Lung cancer suspected by jolinmilioncherie

VIEWS: 5 PAGES: 10

									http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html



Lung cancer - suspected


                                     Background                    Information resources           Updates to this
                                     information                   for patients and carers         pathway




                                                                   Lung cancer - clinical
                                                                   presentation



                                                                   History and
                                                                   examination



                                                                                          Consider differential
                                                                                          diagnoses




                                            RED FLAG!                                           Urgent chest X-ray



                                            Refer immediately to
                                            chest physician within        Abnormal chest X-ray                            Normal chest X-ray
                                            multidisciplinary team
                                            (MDT)

                                                                          Refer urgently to                                                     Consider differential
                                                                          chest physician within                                                diagnoses
                                            Go to lung cancer -           multidisciplinary team
                                            specialist assessment         (MDT)


                                                                                                          High suspicion of lung          Low suspicion of lung
                                                                          Go to lung cancer -             cancer                          cancer - watchful
                                                                          specialist assessment                                           waiting


                                                                                                          Refer urgently to
                                                                                                          chest physician within
                                                                                                          multidisciplinary team
                                                                                                          (MDT)



                                                                                                          Go to lung cancer -
                                                                                                          specialist assessment




Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 1 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

1 Background information
   Quick info:
   Scope:
    • assessment, diagnosis and management of lung cancer in adults, including:
        • small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC)diagnosis and staging of SCLC and NSCLC
        • surgical treatment, chemotherapy, radiotherapy
        • principles of palliative care in lung cancer
   Out of scope:
    • mesothelioma
    • population screening and prevention strategies
    • carcinoma in situ
    • rarer pulmonary cancers, eg carcinoid
    • metastatic disease to the lung from another primary site
   Other pathways to consider when viewing this pathway:
    • 'End of life care in adults'
    • 'Smoking cessation'
   Definition:
    • NSCLC main subtypes:
        • squamous cell carcinoma:
            • arises typically in mainstream, lobar, or segmental bronchi
            • tends to spread locally, metastasising later than other types
            • tumour cells show keratinisation and/or intercellular bridging
        • adenocarcinoma:
            • tends to be peripherally located
            • may be mucinous or non-mucinous
            • shows a variety of histological patterns (lepidic, acinar, papillary, micropapillary, solid) that both reflect the degree of
              differentiation and correlate with some gene mutations
        • NSCLC lacking evidence of squamous or adenocarcinomatous differentiation consists of large polygonal cells with vesicular
          nuclei
    • SCLC:
        • cells are usually round/oval but may be spindle-shaped
        • fine granular nuclear chromatin
        • high mitotic rate
        • only exceptionally curable by surgical means
   Metastatic disease:
    • common sites for lung cancer metastases include:
        • brain
        • liver
        • adrenal glands
        • bone
        • lymph nodes
        • contralateral lung
   Incidence and prevalence:
    • in the UK, lung cancer is the most common cause of cancer death in men, and the second most common cause of
      cancer death in women [1]
    • accounts for approximately 33,000 deaths per year in England and Wales [2]
    • NSCLC accounts for approximately 85% of lung cancer cases [3]
    • SCLC accounts for approximately 15% of lung cancer cases [3]
   Risk factors:
    • cigarette smoking is the primary risk factor, accounting for up to 90% of cases [1]:
        • smoking more than 20 cigarettes per day increases the age-adjusted relative risk of lung cancer by 20 times, compared with
          lifelong non-smoking [1]
        • stopping smoking before middle age means that an individual can avoid almost 90% of the risk, although the risk never drops
          to the pre-smoking level [1]
    • passive tobacco smoke
    • occupational hazards − exposure to:
        • asbestos
        • arsenic


Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 2 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

        • beryllium
        • bis-(chloromethyl)-ether
        • cadmium
        • chromium
        • nickel
        • polycyclic aromatic hydrocarbons
        • vinyl chloride
    • other associations:
        • air pollution and environmental exposure, eg radon
        • poor nutrition
        • previous or co-existing lung disease – patients with chronic obstructive pulmonary disease (COPD) have an excess risk
          (independent of their smoking history) of at least double that of those without COPD, but probably much higher [3]
        • genetic predisposition
    • increasing age:
        • lung cancer under age 40 years is rare – incidence rises sharply with age and the most common age group at diagnosis is
          age 70-74 years [1]
   Prognosis:
    • varies depending on stage and type of lung cancer but generally very poor as symptoms usually present late in disease
      progression
    • 1 year survival rate for all lung cancer is 36% for women and 32.5% for men [3]
    • 5 year survival rate is 8.8% in women and 7.1% in men [3]
    • median survival for small cell cancer with treatment [2]:
        • approximately 14-18 months for limited stage disease
        • approximately 9-12 months for extensive stage disease
    • 2 year survival rate for small cell cancer [2]:
        • approximately 20-40% for limited disease
        • less than 5% for extensive disease
   NB: This information appears on each page of this pathway.
   References:
   [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating Centre
   for Acute Care; 2005.
   [2] National Institute for Health and Clinical Excellence (NICE). Topotecan for the treatment of relapsed small-cell lung cancer.
   Technology appraisal guidance 184. London: NICE; 2009.
   [3] Contributors representing the National Cancer Action Team; 2010.
   [4] National Health and Medical Research Council (NHMRC). Clinical practice guidelines for the prevention, diagnosis and
   management of lung cancer. Canberra; NHMRC; 2004.
   [5] Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh: SIGN; 2005.


2 Information resources for patients and carers
   Quick info:
   Patients and carers in England and Wales can access this pathway through NHS Choices at http://
   healthguides.mapofmedicine.com/choices/map/lung_cancer1.html
   The following resources have been produced by organisations certified by The Information Standard:
    • 'Lung cancer' (URL) from Bupa at http://www.bupa.co.uk/health_information/
    • 'Lung cancer' (URL) from Cancer Help UK at http://www.cancerhelp.org.uk
    • 'Lung cancer' (URL) from Datapharm at http://www.medguides.medicines.org.uk
    • 'Lung cancer' (URL) from Macmillan Cancer Support at http://www.macmillan.org.uk
    • 'Understanding NICE Guidelines: The diagnosis and treatment of lung cancer' (PDF) from National Institute for Health and
      Clinical Excellence (NICE) at http://www.nice.org.uk
    • 'Lung cancer' (PDF) from Patient UK at http://www.patient.co.uk
    • Sue Ryder Care at http://www.suerydercare.org
    • The Carers Resource at http://www.carersresource.org
   Information for carers and people with disabilities is available at:
    • 'Caring for someone' (URL) from Directgov at http://www.direct.gov.uk
    • 'Disabled people' (URL) from Directgov at http://www.direct.gov.uk
   Patient stories describing their care journeys are available at ‘Healthtalkonline' (URL) from DIPEX at http://www.healthtalkonline.org.



Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 3 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

   Explanations of clinical laboratory tests used in diagnosis and treatment are available at ‘Understanding Your Tests’ (URL) from Lab
   Tests Online-UK at http://www.labtestsonline.org.uk.
   The Map of Medicine is committed to providing high quality health and social care information for patients and carers. For details on
   how these resources are identified, please see Map of Medicine Patient and Carer Information.
   NB: This information appears on each page of this pathway.


3 Updates to this pathway
   Quick info:
   Date of publication: 31-Jan-2011
   Interim update:
   This pathway has been updated according to feedback from the National Cancer Action Team (NCAT).
   Information on staging small cell lung cancer (SCLC) has been added according to the following reference:
    • [11] Union for International Cancer Control (UICC). TNM Classification of malignant tumours - 7th ed. Geneva: UICC; 2010.
   Date of publication: 29-Oct-2010
   Three floating nodes now appear at the top of each pathway page. These provide:
    • easy access to scope and background information on each page of the pathway whilst reducing repetition between nodes
    • easy access to patient resources/leaflets
    • information on pathway updates
   This pathway was updated in line with the following guidelines:
    • [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating
      Centre for Acute Care; 2005.
    • [2] National Institute for Health and Clinical Excellence (NICE). Topotecan for the treatment of relapsed small-cell lung cancer.
      Technology appraisal guidance 184. London: NICE; 2009.
    • [4] National Health and Medical Research Council (NHMRC). Clinical practice guidelines for the prevention, diagnosis and
      management of lung cancer. Canberra, ACT: NHMRC; 2004.
    • [5] Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh: SIGN; 2005.
    • [7] National Institute for Health and Clinical Excellence (NICE). Referral guidelines for suspected cancer in adults and children.
      London: NICE; 2010.
    • [8] National Institute for Health and Clinical Excellence (NICE). Endobronchial ultrasound-guided transbronchial biopsy for
      peripheral lung lesions. Interventional procedure guidance 337. London: NICE; 2010.
    • [9] American College of Chest Physicians (ACCP). Diagnosis and management of lung cancer executive summary: ACCP
      evidence-based clinical practice guidelines (2nd Edition). Chest 2007; 132: 1S-19S.
    • [10] Cancer Services Co-ordinating Group. National standards for lung cancer services. Cardiff: Welsh Assembly
      Government; 2005.
    • [11] Union for International Cancer Control (UICC). TNM Classification of malignant tumours - 7th ed. Geneva: UICC; 2010.
    • [12] National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology: Small cell lung cancer.
      V.I. 2010. Fort Washington, PA: NCCN; 2010.
    • [13] Medicines and Healthcare products Regulatory Agency (MHRA). MHRA statement on talc preparations for pleurodesis.
      London: MHRA; 2008.
    • [14] National Institute for Health and Clinical Excellence (NICE). Pemetrexed for the first-line treatment of non-small-cell lung
      cancer. Technology appraisal guidance 181. London: NICE; 2009.
    • [18] National Institute for Health and Clinical Excellence (NICE). Erlotinib for the treatment of non-small-cell lung cancer.
      Technology appraisal guidance 162. London: NICE; 2008.
    • [19] National Institute for Health and Clinical Excellence (NICE). Pemetrexed for the maintenance treatment of non-small-cell
      lung cancer. Technology appraisal guidance 190. London: NICE; 2010.
    • [20] National Institute for Health and Clinical Excellence (NICE). Gefitinib for the first-line treatment of locally advanced or
      metastatic non-small-cell lung cancer. Technology appraisal guidance 192. London: NICE; 2010.
   Further information was provided by the following references: [3,6,15-17,21-24].
   For further information please see the pathway's Provenance.
   Practice-based knowledge has been contributed to this pathway by:
    • Dr Robert Rintoul, Consultant Physician, Papworth Hospital NHS Foundation Trust, Cambridge, UK (clinical facilitator)
    • Dr David Gilligan, Consultant Oncologist, Cambridge University Hospital, Cambridge, UK
    • Dr Andrew Nicholson, Consultant Histopathologist, Royal Brompton and Harefield NHS Foundation Trust, UK
    • Ms Dana Knoyle, Macmillan Lung Cancer Nurse Specialist, Cwm Taf Health Board, Mid Glamorgan, UK
    • Dr Ian Williamson, Consultant Chest Physician, Aneurin Bevan Health Board, Torfaen, UK
    • Selected members of Map of Medicine (MoM) Clinical Editorial team and Fellows board



Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 4 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

   The pathway has been completely restructured and redrafted in line with the Map of Medicine editorial methodology and to bring it in
   line with current clinical practice.
   NB: This information appears on each page of this pathway.


4 Lung cancer - clinical presentation
   Quick info:
   Symptoms and signs of lung cancer include:
    • frequent:
        • cough
        • weight loss
        • dyspnoea
        • chest pain (or shoulder pain)
        • pain radiating down arm (Pancoast tumour)
        • lethargy/tiredness
    • moderately frequent:
        • haemoptysis (blood-stained sputum)
        • bone pain
        • digital clubbing
        • fever
        • weakness
    • infrequent:
        • superior vena cava obstruction
        • dysphagia
        • wheezing and stridor
    • symptoms from metastases, eg to:
        • brain
        • bone
        • liver
        • lymph nodes
   NB: Patients may be diagnosed after their tumour is picked up incidentally on chest X-ray or other imaging tests, and may not
   present with any classic symptoms of lung cancer.
   This information was drawn from the following references:
   [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating Centre
   for Acute Care; 2005.
   [3] Contributors representing the National Cancer Action Team; 2010.
   [5] Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh: SIGN; 2005.


5 History and examination
   Quick info:
   Ask about:
    • symptoms:
       • onset
       • duration
       • frequency
       • any changes to existing symptoms in patients with underlying respiratory problems
    • change in appetite or weight loss
    • history of smoking
    • history of respiratory disease, eg chronic obstructive pulmonary disease (COPD)
    • contact with carcinogenic chemicals
    • occupational exposure to asbestos
    • family history of cancer
    • past medical history
   Examination:
    • general appearance, eg:
       • weight loss
       • shortness of breath at rest

Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 5 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

       • heart rate
       • blood pressure (BP)
    • check for digital clubbing
    • check for enlarged cervical and supraclavicular lymph nodes
    • evidence of superior vena cava obstruction
    • respiratory system:
       • respiratory rate
       • equal chest expansion
       • percussion of chest wall
       • points of bony tenderness
       • auscultation:
          • stridor
          • wheeze
          • crepitations
    • abdominal palpation including inguinal lymph nodes
   This information was drawn from the following references:
   [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating Centre
   for Acute Care; 2005.
   [3] Contributors representing the National Cancer Action Team; 2010.
   [5] Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh: SIGN; 2005.
   [6] Map of Medicine (MoM) Clinical Editorial team and Fellows. London: MoM; 2010.


6 Consider differential diagnoses
   Quick info:
   Differentials of symptoms (non-acute presentation) − these may be present in addition to lung cancer [6]:
    • chronic obstructive pulmonary disease (COPD)
    • pneumonia
    • tuberculosis
    • pleural effusion (all causes)
    • bronchiectasis
    • inhaled foreign body
    • diffuse parenchymal lung diseases
    • carcinoid tumour
    • mesothelioma
    • secondary tumours
   Reference:
   [6] Map of Medicine (MoM) Clinical Editorial team and Fellows. London: MoM; 2010.


7 RED FLAG!
   Quick info:
   National Institute for Health and Clinical Excellence (NICE) guidelines suggest considering immediate (same day) referral to chest
   physician within lung cancer multidisciplinary team (MDT), without waiting for chest X-ray, if either of the following are present [1,7]:
    • signs of superior vena caval obstruction (SVCO):
       • swelling of face or neck
       • fixed elevation of jugular venous pressure
    • stridor
   Reference:
   [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating Centre
   for Acute Care; 2005.
   [7] National Institute for Health and Clinical Excellence (NICE). Referral guidelines for suspected cancer in adults and children.
   London: NICE; 2010.


8 Urgent chest X-ray


Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 6 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

   Quick info:
   Arrange an urgent chest X-ray for patients with:
    • any presentation of haemoptysis [1,5,7]
    • any of the following symptoms or signs that are unexplained or persistent (ie lasting more than 3 weeks) [1,5,7]:
       • cough
       • dyspnoea
       • chest or shoulder pain
       • hoarseness
       • chest signs on examination
       • digital clubbing
       • cervical or supraclavicular lymphadenopathy
       • weight loss
       • features suggestive of metastatic lung cancer, eg to:
           • brain
           • bone
           • liver
       • unexplained changes in existing symptoms in patients with underlying respiratory problems [7]
   Consider urgent chest X-ray or referral sooner for patients in the following groups (eg even if signs and symptoms have lasted less
   than 3 weeks) [7]:
    • current or ex-smokers
    • people with smoking-related chronic obstructive pulmonary disease (COPD)
    • people who have been exposed to asbestos
    • people with a previous history of cancer, especially head and neck
   Offer urgent referral (to be seen within 2 weeks) to chest physician within lung cancer multidisciplinary team (MDT) while waiting for
   chest X-ray result if there is [1,5,7]:
    • persistent haemoptysis in smokers or ex-smokers age 40 years or older
    • signs of superior vena caval obstruction (SVCO)
       • swelling of face or neck
       • fixed elevation of jugular venous pressure
    • stridor
   NB: National Institute for Health and Clinical Excellence guidelines suggest considering immediate (same day) referral to chest
   physician within multidisciplinary team (MDT), without waiting for chest X-ray, if either SVCO or stridor are present [1,7].
   References:
   [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating Centre
   for Acute Care; 2005.
   [5] Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh: SIGN; 2005.
   [7] National Institute for Health and Clinical Excellence (NICE). Referral guidelines for suspected cancer in adults and children.
   London: NICE; 2010.


10 Abnormal chest X-ray
   Quick info:
   Radiographically, lung cancer usually presents as [1]:
    • pleural effusion
    • slowly resolving or recurrent consolidation
    • solitary pulmonary nodule or pulmonary mass
    • pulmonary collapse
    • mediastinal lymphadenopathy
   People with X-ray result suggestive of lung cancer should be referred to chest physician within lung cancer multidisciplinary team
   (MDT) urgently (to be seen within 2 weeks) [1,5,7].
   References:
   [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating Centre
   for Acute Care; 2005.
   [5] Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh: SIGN; 2005.
   [7] National Institute for Health and Clinical Excellence (NICE). Referral guidelines for suspected cancer in adults and children.
   London: NICE; 2010.



Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 7 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

11 Normal chest X-ray
   Quick info:
   98% of people with lung cancer have lung pathology on chest X-ray [5].
   Reference:
   [5] Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh: SIGN; 2005.


13 Consider differential diagnoses
   Quick info:
   Differentials of symptoms (non-acute presentation) − these may be present in addition to lung cancer [6]:
    • chronic obstructive pulmonary disease (COPD)
    • pneumonia
    • tuberculosis
    • pleural effusion (all causes)
    • bronchiectasis
    • inhaled foreign body
    • diffuse parenchymal lung diseases
    • carcinoid tumour
    • mesothelioma
    • secondary tumours
   Reference:
   [6] Map of Medicine (MoM) Clinical Editorial team and Fellows. London: MoM; 2010.


14 High suspicion of lung cancer
   Quick info:
   Referral for high suspicion of lung cancer:
    • National Institute for Health and Clinical Excellence (NICE) guidelines recommend that people with a normal chest X-ray but
      high suspicion of lung cancer should be referred urgently (within 2 weeks) to chest physician within lung cancer multidisciplinary
      team (MDT) for clinical examination, history and blood test [1]
    • Scottish Intercollegiate Guidelines Network (SIGN) recommends that people with normal chest X-ray but unexplained clinical
      findings that have persisted for greater than 6 weeks should be referred urgently to respiratory medicine [5]
   References:
   [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating Centre
   for Acute Care; 2005.
   [5] Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh: SIGN; 2005.


15 Low suspicion of lung cancer - watchful waiting
   Quick info:
   If there is no lung pathology and low suspicion of lung cancer, observe patient and manage symptoms [1].
   Reference:
   [1] National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London: National Collaborating Centre
   for Acute Care; 2005.




Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 8 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

Key Dates
   Published: 19-Apr-2011, by International
   Valid until: 30-Nov-2011

Accreditations
      The care map is accredited by:
             The Chief Knowledge Officer of the NHS:
             Disclaimer


Evidence summary for Lung cancer - suspected
   This pathway has been developed according to the Map of Medicine editorial methodology
   (http://mapofmedicine.com/whatisthemap/editorialmethodology). The content of this pathway is based on high-quality guidelines
   [1-2,4-5,7-9,11-12,14,18-20], critically appraised meta-analyses and systematic reviews [15-17,21-22], and safety and prescribing
   information [13]. Practice-based knowledge has been added by contributors with front-line clinical
   experience [3,6], including any literature endorsed by the contributor group [10,23,24].
   Search date: Jun-2010

References
   This is a list of all the references that have passed critical appraisal for use in the care map Lung cancer
     ID Reference
     1 National Collaborating Centre for Acute Care. The diagnosis and treatment of lung cancer. London:
          National Collaborating Centre for Acute Care; 2005.
          http://www.nice.org.uk/nicemedia/live/10962/29675/29675.pdf
     2 National Institute for Health and Clinical Excellence (NICE). Topotecan for the treatment of relapsed small-
          cell lung cancer. Technology appraisal guidance 184. London: NICE; 2009.
          http://www.nice.org.uk/nicemedia/live/12348/46326/46326.pdf
     3 Contributors representing the National Cancer Action Team. 2010.
     4 National Health and Medical Research Council (NHMRC). Clinical practice guidelines for the prevention,
          diagnosis and management of lung cancer. Canberra, ACT: NHMRC; 2004.
          http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp97.pdf
     5 Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. Edinburgh:
          SIGN; 2005.
          http://www.sign.ac.uk/pdf/sign80.pdf
     6 Map of Medicine (MoM) Clinical Editorial team and Fellows. London: MoM; 2010.
     7 National Institute for Health and Clinical Excellence (NICE). Referral guidelines for suspected cancer in
          adults and children. London: NICE; 2010.
          http://www.nice.org.uk/nicemedia/live/10968/29816/29816.pdf
     8 National Institute for Health and Clinical Excellence (NICE). Endobronchial ultrasound-guided .
          transbronchial biopsy for peripheral lung lesions. Interventional procedure guidance 337. London: NICE;
          2010.
          http://www.nice.org.uk/nicemedia/pdf/IPG337Guidance%20LR%20FINAL.pdf
     9 American College of Chest Physicians (ACCP). Diagnosis and management of lung cancer executive
          summary: ACCP evidence-based clinical practice guidelines (2nd Edition). Chest 2007; 132: 1s-19s.
          http://www.chestnet.org/accp/guidelines/diagnosis-and-management-lung-cancer-executive-summary-accp-
          evidence-based-clinical-practice-guideli
     10 Cancer Services Co-ordinating Group. National standards for lung cancer services. Cardiff: Welsh
          Assembly Government; 2005.
          http://wales.gov.uk/docrepos/40382/dhss/nationalstandardscancer/english/lung-cancer-e.pdf
     11 Union for International Cancer Control (UICC). TNM Classification of malignant tumours - 7th ed. Geneva:
          UICC; 2010.
     12 National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology: small
          cell lung cancer. V.I. 2010. Fort Washington, PA: NCCN; 2010.
     13 Medicines and Healthcare products Regulatory Agency (MHRA). MHRA statement on talc preparations for
          pleurodesis. London: MHRA; 2008.
     14 National Institute for Health and Clinical Excellence (NICE). Pemetrexed for the first-line treatment of non-
          small-cell lung cancer: Technology appraisal guidance 181. London: NICE; 2009.
          http://www.nice.org.uk/nicemedia/live/12243/45501/45501.pdf

Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 9 of 10
http://eng.mapofmedicine.com/evidence/map/lung_cancer1.html


Lung cancer - suspected

      ID Reference
      15 Delbaldo C, Michiels S, Rolland E et al. Second or third additional chemotherapy drug for non-small cell
         lung cancer in patients with advanced disease. Cochrane Database Syst Rev 2007; CD004569.
         http://www.ncbi.nlm.nih.gov/pubmed/17943820?dopt=Citation
      16 Lin H, Jiang J, Liang X et al. Chemotherapy with cetuximab or chemotherapy alone for untreated advanced
         non-small-cell lung cancer: A systematic review and meta-analysis. Lung Cancer 2010; Epub ahead of
         print:
         http://www.ncbi.nlm.nih.gov/pubmed/20149474?dopt=Citation
      17 Di Maio M, Perrone F, Chiodini P et al. Individual patient data meta-analysis of docetaxel administered
         once every 3 weeks compared with once every week second-line treatment of advanced non-small-cell lung
         cancer. J Clin Oncol 2007; 25: 1377-1382.
         http://www.ncbi.nlm.nih.gov/pubmed/17416857?dopt=Citation
      18 National Institute for Health and Clinical Excellence (NICE). Erlotinib for the treatment of non-small-cell lung
         cancer. Technology appraisal guidance 162. London: NICE; 2008.
         http://www.nice.org.uk/nicemedia/pdf/TA162Guidance.pdf
      19 National Institute for Health and Clinical Excellence (NICE). Pemetrexed for the maintenance treatment of
         non-small-cell lung cancer. Technology appraisal guidance 190. London: NICE; 2010.
         http://www.nice.org.uk/nicemedia/live/13028/49355/49355.pdf
      20 National Institute for Health and Clinical Excellence (NICE). Gefitinib for the first-line treatment of locally
         advanced or metastatic non-small-cell lung cancer. Technology appraisal guidance 192. London: NICE;
         2010.
         http://www.nice.org.uk/nicemedia/live/13058/49955/49955.pdf
      21 Douillard JY, Tribodet H, Aubert D et al. Adjuvant cisplatin and vinorelbine for completely resected non-
         small cell lung cancer: subgroup analysis of the Lung Adjuvant Cisplatin Evaluation. J Thorac Oncol 2010;
         5: 220-228.
         http://www.ncbi.nlm.nih.gov/pubmed/20027124?dopt=Citation
      22 O'Rourke N, Macbeth F. Is concurrent chemoradiation the standard of care for locally advanced non-small
         cell lung cancer? A review of guidelines and evidence. Clin Oncol 2010; 22: 347-55.
         http://www.ncbi.nlm.nih.gov/pubmed/20427167
      23 Slotman B, Faivre-Finn C, Kramer G et al. Prophylactic cranial irradiation in extensive small-cell lung
         cancer. N Engl J Med 2007; 357: 664-72.
         http://www.nejm.org/doi/full/10.1056/NEJMoa071780
      24 Akl EA, Kamath G, Kim SY et al. Oral anticoagulation may prolong survival of a subgroup of patients with
         cancer: a Cochrane Systematic Review. J Exp Clin Cancer Res 2007; 26: 175-184.

Disclaimers
   The Chief Knowledge Officer of the NHS
   It is not the function of the Chief Knowledge Officer of the NHS to substitute for the role of the clinician, but to support the clinician
   in enabling access to know-how and knowledge. Users of the Map of Medicine are therefore urged to use their own professional
   judgement to ensure that the patient receives the best possible care. Whilst reasonable efforts have been made to ensure the
   accuracy of the information on this online clinical knowledge resource, we cannot guarantee its correctness or completeness. The
   information on the Map of Medicine is subject to change and we cannot guarantee that it is up-to-date.




Published: 19-Apr-2011          Valid until: 30-Nov-2011 © Map of Medicine Ltd All rights reserved
This care map was published by International. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.



For terms of use please see our Terms and Conditions http://mapofmedicine.com/map/legal                                                                             Page 10 of 10

								
To top