Lung Cancer at St. Anthony's

Lung Cancer St. Anthony’s Hospital 1987 – 2001

We reviewed all analytic cases of lung cancer in the Cancer Registry from 1987 through 2001. A total of 1,713 cases were diagnosed and/or treated at SAH. Lung cancer accounts for 15.3% of all cancers seen (nationally 12.9% in 2003). The number of cases seen increased early in the study years but has been stable over the last five years. Gender distributions were 904 male (53%) and 809 female (47%). Caucasians accounted for 92% and African -Americans 7%. The median age at diagnosis was 71 (in SEER this was 68, see Figure 1). The 5-year relative survival was 15.8% (SEER was 13.8%).The most common histology was adenocarcinoma (24%) followed by squamous cell (21.2%), small cell (17.5%) and large cell (Figure 2).

Small cell carcinoma usually presents with advanced disease. There were 305 cases (17.5% of the total group). The median age was 70y (slightly younger than non-small cell) . There were more women than men (51% female and 49% male). With modern chemoradiation survival in limited stage disease is 12 – 18 months median and for advanced stage 6 – 9 months. Our data are comparable (Table). Overall stage distribution (Figure 3) and survival by stage compares favorably with nation data (Figure 4).

**Small Cell Carcinoma Data for St. Anthony's**
Stage	Incidence	Median Survival	5 Year Survival
Limited	10.2%	15 months	22.8%
Regional	28.2%	14 months	10.3%
Distant	61%	6 months	6.1% (2y)


Non-small cell carcinoma comprises the majority of cases and also presents in advanced stages (Figure 5). There were 1,401 cases. Median age of 71 and more men than women (54% male and 46% female). Stage and survival comparisons are favorable with national data (Figures 5 and 6).

**Non Small Cell Carcinoma at St. Anthony's**
Stage	Incidence	5 Year Survival
I	22%	52%
II	6%	30%
IIIa	15%	13%
IIIb	17%	7%
IV	31%	1%


We also reviewed the impact of therapy on outcome. Surgery is the treatment of choice in operable patients, but there is some role for radiation alone in medically inoperable patients (Figure 7). The management of more advanced cases (IIIA and IIIB) is controversial. There is some evidence that postoperative radiation is beneficial in stage IIIA (Figure 8) and evidence that chemoradiation is superior to radiation alone (Figure 9).In conclusion, despite advances in management lung cancer remains the biggest cancer killer and the greatest impact on reducing this may come from prevention (e.g. smoking cessation). The role of screening is under investigation e.g. spiral CT lung scans, but the Mayo trial of 1,520 smokers found nodules in 70% with only 1.4% of these malignant. The incidence, stage and survival of these patients treated at SAH compares favorably with national data, particularly in view of the older age groups. The oncology committee will continue to monitor our experience with this disease and promote appropriate management as described by the NCCN (National Comprehensive Cancer Network) guidelines.