Lung cancer is the most common fatal malignancy among both men and women in the United States. Its peak incidence is between ages 55-65, and in smokers (increasing with pack years), and is twice as common in men. Mr. Nulle fit all of these criteria. Most lung tumors have a very aggressive natural course with rapid progression and poor survival statistics. The prognosis can be significantly improved by early detection; at the present time there are no universally recommended general screening protocols. Early detection may allow surgical resection which gives the best prognosis for 5 year survival.
Again, there is a dramatic association between the development of lung cancer and cigarette smoking (increasing with pack years). It is an overwhelmingly strong risk factor. There is a well-documented direct relationship between the duration of smoking and daily cigarette consumption and the development of lung cancer. For example, the risk of developing lung cancer is 60-70 times as much for a 2 pk/day smoker for 20 years (40 pack years) than a non-smoker. 80-90% of lung cancers are caused by tobacco, mostly by cigarettes. While there are other significant risk factors consisting of exposure to other carcinogens (asbestos, radioactive materials, other chemicals), cigarette smoking is by far the biggest risk factor. Lung cancer is divided into non-small cell lung cancer (NSCLC) consisting of squamous or epidermoid cell (the most common), adenocarcinoma, large cell, and small cell (oat cell). As noted above, the association between cigarette smoking and development of lung cancer is greatest for epidermoid and small cell undifferentiated (oat cell).
Even though the risk factor is the same, the two types of cancer behave differently. The general 5 year survival rate is between 5-10%. At the time of symptomatic presentation, 75% of patients have unresectable lesions. As mentioned above, lesions that are resectable offer the best chance at survival. In fact, early detection and surgery offer the best chance at cure.
Lung cancer medical expert witness specialties include oncology, internal medicine, radiology, pathology, lung transplant, thoracic surgery, internal medicine, family medicine, and hospitalist medicine.