NICE clinical guidelines
Issued: April 2011
CG121

Lung cancer: The diagnosis and treatment of lung cancer

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg121

Introduction

This guidance updates and replaces NICE clinical guideline 24 (published February 2005).

There are more than 39,000 new cases of lung cancer in the UK each year and more than 35,000 people die from the condition; more than for breast cancer and colorectal cancer combined. Lung cancer is now the leading cause of cancer death in women.

About 90% of lung cancers are caused by smoking. Now that fewer men smoke, lung cancer deaths in men have decreased by more than a quarter in the UK (a 27% reduction between 1971 and 2006). However, the number of women who smoke has risen and deaths from lung cancer in women have increased.

Only about 5.5% of lung cancers are currently cured. Although the cure rate is rising slowly, the rate of improvement has been slower than for other common cancers. Outcomes in the UK are worse than those in some European countries and North America. There is evidence that outcomes vary within the UK, which – among other factors – may be explained by variations in the standard of care.

This updated guideline provides recommendations for good practice in the diagnosis and treatment of non-small-cell (NSCLC) and small-cell lung cancer (SCLC).

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.

Changes in this update

New and updated recommendations are included on communication, diagnosis and staging, selection of patients with non-small-cell lung cancer (NSCLC) for treatment with curative intent, surgery with curative intent for NSCLC, smoking cessation, combination treatment for NSCLC, treatment for small-cell lung cancer (SCLC), managing endobronchial obstruction, managing brain metastases, and follow-up and patient perspectives.

Recommendations are marked as [2005], [2011] or [new 2011].

  • [2005] indicates that the evidence has not been updated and reviewed since 2005.

  • [2011] indicates that the evidence has been reviewed but no changes have been made to the recommendation.

  • [new 2011] indicates that the evidence has been reviewed and the recommendation has been added or updated.

Since publication of NICE clinical guideline 24 in 2005, a number of new systemic therapies have been granted a marketing authorisation by the European Medicines Agency for use in people with NSCLC. NICE has published technology appraisals for pemetrexed, gefitinib and erlotinib. Other technology appraisals are in development.

The NHS has also commissioned a review of first-line therapy for NSCLC through the NIHR Health Technology Assessment Programme. This review is due to be published in 2011.