Pulmonologists and lung cancer: pivotal role in multidisciplinary approach
Authors: Mina Gaga, Jean-Paul Sculier, Klaus F. Rabe
Journal: European Respiratory Journal (2013)

The pulmonologist plays a vital role in the multidisciplinary approach to lung cancer diagnosis and management http://ow.ly/oALXpLung cancer carries a huge disease burden: the death toll is high, the disease severely impacts the quality of life of patients and their families, and it is associated with considerable costs for patients and health systems.It remains the leading cause of cancer mortality in the world, with approximately 1.4 million deaths per year.Lung cancer morbidity and mortality needs to be reduced, mainly through implementation of prevention strategies (including smoking cessation, reduction of occupational exposure and lifestyle measures), and most importantly by early diagnosis and prompt and targeted treatment.The role of the pulmonologist is pivotal in the diagnosis, staging and management of lung cancer and this role is comprehensively described in the joint American Thoracic Society (ATS)/European Respiratory Society (ERS) statement published in the August issue of the American Journal of Respiratory and Critical Care Medicine [1].Pulmonologists are responsible for, and involved with, lung cancer patients from their initial diagnosis and staging through treatment and re-staging.They are also involved in the management of comorbidities and, importantly, complications, either from the tumour itself or the treatment, as well palliative and end-of-life care.Due to their knowledge of lung physiology, they are the appropriate physicians to estimate respiratory reserve, which is crucial for management decisions, and are thus best qualified to deal with lung-related morbidity and respiratory failure.This is even more important since many patients with lung cancer have respiratory comorbidities that affect their performance status and need to be taken into account in management decisions, the most common comorbidity being chronic obstructive pulmonary disease.Early and specific diagnosis is very important in lung cancer, and recent studies demonstrated important advances that promise to decrease death rates over time [2,3].The National Lung Screening Trial (NLST), which included more than 50 000 patients at high risk of lung cancer, showed a relative reduction of 20% in lung cancer mortality with low-dose computed tomography screening [3].The evaluation of lung nodules and other abnormalities detected at screening or diagnostic work-up requires tissue sampling and accurate histological and molecular characterisation of the tumour [4,5].This characterisation is crucial as various lung cancer cell types respond very differently to treatment.Current standards of care for lung cancer assign treatment not only on standard histology but also on the presence of specific molecular markers, including the presence of epidermal growth factor receptor mutation and anaplastic lymphoma kinase translocation status for adenocarcinoma [6,7].Tissue sampling can be performed by the pulmonologist with the use of guided bronchoscopy procedures, such as electromagnetic navigation, endobronchial ultrasound and virtual bronchoscopic navigation [8][9][10][11].Recent