Talk:Lung cancer

"Rate" vs. "Incidence"

In "Diagnosis", subsection "Classification", in the table the word "incidence" has been changed to "rate". I am unhappy about this. "Incidence" has a distinct epidemiological meaning while "rate" is vague. Even though "incidence" is stated in the table's main heading, given that values are quoted, I believe that "incidence" should also be used in the secondary heading. Axl ¤ [Talk] 10:10, 10 June 2013 (UTC)

I sort of consider rate and incidence to be more or less the same with rate per 100,000 being more understandable. Have switched it back per your preference. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:14, 10 June 2013 (UTC)

Thank you for changing the table heading. I note that you say "rate and incidence [are] more or less the same with rate per 100,000 being more understandable." It is precisely this sort of interpretation that leads to confusion with prevalence. Axl ¤ [Talk] 20:25, 10 June 2013 (UTC)

One is per year and the other is not. I added the per year bit. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:28, 10 June 2013 (UTC)

No! Incidence is the number of new cases per unit population per unit time. Prevalence is the number of current cases per unit population at a given moment in time. Axl ¤ [Talk] 09:04, 11 June 2013 (UTC

Yes so should we change it to "New cases per 100,000 per year"? Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:16, 11 June 2013 (UTC)

I'm not keen on doing that, but it would be accurate and unambiguous. Axl ¤ [Talk] 12:24, 11 June 2013 (UTC)

Out of date information

I came here looking for surivival rates, and found a 5 year survival rate of 10%, cited to an article from 2007. This contrasts with http://www.medicinenet.com/lung_cancer/page7.htm#what_is_the_prognosis_outcome_of_lung_cancer which gives a 5 year survival rate of 17%, along with more details of types and stages and their survival rates. I don't know the reliability of that site, which fails to cite its own sources - but its article is labelled as last reviewed on 12/3/2013, so I strongly suspect it is in fact reliable, but things have improved in the past 6 years. My wikipedia mentor has told me not to touch anything medical; apparantly the owning projects have unique standards for reliable sources, and have been known to ban people for using unapproved ones. So I'm commenting here - how about at least putting accurate dates on potentially out of date information - or better yet, updating the information based on more recent sources - rather than giving out-dated and frightening information to readers whose interest in some medical issue stems from someone's recent diagnosis. Kobnach (talk) 19:21, 7 December 2013 (UTC)

Were does our article say the overall 5 year survival is 10%? Are you sure you are looking at the most recent version of the article? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:37, 7 December 2013 (UTC)

Yes medicinenet is not a great source. Globally what is the 5 year survival? This ref says 15% [1] but it is probably for aggressively treated disease in the wealthy parts of the world. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:33, 7 December 2013 (UTC)

Yes this ref says 15% in the USA and worse in the developing world [2]. Will update. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:33, 7 December 2013 (UTC)

Where did the article say 10%? Axl ¤ [Talk] 22:36, 7 December 2013 (UTC)

It might have years ago. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:31, 8 December 2013 (UTC)

Screening

In screening section, it is not mentions anything about tumor marker. Use CT Scan and MRI is expensive and same with tumor marker, it are not diagnosis test, the tumor/cancer should be diagnosed by biopsy. Today, M2-PK cheap tumor marker is very usefull because of high sensitivity compare to use expensive and invasive colonoscopy. The tumor marker tests will be developed further in line with the time.

I propose to add article as below:

According to http://www.aacc.org/SiteCollectionDocuments/NACB/LMPG/tumor/chp3p_lung.pdf CYFRA 21.1 can aid in diagnosis especially when biopsy cannot to be done and CYFRA 21.1 is the most sensitive tumor marker for NSCLC. Together with CEA, CYFRA 21.1 will give more sensitivity. While NSE and ProGRP has more specificity of SCLC when is compared to CEA and CYFRA 21.1. ProGRP is more sensitive than NSE. However, the National Academy of Clinical Biochemistry says that for lung cancer screening purposes uses a single tumor marker only is not recommended. The tumor markers are also useful for monitoring, before and post therapy follow up.Gsarwa (talk) 13:49, 29 December 2013 (UTC)

References

USPSTF screening guidance

Published doi:10.7326/M13-2771 JFW | T@lk 07:47, 31 December 2013 (UTC)

Risk with fruit and vegetables

There has been a lot of editing of the fruit & veg part of the "Prevention" section recently. The reference (Key) states: "Many observational studies have found that lung cancer patients report a somewhat lower intake of fruits and vegetables than controls, but the effect of smoking is so large, compared with the small association with diet, that residual confounding by smoking is likely, and recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and the risk for lung cancer." This certainly does not imply "unidentified lifestyle factors" as currently stated in the article. Axl ¤ [Talk] 19:02, 30 January 2014 (UTC)

Yes feel free to fix. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:17, 30 January 2014 (UTC)

I have changed the text to mention only "confounding". Interested readers can read the reference. Axl ¤ [Talk] 22:34, 15 February 2014 (UTC)

Many of our readers will not know what "confounding" is. We should at least describe it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:50, 15 February 2014 (UTC)

I have expanded on the statement. Axl ¤ [Talk] 00:55, 17 February 2014 (UTC)

How about mentioning the Finnish study that showed excess consumption of vitamins etc. such as ß-carotene and vitamin A decreased survival in lung cancer? I think its been reviewed multiple times.CFCF (talk · contribs · email) 21:00, 21 February 2014 (UTC)

Saw some mention, but maybe more is due, will look up some articles. CFCF (talk · contribs · email) 21:02, 21 February 2014 (UTC)

Pulmonary tumors

"Lung cancer" designates only "Malignant tumors of the lung". It would be interesting tocreate a page "Pulmonary tumors", including benign tumors and malignant tumors. patho (talk) 10:14, 9 February 2014 (UTC)

Technical terms

Typically we list both lay and technical terms in the first sentence of the lead. Thus restored carcinoma of the lung [3]. What are peoples thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:33, 20 February 2014 (UTC)

• Looking at various other cancer articles, I do not see any clear pattern of giving a technical term in the first sentence of the lead. See for example Brain tumour, Skin_cancer, liver cancer, stomach cancer, kidney cancer.
• Google ngrams tells me that the term "lung cancer" is about 10-15 times more common in general literature than "carcinoma of the lung", and google scholar and pubmed return similar proportions in the scientific and medical literature.
• The article itself states that not all lung cancers are carcinomas.

In conclusion I cannot see a good reason for the term "carcinoma of the lung" to be presented in the lead as if it is an equivalent term in similar use to "lung cancer". 200.120.73.176 (talk) 23:36, 20 February 2014 (UTC)

Lung cancer as a term, while common, is pretty generic and could be applied to mediastinal and wall neoplasms (lymphomas or sarcomas) that are not carcinoma. This article, deals exclusively with carcinoma of the lung. It also applies to every histopathologic diagnosis named in the article, "xxxx cell caricinoma of the lung". It's also in many article in pubmed (although lung cancer is more common). I think it's a more precise definition of what this article discusses. I'd leave it in. Ian Furst (talk) 00:12, 21 February 2014 (UTC)

Yes carcinoma of the lung and lung cancer are not exact synonyms if we are being exact. This came up in another cancer article a while ago. Can't remember what consensus was or which article, sorry. Lesion (talk) 00:18, 21 February 2014 (UTC)

If the article is not about lung cancer but specifically about carcinoma of the lung, then its title should be changed. 200.120.73.176 (talk) 02:38, 21 February 2014 (UTC)

I don't think that a name change is good. The main meaning of lung cancer is carcinoma of the lung, and this is the commonest term (even among professionals) for carcinoma of the lung. The most precise term is used when it is necessary to be precise, but reviews like this one may not mention the word carcinoma at all.

That said, I think that the other types of neoplastic lung conditions ought to be mentioned here, either as points of comparison (e.g., this type is far more common than that type, this class does not include those types) and/or with brief mentions to WP:Build the web and help place the carcinomas in context. WhatamIdoing (talk) 03:13, 21 February 2014 (UTC)

(←) I don't think removing the more technical term makes much sense. On many pages we list all the names for conditions (e.g. hepatic encephalopathy has four names for the same condition) and this is to make the terminology accessible to the reader rather than befuddle them. As for carcinoma vs cancer, this distinction is clarified later in the article. "Lung cancer" without a modifier is always carcinoma, because other lung tumours will immediately be labelled more specifically (e.g. carcinoid). JFW | T@lk 08:02, 21 February 2014 (UTC)

I don't think that a name change would be good either. I think that an article about lung cancer should discuss all the types of lung cancer, even if one particular subset accounts for the vast majority of cases. I just don't think there's much point in forcing in an "also known as" for a term which is infrequently used in both popular and medical usage, and is not even a direct synonym for the article's title. It's mentioned in both the lead section and in the body of the article that most but not all lung cancers are carcinomas, and this makes it clearly incorrect to say that "lung cancer is also known as carcinoma of the lung". 200.120.73.176 (talk) 10:21, 21 February 2014 (UTC)

• I remember this happened on Talk:Penile_cancer#Requested_move. The page used to be called "carcinoma of the penis", but it was decided to rename it to "Penile cancer" and widen the scope to include mention of sarcomas etc. Similar situation, almost all of these were carcinomas. Agree with WAID that should mention other types of malignancy that occur in the lungs, even if just to say they are rare. As to mention of "carcinoma of the lung" in parentheses in the lead, I have no particular opinion on this. Lesion (talk) 11:44, 21 February 2014 (UTC)

• Wikipedia:MEDMOS addresses this, though perhaps it needs to be made clearer.LeadSongDog come howl! 13:58, 21 February 2014 (UTC)

" Lung cancer as a term, while common, is pretty generic and could be applied to mediastinal and wall neoplasms (lymphomas or sarcomas) that are not carcinoma. "

— Ian Furst

While it "could" be applied, I am not sure that it ever is. The medical profession would certainly never refer to mediastinal lymphomas as "lung cancer". Histologically proven chest wall sarcomas would only ever be referred to by their histological status: "sarcoma", and never as "lung cancer". There are enough non-malignant nodules (hamartomas, etc.) that we never categorically describe an unknown nodule as "lung cancer". If pressed, we might say that lung cancer is a possibility.

In summary, the medical profession only ever uses the phrase "lung cancer" to mean "lung carcinoma".

The article currently includes the statement "The vast majority of lung cancers are carcinomas—malignancies that arise from epithelial cells." I am not sure if I added the statement. In any case, I think that this is sufficient to imply the few parenchymal sarcomas, etc., that arise within the lungs. I am happy to leave the statement "also known as carcinoma of the lung" in the opening sentence. Axl ¤ [Talk] 14:30, 21 February 2014 (UTC)

How about neuroendocrine tumors of the lung? Normally these aren't referred to as carcinomas, but rather as carcinoid. I'm not sure I share JFW's sentiment that a patient would always know the difference between this an "regular" lung cancer. CFCF (talk · contribs · email) 20:52, 21 February 2014 (UTC)

Upon inspection there are two articles:

Pulmonary carcinoid tumour

Typical pulmonary carcinoid tumour

None of which are of any particular standard (the typical article doesn't even mention that it is a neuroendocrine tumor), but I know pathologists where I come from will call these cancers lung cancer at least when talking to or informing patients. This complicates the mention in the first sentence in my opinion. Maybe a mention of both is in order? Might look into fleshing out the mention of carcinoid/neuroendocrine tumors in this article myself, at least adding a sentence or two. CFCF (talk · contribs · email) 21:09, 21 February 2014 (UTC)

Hey Axl - I should have clarified. What I'd meant is that a layperson might refer to other thoracic/mediastinal tumors as "lung cancer", not realizing the distinction. I thought leaving the technical term in the first sentence might be helpful in this regard. Ian Furst (talk) 00:49, 22 February 2014 (UTC)

" I'm not sure I share JFW's sentiment that a patient would always know the difference between this an "regular" lung cancer. "

— CFCF

JFW does not assert that a patient would always know the difference. JFW states: " "Lung cancer" without a modifier is always carcinoma, because other lung tumours will immediately be labelled more specifically (e.g. carcinoid). " I agree with JFW's statement. Axl ¤ [Talk] 02:29, 22 February 2014 (UTC)

" I know pathologists where I come from will call these cancers lung cancer at least when talking to or informing patients. "

— CFCF

That's a first for me. I have never heard of pathologists talking to patients. Axl ¤ [Talk] 02:31, 22 February 2014 (UTC)

(Well to be frank, it depends on definition here; cytologists do, cytology being considered a sub-speciality here, but lets not get into that). On the other hand Robbins Pathology of disease differentiates between Lung cancer (which is carcinoma) and Lung tumors, which include the lot. Maybe a disambiguation page?CFCF (talk · contribs · email) 08:54, 22 February 2014 (UTC)

You're saying that cytologists inform patients that they have lung cancer? With respect, I don't believe you. Axl ¤ [Talk] 12:49, 22 February 2014 (UTC)

I've only seen a pathologist called out to a clinic once. Sometimes they might do fine-needle aspiration cytology. Rarely they may be present in theatre (e.g. Moh's micrographic surgery although I've never seen this, but then the patient is unconscious).

To clarify and move the discussion forwards, I think the argument is that laypersons would call any cancer occurring in the lungs "lung cancer". Lesion (talk) 13:04, 22 February 2014 (UTC)

Well it seem things are done slightly differently in Sweden, there are consultations with cytologists, where the patient visits the clinic for any number of punctions, some of which where a cytologist may inform the patient of possible diseases before analyzing the sample, or upon follow-up. Fine needle aspiration is the least invasive, and may be done when a cytologist is called out to another clinic (simply bringing the set along), but for larger liver, kidney, breast biopsies etc., which do not require invasive surgery but require more kit are performed at the cytology clinic as long as the patient isn't bed-ridden. [4](Swedish)

Now to get the my suggestion, what about mentioning in the lead that there are other cancers, and linking to for example a lung tumor disambiguation page? CFCF (talk · contribs · email) 13:50, 22 February 2014 (UTC)

PathoWhat do you think? CFCF (talk · contribs · email) 14:03, 22 February 2014 (UTC)

Based on what I'm reading, everyone agrees the term "lung cancer" is only used to refer to carcinoma of the lung when used by professionals. Some of us, believe a layperson might type in lung cancer when in fact they should be looking for another topic (carcinoid, lymphoma, sarcoma, whatever). I think it's less confusing to the average reader to leave the "also known as lung carcinoma" in place and add some "See also"s for other malignancies of the thorax and mediastinum. I'd assume that 99% of people searching for lung cancer are, in fact, looking for information on carcinoma of the lung. Ian Furst (talk) 22:04, 22 February 2014 (UTC)

From Harrison's Principles of Internal Medicine, 18th edition, 2012: "The term lung cancer is used for tumors arising from the respiratory epithelium (bronchi, bronchioles, and alveoli). Mesotheliomas, lymphomas, and stromal tumors (sarcomas) are distinct from epithelial lung cancers. According to the World Health Organization classification, epithelial lung cancers consist of four major cell types: small cell lung cancer (SCLC) and the so-called non-small cell lung cancer (NSCLC) histologies including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These four histologies account for approximately 90% of all epithelial lung cancers. The remainder include undifferentiated carcinomas, carcinoids, bronchial gland tumors (including adenoid cystic carcinomas and mucoepidermoid tumors), and rarer tumor types."

I should point out that "carcinoma" is by definition an epithelial-derived cancer. Our article has a short subsection about "Others", mentioning the rare types.

Fishman's Pulmonary Diseases and Disorders, 4th edition, 2008, does not explicitly define lung cancer. However it does have separate sections for non-small cell lung carcinoma/cancer and small cell lung cancer. Subsequent to these, it includes a chapter on "Primary lung tumors other than bronchogenic carcinoma: benign and malignant". The malignant list includes pulmonary blastoma, carcinoid, carcinosarcoma, epithelioid haemangioendothelioma, lymphomas, plasmacytoma, malignant melanoma, malignant germ cell tumours, salivary gland-type tumours, and sarcomas.

The Merck Manual uses the title "Lung carcinoma" while using "lung cancer" through most of the text. The two are clearly regarded as equivalent.

Holland-Frei Cancer Medicine, 8th edition, 2010, lists the WHO classification. This list of epithelial malignant tumours includes the main four, adenosquamous carcinoma, carcinoid tumour, bronchial gland carcinomas, and "others".

Murray & Nadel's Textbook of Respiratory Medicine, 5th edition, 2010, does not explicitly define "lung cancer".

Of these five sources, two clearly imply that "lung cancer" is synonymous with "lung carcinoma". The other three are non-committal, but certainly do not contradict the assertion. Axl ¤ [Talk] 02:38, 23 February 2014 (UTC)

I really do not understand the voluminous discussion here about the presence of five words in the lead section. We have the manual of style for guidance; it says that "the first occurrence of the title and significant alternative titles are placed in bold", and "significant alternative names for the topic should be mentioned in the article, usually in the first sentence or paragraph". In general literature, and in medical literature, the rate of use of the term "lung cancer" exceeds the rate of use of the term "carcinoma of the lung" by a factor of about 15 to 1. Therefore, "carcinoma of the lung" is not a significant alternative name. It may be useful and indeed essential to discuss this term in the article, but it does not need to be forced into the first sentence of the article.

I also found it spectacularly irritating to have been reverted first of all with the inane summary "try the talk page". If you are going to revert an edit, you are obliged to give a sensible explanation of why you are reverting. That was not a sensible explanation. 200.120.73.176 (talk) 03:03, 23 February 2014 (UTC)

You made three assertions in your initial statement:-

"Looking at various other cancer articles, I do not see any clear pattern of giving a technical term in the first sentence of the lead. See for example Brain tumour, Skin_cancer, liver cancer, stomach cancer, kidney cancer." These comparisons are circumstantial evidence at best. Of more relevance, when the article was promoted to FA status, it included the statement. None of the FAC reviewers voiced misgivings about the statement. Actually, you are the first person to do so in the eight or nine years that I have watched this article.

"Google ngrams tells me that the term "lung cancer" is about 10-15 times more common in general literature than "carcinoma of the lung", and google scholar and pubmed return similar proportions in the scientific and medical literature." That is a good reason to make the article's title "Lung cancer" and not "Lung carcinoma". By the way, PubMed has 89,775 papers with "lung cancer" and 14,551 papers with "lung carcinoma". That's a ratio of about 6:1.

"The article itself states that not all lung cancers are carcinomas." I have demonstrated that lung cancer often, if not always, is synonymous with lung carcinoma.

The bottom line is this: you say that lung carcinoma is not a significant alternative name. No-one agrees with you. Axl ¤ [Talk] 04:43, 23 February 2014 (UTC)

Did you read the comment by the guy who reverted me? After he'd first inanely just said "try the talk page", he then claimed it was about giving technical language. My comments were in response to that. I don't particularly care if you agree with me, as you seem to be trying to be unpleasant about this. Google, google scholar, google ngrams and pubmed all agree with me. Lung cancer is the overwhelmingly used term, and of course medical synonyms should be mentioned in the article but a little used term that most general readers would not use should not be forced into the article's first sentence.

Also, FA status does not make an article immune from improvement. 200.120.73.176 (talk) 12:34, 23 February 2014 (UTC)

"Did you read the comment by the guy who reverted me? After he'd first inanely just said "try the talk page", he then claimed it was about giving technical language." You are referring to these edits: [5], [6], [7] by Jmh649/Doc James. I see that there has also been some "discussion" on your talk page.

At the time of Jmh649's first reversion, he should have left a message on your talk page to expand upon the edit summary. However we are busy editors, and we don't always make time to leave appropriate messages. Also, the signal-to-noise ratio from IP editors tends to be lower than that of named editors, often causing regular editors to be more dismissive of IP editors. Another factor is that this article tends to receive biased edits from pro-tobacco lobbyists, typically IP editors. (Although in this case, it is clear that you are earnestly trying to improve the article.)

On the other hand, you exacerbated the problem by reverting rather than attempting to engage in discussion. I see that you have a history of edit warring ("The Holocaust in Poland"). This edit is particularly odious.

"I don't particularly care if you agree with me, as you seem to be trying to be unpleasant about this." That's a particularly ironic accusation considering the Holocaust discussion. Anyway, I am sorry that you found my comments unpleasant. That was certainly not my intention. Consensus is an important principle in Wikipedia. Thus you should care if I agree with you, regardless of how pleasant or otherwise I am.

"FA status does not make an article immune from improvement." I agree. This article has continued to improve since it reached FA status in 2007. My point is that the FAC reviewers showed a consensus that inclusion of the alternative name is acceptable. That consensus has not changed. Axl ¤ [Talk] 18:22, 24 February 2014 (UTC)

In my experience, an IP editor making an obviously productive edit can expect that someone will revert that edit for no reason probably about 10 per cent of the time. And so it was here. The first reason given was "try the talk page", which is singularly unhelpful and seems designed to irritate. The second reason given was a claim that both technical and lay terms were given in the lead for cancer articles generally. As I said in my edit summary, a cursory glance at a number of other cancer articles shows that that's not true. So, I conclude that the editor simply didn't like an editor from an IP number touching "his" article. Others such as yourself join in, motivated by the prejudice against IP editors that you outlined above. In the end, nothing will satisfy you except the complete expungement of whatever I tried to do in the first place. Your justifications get ever more extreme; FAC does not imply a consensus over the exact wording of any part of the article. You might feel like you sound perfectly pleasant. Your actions are not. I am all too familiar with the unpleasant gang actions of editors who can't stand the thought that someone editing from an IP address might actually know how to improve "their" article.

Here's the simple fact. "Lung cancer" is the overwhelmingly used and familiar term. All sources of usage statistics show this to be the case. The insertion of "also known as carcinoma of the lung" is jarring and unnecessary.

And do tell me, as you want to bring in that Holocaust discussion - how do you react when someone accuses you of holocaust denial for this edit? 200.120.73.176 (talk) 00:31, 25 February 2014 (UTC)

Well, there is nothing to be gained by further discussion here. I shall let other readers/editors decide the validity (or otherwise) of your statements. Axl ¤ [Talk] 01:49, 25 February 2014 (UTC)

Axl - I think you're in the appropriate specialty. How does path usually sign out carcinoma of the lung? Do they label it "lung cancer" or do they give a more detailed histopathologic diagnosis? Ian Furst (talk) 04:09, 23 February 2014 (UTC)

They use the formal histopathological subtype: either small cell lung carcinoma or non-small cell lung carcinoma. Actually it would be unhelpful for them to say "lung cancer" because the treatments are totally different. Axl ¤ [Talk] 04:47, 23 February 2014 (UTC)

If there are no objections I will create this page, and add the about template at the top of the page:

This article is about lung carcinomas. For other lung tumors, see lung tumor.

-- CFCF (talk · contribs · email) 08:32, 23 February 2014 (UTC)

Palliative Care Section

I'm new to editing wikipedia but I feel like the palliative care section is somewhat lacking mainly because it is focused mainly on chemotherapy, not necessarily palliative care (indeed the second paragraph is really all about chemotherapy and not palliative care). I'd like to make the following suggestion as an edit to the palliative care section to talk about the value of palliative care in lung cancer:

Palliative care that is integrated into usual oncologic care benefits patients even when they are still receiving cancer directed chemotherapy. The results of a 2010 study in The New England Journal of Medicine showed that patients with metastatic non-small cell lung cancer receiving early outpatient palliative care experienced less depression, increased quality of life and survived 2.7 months longer than those receiving standard oncologic care alone. Palliative care in this study included meetings with a palliative care team that focused on issues such as assessing physical and psychosocial symptoms, establishing goals of care, assisting with decision making regarding treatment, and coordinating care. For individuals who have more advanced disease, hospice care has been shown to can improve symptom management and quality of life. Ewidera (talk) 06:25, 1 March 2014 (UTC)

Per WP:MEDRS we typically use secondary sources such as review articles as references. If you put together a paragraph using secondary sources we can look at adding it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:46, 1 March 2014 (UTC)

A good place to start might be :

• Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Cochrane Database Syst Rev. 2013 Jun 6; 6:CD007760. Epub 2013 Jun 6. PMID 23744578
• Closing the quality gap: revisiting the state of the science (vol. 8: improving health care and palliative care for advanced and serious illness). Dy SM, Aslakson R, Wilson RF, Fawole OA, Lau BD, Martinez KA, Vollenweider D, Apostol C, Bass EB. Evid Rep Technol Assess (Full Rep). 2012 Oct; (208.8):1-249. PMID 24423021
• Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Irwin KE, Greer JA, Khatib J, Temel JS, Pirl WF. Chron Respir Dis. 2013 Feb; 10(1):35-47. PMID 23355404

CheersLeadSongDog come howl! 15:27, 1 March 2014 (UTC)

Thanks for the help. Trying to learn the rules the best that I can. What about the following (same paragraph except two review articles added, one from the NEJM and one a NCCN review article)

Palliative care that is integrated into usual oncologic care benefits patients even when they are still receiving cancer directed chemotherapy. The results of a 2010 study in The New England Journal of Medicine showed that patients with metastatic non-small cell lung cancer receiving early outpatient palliative care experienced less depression, increased quality of life and survived 2.7 months longer than those receiving standard oncologic care alone. Palliative care in this study included meetings with a palliative care team that focused on issues such as assessing physical and psychosocial symptoms, establishing goals of care, assisting with decision making regarding treatment, and coordinating care. For individuals who have more advanced disease, hospice care has been shown to can improve symptom management and quality of life.Ewidera (talk) 01:42, 2 March 2014 (UTC)

I am reluctant to expand the "Palliative care" section in this way. Most of the principles of palliative care in lung cancer are not actually specific to lung cancer. Parikh's paper is certainly not specific to lung cancer. The relevant trial is mentioned in a table alongside several other generic cancer trials. Similarly, Levy's paper is not specific to lung cancer. Axl ¤ [Talk] 16:14, 2 March 2014 (UTC)

I agree that the principles are not specific to lung cancer however the NEJM study by Temel (RTC on outpatient palliative care) is specific to lung cancer. Not including any discussion about this, rather than focusing most of the palliative care section on chemotherapy is misleading (the prior section on chemotherapy seems like a better place to talk about chemotherapy than the section on palliative care).Ewidera (talk) 05:37, 3 March 2014 (UTC)

Temel's paper is a primary source describing a randomized controlled trial. I don't think that this is a suitable source for Wikipedia's article. (As an aside, it is ironic to see that they used an en dash in "non–small-cell lung cancer".) This paper by Yates looks like a reasonable source.

Anyway, my main point is that readers should be directed towards the main article "Palliative care", with only brief information provided in this article. Axl ¤ [Talk] 20:55, 3 March 2014 (UTC)

Diet

Anonywiki has changed the statement "More rigorous studies have not demonstrated a clear association between diet and lung cancer risk" to "Other studies have not demonstrated a clear association between diet and lung cancer risk", with the edit summary ""more rigorous" is an opinion unsupported by source cited."

The source (Key) states: "Many observational studies have found that lung cancer patients report a somewhat lower intake of fruits and vegetables than controls, but the effect of smoking is so large, compared with the small association with diet, that residual confounding by smoking is likely, and recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and the risk for lung cancer." This clearly implies that the later studies are more rigorous. Axl ¤ [Talk] 23:19, 27 May 2014 (UTC)

Hi Axl, thanks for raising this issue in a clear way. Unusually there are multiple studies listed in that single citation and I didn't actually read that bit. Maybe you should change it to something like: "However recent large prospective analyses with detailed adjustment for smoking", so that it's almost exactly the same as the source including implying that it's overturning the earlier studies. I believe we should avoid introducing new words like "more rigorous". Anonywiki (talk) 01:40, 28 May 2014 (UTC)

I am concerned about close paraphrasing with your suggestion. I have invited WikiProject Medicine editors to comment here. Axl ¤ [Talk] 11:53, 28 May 2014 (UTC)

You could just put that bit in quotes. Wiki CRUK John (talk) 12:02, 28 May 2014 (UTC)

We want to use simple language. I think what we had before was better. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:38, 28 May 2014 (UTC)

Concur with Doc James, "more rigorous" seems better. Though frankly the entire paragraph could use a rewrite. NickCT (talk) 16:45, 28 May 2014 (UTC)

Thank you, everyone. I have changed the text back to "More rigorous". Axl ¤ [Talk] 23:59, 28 May 2014 (UTC)

Cancer

A cancer is a malignant tumour of any sort, but the article with the heading "Lung cancer" does not include sarcoma and lymphoma, and other non-carcinoma primary malignant tumours of the lung. A much better name for the article as it currently stands is "carcinoma of the lung" or "lung carcinoma". Snowman (talk) 17:20, 28 May 2014 (UTC)

While technically true "lung cancer" is so much more commonly used and I think this is a small sacrifice. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:39, 28 May 2014 (UTC)

I think that these sort of unnecessary over-simplifications could be confusing or misleading to some. If the page title is staying at "Lung cancer", then the article should include all the sorts malignant tumours. A patient would probably say correctly that he or she has lung cancer, if he or she has lung sarcoma. Snowman (talk) 19:56, 28 May 2014 (UTC)

We discussed the matter in this section. The onus is upon you to demonstrate that the term "lung cancer" includes sarcomas of the lung and lymphomas within the lung. Axl ¤ [Talk] 00:02, 29 May 2014 (UTC)

It was discussed earlier, but there is still a problem. I think that anyone interested in the article could be more self reflective than saying that it is someones onus to prove something. Snowman (talk) 13:12, 29 May 2014 (UTC)

• First of all, the article has internal contradictions; the navbox {{Respiratory tract neoplasia}} includes the lung cancers: Sarcoma Lymphoma, Immature teratoma, Melanoma. Snowman (talk) 13:12, 29 May 2014 (UTC)

There is no contradiction within the navbox. "Lung cancer" is not synonymous with "cancers in the lung". Axl ¤ [Talk] 13:38, 29 May 2014 (UTC)

• The first line of the article says; "Lung cancer (also known as carcinoma of the lung) is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung.". Hence, this mixes up cancer and carcinoma. Snowman (talk) 13:12, 29 May 2014 (UTC)
• The first three dictionaries I looked at all defined "Cancer" as any malignant growth and "Carcinoma" as a malignancy of epithelial tissue. The three dictionaries: Snowman (talk) 13:12, 29 May 2014 (UTC)

1. Oxford English Dictionary. Current on-line version. Snowman (talk) 13:21, 29 May 2014 (UTC)

2. O'Toole, Marie, ed. (1997). Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health (6th ed.). W. B. Saunders. ISBN 0-7216-6278-1. Snowman (talk) 13:21, 29 May 2014 (UTC)

3. John H. Dirckx (editor) (1997). Stedman's Concise Medical and Allied Health Dictionary (3rd ed.). Williams and Wilkins. ISBN 0-683-23125-1. {{cite encyclopedia}}: |author= has generic name (help) Snowman (talk) 13:12, 29 May 2014 (UTC)

Do they define "lung cancer"? Axl ¤ [Talk] 13:35, 29 May 2014 (UTC)

1. the on-line OED lists lung cancer and gives some quotes, one from 1927 saying; "A diagnosis of endothelioma has been made frequently in primary lung cancers." It does not give a definition, but the mention of endothelioma, would tend to suggest that lung cancer is not limited to only carcinomas. Snowman (talk) 20:01, 30 May 2014 (UTC)

2. On page 940, Miller-Keane defines "lung cancer" as malignant growths of the lung and continues with general information. Snowman (talk) 20:01, 30 May 2014 (UTC)

3. Stedman's does not have an entry speficially for "lung cancer". Snowman (talk) 20:01, 30 May 2014 (UTC)

A few uninvolved remarks:

• I think WP:COMMONNAME is of some relevance here. I feel that finding an editorial solution that is intuitive to lay users is a relevant factor. In particular, I'm wondering whether the dab to "Lung tumors" is sufficient for readers to find everything they're likely to be looking for without having to reach the helpful table at the the foot of the page (the only place, incidentally, where "sarcoma" or "sarcomatoid" currently appears to be mentioned).
• On strictly editorial grounds, WP:SCOPE is surely relevant here... For instance, at present tracheal tumors don't seem to be specifically mentioned in the main text, even though they're the subject of one the ICD-10 categories currently cited in the infobox (and I notice Trachea/bronchus/lung cancers is a redirect).
• Fwiw, entering "lung cancer" in the MeSH browser retrieves Lung neoplasms (rather than Bronchial carcinoma, as currently cited).
  86.181.67.132 (talk) 14:49, 29 May 2014 (UTC)

Here's my thinking:

• What's the subject of the article? (It appears to be carcinomas of the lung.)
• What's the common name for that subject? (It appears to be "lung cancer"—so far, so good.)
• Are there other things that also use that name, but that aren't the subject of this article? (The answer appears to be "yes".) If so, then make a disambiguation page and/or otherwise redirect people to those other subjects—and then quit worrying about it. A page titled "Lung cancer" is not required or expected to cover every single thing that might have that name. WhatamIdoing (talk) 20:19, 29 May 2014 (UTC)

That sounds right to me. We already have Lung tumor as a quasi-disam page and might expand on that - the definition of "lung cancer" there is "Lung cancer, used to refer to carcinoma of the lung" btw. Wiki CRUK John (talk) 09:33, 30 May 2014 (UTC)

Sounds good to me too. I feel some editorial tidy up could be the key: basically, better dab, based on the scope of the page, to orient readers better. (Wikipedia medical pages aren't expected to mirror any one particular subdivision of topics; some of the codes we cite in the infobox perhaps need some editing/pruning.) 86.181.67.132 (talk) 12:57, 30 May 2014 (UTC)

• Looking at the percentages in Lung Cancer: A Multidisciplinary Approach to Diagnosis and Management by Kemp Kernstine (2011) at Google books, then it can be inferred that 99% of lung cancers are lung carcinomas in the introduction to paragraph 3 of the book. The introduction goes on to say that it discusses the most common histological types of lung cancer. I think that many articles like the Merck manual and Encyclopaedia Britannica say "the main groups of lung cancer are xzy" without saying what the minor groups are (ie without including the 1% non-epithelial tumours). I think that the article should not use "lung cancer" and "lung carcinoma" as synonymous. Snowman (talk) 18:56, 30 May 2014 (UTC)

That's why we need better disambiguation. "Lung cancer" is the common name for "lung carcinoma" (not for sarcomas or lymphomas, etc of the lung). The basic scope of the page is fine. If we go for the broadest usage of the term (as Snowman seems to be advocating), then we risk creating kind of a mini-encyclopedia in itself, rather than a manageable Wikipedia page. The page may need one or two tweaks in the infobox, etc, but the key issue here is surely better disambiguation, for the benefit of everyone, including general readers. So that our readership can readily find the less common, non-epithelial tumors you're mentioning (which, to say it again, aren't commonly referred to as "Lung cancer"). 86.181.67.132 (talk) 20:24, 30 May 2014 (UTC)

In the introduction to chapter 3, Kernstine states "The most frequently occurring types are small cell lung carcinoma (SCLC, 15%), and non-small cell lung carcinoma (NSCLC), with NSCLC consisting of squamous cell carcinoma (SCC) (30%), adenocarcinoma (45%), and large cell carcinoma (9%) subtypes." I presume that you have derived the value of 99% by adding together the values of the different subtypes listed. It is possible that rounding of values may have led to the 1% discrepancy. However, given that Kernstine indicates that these are the "most frequent" subtypes, it is plausible that there are another 1% not listed. Even if this is the case, Kernstine certainly does not imply that the remainder are not carcinomas.

By the way, have you reviewed the text in the Merck Manual and Harrison's Principles of Internal Medicine? Axl ¤ [Talk] 20:34, 30 May 2014 (UTC)

Note that the relevant article in the Merck Manual is entitled "Lung Carcinoma". Snowman (talk) 14:11, 2 June 2014 (UTC)

I hope that you looked at more than just the title. Axl ¤ [Talk] 14:21, 2 June 2014 (UTC)

CRUK review

This is a write-up of the notes made in an initial review by a CRUK specialist. The idea is to sort these points out in the article before sending the article for review by other outside specialists. Epidemiology & the missing research section were not covered - will be done with other people. Not all points made are written up. I'm hoping this gives the medical editing community enough to go on to start serious work on the article, but I realize it may not. This is 3rd in a series - see also Talk:Esophageal_cancer#Initial_review_by_CRUK and Talk:Pancreatic_cancer#Initial_review_by_CRUK. Wiki CRUK John (talk) 12:13, 10 July 2014 (UTC)

DC points

• Stats - TNN 2009 figures are more recent and global. Better to use. Ref 54 (Rami-Porta et al). Used already
• distinguish between earlier & more advanced symptoms
• needs explaining: "symptoms due to local compress: chest pain, bone pain, superior vena cava obstruction, difficulty swallowing"
• "so-called paraneoplastic phenomena " explain, check refs, esp. syndrome of inappropriate antidiuretic hormone (SIADH)
• the PAIN caused by "as well as damage to the brachial plexus." is the symptom.
• "Cigarette smoke contains over 60 known carcinogens", - 2003 ref, there are more
• Pathogenesis needs more explaining
• Screening - needs to explain not in normal practice anywhere yet done - see below Blue Rasberry (talk) 17:12, 22 July 2014 (UTC)
• Targeted therapy of lung cancer only just linked here; this stuff needs expanding.
• Radioactive iodine brachytherapy - not common in UK anyway
• ".[72] Video-assisted thoracoscopic surgery (VATS) and VATS lobectomy use ..." - odd. Should be either "in the the form of" or "including" .
• UK Lung Cancer guidelines are full and recent - online at NICE site. Also ESMO
• Make clearer Radio/chemo often palliative only - move up last sentence in radio
• Options for early cancer trtmts when surgery not possible or palliative need expanding
• Biological treatments need adding - see NICE
• Epidemiology not looked at
• Research section needed

JB points

• Types are messy: are Adenocarcinoma of the lung, Typical pulmonary carcinoid tumour, Atypical pulmonary carcinoid tumour, Pulmonary neuroendocrine tumor even linked?
  • • Yes,yes, no, no currently Wiki CRUK John (talk) 12:22, 28 July 2014 (UTC)

fill out later Wiki CRUK John (talk) 11:45, 10 July 2014 (UTC)

Comments/discussion

I shall try to deal with these recommendations. Axl ¤ [Talk] 11:27, 11 July 2014 (UTC)

Many thanks - I should have told you directly this was under way. Wiki CRUK John (talk) 13:44, 11 July 2014 (UTC)

I have added a statement about the symptoms of metastatic disease. Axl ¤ [Talk] 10:09, 12 July 2014 (UTC)

I have clarified local compression. Axl ¤ [Talk] 19:38, 11 July 2014 (UTC)

I have expanded on "paraneoplastic phenomena". Axl ¤ [Talk] 19:42, 11 July 2014 (UTC)

I am not really sure what the issue about SIADH is. Lung cancer is well known to cause SIADH. The statement is referenced to Harrison's Principles of Internal Medicine and I have confirmed this. Axl ¤ [Talk] 09:40, 12 July 2014 (UTC)

I have added a very brief description of SIADH: "abnormally concentrated urine and dilute blood". Axl ¤ [Talk] 09:51, 12 July 2014 (UTC)

Brachial plexus damage certainly may cause pain. However I suspect that neurological dysfunction—sensory loss/paraesthesia or motor palsy—is a more common finding. We could link to "brachial plexus injury". I don't really want to expand this article into a discussion of the various manifestations of brachial plexus injury. Axl ¤ [Talk] 20:32, 13 July 2014 (UTC)

I have updated the carcinogens statement & reference. Axl ¤ [Talk] 11:44, 11 July 2014 (UTC)

I have tried updating and expanding the "Pathogenesis" section. It is still rather disjointed. If someone else would like to improve this, that would be great. Axl ¤ [Talk] 07:50, 24 July 2014 (UTC)

Screening updated

Wiki CRUK John I took recommendations from the American Association for Thoracic Surgery and integrated them into the screening section. I was unable to find suggested information about prevalence of use, but I did rephrase the section to match the sources in saying that one test is recommended, that it is new, and that the other tests regardless of their use are reported by Cochrane to not be backed by evidence. Blue Rasberry (talk) 17:12, 22 July 2014 (UTC)

Jmh649 Thank you for tweaking my addition. You put this sentence back in that section "For each true positive scan there are more than 19 falsely positives scans".

In the original source, this "19" number does not appear. I am not sure of the source of this figure. This stuff is a bit heavy, but I think a close statement is "Across studies, the average nodule detection rate per round of screening was 20% (Table 5, eFigure 1), but varied from 3–30% in RCTs and 5–51% in cohort studies. Most studies reported that >90% of nodules were benign". I think this means that when high-risk individuals were screened, 20% of them tested positive, but only 2% of those actually had cancer. To me, this seems like 1 in 10 (or 9 false positives per true detection) and not 1 in 20 (or 19 for every 1, as originally stated). Lots of false positives are certain but I am not sure of the utility of leaving numbers here. I changed your text to "20% of people at high risk for lung cancer tested with CT screening tested positive, but among those, 90% got a false positive and did not actually have the cancer the test was designed to detect." This still seems complicated to me to drop numbers like this in a summary, but I have no strong feelings about including it here. If you know more about these numbers then feel free to correct or improve what I did. Blue Rasberry (talk) 18:31, 23 July 2014 (UTC)

The abstract states "In terms of potential harms of LDCT screening, across all trials and cohorts, about 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer." Axl ¤ [Talk] 18:45, 23 July 2014 (UTC)

Yup thanks Axl. IMO "For each true positive scan there are more than 19 falsely positive scans" is a similar way to say it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:09, 23 July 2014 (UTC)

I see it now. What you say is a correct way of presenting what is written. I think this is a clear way of giving the information, so I put it back to the way it was. Blue Rasberry (talk) 19:54, 23 July 2014 (UTC)

At a rapid glance (and I could be wrong), my understanding is that 20% of the women screened were followed up due to radiographic evidence of nodules; and of all the women screened (ie including those 20%), 1% eventually turned out to have "the cancer the test was designed to detect". So, if I've understood correctly, that would actually mean that 1 out of 20 of the positive scans is a true positive. Or, in other words (expressing the concept as a ratio rather than a proportion) "For each true positive scan there are more than about 19 falsely positive scans." 31.48.175.145 (talk) 19:35, 24 July 2014 (UTC)

Yes, which is why I have already edited the article to say that. (Both men and women were included in the analysis.) Axl ¤ [Talk] 19:52, 24 July 2014 (UTC)

Oops, sorry Axl... I'm really good at doing misreadings. 31.48.175.145 (talk) 20:03, 24 July 2014 (UTC)

Other

• "Cite error: A list-defined reference named "Salgia" is not used in the content (see the help page). Cite error: A list-defined reference named "Fong" is not used in the content (see the help page)." - I presume these can just be removed.
• Thorax, 2010;65:iii1-iii27, doi:10.1136/thx.2010.145938, Supplement, "Guidelines on the radical management of patients with lung cancer", by Eric Lim, David Baldwin, etc etc. open access - useful?
• Should we link to Manchester score? Recent refs seem hard to find. Wiki CRUK John (talk) 13:07, 28 July 2014 (UTC)

No, there's this

"The Manchester score is a valuable tool for decision making for administering chemotherapy in patients admitted to the ICU and ICU admission (30). ....We recommend based on the published literature that the LOD score is used as a predictive factor for extensive stage lung cancer patients (25) and the Manchester score when we want to administer chemotherapy in ICU admitted lung cancer patients." Wiki CRUK John (talk) 16:00, 28 July 2014 (UTC)

References

I deleted the old information referenced to Salgia & Fong. I have now deleted the references. Axl ¤ [Talk] 17:06, 28 July 2014 (UTC)

I previously (some years ago) included Manchester score in the article. I don't know when it was removed or by whom. Axl ¤ [Talk] 17:32, 28 July 2014 (UTC)

Just now, by me. It was clearly misplaced as "main". The survival figures are referenced to a 1997 paper btw. Wiki CRUK John (talk) 17:51, 28 July 2014 (UTC)

Indeed I wrote the article "Manchester score" in 2006–07. Axl ¤ [Talk] 17:34, 28 July 2014 (UTC)

lol, okay. I added the Rami-Porta data a few years ago. This is more relevant and more useful than the somewhat outdated Manchester score.

I created the article "Non-small cell lung cancer staging" in 2007. That article included the TNM classification and subsequent grouping because I felt that the size of the tables would have occupied too much room in this article. That article has since been heavily edited by other people and the information moved around. I am intending to add the TNM classification to this article—I just haven't got around to it yet. Axl ¤ [Talk] 20:01, 28 July 2014 (UTC)

Great, thanks. I'm pretty much leaving this alone but do let me know if you think there's anything I can help with. Wiki CRUK John (talk) 11:00, 29 July 2014 (UTC)

I have added a table with the "T" part of the TNM classification. It is already rather unwieldy—and that's without the "N", "M", and grouping information. Axl ¤ [Talk] 19:50, 30 July 2014 (UTC)

Cannabis

I am adding a statement about how i believe marijuana smoke and tobacco smoke should be compared in the main article on lung cancer. I agree that the actual smoke generated from the physical burning of tobacco and marijuana can be harmful because it is generally not healthy to inhale smoke of any kind, however, the argument hear is about the carcinogens and their cancer causing agents. Marijuana smokers typically smoke the bud of the plant and not the leaf, which is the opposite of that of tobacco smokers. Studies have also shown that marijuana contains 33% as much tar as tobacco, which is substantially less. Studies have also shown that THC may lessen the effects of such carcinogens as where tobacco smoke increases the effects of such carcinogens. Furthermore, studies have also shown that long term effects of moderate to heavy marijuana use have yielded better lung tests as compared to the lungs of tobacco smokers. Those tested for smoking marijuana over a long period of time have actually showed better results when it comes to lung function as where tobacco smokers have shown opposite results. Studies have also shown that marijuana smoke can increase the function of the lungs since smoking the plant involves long inhales and holding your breath which in return expands the passages in the lungs. Tests were conducted in the 1970's by the government (keep in mind that this was the 1970's. Medical technology was not as advanced and marijuana was a likely competitor to tobacco) and i am saying that tobacco companies may have lobbied government officials into conducting biased tests, thus creating the illusion that marijuana was more lethal than tobacco when it was actually the opposite. Also, the THC levels in marijuana in the 1970's were far less than they are today meaning that tests were ultimately biased. There are higher levels of THC in today's marijuana then there ever were previously and tests of today are still yielding better health results than the results of tobacco smoke. — Preceding unsigned comment added by Johnthegreat2014 (talk • contribs) 18:18, 15 July 2014 (UTC)

John, please be mindful that this article is specifically about lung cancer. It is not appropriate to add detailed information about the effects of marijuana on the lungs to this article. Axl ¤ [Talk] 18:59, 15 July 2014 (UTC)

Airway stem cells in lung cancer

doi:10.1093/qjmed/hcu040 - review in QJM. JFW | T@lk 10:55, 24 July 2014 (UTC)

IIB

One option for stage 2Bb lung cancer; but if tumour is within 2 cm of the carina, this is stage 3

There is a minor anomaly with this diagram of stage IIB. Tumour in the main bronchus (more than 2 cm away from the carina) is T2 disease. If the tumour is within 2 cm of the carina, it is T3. Axl ¤ [Talk] 11:48, 29 August 2014 (UTC)

Ok thanks, I'll raise this. I take it there is no issue of different systems? Wiki CRUK John (talk) 11:53, 29 August 2014 (UTC)

No. The old system used the same distance from the carina to differentiate between T2 & T3. Axl ¤ [Talk] 11:59, 29 August 2014 (UTC)

Does the expanded caption resolve this? Wiki CRUK John (talk) 15:15, 5 January 2015 (UTC)

No, not really. I don't think that it is a good idea to mix different stages in the same image. It would be better to change the image itself. Axl ¤ [Talk] 12:20, 6 January 2015 (UTC)

IIIA

stage 3A lung cancer

The second diagram of stage IIIA seems to be somewhat confusing. Axl ¤ [Talk] 11:57, 29 August 2014 (UTC)

Does how they now look in the article resolve this? It all is "somewhat confusing" really, and the diagrams have possibly bitten off at least as much as they can chew. I think they are still helpful, & I've now set them up so it should be possible to read the text straight from the article page, with space to add further explanation in the captions. But if there are specific changes to the internal labels that would help, please let me know. Wiki CRUK John (talk) 15:35, 5 January 2015 (UTC)

My main concern about this image is that it should imply one feature from the left column and one feature from the right column. I'm not sure if this is clear to readers. Still, if you are comfortable with the current image, I won't press the matter further. Axl ¤ [Talk] 12:25, 6 January 2015 (UTC)

I hope I have clarified this by adding to the caption, now "Stage IIIA lung cancer, if there is one feature from the list on each side". It is easy to do this. But if changes to the internal image labels themselves are wanted, I really need a new text to take to the graphics person, so we should agree this in advance. Wiki CRUK John (talk) 13:09, 6 January 2015 (UTC)

Cornwall, radon

"For example, in areas such as Cornwall in the UK (which has granite as substrata), radon gas is a major problem, and buildings have to be force-ventilated with fans to lower radon gas concentrations." - unreferenced. My impression was that this has normally been dealt with for some time by membranes impervious to the gas underneath the ground floor, venting to the outside of the house. Fans are mostly for back-up and maybe older properties where a membrane can't be fitted. At least most of Cornwall is pretty windy. From the council: "Since the 1990’s all new build properties have had radon precautions installed. This is inevitably a radon barrier (plastic membrane) and depending upon its construction type, a mini sump or air bricks. If the barrier fails then the sump if fitted can be activated by attaching an electric fan. It is suggested that all new build properties are tested for radon once they are inhabited." (from here) I'll try to get an accurate picture here. Wiki CRUK John (talk) 16:14, 4 September 2014 (UTC)

The reference used does not support the statement. Therefore I have deleted the statement from the article. Actually I think that there should be a short subsection about radon in the "Prevention" section. Axl ¤ [Talk] 18:27, 4 September 2014 (UTC)

Certainly there should. Government sources are fine for regulations and typical measures taken (I mean the right, here UK, government). Johnbod (talk) 21:43, 4 September 2014 (UTC)

Agree that radon (second most important risk factor after smoking) deserves appropriate space in the Prevention section. Despite being a UK resident in another area with high exposure to radon, I'd like the perspective to be broadly international.
Anyhow... perhaps this critical appraisal [8] from the Centre for Reviews and Dissemination of a (UK-based) cost-effectiveness analysis ([9]) could qualify as a MEDRS? 86.164.164.123 (talk) 19:23, 10 September 2014 (UTC)

Radon is a risk for smokers, but practically harmless for never smokers. Apparently something of a hoax, directed by the radon industry, mass media, politicians and others. See for example Edelstein & Makofske, Radon´s Deadly Daughters, 1998. — Preceding unsigned comment added by Ravenlogos (talk • contribs) 23:08, 30 September 2014 (UTC)

IIIA again

stage 3A lung cancer

This diagram seems to be demonstrating T4 N1. However invasion into the diaphragm is T3. While T3 N1 is also stage IIIA, it seems odd to single out invasion into the diaphragm, and in any case, diagram 2 already implied this.

Also, there is no diagram that demonstrates T4 N0. Axl ¤ [Talk] 22:32, 4 September 2014 (UTC)

See above - are there specific changes that would improve it? Wiki CRUK John (talk) 13:16, 6 January 2015 (UTC)

Statement that has little meaning

The article says "Overall, 16.8% of people in the United States diagnosed with lung cancer survive five years after the diagnosis" but doesn't go any further. Do the other 83.2% live longer, or die before 5 years?! Yevad (talk) 16:02, 11 September 2014 (UTC)

They die - but it's a fair point. Statements about cancer survival tend to use slightly veiled language, on and off-wiki. Wiki CRUK John (talk) 17:10, 11 September 2014 (UTC)

I thought that meaning of "survive" was fairly well known. They are either alive after five years, or not alive. Anyway, I have changed the text to "at least five years". Axl ¤ [Talk] 17:14, 11 September 2014 (UTC)

and I've changed the link to Five-year survival rate. Wiki CRUK John (talk) 17:29, 11 September 2014 (UTC)

Thanks. Axl ¤ [Talk] 18:44, 11 September 2014 (UTC)

Nature Outlook articles on LC

A series just out, produced in conjunction with CRUK. Not sure these are MEDRS, but interesting reading. Summary and links at The big issues affecting lung cancer worldwide - CRUK science blog. Wiki CRUK John (talk) 17:29, 11 September 2014 (UTC)

radon effects by cancer type

"The risk from radon differs by lung cancer type. Small cell lung carcinoma has a high risk from radon. For other histological types such as adenocarcinoma the risk from radon appears to be lower."

References

Thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:51, 30 September 2014 (UTC)

Ravenlogos recently added information about the relative proportions of the different histological subtypes caused by radon. This text was further edited by Jmh649.

I saw these edits and looked at the references. The first reference is Darby. It is a primary source, albeit a large one, from 2005. It does indeed show an increased risk for small-cell lung carcinoma, with little/no increased risk for the other types.

The second reference is Field. It is unclear if this is an article in a peer-reviewed journal. It is certainly not indexed in Pubmed. Given that it includes the subtitle "Testimony", I suspect that it is actually a legal document written by an expert witness. Field's document refers to three papers that assess the different proportions of the histological subtypes. The first paper is the Iowa Radon Lung Cancer Study. This found a positive trend for large-cell lung carcinoma and a suggestive trend for squamous-cell lung carcinoma. The second paper, Darby, showed a big increase for small-cell lung carcinoma. The third paper, the North American Pooling, also suggested a bigger increase for small-cell lung carcinoma.

After reviewing these documents, I did another Pubmed search for review papers about radon that might discuss these findings. (I have recently looked into radon & lung cancer so I have an idea about it anyway.) I did not find any secondary sources that discuss these findings. Neither Darby's paper nor Field's document are suitable for use as references in Wikipedia's lung cancer article. In the absence of any suitable secondary sources, I deleted the text.

Ravenlogos reverted my edit, indicating that this is "reputable information from the most recent study".

Jmh649 then reverted Ravenlogos and opened this discussion.

It is interesting to see that Ravenlogos now states that "radon is ... something of a hoax, directed by the radon industry, mass media, politicians and others." Axl ¤ [Talk] 10:23, 1 October 2014 (UTC)

I'll ask here. Wiki CRUK John (talk) 11:05, 2 October 2014 (UTC)

Epidemiology Section

We are from CRUK and going to add some UK stats to this section using data compiled from ONS, Welsh Cancer Intelligence and Surveillance Unit, ISD Scotland and the Northern Ireland Cancer Registry.

Gireland89 (talk) 15:25, 3 October 2014 (UTC)

Primary versus secondary sources

Per WP:MEDRS we typically use secondary sources. This edit replaced a 2013 review with a 2006 primary source [10]. The 2013 review takes the primary source into account thus reverted to the previous sourcing and wording. Doc James (talk · contribs · email) 02:00, 2 January 2015 (UTC)

Perhaps Alwayslearning678 can join the discussion here rather than repeatedly adding the same dopecruft. JFW | T@lk 23:11, 3 January 2015 (UTC)

Pulmonary nodules

The following text was recently added to the "Diagnosis" section: "Clinical practice guidelines have recommended frequencies for pulmonary nodule evaluation and surveillance. The therapy should not be used for longer or more frequently than indicated. Extended surveillance exposes people to increased radiation." The reference provided is here.

I am unconvinced that this text is helpful in the article. The "Diagnosis" section already mentions the solitary pulmonary nodule, and interested readers are able to use the wikilink to go to that article. I don't think that the reference is suitable. If the text (or a modification of it) is to remain, it would be better to use the actual ACCP guideline. Also, the word "therapy" is misused. Axl ¤ [Talk] 11:06, 28 April 2015 (UTC)

Can the existing mention be expanded with a phrase on the frequency issue? Generally I will support your judgement; anything involving radiation has similar risks and guidelines, & we may not always need to spell this out. Also, I think "evaluation and surveillance" are not "therapy". The editor concerned recently introduced herself at the med project talk. She is experienced but new to medical editing, which as I know, is a steep learning curve. I wonder if someone suggestede to her this point needed expansion? Johnbod (talk) 12:29, 28 April 2015 (UTC)

Yes maybe in the section on screening? Or on another page would be better. Feel free to adjust as you see fit. Doc James (talk · contribs · email) 17:56, 28 April 2015 (UTC)

URFA note

Per the ongoing review to develop a new WP:URFA list, this is a 2007 promotion that has taken on a few (hopefully minor) issues:

1. There is a bit of uncited text
2. Citation style is inconsistent (it appears that the article once used the Diberri format, but newer citations do not)
3. Image layout could use work to avoid text squeeze and jumble
4. Pls review for WP:REALTIME (words like current, recent, today, etc and the use of as of date)
5. There are unformatted citations.

Thankfully that is generally stuff that should be easy to fix! SandyGeorgia (Talk) 16:51, 4 May 2015 (UTC)

ICD10 - C33

Previous versions (ICD8 from the 60's and ICD9 from the 70's) grouped the lower respiratory tract together so that trachea and lung fell under a main code (162) with distinctions based on the subcode (162.0 was trachea and 162.5 was lower lobe of the lung). With ICD10 they broke these apart and applied C33 to trachea and C34 to lung cancer. I feel like there is a reason for that. So I'm not sure about listing C33 as a code for lung cancer. But I am not well versed on the ICD10 and somebody with a better knowledge base might be able to clarify. There is not enough evidence to warrant an edit but it is possibly worth an investigation/dialogue to determine.

Thanks