This dissertation looks at the different cancers arising from the cells in the tissue of the lungs. In the first section I look at normal lung anatomy and physiology. In lung cancer the normal process is interrupted, I next look at the process of tumour formation and metastasis and the classification of different types of lung cancer.

In the UK the various types of lung cancer are the highest cancer killers in Men and second highest in Women.¹ Smoking causes lung cancer; over 80% of lung cancers are attributable to smoking.² The next section covers the aetiology of lung cancer and looks at the role of smoking, other environmental factors and genetic influences.

Smoking is the single biggest cause of preventable illness and premature death in the UK. Lung cancer was extremely rare in the nineteenth century, even as late as 1912, Adler could find only 374 cases. ³ By the 1970s lung cancer had become the biggest killing cancer. The increase in lung cancer coincides with the advent of smoking as a mass habit. In the late nineteenth century tobacco companies developed machines to mass produce cigarettes and made smoking accessible to the masses, smoking was heavily promoted and by 1950 the top five US brands sold over 300 billion cigarettes with 44-47% of all adult Americans smoking.³ Today the rate of lung cancer in the UK is falling in Men, but still rising in women, with increasing numbers of children aged 11-15 smoking.⁴ In the next section I look in more detail at the epidemiology of lung cancer.

Moving towards the medical aspects of lung cancer I look first at the clinical features and then what investigations are used in the diagnosis of lung cancer. After looking at the ways we can diagnose lung cancer I examine how these could be applied in screening programs.

Staging of lung cancer is important when assessing treatment options and a brief account of the staging classifications used in lung cancer is covered in the next section.

There have been many attempts to find a cure for lung cancer, therapies such as surgery, chemotherapy, radiotherapy, laser therapy, immunotherapy and photodynamic therapy have been subject to extensive research and improvement. Despite this, little progress has been made in the treatment of lung cancer, with little increase in survival rates after diagnosis.⁵ The section on Management covers the options for treatment including surgery, radiotherapy, chemotherapy and palliative care.

Understanding the effect that lung cancer has on a patient and their families is very important in helping to care for these people. In this section I look at the effect on the patient and family and look at two suggested models for coping with diagnosis of this illness.

We are increasingly looking at ways to stop the needless suffering caused by smoking and lung cancer. In the next section I examine the options for prevention and the work ongoing in this area. Banning tobacco advertising, increased taxation and anti-smoking campaigns are being used to prevent uptake of smoking. Nicotine in Cigarette smoke is highly addictive and help is needed by people wishing to quit smoking. There is an increasing amount of advice and support material available to help these people. In America we are increasingly seeing litigation cases brought against tobacco companies by American States including Texas, Mississippi and Florida in attempts to recover healthcare costs for smokers under the ‘Medicaid’ schemes.5

I find it hard to believe that what is essentially a preventable illness, and causes such a great deal of pain, suffering and deaths is still so prevalent.