PROGRAM AREA REPORT

LUNG CANCER

Coordinators: Dr. Oleg S. Selawry
Dr. Takeshi Hirayama



Lung cancer is the most commonly lethal type of cancer in the U.S.A., and the disease is substantially increasing in Japan. General principles and basic strategies of the Lung Cancer program area were discussed and as the result the following four major clinical areas were focused on for joint cooperation in the first two years.

1. Microscopic classification of lung cancer
A joint meeting was held on March 27, 1975 in Tokyo. Full agreement was reached on acceptance of the main classification of lung cancer according to WHO with subclassification of the jamor cell types. Data on reproducibility of microscopic diagnosis (blind evaluation of slides) were also exchanged. The use of electronmicro-scopy for effective subclassification was advanced by the Japanese scientists with focus on oat cell carcinoma. Substantial progress on subclassification of this particular cell type was also made by a Japanese scientist and by the Pathology Evaluation Panel of the Working Party for Treatment of Lung Cancer. Future cooperation will focus on the impact of electronmicro-scopic findings on subclassification of lung cancer, especially in the areas of small cell carcinoma, adenocarcinoma, and large cell carcinoma.

2. Staging
A joint meeting was held on March 26, 1975, in Tokyo on staging and the task of finding mutual agreement on staging was achieved. The U.S. and the Japanese TNM staging system are very close ; minor variants between the systems are easily translated into each other.

3. Early diagnosis
A meeting of Early Detection of Lung Cancer was held in Tokyo, November 25-26, 1975. This meeting focused on the role of sputum cytology, fiber-optic broncho-scopy, and roentgenologic examination of the chest for early diagnosis of lung cancer. The following conclusions were drawn at the meeting:

  1. A variety of occupational and environmental factors have been implicated in the etiology of bronchogenic carcinoma. However, cigarette smoking remains by far the most important and heavy smokers are considered as the highest risk group.
  2. Recent data strongly suggest that bronchogenic carcinoma can be detected and localized at an earlier, curable stage. This has been accomplished by intensive application of radiologic, cytologic and endoscopic techniques. In particular, development of the flexible bronchofiberscope has allowed close inspection of the smaller segmental and subsegmental bronchi, especially in the upper lobes.
  3. Radiographically unapparent, or “occult” bronchogenic carcinoma has been localized with regularity by means of the bronchofibersoope, but it is often difficult to identify the precise site of early bronchogenic carcinoma and some type of mucosal “marker” is urgently needed.
  4. Screening for early, presymptomatic lung cancer by chest radiography and spectrum cytology is currently being evaluated. Preliminary results demonstrate sufficient promise to warrant continued efforts. However, screening of clinical outpatients or more general populations should be conducted under very carefully controlled conditions.


4. Cancer Therapy
The U.S. program coordinator was privileged to be invited to Japan in October 1974 for exploratory exchanges on cancer therapy. The meetings served mainly as an exchange of current information especially mono- and multi-discipinary studies for treatment of lung cancer in U.S.A. It was anticipated that a broader and more extensive exchange on therapy of lung cancer could be made in 1975, however this type, of meeting is being postponed.

It might be considered that additional program areas, such as etiology, morphogenesis and epidemiology be included. Two Japanese scientists were sent to the U.S.A., visited leading institutions. Other forernbst investigators from both countries visited each other outside the auspices of the U.S.-Japan Cooperative Cancer Research Program, but related to its purposes. There has been no exchange of junior scientists in this area thus far.