Numerous
screening studies performed on asymptomatic individuals, based on sputum
cytology and chest radiography, have not shown any benefit, either in the
increase of overall survival or in decreasing mortality rates from lung cancer.
To date, no organization recommends screening for lung cancer in asymptomatic
individuals.
In the
natural evolution of cancer, which has been taking place over decades, clinical
symptoms are the only indication of lung cancer until the disease takes its
course. To passively wait, is to have a limited and very restricted
perspective of oncological disease in general and of lung disease in
particular.
The
recent understanding of carcinogenesis, as a progressive and autonomous
dysregulation in the response to cellular aggression, genetic control of
cellular functions, oncogenes, suppressor genes and the multiple factors
controlling cell growth, has led to a greater understanding of the disease and
new ways of approaching it.
These
recent advances in molecular biology and genetics, associated with a remarkable
development of imaging techniques, such as computed axial tomography (CT Scan)
and positron emission tomography (PET Scan), led to new approaches for an early
diagnosis, the results of which are still under study.
The goal
is the population at risk for lung cancer, asymptomatic individuals or
individuals with symptoms unrelated to the disease who are exposed to
carcinogenic agents. Identifying the genetic alterations that facilitate the
deregulations of cells and somatic mutations together with new imaging
technology capable of greater and precocious detection.
Smokers,
men and women, over the age of 55 years, often with previous respiratory
disorders, associated with risk occupations (such as handling asbestos,
arsenic, chloromethyl, nickel) and/or previous neoplasia, and/or family history
of lung cancer, are all considered to be at risk for lung cancer.
For an early diagnosis of lung cancer, it is also important to mention
bronchoscopy.
It is
the main evaluation screening technique for patients with suspected lung
cancer. This exam is well tolerated and safe. It is performed on an outpatient
basis, requiring only light oropharyngeal anaesthesia. This exam has replaced rigid
bronchoscopy many years ago. It allows direct visualization and evaluation, not
only of the trachea and main bronchi, but also of some fourth-generation
bronchi. Contraindications are few, and it is considered a safe procedure with
a complication rate of 0.12%. More than 70% of lung cancers are visible by
bronchofibroscopy and of these the combination of bronchial aspiration and 3 to
5 bronchial biopsies will permit a diagnosis to be reached in more than 90% of
cases. A bronchoscopy also plays an important role in cancer staging.
Staging
a tumour means evaluating its extent and integrating it into a group where
therapeutic options and prognostic perspectives are as uniform as possible.
As important as the anatomical staging, is the physiological staging, which seeks to assess the ability of each patient to tolerate the recommended therapy. Characterizing the patient’s general condition or performance status is of undeniable prognostic and therapeutic value.
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