Prognosis & Prevention

• Overall 5‑year survival rate: approx. 20%

• SCLC

  • Limited disease 5-year survival: 16% (median survival up to 20 months)

  • Extended disease 5-year survival: 3% (median survival up to 13 months)

• NSCLC

  • Better prognosis

  • Depends primarily on the extent of disease and lymph node status

  • Locally confined stages (no lymph node involvement, no metastasis) have a 5-year survival rate of approx. 60–70%.

Smoking cessation can reduce the risk of developing lung cancer by up to 50% after 5–10 years. After 15–20 years, the risk of lung cancer is the same as that of never smokers. [80][81][82]

• General measures: counseling on smoking cessation and behavioral support (e.g., cognitive behavioral therapy)

• Pharmacological measures

  • Nicotine replacement therapy (NRT): gum, lozenges, transdermal patches, inhalers, nasal spray

    • Replaces tobacco with other sources of nicotine to reduce craving and withdrawal symptoms until complete nicotine cessation becomes possible.

    • Combined NRT medications (e.g., nicotine patch, a long-acting form of NRT, plus nicotine gum, a short-acting form of NRT) increase the likelihood of success

  • Bupropion: reduces craving and withdrawal symptoms

  • Varenicline (alpha-4-beta-2 nACHR partial agonist): reduces craving and withdrawal symptoms

Smoking cessation can reduce the risk of developing lung cancer by up to 50% after 5–10 years. After 15–20 years, the risk of lung cancer is the same as that of never smokers. [80][81][82]

• General measures: counseling on smoking cessation and behavioral support (e.g., cognitive behavioral therapy)

• Pharmacological measures

  • Nicotine replacement therapy (NRT): gum, lozenges, transdermal patches, inhalers, nasal spray

    • Replaces tobacco with other sources of nicotine to reduce craving and withdrawal symptoms until complete nicotine cessation becomes possible.

    • Combined NRT medications (e.g., nicotine patch, a long-acting form of NRT, plus nicotine gum, a short-acting form of NRT) increase the likelihood of success

  • Bupropion: reduces craving and withdrawal symptoms

  • Varenicline (alpha-4-beta-2 nACHR partial agonist): reduces craving and withdrawal symptoms

The following recommendations are consistent with those of the US Preventive Services Task Force.

• Annual screening with a low-dose CT scan in patients 50–80 years of age with ≥ 20 pack-year smoking history who have smoked within the past 15 years [85]

• Discontinue screening if the patient:

  • Has abstained from smoking for 15 years

  • Develops a comorbidity that substantially limits their life expectancy

  • Expresses unwillingness to have curative lung surgery