Volume 5, Number 3

Tony Dhillon BSc MRCP Cancer Research UK Clinical Training Fellow, Imperial College; Honorary SpR in Medical Oncology, Imperial College Healthcare Trust; Michael J Seckl FRCP PhD Professor of Molecular Cancer Medicine, Imperial College; Honorary Consultant Medical Oncologist, Imperial College Healthcare Trust, London

Lung cancer is the most common cancer killer in men and women. Small cell lung cancer (SCLC) comprises about 20% of cases, and is characterised by early metastasis, rapid growth and initial sensitivity to chemotherapy (CT) and/or radiotherapy (RT). Despite good initial responses, the disease rapidly relapses and the overall five-year survival is less than 5%. Novel therapies are required.

Michael D Peake, Editor

The five-year survival rate for lung cancer (LC) in England for patients diagnosed in 2000–2002 was estimated to be 8.4%. While this has slowly improved over the last ten years, it is below the average for the rest of Europe (10.9%), and the USA (15.7%) for the same period. There are also wide variations in survival across the UK. Since, with current therapeutic options, surgical resection is by far the treatment most likely to result in survival to five years and beyond, it is vital that we examine possible shortcomings and variations in surgical practice.

Clive W Mulatero MA MB BChir MRCP PhD Senior Lecturer in Medical Oncology, St James’s Hospital, Leeds

n recent times, through a study of the signalling pathways involved in cancer development, growth and spread, we have passed a number of important milestones in our understanding of cancer. Since the turn of the century, a number of inhibitors of these pathways have been developed and tested. Some of these products have proved a success and have already found their way into clinical practice.

Liz Darlison BSc(Hons) RN FETC Consultant Nurse, Thoracic Oncology – Mesothelioma, Glenfield Hospital, Leicester

The UK incidence of mesothelioma has been increasing rapidly since the late 1960s, when the Mesothelioma Register began. Currently in the UK, well over 2,000 people a year are diagnosed. There will be an annual increase, with the peak in numbers estimated as 1,950–2,450 deaths per year in 2011–2015.

Dean A Fennell PhD FRCP Cancer Research UK Clinician Scientist; Consultant and Senior Lecturer in Thoracic Medical Oncology, Queen’s University, Belfast; Paula Scullin PhD MRCP Locum Consultant in Medical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital

Lung cancer (LC) is the leading cause of cancer death in the UK and the USA. At least 70% of patients with LC present with locally advanced or metastatic disease at the time of diagnosis. Despite the major improvements in the treatment of LC over the past decades, the outlook for these patients is dismal, with a five-year survival of only 7%. Chemotherapy (CT) is of proven benefit in the management of patients with both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In NSCLC, while surgery is the treatment modality that offers the best chance of cure, CT has a role in the neo-adjuvant, adjuvant, radical, and palliative settings. In SCLC patients, in contrast, systemic treatment is the key modality.

Antonio E Martin-Ucar FRCS (CTh) Consultant Thoracic Surgeon, Department of Thoracic Surgery, Glenfield Hospital, Leicester

Surgical resection provides the best chance of long-term survival in early stage (I and II) non-small cell lung cancer (NSCLC). However, surgery carries significant risks in patients with poor pulmonary reserve. The balance between the risks and benefits of treatment should be determined individually for patients in high-risk groups, but a vital element in the decision is the likely outcome of the non-surgical treatment options available.