Lungenkrebs – Geschichtliche Entwicklung, derzeitiger Stand und Ausblick

Abstract

One hundred years ago lung cancer was a rare disease. In the meantime, as a result of the sharp increase of tobacco smoking, in Germany and worldwide it is the most common cause of cancer death. Since lung cancer is largely asymptomatic in its early stages, the diagnosis is usually first made in the advanced stages IIIB or IV. The development of diagnostic imaging and minimally invasive procedures as well as the refinement of the staging classification allow a better allocation to the tumor stages. The surgical mortality has declined significantly since the 1950s, yet the 5-year survival rates are low. For locally advanced, unresectable non-small cell lung carcinoma a moderate improvement of the prognosis could be achieved by newer methods of radiotherapy and the combination of radiotherapy with chemotherapy. As a result of chemotherapy in patients with non-small cell lung cancer a moderate life extension has been reached, while the new agents are better tolerated and allow for an improved quality of life. The survival of small cell lung cancer has been significantly prolonged by chemotherapy since the 1970s, however, little progress was made in the last 15 - 20 years. The most important and effective preventive measure against lung cancer is to avoid tobacco smoke. Screening tests using annual chest X-ray images and sputum cytology have shown no improvement in overall mortality compared with the control groups in extensive studies. Whether or not an improvement of prognosis is possible by a screening using low-dose CT is being tested by the ongoing studies. For patients with lung cancer more effective agents and therapies are still needed.