 6: 1127-1131, 1979
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