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Non-small cell lung cancer
Causes and risk factors

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	Lung Cancer
	- Introduction - Causes - Clinical picture - Diagnosis - Pathology - Staging - Treatment

Smoking

• Cigarette smoking is the cause of 85% of all cases of lung cancer (30 times).

• Cigars and pipes also increase the risk of lung cancer (2 times).

• Passive smoking increases the risk of lung cancer slightly (<2 times).

• The risk of lung cancer is related to the cumulative dose (pack years) with the risk diverging from the nonsmoking population at 10 pack years.

• After cessation of smoking the risk steadily declines to that of nonsmokers after 15 years in those who smoked less than 20 years.

Asbestos

Asbestos exposure increases the risk of lung cancer in smokers (3 times greater risk than smoking alone).

Other carcinogens

Exposure to environmental carcinogens other than smoking and asbestos include: arsenic, beryllium, chloromethyl ethers, chromicin, hydrocarbons, mustard gas, nickel.

Other lung diseases

The presence of lung scars, chronic obstructive lung disease have been reported to be associated with lung cancer. Lung cancer itself is associated with an increased risk of second lung cancer (synchronous and metasynchronous). Other cancers of the head and neck, esophagus are associated with increased risk of lung cancer due to the 'field cancerization' effects of smoking.

Chromosomal abnormalities

• The K-ras oncogene is activated by point mutation in lung cancer cell lines. In most studies, K-ras mutations were confined to adenocarcinomas of the lung and occurred in 30% of tumors. Mutations were not observed in adenocarcinomas from nonsmokers.

• The erbB2 gene is activated in NSCLC. c-erbB2 (HER2/neu) is a member of the EGFR family. Adenocarcinomas showed high levels of erbB2 mRNA.

• Two additional candidate tumor suppressor genes in lung cancer are the nuclear phosphoproteins p53 and Rb.

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