W. Michael Alberts

Introduction to the Third Edition: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

I preparing to write this introduction to the third edition of the American College of Chest Physicians (ACCP) Lung Cancer Guidelines (LC III), I took the opportunity to review the introductions to the fi rst two editions. The theme of both the 2003 and the 2007 articles was that (1) the disease is common; (2) the current treatment leaves a lot to be desired; and (3) there is room for optimism, as the pace of relevant research has quickened. The theme for the introduction to this edition is, appropriately, very much the same. The numbers continue to be staggering. It is projected that in 2012, 226,160 individuals (up from 169,400 in 2002 and 213,380 in 2006) in the United States will be diagnosed with cancer of the lung (116,470 men and 109,690 women). 2 Some 160,340 individuals (up from 154,900 in 2002 and, actually, down from 160,390 in 2006) will succumb to this disease (87,750 men and 72,590 women) during the year. 2 Lung cancer continues to be the leading cause of cancer deaths in both men and women in the United States. Deaths from lung cancer in women surpassed those due to breast cancer in 1987 and are expected to account for about 26% of all female cancer deaths in 2011. 2 Twenty-eight percent of cancer deaths in men are attributable to lung cancer. 2

Follow up and surveillance of the patient with lung cancer: What do you do after surgery?

Abstract:  Of the new cases of lung cancer discovered each year, it has been estimated that 50–55% have localized disease and are thus candidates for potentially curative treatment. Some of these patients will refuse surgery or will have co‐morbidities that preclude surgery. The remainder will undergo an attempted curative resection. A common clinical question arises in these patients: how should this patient be followed after surgery? Post‐treatment surveillance is indicated to monitor for recurrence of the original tumor and for the development of a metachronous tumor. The appropriate protocol is controversial and current recommendations are primarily expert opinion or consensus‐based and await further study. A suggested clinically reasonable and cost‐effective surveillance approach would include a history, physical examination and an imaging study (either chest radiograph or CT) every 6 months for 2 years and then annually. Patients should be counselled on symptom recognition and advised to contact their physician should such symptoms appear.