The Early Diagnosis of Primary Lung Cancer

There is almost no chest disease which may not be simulated by lung cancer, and it is essential that the methods of investigation outlined above should be applied with expedition if the diagnosis is to be made in time for treatment to be effective. The diagnosis should be made by those methods which upset the patient least, but where the problem persists, all aids must be brought into use without delay. To spend three months looking for the tubercle bacillus while a carcinoma is spreading and when other methods of investigation will yield a quick answer is negligent, and it is not in a patient's interest to watch a shadow for weeks or months radiologically when a bronchoscopic examination may give an immediate diagnosis. [SEE THE TABLE IN SOURCE PDF]

A thorough search of the literature revealed that over the past 14 years 4,376 of 22,095 cases of lung cancer (reported by some 52 authors) were subjected to resection (19.8 per cent); however, the 1954 resectability rates are practically double those given in 1940—a tribute to an increasingly alert medical population. Since the average duration of symptoms before treatment is instituted is 8 to 13 months, continued vigilance on the part of the physician is necessary; insistence upon accurate diagnoses of lesions appearing within the lung will bring more and more patients having cancer to the thoracic surgeon at a stage where the lesion can be completely removed.

The operative mortality rates with pneumonectomy for cancer of the lung have now been reduced in most clinics to about 5 to 10 per cent. Surgical techniques have been perfected, and there is no doubt of their potentials, yet the best results that the most experienced thoracic surgeons can accomplish is an overall 5 to 9 per cent five-year salvage. Two-thirds to three-quarters of all patients are inoperable when they are first seen. From one-third to one-half of those who are explored have disease that is too far advancd to permit resection, and well over one-half of the resections that are done are merely palliative. However, series are accumulating that show that the five year survival rate in resected cases is 18 to 23 per cent; in those patients given "curative" resections the five year survival rate may be as high as 38 per cent. The increase in salvage is not great, but the indications are clear. The more patients who can be gotten to the thoracic surgeon in time for a curative resection, the greater is the hope for a successful attack on lung cancer.