The coexistence of lung disease and cancer in the same person is a frequent occurrence. Evidence suggests that this coexistence sometimes goes beyond chance; in fact, both disease types are associated and the presence of one can be a risk factor or a protective factor for the other. In this Monograph, the Guest Editors bring together renowned clinical and scientific experts to provide an exhaustive review of the bidirectional relationship between respiratory diseases and cancer (not just lung cancer). The chapters: explore the common causal pathways of cancer and lung disease; consider the diseases from an epidemiological, clinical and therapeutic point of view; and discuss the many ways in which they interact to influence patient management. The result is a book that will generate a better understanding of this relationship, giving rise to a greater awareness of the possible development of lung disease in people with cancer, and of the different types of cancer that are frequently seen in those with lung diseases.
- Page 1AbstractCorresponding author: Carolina Cubillos-Zapata (cubilloszapata@gmail.com)
The immune system constitutes the main defence against biological aggression, playing a crucial role in the control of cells undergoing neoplastic transformation. Hypoxia, together with the systemic inflammation and oxidative stress present in many respiratory diseases, compromise the function of the innate and adaptive immune systems. Several cell subsets are dysregulated in both chronic sustained hypoxia and IH conditions, mainly myeloid-derived suppressor cells, tumour-associated macrophages, natural killer cells and cytotoxic T-cells. Inhibition of antigen recognition, cell recruitment and cytotoxic activity, as well as higher levels of secretion of TGF-β, favour the evasion of tumour cells and even progress the tumour. The identification of hypoxia-induced overregulation of some immune checkpoints, such as the PD-1–PD-L1 axis, provides an explanation for the weak antitumour functions resulting from T-cell exhaustion and constitutes a promising way to identify biomarkers that will allow us to select patients with respiratory diseases at high risk of cancer, and to develop new therapeutic targets.
Cite as: Cubillos-Zapata C, Díaz-García E, García-Río F. Cancer immunosurveillance in respiratory diseases. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 1–14 [https://doi.org/10.1183/2312508X.10018021].
- Page 15AbstractCorresponding author: James D. Chalmers (jchalmers@dundee.ac.uk)
Respiratory infection may be associated with the risk of the development of malignancy. There are well-established associations between bacterial and viral pathogens and cancer development in other organs, but fewer data are available for the risk of lung cancer in relation to respiratory pathogens. Chronic lung inflammation is associated with increased risk of cancer development and disruption of the resident lung microbiome is increasingly recognised as a risk factor for cancer development and progression. This is particularly relevant in diseases such as COPD where patients are at increased risk of lung cancer. Patients with cancer are at markedly increased risk of infection, with pneumonia accounting for more than 50% of cases of septic shock in this population. Pneumonia in patients with cancer carries a poor prognosis and may be associated with “typical” bacterial pathogens such as Streptococcus pneumoniae or opportunistic pathogens particularly in patients receiving chemotherapeutic agents. This chapter reviews the interaction between respiratory infection and cancer.
Cite as: Pollock J, Hughes C, Chalmers JD. Respiratory infections and cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 15–30 [https://doi.org/10.1183/2312508X.10018121].
- Page 31AbstractCorresponding author: Silke Ryan (silke.ryan@ucd.ie)
Hypoxia is a common feature of the tumour micro-environment and is associated with poor prognosis. Hypoxic signalling mediated mainly by the transcription factor families hypoxia-inducible factor (HIF) and NF-κB results in tumour cell migration, proliferation, angiogenesis, inflammation, immunosuppression, and resistance to radio- and chemotherapy. A systemic hypoxaemic environment occurring in many respiratory diseases is likely to modulate these responses; however, the interaction between intratumoural hypoxia and an external hypoxic environment remains poorly explored. Chronic, sustained hypoxia as a characteristic feature of advanced pulmonary diseases such as COPD, pulmonary fibrosis and bronchiectasis may attenuate the adverse effects of hypoxic signalling due to preconditioning effects, whereby IH as a hallmark feature of OSA has consistently been linked with tumour promotion. In this chapter, we provide a brief overview of the hypoxia-responsive activation of HIF and NF-κB and explore the available evidence from preclinical models of the impact of sustained and intermittent hypoxaemia on the tumour micro-environment.
Cite as: O'Donnell C, King A, Ryan S. Continuous and intermittent hypoxia in cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 31–47 [https://doi.org/10.1183/2312508X.10018221].
- Page 48AbstractCorresponding author: Yoshinosuke Fukuchi (yfukuchi@tea.ocn.ne.jp)
Air pollution, climate and population health are closely related in terms of their impacts on respiratory health and lung cancer. Air pollutants contribute to the exacerbation of chronic respiratory problems such as COPD and asthma. Air pollutants are also toxic and carcinogenic, initiating and promoting lung cancer development. Climate change in relation to environmental pollution affects the geographical distribution of food supply and diseases such as pneumonia in adults and children. The threat of air pollution, and hence global warming and climate changes, and their effects on population and respiratory health, is an imminent threat to the world and deserves immediate and sustainable combating strategies and efforts. The goals are to increase public awareness and engagement in action, with alignment of international collaboration and policy, and with steering towards further research. Now is the prime time for international collaborative efforts on planning and actions to fight air pollution and climate change before it is too late.
Cite as: Lam DC-L, Nakanishi Y, Fukuchi Y. Future challenges and their impact on respiratory health and lung cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 48–58 [https://doi.org/10.1183/2312508X.10018321].
- Page 59AbstractCorresponding author: Carlos A. Jiménez-Ruiz (victorina@separ.es)
Tobacco smoke, vaping and nicotine damage results from the joint action of multiple substances potentiated by diverse mechanisms such as immunity impairment, direct cellular activity and enzymatic modification. Many of the substances identified within e-cigarettes are human carcinogens, and even chemicals affecting the taste of e-cigarettes have been implicated in their potential oncogenic effect. It is important to note that these toxic effects have also been demonstrated in devices that have been marketed as safer (IQOS and other similar devices). Some studies suggest that nicotine and its metabolites can cause cancer. According to in vivo studies, nicotine can damage the genome, interrupt cellular metabolic processes, amplify oncogenes and inactivate tumour-suppressor genes. This chapter discusses the substances in tobacco smoke and e-cigarettes that cause damage, as well as the types of cancer that develop and the main mechanisms involved.
Cite as: Jiménez-Ruiz CA, Rabade-Castedo C, García-Rueda M, et al. Smoking, vaping, nicotine and the risk of cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 59–70 [https://doi.org/10.1183/2312508X.10007022].
- Page 71AbstractCorresponding author: Preston Ngo (preston.ngo@nswcc.org.au)
Occupational carcinogens account for a significant proportion of cancer deaths worldwide. In the 2016 Global Burden of Disease Study, the leading causes of occupation-attributable cancer were asbestos, second-hand smoke, silica and diesel engine exhaust. Welding fumes, recently classified as a human carcinogen, also have significant potential for harm. In this chapter, the epidemiological evidence, occupations at highest risk and temporal trends in exposure are discussed. The most common occupation-related cancer is lung cancer, although workplace exposures have also been linked in particular to mesothelioma, laryngeal cancer and ovarian cancer. The current burden of occupational cancer largely reflects past exposure to asbestos. Given the latency between exposure and diagnosis, the impact of prevention activities on cancer rates, including regulations, will only be seen in the coming decades. Industries of concern (particularly mining, construction and manufacturing) continue to grow in low- and middle-income countries, and the burden of occupation-related cancers in these settings is likely to rise as a result.
Cite as: Ngo P, Sarich P, Feletto E, et al. Occupational exposure to respirable carcinogens and the risk of cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 71–81 [https://doi.org/10.1183/2312508X.10018521].
- Page 82AbstractCorresponding author: Catherine Bettington (Catherine.Bettington@health.qld.gov.au)
Globally, there is increasing exposure of the human population to ionising radiation from medical sources. Ionising radiation is a well-established human carcinogen. Cancer induction risk increases with radiation dose, and there is generally accepted to be no radiation dose below which the risk is zero, known as the linear no-threshold hypothesis. Estimates of radiation-induced cancer risk from medical imaging have been derived from large epidemiological studies and inform risk–benefit analysis, particularly in the case of screening imaging. Excess second malignancy risk is observed following therapeutic, high-dose thoracic radiotherapy.
Cite as: Bettington C, Chan P, Pratt G. Exposure to thoracic radiation and the risk of cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 82–90 [https://doi.org/10.1183/2312508X.10018621].
- Page 91AbstractCorresponding author: Ian A. Yang (Ian.Yang@health.qld.gov.au)
COPD is a common and important comorbidity of cancer. COPD increases the risk of lung cancer and nonpulmonary cancer. COPD has a considerable impact on cancer care in patients with pulmonary and nonpulmonary cancers. However, COPD is often overlooked in patients undergoing treatment for cancer, when optimisation of COPD management would be beneficial for cancer care outcomes. Here, we provide a synthesis of the evidence base for the epidemiology and clinico-pathological features of COPD and shared molecular pathogenesis with cancer, the impact of COPD on cancer care and the impact of cancer treatment on COPD. Our objective is to highlight the overlap between COPD and cancer, as well as the opportunities to enhance clinical management of patients when the conditions coexist.
Cite as: Yang IA, Shaw JG, Stephens EKH, et al. COPD: the risk of cancer and the impact on cancer care. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 91–104 [https://doi.org/10.1183/2312508X.10018721].
- Page 105AbstractCorresponding author: Juan P. de Torres (jupa65@hotmail.com)
Pulmonary emphysema is a pathological process that is usually associated with COPD, is secondary to the inhalation of toxic fumes (mainly tobacco smoking) or is caused by a genetic defect (α1-antitrypsin deficiency). With the increasing use of chest CT, emphysema identification has been made easier. It is postulated to be one of the most important risks factors for lung cancer, independently of the presence of COPD. This risk seems to specifically relate to centrilobular subtype and increases with emphysema severity. Its presence can also lead to an increased risk of complications during diagnostic and surgical procedures. Additionally, irrespective of lung cancer stage or histological type, patients with emphysema have a higher risk of recurrence and a worse overall survival. Therefore, the identification of pulmonary emphysema on chest CT could have important implications for risk assessment, diagnostic procedures, selection of the best therapy and the prognosis in patients at risk of lung cancer.
Cite as: Gonzalez-Gutierrez J, Sanchez-Salcedo P, de Torres JP. Emphysema: the risk of cancer and the impact on cancer care. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 105–117 [https://doi.org/10.1183/2312508X.10018821].
- Page 118AbstractCorresponding author: Anh Tuan Dinh-Xuan (anh-tuan.dinh-xuan@aphp.fr)
Morbidity and mortality related to allergic diseases and cancer of various systems and organs represent an increasing burden on healthcare organisations worldwide. The rise of cancer prevalence can be explained by augmented life expectancy, particularly in developed countries. Environmental pollution and climate change also contribute to the global increase in mortality and morbidity relating to cancer. Although usually nonlethal, allergies profoundly impact on the daily life of billions of people worldwide, from infants to elderly patients. The complexity of the biological mechanisms of allergies partly explains our relative therapeutic inefficiency. The relationship between allergies and cancer is complex, the former counteracting the latter in some cases but accelerating cancer development in other circumstances. The pivotal role of inflammation, however, is unquestionable in both cancer and allergies. Selective and effective anti-inflammatory compounds are urgently needed as inflammation is a common feature of cancer and allergies, and it favours neoplastic development and aggravates allergic reactions.
Cite as: Phan T-P, Vu-Van G, Tran-Xuan B, et al. Allergy: the risk of cancer and the impact on cancer care. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 118–122 [https://doi.org/10.1183/2312508X.10018921].
- Page 123AbstractCorresponding author: Pierre-Régis Burgel (pierre-regis.burgel@aphp.fr)
Cystic fibrosis (CF) and bronchiectasis are characterised by chronic airway infection with airway and systemic inflammation. Because cancer cases have been reported in people with CF (pwCF) and those with bronchiectasis, and because inflammation and cancer share biological pathways, studies have examined the risk of cancer in pwCF or people with bronchiectasis. Increased risk of colorectal cancer is well established in the ageing CF population and is further increased after lung transplantation; systematic screening using colonoscopy has been proposed in pwCF after 40 years and after 30 years in those living with lung transplantation. The absolute number of cancers remains small in the relatively young CF population but will increase in future years due to increased longevity. The absolute risk of cancer appears to be greater in the older bronchiectasis population. Several studies have suggested an increased risk of cancer in patients with bronchiectasis, but this relative increase remained small after adjustment for the usual risk factors. The consequences of CF and bronchiectasis on cancer treatments are discussed.
Cite as: Akdime F, Alabadan E, Martin C, et al. Cystic fibrosis and bronchiectasis: the risk of cancer and the impact on cancer treatment. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 123–133 [https://doi.org/10.1183/2312508X.10019021].
- Page 134AbstractCorresponding author: Carlo Vancheri (vancheri@unict.it)
IPF is a disease characterised by the progressive fibrosis of lung tissue that shares a number of aetiological and pathogenic commonalities with cancer. Similarities such as epigenetic and genetic alterations, cellular and molecular aberrances, delayed apoptosis, reduced cell-to-cell communication or activation of specific signalling transduction pathways could explain why lung cancer is a frequent comorbidity of IPF. The clinical approach to patients with this lethal association is difficult and is marked by a series of objective obstacles. The paucity of proper and larger studies in this field and the lack of specific guidelines suggest a multidisciplinary approach that should build a diagnostic and therapeutic itinerary for each patient. This individual plan must consider all clinical variables related to lung cancer and IPF, and the risk of acute exacerbations of IPF that invasive diagnostic procedures or treatments such as surgery, radiation or chemotherapy may trigger in this context.
Cite as: Vancheri C. Idiopathic pulmonary fibrosis: the risk of cancer and the impact on cancer care. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 134–144 [https://doi.org/10.1183/2312508X.10019121].
- Page 145AbstractCorresponding author: Ivette Buendía-Roldán (ivettebu@yahoo.com.mx)
ILDs are a group of diffuse parenchymal lung disorders with various comorbidities associated, especially lung cancer. Several studies have reported a higher incidence of lung cancer in ILD patients, particularly in those with IPF. It remains unclear whether ILD precedes lung cancer or vice versa. However, both diseases share common risk factors, such as exposure to tobacco and occupational factors. Genetic mutations and epigenetic mechanisms are relevant in the association of ILD and lung cancer. Myofibroblasts represent the critical cellular players in ILD and lung cancer, causing fibrosis, an aberrant accumulation of extracellular matrix. Treatment should be discussed carefully, because some treatments could be a risk factor for acute exacerbation. The prognosis in general for ILD patients with lung cancer is very poor, with an average survival time of 2.2 months. There is little knowledge on the impact of ILDs on cancer care, especially in the case of non-IPF ILDs.
Cite as: Buendía-Roldán I, Aguilar-Duran H, Juarez F. Other interstitial lung diseases: the risk of cancer and the impact on cancer care. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 145–151 [https://doi.org/10.1183/2312508X.10019221].
- Page 152AbstractCorresponding author: Catia Cillóniz (catiacilloniz@yahoo.com)
Lung cancer is the most common cancer in males and the second most common among females both in Europe and worldwide. Moreover, lung cancer is the leading cause of death due to cancer in males. The European region accounts for 23% of total cancer cases and 20% of cancer-related deaths. Relationships have been described between a number of infectious agents and cancers, but our knowledge of the role of viruses, both respiratory and systemic, in the pathogenesis of lung cancer is still rudimentary and has been poorly disseminated. In this chapter, we review the available evidence on the involvement of HPV, Epstein–Barr virus, HIV, cytomegalovirus and measles virus in the epidemiology and pathogenesis of lung cancer.
Cite as: Cillóniz C, Pericàs JM, Pinto JA. Viruses and the risk of lung cancer: prevention and treatment. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 152–162 [https://doi.org/10.1183/2312508X.10019421].
- Page 163AbstractCorresponding author: Jean-Pierre Zellweger (zellwegerjp@swissonline.ch)
The coincidence of lung cancer and tuberculosis (TB) in the same patient is more frequent than expected by chance alone and may give rise to diagnostic difficulties. TB may favour carcinogenesis, and lung cancer may increase the risk of re-activation from latent TB infection to active disease. In patients with cancer receiving immunosuppressive therapy, screening for TB infection and preventative treatment of infected individuals should be considered.
Cite as: Zellweger J-P. Pulmonary tuberculosis and the risk of cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 163–167 [https://doi.org/10.1183/2312508X.10019621].
- Page 168AbstractCorresponding author: Miguel Ángel Martínez-García (mianmartinezgarcia@gmail.com)
Two of the characteristics that define OSA from a pathophysiological point of view are IH and sleep fragmentation produced by various sleep respiratory events. These two factors have been attributed carcinogenic properties and considered inducers of greater aggressiveness or resistance to treatment of a pre-existing tumour. They have recently been complemented in this respect by other factors such as changes in the immune system, the sympatho-catecholaminergic system, exosomes and IH-mediated pathways. In recent years, efforts have been made to assess the real increase in the incidence of mortality from all-cause or specific types of cancer in individuals with OSA. Several studies using murine models have shown that the induction of sleep fragmentation or IH produced greater tumour growth and metastases, but this research was preceded by a host of clinical studies with conflicting results and various limitations. In this chapter, we review the evidence currently available on the relationship between the incidence and aggressiveness of all-cause or specific types of cancer and OSA, based on both murine and clinical studies.
Cite as: Martínez-García MÁ, Oscullo G, Gómez-Olivas JD. Obstructive sleep apnoea and the risk of cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 168–177 [https://doi.org/10.1183/2312508X.10019821].
- Page 178AbstractCorresponding author: Erik Klok (F.A.Klok@LUMC.nl)
The close relationship between cancer and venous thromboembolism (VTE) has long been recognised. While most cancer diagnoses are known at the time of VTE development, in some cases, VTE may be the first manifestation of cancer (i.e. occult). With a reported 1-year incidence of ∼5%, dedicated cancer screening seems a logical choice in patients with unprovoked VTE. The rationale behind screening is that early identification of cancer may allow earlier treatment, to ultimately reduce cancer-related morbidity and mortality. However, current evidence does not strongly support extensive-screening tests over a limited clinical work-up. Selecting subgroups of patients with a higher risk of occult cancer might enable more effective screening strategies in terms of costs and prognosis. Also, novel biomarker-based strategies for early cancer detection, including analysis of circulating tumour-derived cells, cell-free DNA, proteomics or platelet mRNA sequencing, are under investigation and are likely to provide valuable information for the clinical utility of various screening tests.
Cite as: Martens ESL, Huisman MV, Ninaber MK, et al. Venous thromboembolism: an indicator of malignancy. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 178–189 [https://doi.org/10.1183/2312508X.10019921].
- Page 190AbstractCorresponding author: Mina Gaga (minagaga@yahoo.com)
Pulmonary metastases are found in up to 50% of extrathoracic malignancies, and lungs are the second most frequent site of metastases in solid and haematological cancers. Pulmonary metastases play a significant role in increased morbidity and mortality of the primary tumour and are associated with an adverse prognosis, resulting in modification of the management plan. Metastatic dissemination is a complex process involving various mechanisms and signalling pathways that lead to alterations in tumour properties and the lung micro-environment. Imaging plays an important role in the detection and diagnosis of pulmonary involvement in metastatic disease. Most pulmonary metastases are asymptomatic, but a minority of patients present with nonspecific pulmonary symptoms such as cough, haemoptysis and shortness of breath. The management of pulmonary metastases can be part of the systemic therapeutic plan of the disease, or a locoregional approach can be used in specific cases and scenarios.
Cite as: Charpidou A, Panagiotou E, Karakatsanis S, et al. Pulmonary metastasis: from pathophysiology to management. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 190–200 [https://doi.org/10.1183/2312508X.10020222].
- Page 201AbstractCorresponding author: Mina Gaga (minagaga@yahoo.com)
Pulmonary involvement in haematological neoplasms is not uncommon, and physicians should be familiar with the specific characteristics of such an involvement. Even in patients without a history of haematological disease, the presence of respiratory symptoms accompanied by abnormal findings in full blood count measurements and physical findings such as lymphadenopathy, organomegaly and/or skin infiltration, should raise such a suspicion, especially when radiological findings (even nonspecific) are also present. Although necrotic lesions, cavitation, lymphadenopathy, pleural effusion without the presence of pulmonary lesions or the absence of radiological findings in general may be indicative of haematological neoplasms in patients with respiratory symptoms, they are not considered pathognomonic. Epidemiology data and specific clinical and radiological manifestations, as well as treatment options and prognosis of pulmonary involvement in common haematological malignancies, are presented in this chapter.
Cite as: Karakatsanis S, Charpidou A, Panagiotou E, et al. Pulmonary metastasis from haematological cancers. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 201–211 [https://doi.org/10.1183/2312508X.10020322].
- Page 212AbstractCorresponding author: Mina Gaga (minagaga@yahoo.com)
The lung is a common metastatic target site for solid tumours, with a variable presentation time ranging from as early as the time of initial diagnosis to as late as decades after. Lung metastases may present as single lesions but are more frequently seen as multiple findings. They generally have minimal, nonspecific or no symptoms, resulting in late diagnosis. Symptoms such as shortness of breath, chest pain and haemoptysis are rare and, in most cases, they are detected in routine surveillance chest imaging. Therapeutic approaches include chemotherapy – often the mainstay of treatment – radiotherapy and surgical resection. Metastasectomy is safe in selected patients, although eligibility criteria need further definition. In patients who are not surgical candidates, ablative techniques such as radiofrequency ablation or stereotactic ablative body radiotherapy can be considered. Prognosis is associated with the metastatic pattern, the disease-free interval before the development of metastases, the tumour number and volume, and the feasibility of complete resection.
Cite as: Zervas E, Samitas K, Vlachantoni I, et al. Pulmonary metastasis of solid tumours. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 212–224 [https://doi.org/10.1183/2312508X.10020121].
- Page 225AbstractCorresponding author: John A. Mackintosh (john.mackintosh@health.qld.gov.au)
Lymphangitis carcinomatosa refers to pulmonary interstitial involvement by cancer and is a dreaded clinical finding in oncology because it is a late manifestation indicative of metastatic malignancy, from either a lung or a nonlung primary cancer, and is associated with poor prognosis. Its presentation is nonspecific, often with subacute dyspnoea and a nonproductive cough in a person with a known history of malignancy, but in some cases is the first manifestation of cancer. CT imaging can be suggestive, typically demonstrating thickening of the peribronchovascular interstitium, interlobular septa and fissures. However, a biopsy may be required to confirm the pathological diagnosis as these changes can also be due to concurrent disease such as heart failure, ILD, infection, radiation pneumonitis and drug reactions. Diagnosis allows symptomatic treatment, with personalised treatment directed towards the primary cancer most likely to provide a meaningful benefit. Future research should focus on prospective clinical trials to identify new interventions to improve both diagnosis and treatment of lymphangitis carcinomatosa.
Cite as: Mackintosh JA, Duhig EE, Reddy T, et al. Interstitial abnormalities from solid and haematological cancers. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 225–240 [https://doi.org/10.1183/2312508X.10020221].
- Page 241AbstractCorresponding author: Sita Andarini (sitaandarini@yahoo.com)
The risk of infection is increasing in cancer patients. Infectious complications in patients with cancer are the second leading cause of death in this group. Patients with cancer have a 3-fold higher risk of dying from infection than the population without cancer. Pneumonia plays a major role in all cancer groups by increasing the risk of morbidity and mortality in these patients. Clinical diagnosis of infection in cancer patients can be challenging. A thorough history and comprehensive laboratory and imaging examinations must be performed to exclude any other aetiology. Treatment of lung infection in cancer patients is also a challenge, although there are already several modalities such as antibiotic, antiviral and vaccine therapies. Despite impaired immune responses in cancer patients, vaccines for specific micro-organisms can still induce adequate protection among cancer patients. However, widespread use of broad-spectrum antibiotics with prolonged duration and minimal indication has led to an increase in antibiotic resistance. The aim of this chapter is to describe the prevalence, impact and treatment of pulmonary infections (pneumonia) in individuals with both haematological and solid cancers.
Cite as: Andarini S, Hilmi Taufikulhakim F, Maryam S, et al. Pulmonary infections in cancer patients. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 241–252 [https://doi.org/10.1183/2312508X.10019822].
- Page 253AbstractCorresponding author: Argyrios Tzouvelekis (argyris.tzouvelekis@gmail.com)
A revolution in cancer management has been brewing in the past 10 years with the implementation of novel chemotherapeutic compounds and techniques of radiation therapy. A minority of patients receiving ICIs, TKIs and radiotherapy techniques present with pulmonary toxicity. Lung toxicity secondary to cancer treatments is an infrequent but potentially severe complication, usually occurring during the first months of treatment. Timely diagnosis and management are crucial to achieving recovery or substantial improvement. This chapter aims to summarise the pulmonary effects of cancer treatment and highlight future perspectives in the field.
Cite as: Karampitsakos T, Sampsonas F, Spagnolo P, et al. Pulmonary effects of cancer treatments. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 253–264 [https://doi.org/10.1183/2312508X.10020421].
- Page 265AbstractCorresponding author: Mario Cazzola (mario.cazzola@uniroma2.it)
The immune system, in normal circumstances, detects and eliminates tumour cells, preventing tumour growth. However, inflammatory cells and cytokines may operate as tumour promoters during chronic inflammation, influencing cell survival, proliferation, invasion and angiogenesis. Biological and immunosuppressive therapies for chronic inflammatory lung diseases profoundly affect innate and adaptive immune pathways, which may hurt malignancy immunosurveillance mechanisms. Thus, it cannot be excluded that their use increases the risk for most malignancies. It is debatable if a prior history of malignancy is a contraindication for biological and immunosuppressive therapies. Therefore, the decision should be taken case by case. Using these therapies is very difficult when treating patients with different chronic inflammatory lung diseases, due to the paucity of available information. However, the impact of malignancy on the responses to biological and immunosuppressive therapies used in respiratory diseases other than cancer can be hypothesised. Unfortunately, this possibility has not yet been specifically studied.
Cite as: Matera MG, Rogliani P, Bianco A, et al. Biological and immunosuppressive therapies for lung disease: a potential reciprocal influence between their use and malignancy. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 265–280 [https://doi.org/10.1183/2312508X.10020621].
- Page 281AbstractCorresponding author: Don D. Sin (Don.Sin@hli.ubc.ca)
Lung cancer is one of the leading causes of mortality in patients with COPD. Beyond the common risk factors, COPD and lung cancer are closely related, sharing linked pathogenic pathways, some of which may be modifiable with inhaled corticosteroids (ICSs). Emerging animal and human studies have shown that ICSs may be able to halt the progression of precancerous lesions in the airways and significantly reduce the risk of lung cancer and related mortality. The mechanisms by which ICSs modify the risk of lung cancer are largely unknown but may include their anti-inflammatory properties and their ability to halt cellular growth, suppress EMT and alter the airway microbiome. In this chapter, we discuss the clinical evidence for the possible chemopreventative effects of ICSs on lung cancer in COPD patients, the possible pathophysiological link between COPD and lung cancer, the potential mechanisms by which ICSs can modify the risk, and future directions and unanswered questions regarding the role of ICSs in reducing lung cancer in patients with COPD.
Cite as: Lee H, Sin DD. Inhaled corticosteroids and lung cancer in COPD: evaluating their role in chemoprevention. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 281–298 [https://doi.org/10.1183/2312508X.10020721].
- Page 299AbstractCorresponding author: Andrea Gramegna (andrea.gramegna@unimi.it)
Lung cancer patients frequently present with respiratory tract infections. The presence of multidrug-resistant pathogens is associated with unfavourable outcomes, including the persistence of bacteraemia, metastatic infection and higher case-fatality rates. Antibiotics may increase the risk of cancer development, and affect cancer treatment efficacy and toxicity by inducing changes in the microbiota. Further research is needed to clarify the role of antibiotics in the dysregulation between the microbiota and the immune system, and is crucial for lung cancer prevention and treatment. Monitoring gut microbiota composition and administering protective commensal bacteria could potentially improve cancer treatment response and tolerability, leading to better oncological outcomes.
Cite as: Arcadu A, Silani MS, Amati F, et al. Antibiotics for lung disease and cancer. In: Martínez-García MÁ, Gaga M, Fong KM, eds. Lung Diseases and Cancer (ERS Monograph). Sheffield, European Respiratory Society, 2022; pp. 299–305 [https://doi.org/10.1183/2312508X.10020821].