Lung cancer is one of the biggest challenges in oncology today. The challenge is due to the recognition of the possibility of prevention in at least 70-80 % of all the cases and the extreme difficulties encountered in the treatment of this neoplasm. Despite the knowledge of prevention measures such as cessation of cigarette smoking the incidence continues to increase in many countries. The increase is particularly notable in females in the west ernized countries where the death rate in females in certain regions sur passes that of breast cancer. Furthermore, in many developing countries lung cancer is now being diagnosed with increasing frequency in both sexes and it is expected to be a major cause of death in those countries later in this century or the beginning of next century if the tobacco consumption will continue its rapid rise. With respect to therapy the 1970'es brought considerable progress in understanding of the clinical behaviour of lung cancer thereby establishing the importance of distinguishing between the major histologic types. Thera peutic advancement was particularly experienced in small cell carcinoma with the introduction of combination chemotherapy after this special dis ease entity among lung cancers was recognized as being a disseminated dis ease in almost all cases at the time of diagnosis. It was expected that the improvement in therapy would have continued in the early 1980'es, not only for small cell lung cancer but also for the other cell types."

The last volume dealing with lung cancer in this series in Cancer Treatment and Research was published in 1986 and entitled Lung Cancer: Basic and Clinical Aspects. The present book continues the outline of the previous volume by presenting up-to-date information on lung cancer in critical reviews of new important basic and clinical concepts of lung cancer. The present volume has broadened the scope by also including chapters dealing with issues such as epidemiology, prophylaxis, and histopathology of lung cancer. The content of the book thus reflects the increasing awareness of a global disease that is more and more in focus, not only scientifically but also politically. The latter fact results increasingly in changes in health legisla tion, with prevention measures influencing everyday life. The great interest in the disease is natural, considering that more than one patient dies from lung cancer every minute globally. The first chapter is from the Cancer Unit, WHO, Geneva, and describes in detail the epidemiologic features of lung cancer, which is the second most frequent cancer in the world with 660,500 new cases annually; it will soon surpass stomach cancer as the leader. Thirty-one percent of the cases occur in developing countries, where the increase is especially dramatic."

Primary lung tumors are now a global health problem. The incidence has risen dramatically during the last 5--6 decades, reflecting the popularity of cigarette smoking. In this, the fifth volume dealing with lung cancer in the series KappaCANCER TREATMENT AND RESEARCHkappa, many current research topics are covered by notable authorities, including chemoprevention, growth factors, multidrug resistance, new agents, and haematopoietic growth factors. Altogether, the 17 chapters from twelve countries highlight some of the rapid developments taking place in basic and clinical research of lung cancer. These chapters not only give up-to-date information, they will also stimulate further research into this man-made disease which was almost unheard of a century ago.

Effective care of the cancer patient increasingly involves systemic treatment, and as the range of available therapeutic agents continues to expand, the medical oncologist must be fully aware of the rationale for choosing specific drugs and combinations. Textbook of Medical Oncology, 4th edition, is written by a highly acclaimed list of international authors and is a key source of reference for all working in the field of oncology.

Primary lung tumors are now a global health problem. The incidence has risen dramatically during the last 5--6 decades, reflecting the popularity of cigarette smoking. In this, the fifth volume dealing with lung cancer in the series KappaCANCER TREATMENT AND RESEARCHkappa, many current research topics are covered by notable authorities, including chemoprevention, growth factors, multidrug resistance, new agents, and haematopoietic growth factors. Altogether, the 17 chapters from twelve countries highlight some of the rapid developments taking place in basic and clinical research of lung cancer. These chapters not only give up-to-date information, they will also stimulate further research into this man-made disease which was almost unheard of a century ago.

The last volume dealing with lung cancer in this series in Cancer Treatment and Research was published in 1986 and entitled Lung Cancer: Basic and Clinical Aspects. The present book continues the outline of the previous volume by presenting up-to-date information on lung cancer in critical reviews of new important basic and clinical concepts of lung cancer. The present volume has broadened the scope by also including chapters dealing with issues such as epidemiology, prophylaxis, and histopathology of lung cancer. The content of the book thus reflects the increasing awareness of a global disease that is more and more in focus, not only scientifically but also politically. The latter fact results increasingly in changes in health legisla tion, with prevention measures influencing everyday life. The great interest in the disease is natural, considering that more than one patient dies from lung cancer every minute globally. The first chapter is from the Cancer Unit, WHO, Geneva, and describes in detail the epidemiologic features of lung cancer, which is the second most frequent cancer in the world with 660,500 new cases annually; it will soon surpass stomach cancer as the leader. Thirty-one percent of the cases occur in developing countries, where the increase is especially dramatic."

Lung cancer is one of the biggest challenges in oncology today. The challenge is due to the recognition of the possibility of prevention in at least 70-80 % of all the cases and the extreme difficulties encountered in the treatment of this neoplasm. Despite the knowledge of prevention measures such as cessation of cigarette smoking the incidence continues to increase in many countries. The increase is particularly notable in females in the west ernized countries where the death rate in females in certain regions sur passes that of breast cancer. Furthermore, in many developing countries lung cancer is now being diagnosed with increasing frequency in both sexes and it is expected to be a major cause of death in those countries later in this century or the beginning of next century if the tobacco consumption will continue its rapid rise. With respect to therapy the 1970'es brought considerable progress in understanding of the clinical behaviour of lung cancer thereby establishing the importance of distinguishing between the major histologic types. Thera peutic advancement was particularly experienced in small cell carcinoma with the introduction of combination chemotherapy after this special dis ease entity among lung cancers was recognized as being a disseminated dis ease in almost all cases at the time of diagnosis. It was expected that the improvement in therapy would have continued in the early 1980'es, not only for small cell lung cancer but also for the other cell types."

The "Europe against Cancer" programme has, from its inception, emphasised the key role which general practitioners must play in the actions necessary to achieve its aim of reduc ing the incidence and the mortality from cancer in the European Community. General practitioners, because of their day-to-day direct and continuing contact with patients, playa role not only in primary prevention and education of patients, but also in motivating their patients to accept secondary prevention and screening, some of it carried out by general practitioners themselves. These preventive activities are in addition to their traditional role in the care and management of patients with cancer at home, and increas ingly, their role in active treatment. In view of the importance of the general practitioner in the "Europe against Cancer" pro gramme, the European Commission, with a view to providing general practitioners with up-to-date useful information, has sponsored the production of this series of publications on organ based cancers, especially written for general practitioners. MICHEL RICHONNIER Coordinator ofthe "Europe against Cancer" programme, Commission ofthe European Communities, Brussels Preface To decrease the death rate of lung cancer is today one of the major challenges of medical doctors all over the world. In Europe alone, one person is dying of lung cancer every two minutes. Accordingly, most physicians will regularly in their career be confronted with a patient being either suspect of or having a lung cancer.

This series on the treatment of cancer is sponsored by the UICe. The editors and authors feel strongly that more standar dization in cancer therapy is needed on a worldwide basis. This, of course, is only possible if experts from all countries subscribe to a joint policy of making their treatment designs available to practising oncologists all over the world. Current Treatment of Cancer discusses all the equipment and methods now in use in cancer therapy. It covers all types of cancer, thus providing the reader with comprehensive infor mation on cancer management. In recent decades there has been a tremendous improve ment in the treatment of cancer, and there is hope for even fur ther success in this fight. We are convinced that this series will help us to make a concerted response to the challenge of can cer. UICC Treatment and Rehabilitation Programme Ismail Elsebai Chairman Preface Part I Members of two institutions, the Brompton Hospital in London and the Finsen Institute in Copenhagen, were invited to write on lung cancer, and after reading the manuscripts it was decided that the contents of three pairs of chapters overlapped sufficiently for them to be combined.