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Precision Diagnosis and Treatment for Advanced Non–Small-Cell Lung Cancer Lung cancer remains one of the most frequent and most deadly tumor entities.The correlation between smoking status and mortality from lung cancer has been confirmed, and a decrease in mortality after cessation of tobacco. Although direct or environmental exposure to tobacco smoke is the predominant risk factor, inhalation of carcinogens through marijuana or hookah use also contributes to the risk of lung cancer. Additional risk factors include exposures to radon, asbestos, diesel exhaust, and ionizing radiation. Increasing evidence suggests a correlation between lung cancer and chronic obstructive lung disease that is independent of tobacco use and is probably mediated by genetic susceptibility. Lung cancer in patients who have never smoked, accounting for approximately one quarter of all cases of lung cancer in the United States, has attracted growing interest because of treatable oncogenic alterations and the opportunity for individualized treatment.
The development of biomarker-driven targeted therapy has resulted in substantial benefits for patients with non–small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, and rearrangements involving the anaplastic lymphoma kinase (ALK) gene or the ROS1 gene. For patients with EGFR-mutant NSCLC EGFR tyrosine kinase inhibitors (eg, gefitinib, erlotinib, and afatinib) have a superior objective response rate and progression-free survival compared with chemotherapy in the first-line setting. For patients who have disease progression on EGFR tyrosine kinase inhibitor and with NSCLC with an EGFR T790M mutation osimertinib has demonstrated a superior response rate and progression-free survival compared with chemotherapy in the second-line setting.4 For patients with ALK rearrangements ALK tyrosine kinase inhibitors (eg, crizotinib, ceritinib) have a superior response rate and progression-free survival compared with chemotherapy in the first-line setting, and for patients who experience disease progression, ceritinib and alectinib have demonstrated clinically relevant response rates and progression-free survival..For patients with ROS1 rearrangements, targeted therapy, is associated with a higher response rate and longer progression-free survival than has been observed with chemotherapy. These molecular alterations are more common in NSCLC with adenocarcinoma histology and in the minority of patients with a light smoking or never smoking history. The success of these targeted therapies in molecularly defined subsets of NSCLC made the development of targeted therapies and identification of predictive biomarkers a focus of thoracic oncology research. Routine molecular testing is now the standard of care for patients with NSCLC with adenocarcinoma histology
Risk factors for lung cancer worldwide Tobacco smoking is the major determinant of lung cancer risk; genetics, occupation, pollution, poor diet also contribute.
Postoperative Pulmonary Complications Br J Anaesth. 2017;118(3):317-334. Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug..The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery. clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care.Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight. the most beneficial level of PEEP is required,
Cigarette smoke damages the lining of the airways and makes the lungs more prone to infection. So stopping smoking will lessen your risk of developing lung infections.
COPD (Chronic obstructive pulmonary diseases or chronic bronchitis) Assessment of the risk of death in this patients depend on their BODE Index B stand for BMI, O- Obstruction depending on FEV1, D - Shortness of breath OR dyspnea using MMRC scale , E - Exercise capacity, measured by 6 minutes walk test 6MWT.This index calculated using a scale of 0 to 3 for each parameter, depending on severity. except BMI scale different < 21 is 0 and more than >21 is 1. BODE score of 7 to 10 falls in the higher chance of mortality. Other factors have also been associated with increased moribidity and mortality in COPD , For example : acute exacerbation of COPD, Hospitalization, cardiac comorbidities Survival benefit are smoking cessation and lung volume reduction surgery in selected patients .Oxygen is beneficial who are hypoxemic on room air. None of the medications consistently demonstrated to prolong life.
Patients with persistent exacerbations despite treatment with triple therapy (LABA plus LAMA plus ICS) and with a history of smoking may be candidates for additional treatment with a macrolide.The macrolide azithromycin has been shown to be effective in these patients in decreasing the frequency of exacerbations and improving quality of life, although hearing impairment was observed in a small percentage of patients treated with azithromycin. Because the treatment effect of azithromycin was not seen in current smokers, its use is restricted to ex-smokers.
How to increase life expectancy by public health measures Around 97% of the health budget goes for treatment and 3% only on prevention . This is the western data. What about India?.There is no data by government if data is available . There IS no force by government to implement it. What measures we can take to improve standard of health: Vaccination Motor vehicle safety Safer workplace coronary heart ds/stroke prevention Safer and healthier food Healthier mother and babies Tobacco legislation Family planning Flouridasiation